Cross-sector Service Provision in Health and Social Care: An Umbrella Review.

PubMed

Winters, Shannon; Magalhaes, Lilian; Anne Kinsella, Elizabeth; Kothari, Anita

2016-04-08

Meeting the complex health needs of people often requires interaction among numerous different sectors. No one service can adequately respond to the diverse care needs of consumers. Providers working more effectively together is frequently touted as the solution. Cross-sector service provision is defined as independent, yet interconnected sectors working together to better meet the needs of consumers and improve the quality and effectiveness of service provision. Cross-sector service provision is expected, yet much remains unknown about how it is conceptualised or its impact on health status. This umbrella review aims to clarify the critical attributes that shape cross-sector service provision by presenting the current state of the literature and building on the findings of the 2004 review by Sloper. Literature related to cross-sector service provision is immense, which poses a challenge for decision makers wishing to make evidence-informed decisions. An umbrella review was conducted to articulate the overall state of cross-sector service provision literature and examine the evidence to allow for the discovery of consistencies and discrepancies across the published knowledge base. Sixteen reviews met the inclusion criteria. Seven themes emerged: Focusing on the consumer, developing a shared vision of care, leadership involvement, service provision across the boundaries, adequately resourcing the arrangement, developing novel arrangements or aligning with existing relationships, and strengthening connections between sectors. Future research from a cross-organisational, rather than individual provider, perspective is needed to better understand what shapes cross-sector service provision at the boundaries. Findings aligned closely with the work done by Sloper and raise red flags related to reinventing what is already known. Future researchers should look to explore novel areas rather than looking into areas that have been explored at length. Evaluations of out-comes related to cross-sector service provision are still needed before any claims about effectiveness can be made.

Cross-sector Service Provision in Health and Social Care: An Umbrella Review

PubMed Central

Magalhaes, Lilian; Anne Kinsella, Elizabeth; Kothari, Anita

2016-01-01

Introduction: Meeting the complex health needs of people often requires interaction among numerous different sectors. No one service can adequately respond to the diverse care needs of consumers. Providers working more effectively together is frequently touted as the solution. Cross-sector service provision is defined as independent, yet interconnected sectors working together to better meet the needs of consumers and improve the quality and effectiveness of service provision. Cross-sector service provision is expected, yet much remains unknown about how it is conceptualised or its impact on health status. This umbrella review aims to clarify the critical attributes that shape cross-sector service provision by presenting the current state of the literature and building on the findings of the 2004 review by Sloper. Methods: Literature related to cross-sector service provision is immense, which poses a challenge for decision makers wishing to make evidence-informed decisions. An umbrella review was conducted to articulate the overall state of cross-sector service provision literature and examine the evidence to allow for the discovery of consistencies and discrepancies across the published knowledge base. Findings: Sixteen reviews met the inclusion criteria. Seven themes emerged: Focusing on the consumer, developing a shared vision of care, leadership involvement, service provision across the boundaries, adequately resourcing the arrangement, developing novel arrangements or aligning with existing relationships, and strengthening connections between sectors. Future research from a cross-organisational, rather than individual provider, perspective is needed to better understand what shapes cross-sector service provision at the boundaries. Conclusion: Findings aligned closely with the work done by Sloper and raise red flags related to reinventing what is already known. Future researchers should look to explore novel areas rather than looking into areas that have been explored at length. Evaluations of out-comes related to cross-sector service provision are still needed before any claims about effectiveness can be made. PMID:27616954

Attitudes of Scottish abortion care providers towards provision of abortion after 16 weeks' gestation within Scotland.

PubMed

Cochrane, Rosemary A; Cameron, Sharon T

2013-06-01

In Scotland, in contrast to the rest of Great Britain, abortion at gestations over 20 weeks is not provided, and provision of procedures above 16 weeks varies considerably between regions. Women at varying gestations above 16 weeks must travel outside Scotland, usually to England, for the procedure. To determine the views of professionals working within Scottish abortion care about a Scottish late abortion service. Delegates at a meeting for abortion providers in Scotland completed a questionnaire about their views on abortion provision over 16 weeks and their perceived barriers to service provision. Of 95 distributed questionnaires, 70 (76%) were analysed. Fifty-six respondents (80%) supported a Scottish late abortion service, ten (14%) would maintain current service arrangements, and five (7%) were undecided. Forty (57%) of the supporters of a Scottish service would prefer a single national service, and 16 (22%) several regional services. Perceived barriers included lack of trained staff (n = 39; 56%), accommodation for the service (n = 34; 48%), and perception of lack of support among senior management (n = 28; 40%). The majority of health professionals surveyed who work in Scottish abortion services support provision of abortion beyond 16 weeks within Scotland, and most favour a single national service. Further work on the feasibility of providing this service is required.

Family-centered services for children with complex communication needs: the practices and beliefs of school-based speech-language pathologists.

PubMed

Mandak, Kelsey; Light, Janice

2018-06-01

This study used an online focus group to examine the beliefs and practices of school-based speech-language pathologists (SLPs) who served children with complex communication needs regarding their provision of family-centered services. Participants revealed that despite their desire for family involvement and reported beliefs in the importance of family-centered services, there were barriers in place that often limited family-centered service provision. Across the SLPs, many were dissatisfied with their current provision of family-centered services. The SLPs varied in their reported practices, with some reporting family-centered services and others, professional-centered services. Future research is recommended in order to investigate which factors contribute to the variation among SLPs and how the variation impacts children who require augmentative and alternative communication (AAC) and their families. Potential clinical implications for in-service and pre-service SLPs are discussed to improve future family-centered AAC services.

The Bottom Line: Quality/Consumer-Oriented Child Care.

ERIC Educational Resources Information Center

Jackson, Cheryl D.

Arguing that the provision of child care services is consistent with the role of the community college, this paper provides an overview of the current demand for and delivery of child care services and briefly discusses ways in which community colleges can assist in the development and provision of consumer-oriented, high-quality child care.…

Service provision in the wake of a new funding model for community pharmacy.

PubMed

Smith, Alesha J; Scahill, Shane L; Harrison, Jeff; Carroll, Tilley; Medlicott, Natalie J

2018-05-02

Recently, New Zealand has taken a system wide approach providing the biggest reform to New Zealand community pharmacy for 70 years with the aim of providing more clinically orientated patient centred services through a new funding model. The aim of this study was to understand the types of services offered in New Zealand community pharmacies since introduction of the new funding model, what the barriers are to providing these services. A survey of all community pharmacies were undertaken between August, 2014 and February, 2015. Basic descriptive statistics were completed and group comparisons were made using the chi squared test with significance set at p < 0.05. 528 responses were received. Education and advice on prescription and non-prescription medicines were the two top listed services provided. There were no significant differences in service provision between rural and metro based pharmacies. Many pharmacies were considering introducing new patient centred services. Four of the top ten frequently provided services have no public funding attached. Costs and staff availability are the most common barriers to undertake services, more predominantly in patient centred services. This study was the first to provide an evaluation of service provision in response to a new funding model for New Zealand Community Pharmacies. A broad range of services are being undertaken in New Zealand community pharmacies including patient-centred services. A number of barriers to service provision were identified. This study provides a baseline for the current levels of service provision upon which future studies can compare to and evaluate any changes in service provision with differing funding models going forward.

Aftercare Services for Child Victims of Sex Trafficking: A Systematic Review of Policy and Practice.

PubMed

Muraya, Dorothy Neriah; Fry, Deborah

2016-04-01

To explore aftercare services provided to child victims of sex trafficking globally based on the results of a systematic review of published and unpublished research, organizational policy, and current practice. This systematic review serves as a first step toward developing best practices for aftercare service providers. A systematic search was conducted of four English language databases, two human trafficking resource libraries, and one Internet search engine for journal articles and "grey" literature published between January 2000 and May 2013 on the services offered to child sex trafficking victims globally. The search yielded 15 documents for inclusion in the review. The 15 documents emphasized the need for aftercare service provision to be founded on children's rights and trauma-informed service provision. They recommended delivery practices such as case management and multidisciplinary, multiagency and multinational coordination to ensure the child victims benefit fully from the services. The systematic review revealed that there are three phases to aftercare service provision: rescue, recover, and reintegration. Each of these phases is characterized by different needs and types of services provided. The recovery phase received the most attention compared to recovery and reintegration phases. The literature highlighted that aftercare service provision for child sex trafficking victims is a new area that needs an evidence base from which policy and practice can be formed. There is great need for further research and better documentation of service provision. While this research provides insight into this area, the gap in literature remains wide. The area of aftercare service provision for children who have been trafficked has experienced phenomenal growth within the last 10 years, and with more research and resources being directed to the area, the achievement of international minimum standards of care provision is possible. © The Author(s) 2015.

Identifying and addressing sexual health in serious mental illness: Views of mental health staff working in two National Health Service organizations in England.

PubMed

Hughes, Elizabeth; Edmondson, Amanda J; Onyekwe, Ijeoma; Quinn, Chris; Nolan, Fiona

2018-06-01

People with serious mental illness (service users) have needs related to sexual health and sexuality, yet these have been poorly addressed in mental health services. In the present study, we report the current practice of mental health professionals in relation to sexual health. Focus groups conducted in two mental health trusts explored routine practice in relation to discussing, assessing, and planning care in relation to sexual health. A thematic analysis identified seven themes: (i) sexual health provision is a complex issue; (ii) mental health staff are aware of sexual health needs; (iii) current provision regarding sexual health is 'neglected'; (iv) barriers to sexual health provision; (v) enabling a discussion around sexual health; (vi) sexual health provision is a role for mental health professionals; and (vii) training needs. Mental health staff are aware of complex issues related to sexual health for service users, but this is mainly seen through the lens of risk management and safeguarding. We need to develop the mental health workforce to be able to incorporate sexual health into routine health care. © 2017 Australian College of Mental Health Nurses Inc.

Incentives in Rheumatology: the Potential Contribution of Physician Responses to Financial Incentives, Public Reporting, and Treatment Guidelines to Health Care Sustainability.

PubMed

Harrison, Mark; Milbers, Katherine; Mihic, Tamara; Anis, Aslam H

2016-07-01

Concerns about the sustainability of current health care expenditure are focusing attention on the cost, quality and value of health care provision. Financial incentives, for example pay-for-performance (P4P), seek to reward quality and value in health care provision. There has long been an expectation that P4P schemes are coming to rheumatology. We review the available evidence about the use of incentives in this setting and provide two emerging examples of P4P schemes which may shape the future of service provision in rheumatology. Currently, there is limited and equivocal evidence in rheumatology about the impact of incentive schemes. However, reporting variation in the quality and provision of rheumatology services has highlighted examples of inefficiencies in the delivery of care. If financial incentives can improve the delivery of timely and appropriate care for rheumatology patients, then they may have an important role to play in the sustainability of health care provision.

7 CFR 226.18 - Day care home provisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 4 2014-01-01 2014-01-01 false Day care home provisions. 226.18 Section 226.18... care home provisions. (a) Day care homes shall have current Federal, State or local licensing or approval to provide day care services to children. Day care homes which cannot obtain their license because...

7 CFR 226.18 - Day care home provisions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 4 2013-01-01 2013-01-01 false Day care home provisions. 226.18 Section 226.18... care home provisions. (a) Day care homes shall have current Federal, State or local licensing or approval to provide day care services to children. Day care homes which cannot obtain their license because...

7 CFR 226.18 - Day care home provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 4 2012-01-01 2012-01-01 false Day care home provisions. 226.18 Section 226.18... care home provisions. (a) Day care homes shall have current Federal, State or local licensing or approval to provide day care services to children. Day care homes which cannot obtain their license because...

The recovery model and complex health needs: what health psychology can learn from mental health and substance misuse service provision.

PubMed

Webb, Lucy

2012-07-01

This article reviews key arguments around evidence-based practice and outlines the methodological demands for effective adoption of recovery model principles. The recovery model is outlined and demonstrated as compatible with current needs in substance misuse service provision. However, the concepts of evidence-based practice and the recovery model are currently incompatible unless the current value system of evidence-based practice changes to accommodate the methodologies demanded by the recovery model. It is suggested that critical health psychology has an important role to play in widening the scope of evidence-based practice to better accommodate complex social health needs.

Indicators and Methods for Evaluating Economic, Ecosystem ...

EPA Pesticide Factsheets

The U.S. Human Well-being Index (HWBI) is a composite measure that incorporates economic, environmental, and societal well-being elements through the eight domains of connection to nature, cultural fulfillment, education, health, leisure time, living standards, safety and security, and social cohesion (USEPA 2012a; Smith et al. 2013). Twenty-eight services, represented by a collection of indicators and metrics, have been identified as influencing these domains of human well-being. By taking an inventory of stocks or measuring the results of a service, a relationship function can be derived to understand how changes in the provisioning of that service can influence the HWBI. An extensive review of existing services was performed to identify current services, indicators and metrics in use. This report describes the indicators and methods we have selected to evaluate the provisioning of economic, ecosystem, and social services related to human well-being. Provide metadata and methods for calculating services provisioning scores for HWBI modeling framework

Evaluating Options for Civil Space Situational Awareness (SSA)

NASA Astrophysics Data System (ADS)

Lal, B.; Carioscia, S. A.

In recent years, the number of active satellites and human-made orbital space debris has increased dramatically. An expansion of activities in space, as is currently being proposed by many commercial and international entities, is expected to further exacerbate this challenge. The 18th Space Control Squadron under the Department of Defense (DOD) United States Strategic Command provides space situational awareness (SSA) services to users outside the national security community at no cost. International and commercial users demand better SSA service than is currently feasible, and the demand comes at a time when DOD is under pressure to better prepare for and respond to growing space-based threats to national security. Concerned about the possibility of overextending across conflicting missions in a fiscally constrained environment, some DOD officials have publicly noted a desire to move SSA services not related to national security out of DOD purview. Responding to a request from the Federal Aviation Administration (FAA) Office of Commercial Space Transportation (AST), researchers at the Science and Technology Policy Institute (STPI) identified and evaluated potential approaches for providing SSA services for civil and commercial operations in space. In this paper, we summarize the report [1] and present the pros and cons of four approaches to the provision of civil SSA services in the United States: (1) maintaining status quo through continued provision by DOD; (2) provision by a civil government entity; (3) industry self-provision; and (4) provision by an international organization. Within the second approach, assuming the provision of SSA by a civil agency, STPI further identified and discussed four options: (1) civil agency service capability embedded within DOD; (2) independent civil service capability, using DOD software and systems; (3) independent civil service capability, using commercial software and systems; and (4) the government certifies non-governmental entities (NGEs) to provide service capability. All of these approaches keep military and national security SSA services within DOD. Selecting which approach or option to proceed with depends on the determination of the role of government in the domain as well as consideration of other policy challenges.

[The roles and functions of volunteer counselors to the elderly].

PubMed

Chen, Chun-Yu

2004-06-01

In Taiwan's current counseling centers for the elderly, large numbers of volunteers are supervised by only a few social workers or nurses, so the roles and functions of these volunteers are very important. A neat summary of the services provided by the volunteers would include: (1) Direct services: telephone counseling, telephone interviewing, case handling, mail counseling, resource provision. (2) Indirect services: fundraising, supervision. (3) Administration: administrative assistance, management of institutional web sites. (4) Strategic consultancy: consultancy, provision of expertise. (5) Advocacy: service as educators and spokespersons; public relations and marketing. (6) MANAGEMENT: team leadership, plan implementation. To sum up, their functions are, by means of telephone and face-to-face contact, to provide information to the elderly about finances, medical services, housing, citizenship, the dignity of life and death, and related issues, as well as to serve as advocates for the provision of resources--such as educational courses--and to facilitate such provision. Indeed, the roles and functions of volunteer counselors become more diverse and more comprehensive by the day.

Emergency medical services outcomes evaluation

DOT National Transportation Integrated Search

2003-07-01

The provision of prehospital (Emergency Medical Services (EMS)) care has come under increased scrutiny in recent years. Many have questioned the value of the range of EMS services currently provided. There is a persistent concern about the lack of pr...

Provision of magnetic resonance imaging for patients with 'MR-conditional' cardiac implantable electronic devices: an unmet clinical need.

PubMed

Sabzevari, Kian; Oldman, James; Herrey, Anna S; Moon, James C; Kydd, Anna C; Manisty, Charlotte

2017-03-01

Increasing need for magnetic resonance imaging (MRI) has driven the development of MR-conditional cardiac implantable electronic devices (CIEDs; pacemakers and defibrillators); however, patients still report difficulties obtaining scans. We sought to establish current provision for MRI scanning of patients with CIEDs in England. A survey was distributed to all hospitals in England with MRI, to assess current practice. Information requested included whether hospitals currently offer MRI to this patient group, the number and type of scans acquired, local safety considerations, complications experienced and perceived obstacles to service provision in those departments not currently offering it. Responses were received from 195 of 227 (86%) of hospitals surveyed. Although 98% of departments were aware of MR-conditional devices, only 46% (n = 89) currently offer MRI scans to patients with CIED's; of these, 85% of departments perform ≤10 scans per year. No major complications were reported from MRI scanning in patients with MR-conditional devices. Current barriers to service expansion include perceived concerns regarding potential risk, lack of training, logistical difficulties, and lack of cardiology support. Provision of MRI for patients with CIEDs is currently poor, despite increasing numbers of patients with MR-conditional devices and extremely low reported complication rates. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Recovery-oriented service provision and clinical outcomes in assertive community treatment.

PubMed

Kidd, Sean A; George, Lindsey; O'Connell, Maria; Sylvestre, John; Kirkpatrick, Helen; Browne, Gina; Odueyungbo, Adefowope O; Davidson, Larry

2011-01-01

While the term "recovery" is routinely referenced in clinical services and health policy, few studies have examined the relationship between recovery-oriented service provision and client outcomes. The present study was designed to examine the relationship between recovery-orientation of service provision for persons with severe mental illnesses and outcomes in Assertive Community Treatment (ACT). Client, family, staff, and manager ratings of service recovery-orientation and outcomes across a range of service utilization and community functioning indicators were examined among 67 ACT teams in Ontario, Canada. Significant associations were found between ratings of recovery-oriented service provision and better outcomes in the domains of legal involvement, hospitalization days, education involvement, and employment. Results were not uniformly positive or consistent, however, across stakeholder Recovery Self-Assessment (RSA) ratings or outcomes. These findings provide some preliminary support for an association between recovery-oriented service delivery for persons with severe mental illnesses and better outcomes. In line with the current practice commentary, this association would suggest the importance of evaluating and cultivating recovery-oriented values and practices in ACT contexts. This is a particularly salient point given that ACT standards minimally address key domains of recovery-oriented service provision. Further study is required, however, to determine if these findings apply to the implementation of ACT in other jurisdictions or generalize to other community support programs.

Provision of Early Intervention and Special Education Services to Eligible DoD Dependents. Final rule.

PubMed

2015-06-25

This rule reissues the current regulations and: Establishes policy, assigns responsibilities, and implements the non-funding and non-reporting provisions in DoD for: Provision of early intervention services (EIS) to infants and toddlers with disabilities and their families, as well as special education and related services to children with disabilities entitled under this part to receive education services from the DoD; implementation of a comprehensive, multidisciplinary program of EIS for infants and toddlers with disabilities and their families who, but for age, are eligible to be enrolled in DoD schools; provision of a free appropriate public education (FAPE), including special education and related services, for children with disabilities, as specified in their individualized education programs (IEP), who are eligible to enroll in DoD schools; and monitoring of DoD programs providing EIS, and special education and related services for compliance with this part. This rule also establishes a DoD Coordinating Committee to recommend policies and provide compliance oversight for early intervention and special education.

45 CFR 1634.10 - Transition provisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Public Welfare Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION COMPETITIVE BIDDING FOR GRANTS AND CONTRACTS § 1634.10 Transition provisions. (a) When the competitive bidding process... the area currently served by that recipient, the Corporation— (1) may provide, if the law permits...

Rehabilitation therapies for older clients of the Ontario home care system: regional variation and client-level predictors of service provision.

PubMed

Armstrong, Joshua J; Zhu, Mu; Hirdes, John P; Stolee, Paul

2015-01-01

To examine regional variation in service provision and identify the client characteristics associated with occupational therapy (OT) and physiotherapy (PT) services for older adults in the Ontario Home Care System. Secondary analyses of a provincial database containing comprehensive assessments (RAI-HC) linked with service utilization data from every older long-stay home care client in the system between 2005 and 2010 (n = 299 262). Hierarchical logistic regression models were used to model the dependent variables of OT and PT service use within 90 d of the initial assessment. Regional differences accounted for 9% of the variation in PT service provision and 20% of OT service provision. After controlling for the differences across regions, the most powerful predictors of service provision were identified for both OT and PT. The most highly associated client characteristics related to PT service provision were hip fracture, impairments in activities of daily living/instrumental activities of daily living, cerebrovascular accidents, and cognitive impairment. For OT, hazards in the home environment was the most powerful predictor of future service provision. Where a client lived was an important determinant of service provision in Ontario, raising the possibility of inequities in access to rehabilitation services. Health care planners and policy makers should review current practices and make adjustments to meet the increasing and changing needs for rehabilitation therapies of the aging population. Implications for Rehabilitation For older adults in home care, the goal of rehabilitation therapy services is to allow individuals to maintain or improve physical functioning, quality of life and overall independence while living within their community. Previous research has demonstrated that a large proportion of home care clients specifically identified as having rehabilitation potential do not receive it. This article used clinical assessment data to identify the predictors of and barriers to rehabilitation services for older adults in the Ontario Home Care System. Barriers of PT included dementia diagnosis and French as a first language. Barriers to OT included dementia diagnosis. Policies and practices related to service provision for older adults should be reconsidered if we are going to meet the demands of aging populations and increasing rates of functional and cognitive impairments.

Reducing inequalities in access to health care: developing a toolkit through action research.

PubMed

Goyder, E C; Blank, L; Ellis, E; Furber, A; Peters, J; Sartain, K; Massey, C

2005-10-01

Healthcare organisations are expected both to monitor inequalities in access to health services and also to act to improve access and increase equity in service provision. Locally developed action research projects with an explicit objective of reducing inequalities in access. Eight different health care services in the Yorkshire and Humber region, including community based palliative care, general practice asthma care, hospital based cardiology clinics, and termination of pregnancy services. Changes in service provision, increasing attendance rates in targeted groups. Local teams identified the population concerned and appropriate interventions using both published and grey literature. Where change to service provision was achieved, local data were collected to monitor the impact of service change. A number of evidence based changes to service provision were proposed and implemented with variable success. Service uptake increased in some of the targeted populations. Interventions to improve access must be sensitive to local settings and need both practical and managerial support to succeed. It is particularly difficult to improve access effectively if services are already struggling to meet current demand. Key elements for successful interventions included effective local leadership, identification of an intervention which is both evidence based and locally practicable, and identification of additional resources to support increased activity. A "toolkit" has been developed to support the identification and implementation of appropriate changes.

Provision of Prosthetic Services Following Lower Limb Amputation in Malaysia

PubMed Central

Arifin, Nooranida; Hasbollah, Hasif Rafidee; Hanafi, Muhammad Hafiz; Ibrahim, Al Hafiz; Rahman, Wan Afezah Wan Abdul; Aziz, Roslizawati Che

2017-01-01

The incidence of lower limb amputation is high across the globe and continues to be a major threat to morbidity and mortality. Consequently, the provision of high quality and effective prosthetics services have been known as an essential component for a successful rehabilitation outcome. In Malaysia, amputation prevalence has been increasing in which several main components of service delivering aspects (such as service intervention, prosthetic personnel) should be anticipated to accommodate for the increasing demand. This article highlights the hurdles experienced in providing prosthetic services in Malaysia from multiple aspects such as financial burden to acquire the prosthesis and lack of expertise to produce quality prosthesis. This paramount issues consequently justify for the urgency to carry out national level survey on the current statistics of lower limb amputation and to ascertain the available workforce to provide a quality prosthetics services. Only with accurate and current information from the national survey, strategies and policies aimed at enhancing the outcome from prosthetics services can be achieved. PMID:29386978

Provision of Prosthetic Services Following Lower Limb Amputation in Malaysia.

PubMed

Arifin, Nooranida; Hasbollah, Hasif Rafidee; Hanafi, Muhammad Hafiz; Ibrahim, Al Hafiz; Rahman, Wan Afezah Wan Abdul; Aziz, Roslizawati Che

2017-10-01

The incidence of lower limb amputation is high across the globe and continues to be a major threat to morbidity and mortality. Consequently, the provision of high quality and effective prosthetics services have been known as an essential component for a successful rehabilitation outcome. In Malaysia, amputation prevalence has been increasing in which several main components of service delivering aspects (such as service intervention, prosthetic personnel) should be anticipated to accommodate for the increasing demand. This article highlights the hurdles experienced in providing prosthetic services in Malaysia from multiple aspects such as financial burden to acquire the prosthesis and lack of expertise to produce quality prosthesis. This paramount issues consequently justify for the urgency to carry out national level survey on the current statistics of lower limb amputation and to ascertain the available workforce to provide a quality prosthetics services. Only with accurate and current information from the national survey, strategies and policies aimed at enhancing the outcome from prosthetics services can be achieved.

INCREASING CULTURALLY COMPETENT NEUROPSYCHOLOGICAL SERVICES FOR ETHNIC MINORITY POPULATIONS: A CALL TO ACTION

PubMed Central

Mindt, Monica Rivera; Byrd, Desiree; Saez, Pedro; Manly, Jennifer

2010-01-01

US demographic and sociopolitical shifts have resulted in a rapidly growing need for culturally competent neuropsychological services. However, clinical neuropsychology as a field has not kept pace with the needs of ethnic minority clients. In this discussion we review: historical precedents and the limits of universalism in neuropsychology; ethical/professional guidelines pertinent to neuropsychological practice with ethnic minority clients; critical cultural considerations in neuropsychology; current disparities germane to practice; and challenges to the provision of services to racial/ethnic minority clients. We provide a call to action for neuropsychologists and related organizations to advance multiculturalism and diversity within the field by increasing multicultural awareness and knowledge, multicultural education and training, multicultural neuropsychological research, and the provision of culturally competent neuropsychological services to racial/ethnic minority clients. Lastly, we discuss strategies for increasing the provision of culturally competent neuropsychological services, and offer several resources to meet these goals. PMID:20373222

The "empty void" is a crowded space: health service provision at the margins of fragile and conflict affected states.

PubMed

Hill, Peter S; Pavignani, Enrico; Michael, Markus; Murru, Maurizio; Beesley, Mark E

2014-01-01

Definitions of fragile states focus on state willingness and capacity to ensure security and provide essential services, including health. Conventional analyses and subsequent policies that focus on state-delivered essential services miss many developments in severely disrupted healthcare arenas. The research seeks to gain insights about the large sections of the health field left to evolve spontaneously by the absent or diminished state. THE STUDY EXAMINED SIX DIVERSE CASE STUDIES: Afghanistan, Central African Republic, Democratic Republic of the Congo, Haïti, Palestine, and Somalia. A comprehensive documentary analysis was complemented by site visits in 2011-2012 and interviews with key informants. Despite differing histories, countries shared chronic disruption of health services, with limited state service provision, and low community expectations of quality of care. The space left by compromised or absent state-provided services is filled by multiple diverse actors. Health is commoditized, health services are heterogeneous and irregular, with public goods such as immunization and preventive services lagging behind curative ones. Health workers with disparate skills, and atypical health facilities proliferate. Health care absorbs large private expenditures, sustained by households, remittances, charitable and solidarity funding, and constitutes a substantial portion of the country economy. Pharmaceutical markets thrive. Trans-border healthcare provision is prominent in most studied settings, conferring regional and sometimes true globalized characteristics to these arenas. We identify three distortions in the way the global development community has considered health service provision. The first distortion is the assumption that beyond the reach of state- and donor-sponsored services is a "void", waiting to be filled. Our analysis suggests that the opposite is the case. The second distortion relates to the inadequacy of the usual binary categories structuring conventional health system analyses, when applied to these contexts. The third distortion reflects the failure of the global development community to recognise-or engage-the emergent networks of health providers. To effectively harness the service provision currently available in this crowded space, development actors need to adapt their current approaches, engage non-state providers, and support local capacity and governance, particularly grassroots social institutions with a public-good orientation.

77 FR 28797 - Redundancy of Communications Systems: Backup Power Private Land Mobile Radio Services: Selection...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-16

... Systems: Backup Power Private Land Mobile Radio Services: Selection and Assignment of Frequencies, and... certain rule provisions that are without current legal effect and obsolete. These nonsubstantive revisions... current legal effect and is deleted as obsolete. 2. This Order also deletes a rule providing that UHF...

Dynamics of ecosystem services provided by subtropical ...

EPA Pesticide Factsheets

The trends in the provision of ecosystem services during restoration and succession of subtropical forests and plantations were quantified, in terms of both receiver and donor values, based on a case study of a 3-step secondary succession series that included a 400-year-old subtropical forest and a 23-year history of growth on 3 subtropical forest plantations in Southeastern China. The ‘People's Republic of China Forestry Standard: Forest Ecosystem Service Valuation Norms’ was revised and applied to quantify the receiver values of ecosystem services, which were then compared with the emergy-based, donor values of the services. The results revealed that the efficiencies of subtropical forests and plantations in providing ecosystem services were 2 orders of magnitude higher than similar services provided by the current China economic system, and these efficiencieskept increasing over the course of succession. As a result, we conclude that afforestation is an efficient way to accelerate both the ability and efficiency of subtropical forests to provide ecosystem services. This paper is significant because it examines the dynamics of the provision of ecosystem services by forests over a succession series that spans 400 years. The paper also examines the rate of increase of services during forest restoration over a period of 23 years. The emergy used in ecosystem services provision is compared to the provision of similar services by economic means in the Chinese e

University Chaplaincy Provisions: Taking the Religion Out?

ERIC Educational Resources Information Center

Hunt, Stephen

2013-01-01

Albeit fragmented and largely uncoordinated, there is currently considerable debate regarding the nature and rationale of university chaplaincy provisions in England and Wales. Clearly chaplaincies have repositioned themselves from an exclusively Christian ethical and service-based provider to cater for the challenging demands of a multi-faith…

Climate Change and Ecosystem Services Output Efficiency in Southern Loblolly Pine Forests.

PubMed

Susaeta, Andres; Adams, Damian C; Carter, Douglas R; Dwivedi, Puneet

2016-09-01

Forests provide myriad ecosystem services that are vital to humanity. With climate change, we expect to see significant changes to forests that will alter the supply of these critical services and affect human well-being. To better understand the impacts of climate change on forest-based ecosystem services, we applied a data envelopment analysis method to assess plot-level efficiency in the provision of ecosystem services in Florida natural loblolly pine (Pinus taeda L.) forests. Using field data for n = 16 loblolly pine forest plots, including inputs such as site index, tree density, age, precipitation, and temperatures for each forest plot, we assessed the relative plot-level production of three ecosystem services: timber, carbon sequestered, and species richness. The results suggested that loblolly pine forests in Florida were largely inefficient in the provision of these ecosystem services under current climatic conditions. Climate change had a small negative impact on the loblolly pine forests efficiency in the provision of ecosystem services. In this context, we discussed the reduction of tree density that may not improve ecosystem services production.

Climate Change and Ecosystem Services Output Efficiency in Southern Loblolly Pine Forests

NASA Astrophysics Data System (ADS)

Susaeta, Andres; Adams, Damian C.; Carter, Douglas R.; Dwivedi, Puneet

2016-09-01

Forests provide myriad ecosystem services that are vital to humanity. With climate change, we expect to see significant changes to forests that will alter the supply of these critical services and affect human well-being. To better understand the impacts of climate change on forest-based ecosystem services, we applied a data envelopment analysis method to assess plot-level efficiency in the provision of ecosystem services in Florida natural loblolly pine ( Pinus taeda L.) forests. Using field data for n = 16 loblolly pine forest plots, including inputs such as site index, tree density, age, precipitation, and temperatures for each forest plot, we assessed the relative plot-level production of three ecosystem services: timber, carbon sequestered, and species richness. The results suggested that loblolly pine forests in Florida were largely inefficient in the provision of these ecosystem services under current climatic conditions. Climate change had a small negative impact on the loblolly pine forests efficiency in the provision of ecosystem services. In this context, we discussed the reduction of tree density that may not improve ecosystem services production.

A scoping literature review of the provision of orthoses and prostheses in resource-limited environments 2000-2010. Part one: considerations for success.

PubMed

Ikeda, Andrea J; Grabowski, Alena M; Lindsley, Alida; Sadeghi-Demneh, Ebrahim; Reisinger, Kim D

2014-08-01

Literature Review We estimate that over 29 million people worldwide in resource-limited environments (RLEs) are in need of orthotic and prosthetic (O&P) devices and services. Our goal was to ascertain the current state of O&P provision in RLEs and identify factors that may lead to more successful O&P provision. We conducted a comprehensive scoping literature review of all information related to O&P provision in RLEs published from 2000 to 2010. We targeted Vietnam, Cambodia, Tanzania, Malawi, Colombia, and the Navajo Nation, but also included information about developing countries in general. We searched academic databases and grey literature. We extracted information from each article in the areas of design, manufacturing, distribution, service provision, and technology transfer. We identified commonly reported considerations and strategies for O&P provision from 431 articles. Analysis of expert consensus documents revealed recurring themes for improving O&P provision. We found that some suggestions from the consensus documents are being followed, but many are overlooked or have not yet been implemented. Areas for improvement include conducting field testing during the design process, providing services to rural environments, offering follow-up services, considering government collaboration, and encouraging an active role of the orthosis/prosthesis user. Outcomes and research studies will be further discussed in Part Two. © The International Society for Prosthetics and Orthotics 2013.

Perceptions of current and potential public health involvement of pharmacists in developing nations: The case of Zimbabwe.

PubMed

Mdege, Noreen Dadirai; Chevo, Tafadzwa; Toner, Paul

There is increasing recognition of the potential significant contribution that pharmacy personnel can make to improve the public's health. However, there is an evidence gap in developing countries on the public health role of pharmacy personnel. This study aimed to explore the current public health activities that pharmacy professionals in Zimbabwe are currently involved in, and the potential of expanding this role. The study utilized individual, face-to-face, semi-structured qualitative interviews with 9 key informants. The sample reflected the diversity of pharmacy practice groups and levels as well as professional experience, and included a representative from a patient group, and a non-pharmacist national level public health expert. Data collection and analysis was an iterative process informed both by the currently available literature on the topic, as well as themes emerging from the data. Framework analysis was utilized with two independent analyses performed. There was a general consensus among participants that pharmacy practice in Zimbabwe was mainly focused on curative services, with very limited involvement in public health oriented activities. The following were identified as pharmacists' current public health activities: supply chain management of pharmaceutical products, provision of medications and other pharmaceutical products to patients, therapy monitoring, identification and monitoring of chronic illnesses, information provision and training of pharmacists. Nevertheless, there were concerns regarding the quality of some of these services, and lack of consistency in provision across pharmacies. Other potential areas for pharmacists' public health practice were identified as emergency response, drug abuse, addressing social determinants of health particularly promoting healthy lifestyles, applied health research, counterfeit and substandard medicines, and advocacy. There is perceived potential for Zimbabwean pharmacists to become more involved in public health oriented services. However, concerns regarding the quality of services and lack of consistency in provision need to be addressed. Copyright © 2015 Elsevier Inc. All rights reserved.

Universal health care in India: Panacea for whom?

PubMed

Qadeer, Imrana

2013-01-01

This paper examines the current notion of universal health care (UHC) in key legal and policy documents and argues that the recommendations for UHC in these entail further abdication of the State's responsibility in health care with the emphasis shifting from public provisioning of services to merely ensuring universal access to services. Acts of commission (recommendations for public private partnership [PPPs], definition and provision of an essential health package to vulnerable populations to ensure universal access to care) and omission (silence maintained on tertiary care) will eventually strengthen the private and corporate sector at the cost of the public health care services and access to care for the marginalized. Thus, the current UHC strategy uses equity as a tool for promoting the private sector in medical care rather than health for all.

England Policy in Gifted Education: Current Problems and Promising Directions

ERIC Educational Resources Information Center

Koshy, Valsa; Smith, Carole Portman; Casey, Ronald

2018-01-01

This article presents and analyzes policies in identification and provisions in England with respect to gifted education. England has developed a national policy to provide services to identified students. Surveys and interviews with teachers illustrate how implementation of both identification and provision policy elements were handled. Although…

21 CFR 111.5 - Do other statutory provisions and regulations apply?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Do other statutory provisions and regulations apply? 111.5 Section 111.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION CURRENT GOOD MANUFACTURING PRACTICE IN MANUFACTURING...

75 FR 78688 - Inland Waterways Users Board; Request for Nominations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-16

.... Reflecting preceding selection criteria, the current representation by the ten (10) Board members whose terms.... SUPPLEMENTARY INFORMATION: The selection, service, and appointment of Board members are covered by provisions of Section 302 of Public Law 99-662. The substance of those provisions is as follows: a. Selection. Members...

Assessing Service Delivery Systems for Assitive Technology in Brazil using HEART Study quality indicators.

PubMed

Maximo, Tulio; Clift, Laurence

2015-01-01

recently in Brazil, there have been investments and improvements in the service delivery system for assistive technology provision. However, there is little documentation of this process, or evidence that users are being involved appropriately. to understand how a ssistive technology service provision currently functions in Belo Horizonte city, Brazil, in order to provide context-specific interventions and recommendations to improve services. Qualitative research design, including visits to key institutions and semi-structured interviews with key stakeholders. Interview questions were divided with two purposes: 1) Exploratory, aiming to understand present service functioning; 2) Evaluative, aiming to assess staff difficulties in applying best existing best practices. Assistive Technology services in Belo Horizonte fall under the 'medical model' definition of service delivery developed by AAATE. It was also found that staff lack training and knowledge support to assess user requirements and involve them during the decision process. Additionally, there is no follow up stage after the device is delivered. The study clearly defines the service provision function and the staff difficulties at Belo Horizonte city, providing information for further studies.

User involvement in service delivery predicts outcomes of assistive technology use: a cross-sectional study in Bangladesh.

PubMed

Borg, Johan; Larsson, Stig; Ostergren, Per-Olof; Rahman, A S M Atiqur; Bari, Nazmul; Khan, A H M Noman

2012-09-20

Knowledge about the relation between user involvement in the provision of assistive technology and outcomes of assistive technology use is a prerequisite for the development of efficient service delivery strategies. However, current knowledge is limited, particularly from low-income countries where affordability is an issue. The objective was therefore to explore the relation between outcomes of assistive technology use and user involvement in the service delivery process in Bangladesh. Using structured interviews, data from 136 users of hearing aids and 149 users of manual wheelchairs were collected. Outcomes were measured using the International Outcome Inventory for Hearing Aids (IOI-HA), which was adapted for wheelchair users. Predictors of user involvement included preference, measurement and training. Users reported outcomes comparable to those found in other high- and low-income countries. User involvement increased the likelihood for reporting better outcomes except for measurement among hearing aid users. The findings support the provision of assistive technology as a strategy to improve the participation of people with disabilities in society. They also support current policies and guidelines for user-involvement in the service delivery process. Simplified strategies for provision of hearing aids may be explored.

"Selling It as a Holistic Health Provision and Not Just about Condoms..." Sexual Health Services in School Settings: Current Models and Their Relationship with Sex and Relationships Education Policy and Provision

ERIC Educational Resources Information Center

Formby, Eleanor; Hirst, Julia; Owen, Jenny; Hayter, Mark; Stapleton, Helen

2010-01-01

In this article we discuss the findings from a recent study of UK policy and practice in relation to sexual health services for young people, based in--or closely linked with--schools. This study formed part of a larger project, completed in 2009, which also included a systematic review of international research. The findings discussed in this…

Equitable service provision for inclusive education and effective early intervention.

PubMed

Wicks, K M

1998-01-01

This paper illustrates one model of providing an integrated paediatric speech and language therapy service which attempts to meet the demands of both inclusive education and effective early intervention. A move has been made from location-oriented therapy provision to offering children and their families equal opportunities to have appropriate intervention according to need. The model incorporates the philosophy of inclusive education and supports the development of current specialist educational establishments into resource bases of expertise for children with special needs in mainstream schools.

Managing obesity in pharmacy: the Australian experience.

PubMed

Um, Irene S I; Armour, Carol; Krass, Ines; Gill, Timothy; Chaar, Betty B

2010-12-01

To explore pharmacists' opinions about the provision of weight management services in community pharmacy and their attitudes towards the establishment of an accredited training course in weight management in pharmacy. Interviews were conducted with practising pharmacists on site in various community pharmacies in metropolitan Sydney, Australia. In-depth, semi-structured interviews with twenty practising pharmacists were conducted. Of the twenty interviewed pharmacists, sixteen were involved in the provision of one or more pharmacy based weight management programs in their pharmacies. Interviews were audio-recorded, transcribed and analysed using the grounded theory approach. The data were thematically analysed to identify facilitators and perceived barriers to the provision of high quality services, and pharmacists' willingness to undertake training and accreditation. Participants clearly perceived a role for pharmacy in weight management. Key facilitators to provision of service were accessibility and the perception of pharmacists as trustworthy healthcare professionals. The pharmacists proposed collaboration with other healthcare professionals in order to provide a service incorporating diet, exercise and behavioural therapy. A program that was not-product-centred, and supported by ethical marketing was favoured. Appropriate training and accreditation were considered essential to assuring the quality of such services. Barriers to the provision of high quality services identified were: remuneration, pharmacy infrastructure, client demand and the current marketing of product-centred programs. Australian pharmacists believe there is a role for pharmacy in weight management, provided training in accredited programs is made available. A holistic, evidence-based, multi-disciplinary service model has been identified as ideal.

Perceptions of retired professional soccer players about the provision of support services before and after retirement.

PubMed

Drawer, S; Fuller, C W

2002-02-01

To determine the views of retired players about the provision of support services in English professional soccer before and after retirement and to assess the impact of career ending injury on these views. An anonymous self administered questionnaire was distributed to 500 former players registered with the English Professional Footballers' Association. The questions asked about personal details, current medical status, reasons for retirement, perceptions of the provision and quality of support services, and use of prophylactic treatments while injured. Of the 500 questionnaires distributed, 185 (37%) were returned. The Professional Footballers' Association provided significantly (p<0.001) more help and advice to retired players on medical, financial, career, and educational matters than any other organisation. Although respondents showed some satisfaction with the provision of medical support, they were significantly (p<0.001) less satisfied with the provision of sports science (23%) and education/welfare (19%) support. Respondents who had retired through injury, however, were more dissatisfied with the provision of all services. Significantly (p<0.001) more respondents agreed with the view that injuries would reduce income earning potential, contribute to medical problems, and restrict the duration of their playing career. Respondents who had been medically diagnosed with osteoarthritis were significantly more likely, at some time, to have regularly received steroid injections while injured. The results presented are consistent with other evidence that the provision of injury prevention and socioeconomic services at professional soccer clubs is inadequate. The soccer industry should therefore develop a long term strategy for managing the needs of players who are forced to retire through injury.

Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD.

PubMed

Trapero-Bertran, Marta; Muñoz, Celia; Coyle, Kathryn; Coyle, Doug; Lester-George, Adam; Leidl, Reiner; Németh, Bertalan; Cheung, Kei-Long; Pokhrel, Subhash; Lopez-Nicolás, Ángel

2018-03-13

To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov-based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life-time costs and benefits. Spain. Adult smoking population (16+ years). Health-care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality-adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates. The cost of implementing the current provision of smoking cessation services is approximately €61 million in the current year. This translates to 18 quitters per 1000 smokers and a life-time benefit-cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost-saving: less expensive to run and generated more QALYs) from the life-time perspective, compared with the current provision. The life-time benefit-cost ratios were: 1.87 (proactive telephone calls); 1.17 (Rx NRT); 2.40 (varenicline-standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis. According to the EQUIPTMOD modelling tool it would be cost-effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro-active telephone support, and reimburse smoking cessation medication to smokers trying to stop. Such policies would more than pay for themselves in the long run. © 2018 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

75 FR 5769 - Inland Waterways Users Board; Request for Nominations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-04

... preceding selection criteria, the current representation by the one (1) Board member whose term has expired... selection, service, and appointment of Board members are covered by provisions of Section 302 of Public Law 99-662. The substance of those provisions is as follows: a. Selection. Members are to be selected...

How Outpatient Substance Abuse Treatment Unit Director Activities May Affect Provision of Community Outreach Services

ERIC Educational Resources Information Center

Chuang, Emmeline; Wells, Rebecca; Alexander, Jeffrey; Green, Sherri

2013-01-01

Aims: Community outreach services play an important role in infectious disease prevention and engaging drug users not currently in treatment. However, fewer than half of US substance abuse treatment units provide these services and many have little financial incentive to do so. Unit directors generally have latitude about scope of services,…

Consumer participation in the planning and delivery of drug treatment services: the current arrangements.

PubMed

Bryant, Joanne; Saxton, Melissa; Madden, Annie; Bath, Nicky; Robinson, Suzanne

2008-03-01

Consumer participation in decision-making about service planning is common in certain health services in Australia but is thought to be largely underdeveloped in drug treatment services. This paper (1) describes the current practices within Australian drug treatment services that aim to include consumers in service planning and provision; and (2) determines how much consumers know about the existing opportunities for involvement. Sixty-four randomly selected service providers (representing 64 separate services) completed interviews about the current arrangements for consumer participation within their services (response rate = 82%). A total of 179 consumers completed interviews assessing their knowledge of the consumer participation activities available at the service they attended. Consumer participation activities were not uncommon in drug treatment services, although the existing activities were concerned largely with providing information to or receiving information from consumers. Activities that included consumers in higher forms of involvement, such as those in which consumers took part in decision-making, were largely uncommon. Consumers had a considerable lack of knowledge about the participation activities available to them, revealing a lack of communication between providers and consumers. While service providers were making efforts to engage consumers in service planning and provision (despite the general lack of State or Commonwealth policy directives and extra funding to do so), these appear ineffectual because of poor communication between providers and consumers. As a starting point, a critical part of any meaningful consumer participation initiative must include systems to ensure that consumers know about available opportunities.

The “empty void” is a crowded space: health service provision at the margins of fragile and conflict affected states

PubMed Central

2014-01-01

Background Definitions of fragile states focus on state willingness and capacity to ensure security and provide essential services, including health. Conventional analyses and subsequent policies that focus on state-delivered essential services miss many developments in severely disrupted healthcare arenas. The research seeks to gain insights about the large sections of the health field left to evolve spontaneously by the absent or diminished state. Methods The study examined six diverse case studies: Afghanistan, Central African Republic, Democratic Republic of the Congo, Haïti, Palestine, and Somalia. A comprehensive documentary analysis was complemented by site visits in 2011–2012 and interviews with key informants. Results Despite differing histories, countries shared chronic disruption of health services, with limited state service provision, and low community expectations of quality of care. The space left by compromised or absent state-provided services is filled by multiple diverse actors. Health is commoditized, health services are heterogeneous and irregular, with public goods such as immunization and preventive services lagging behind curative ones. Health workers with disparate skills, and atypical health facilities proliferate. Health care absorbs large private expenditures, sustained by households, remittances, charitable and solidarity funding, and constitutes a substantial portion of the country economy. Pharmaceutical markets thrive. Trans-border healthcare provision is prominent in most studied settings, conferring regional and sometimes true globalized characteristics to these arenas. Conclusions We identify three distortions in the way the global development community has considered health service provision. The first distortion is the assumption that beyond the reach of state- and donor-sponsored services is a “void”, waiting to be filled. Our analysis suggests that the opposite is the case. The second distortion relates to the inadequacy of the usual binary categories structuring conventional health system analyses, when applied to these contexts. The third distortion reflects the failure of the global development community to recognise—or engage—the emergent networks of health providers. To effectively harness the service provision currently available in this crowded space, development actors need to adapt their current approaches, engage non-state providers, and support local capacity and governance, particularly grassroots social institutions with a public-good orientation. PMID:25349625

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-searchable database that allows users to see what climate services activities are underway in what locations, to gather and analyze information. As part of the knowledge capture system, more than 10 CSP members are currently developing case studies to describe specific climate services activities; in a few cases, this involves in-depth evaluations of the service in question. Finally, the Economics Working Group of the Climate Services Partnership is analyzing previous methods to economically value climate services in hopes of generating knew knowledge regarding the methods are best suited to assessing the benefits associated with various climate services. Other groups are working to develop guidance materials for the development and use of climate information to support decision and policy-making. The Climate Services Partnership is an open, informal network that builds on activities that are already underway and works to create synergies to improve the provision and development for climate services. Its members currently number more than 50 organizations; it seeks new participants and new initiatives.

78 FR 77708 - Notice of Continuation of Visitor Services

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-24

... been extended to the maximum allowable under 36 CFR 51.23. Under the provisions of current concession... Entertainment Recreation Area. Services, Inc. GLCA003-69 ARAMARK Sports and Glen Canyon National Entertainment Recreation Area. Services, Inc. GRCA003-97 D.N.C. Parks and Grand Canyon Resorts at Grand National Park...

75 FR 20857 - 60-Day Notice of Intention To Request Clearance of Collection of Information-Opportunity for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-21

... DEPARTMENT OF THE INTERIOR National Park Service 60-Day Notice of Intention To Request Clearance...; National Park Service. ACTION: Notice and request for comments. SUMMARY: Under the provisions of the... Requirements, the National Park Service invites public comments on an extension of a currently approved...

Urban ecosystem services for resilience planning and management in New York City.

PubMed

McPhearson, Timon; Hamstead, Zoé A; Kremer, Peleg

2014-05-01

We review the current state of knowledge about urban ecosystem services in New York City (NYC) and how these services are regulated, planned for, and managed. Focusing on ecosystem services that have presented challenges in NYC-including stormwater quality enhancement and flood control, drinking water quality, food provisioning and recreation-we find that mismatches between the scale of production and scale of management occur where service provision is insufficient. Adequate production of locally produced services and services which are more accessible when produced locally is challenging in the context of dense urban development that is characteristic of NYC. Management approaches are needed to address scale mismatches in the production and consumption of ecosystem services. By coordinating along multiple scales of management and promoting best management practices, urban leaders have an opportunity to ensure that nature and ecosystem processes are protected in cities to support the delivery of fundamental urban ecosystem services.

21 CFR 212.2 - What is current good manufacturing practice for PET drugs?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false What is current good manufacturing practice for... HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR POSITRON EMISSION TOMOGRAPHY DRUGS (Eff. 12-12-2011) General Provisions § 212.2 What is current good manufacturing practice for...

18 CFR 367.1440 - Account 144, Accumulated provision for uncollectible accounts-Credit.

Code of Federal Regulations, 2010 CFR

2010-04-01

... UTILITY HOLDING COMPANY ACT OF 2005, FEDERAL POWER ACT AND NATURAL GAS ACT UNIFORM SYSTEM OF ACCOUNTS FOR CENTRALIZED SERVICE COMPANIES SUBJECT TO THE PROVISIONS OF THE PUBLIC UTILITY HOLDING COMPANY ACT OF 2005, FEDERAL POWER ACT AND NATURAL GAS ACT Balance Sheet Chart of Accounts Current and Accrued Assets § 367...

Perceptions of retired professional soccer players about the provision of support services before and after retirement

PubMed Central

Drawer, S; Fuller, C.; Waddington, I

2002-01-01

Objective: To determine the views of retired players about the provision of support services in English professional soccer before and after retirement and to assess the impact of career ending injury on these views. Method: An anonymous self administered questionnaire was distributed to 500 former players registered with the English Professional Footballers' Association. The questions asked about personal details, current medical status, reasons for retirement, perceptions of the provision and quality of support services, and use of prophylactic treatments while injured. Results: Of the 500 questionnaires distributed, 185 (37%) were returned. The Professional Footballers' Association provided significantly (p<0.001) more help and advice to retired players on medical, financial, career, and educational matters than any other organisation. Although respondents showed some satisfaction with the provision of medical support, they were significantly (p<0.001) less satisfied with the provision of sports science (23%) and education/welfare (19%) support. Respondents who had retired through injury, however, were more dissatisfied with the provision of all services. Significantly (p<0.001) more respondents agreed with the view that injuries would reduce income earning potential, contribute to medical problems, and restrict the duration of their playing career. Respondents who had been medically diagnosed with osteoarthritis were significantly more likely, at some time, to have regularly received steroid injections while injured. Conclusion: The results presented are consistent with other evidence that the provision of injury prevention and socioeconomic services at professional soccer clubs is inadequate. The soccer industry should therefore develop a long term strategy for managing the needs of players who are forced to retire through injury. PMID:11867490

Historical dynamics in ecosystem service bundles.

PubMed

Renard, Delphine; Rhemtulla, Jeanine M; Bennett, Elena M

2015-10-27

Managing multiple ecosystem services (ES), including addressing trade-offs between services and preventing ecological surprises, is among the most pressing areas for sustainability research. These challenges require ES research to go beyond the currently common approach of snapshot studies limited to one or two services at a single point in time. We used a spatiotemporal approach to examine changes in nine ES and their relationships from 1971 to 2006 across 131 municipalities in a mixed-use landscape in Quebec, Canada. We show how an approach that incorporates time and space can improve our understanding of ES dynamics. We found an increase in the provision of most services through time; however, provision of ES was not uniformly enhanced at all locations. Instead, each municipality specialized in providing a bundle (set of positively correlated ES) dominated by just a few services. The trajectory of bundle formation was related to changes in agricultural policy and global trends; local biophysical and socioeconomic characteristics explained the bundles' increasing spatial clustering. Relationships between services varied through time, with some provisioning and cultural services shifting from a trade-off or no relationship in 1971 to an apparent synergistic relationship by 2006. By implementing a spatiotemporal perspective on multiple services, we provide clear evidence of the dynamic nature of ES interactions and contribute to identifying processes and drivers behind these changing relationships. Our study raises questions about using snapshots of ES provision at a single point in time to build our understanding of ES relationships in complex and dynamic social-ecological systems.

Toward eliminating blindness due to uncorrected refractive errors: assessment of refractive services in the northern and central regions of Ghana.

PubMed

Ntodie, Michael; Danquah, Lisa; Kandel, Himal; Abokyi, Samuel

2014-11-01

This study sought to document current refractive services in the northern and central regions of Ghana as a first step toward evidence-based planning of refractive services. A descriptive cross-sectional survey was carried out in health facilities in the northern and central regions of Ghana, which provided eye-care services. A semi-structured questionnaire was administered to gather information on each facility type, human resources providing refractive services, assessment of refraction and spectacle dispensing output and provider barriers to the services. Current outputs of refraction in the northern and central regions were 0.5 and 1.2 per cent of the estimated refractive needs, respectively. Spectacle dispensing services were below the outputs of refraction. Lack of equipment (36.8 per cent) and cost of providing spectacles frames (31.6 per cent), were identified as the main barriers to providing refractive services. The provision of refractive services in the study regions was inadequate. Lack of infrastructure and inadequate human resource were the major reasons for the limited service provision. This should be considered for planning refractive services in the study regions and Ghana as a whole. © 2014 The Authors. Clinical and Experimental Optometry © 2014 Optometrists Association Australia.

Service implications from a comparison of the evidence on the effectiveness and a survey of provision in England and Wales of COPD specialist nurse services in the community.

PubMed

Candy, Bridget; Taylor, Stephanie J C; Ramsay, Jean; Esmond, Glenda; Griffiths, Chris J; Bryar, Rosamund M

2007-05-01

Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of mortality worldwide and is a burden on healthcare resources. Therefore, implementing the right care model(s) for patients with COPD is a priority. Nurses, particularly those with specialist roles, are often the principal health professionals involved in new service models. for patients in the community with COPD are increasing in many countries. Two main types of initiatives have been evaluated; those designed to transfer acute care out of hospital and into the community, and those offering chronic disease management. The extent and nature of such specialist services in the UK and internationally are unknown. To present the results of the first survey of specialist nurse service provision for patients in the community with COPD in England and Wales. To combine the survey findings with systematic review evidence to explore to what extent provision is supported by evidence of effectiveness. A postal survey of respiratory healthcare professionals undertaken concurrently with a review of the evidence of the effectiveness of nurse COPD services (review findings are reported fully elsewhere). Two hundred and thirty four specialist nurse services were identified; 71% involved chronic disease management, of which 47% also provided acute care. Seventeen per cent of services involved acute care only. The review identified evidence to support the provision of acute services but data on chronic disease management services are sparse and there is currently little evidence to support these services. Those interventions that have been evaluated to date differed from many of the services provided. This study identifies a considerable mismatch between existing evidence around effectiveness and services provision for patients with COPD. It clearly highlights the need for greater interaction between what happens in practice and research. This is an issue that has relevance across all healthcare practice, both nationally and internationally.

Denitrification in Headwater Wetlands with Varying Surrounding Land Cover Types

EPA Science Inventory

Wetlands are recognized for their significant role in providing a range of ecosystem services. In light of this, research is currently being performed to characterize how forcing functions (e.g., climate change and land cover change) affect the provision of ecosystem services by ...

Medicaid program; home and community-based services. Health Care Financing Administration (HCFA), HHS. Final rule with comment period.

PubMed

2000-10-10

This final rule with comment period expands State flexibility in providing prevocational, educational, and supported employment services under the Medicaid home and community-based services waiver provisions currently found in section 1915(c) of the Social Security Act (the Act); and incorporates the self-implementing provisions of section 4743 of the Balanced Budget Act of 1997 that amends section 1915(c)(5) of the Act to delete the requirements that an individual have prior institutionalization in a nursing facility or intermediate care facility for the mentally retarded before becoming eligible for the expanded habilitation services. In addition, we are making a number of technical changes to update or correct the regulations.

78 FR 57250 - Federal Credit Union Ownership of Fixed Assets

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-18

..., branch office, suboffice, service center, parking lot, facility, real estate where an FCU transacts or... waiver request and suggested that the automatic approval provision in the current rule should be... office, suboffice, service center, parking lot, other facility, or real estate where the federal credit...

Evaluating a primary care psychology service in Ireland: a survey of stakeholders and psychologists.

PubMed

Corcoran, Mark; Byrne, Michael

2017-05-01

Primary care psychology services (PCPS) represent an important resource in meeting the various health needs of our communities. This study evaluated the PCPS in a two-county area within the Republic of Ireland. The objectives were to (i) examine the viewpoints of the service for both psychologists and stakeholders (healthcare professionals only) and (ii) examine the enactment of the stepped care model of service provision. Separate surveys were sent to primary care psychologists (n = 8), general practitioners (GPs; n = 69) and other stakeholders in the two counties. GPs and stakeholders were required to rate the current PCPS. The GP survey specifically examined referrals to the PCPS and service configuration, while the stakeholder survey also requested suggestions for future service provision. Psychologists were required to provide information regarding their workload, time spent on certain tasks and productivity ideas. Referral numbers, waiting lists and waiting times were also obtained. All 8 psychologists, 23 GPs (33% response rate) and 37 stakeholders (unknown response rate) responded. GPs and stakeholders reported access to the PCPS as a primary concern, with waiting times of up to 80 weeks in some areas. Service provision to children and adults was uneven between counties. A stepped care model of service provision was not observed. Access can be improved by further implementation of a stepped care service, developing a high-throughput service for adults (based on a stepped care model), and employing a single waiting list for each county to ensure equal access. © 2016 John Wiley & Sons Ltd.

Ecosystem services in Mediterranean river basin: climate change impact on water provisioning and erosion control.

PubMed

Bangash, Rubab F; Passuello, Ana; Sanchez-Canales, María; Terrado, Marta; López, Alfredo; Elorza, F Javier; Ziv, Guy; Acuña, Vicenç; Schuhmacher, Marta

2013-08-01

The Mediterranean basin is considered one of the most vulnerable regions of the world to climate change and such changes impact the capacity of ecosystems to provide goods and services to human society. The predicted future scenarios for this region present an increased frequency of floods and extended droughts, especially at the Iberian Peninsula. This paper evaluates the impacts of climate change on the water provisioning and erosion control services in the densely populated Mediterranean Llobregat river basin of. The assessment of ecosystem services and their mapping at the basin scale identify the current pressures on the river basin including the source area in the Pyrenees Mountains. Drinking water provisioning is expected to decrease between 3 and 49%, while total hydropower production will decrease between 5 and 43%. Erosion control will be reduced by up to 23%, indicating that costs for dredging the reservoirs as well as for treating drinking water will also increase. Based on these data, the concept for an appropriate quantification and related spatial visualization of ecosystem service is elaborated and discussed. Copyright © 2013 Elsevier B.V. All rights reserved.

Renewing Occupational Cultures--Bridging Boundaries in Learning Spaces

ERIC Educational Resources Information Center

Kalliola, Satu; Nakari, Risto

2007-01-01

Professional bureaucracies of the Finnish municipal services are challenged by many modernization pressures manifested currently in the form of New Public Management. Along with efficiency demands the new emphasis is on the provision of client-oriented services by the means of multi-professional teamwork crossing the traditional sector boundaries.…

Disabilities and Inclusive Practices within Toronto Preschools

ERIC Educational Resources Information Center

Killoran, Isabel; Tymon, Dorothy; Frempong, George

2007-01-01

A current objective in Canada is a provision of childcare services for all children. This objective has not been achieved as many children, especially those with disabilities, are often denied services from publicly funded daycare centres. The authors argue that policy discussions framed from an inclusive perspective provide a better understanding…

78 FR 52511 - Procurement List; Additions and Deletions

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-23

..., W7NX USPFO Activity PA ARNG, Annville, PA. Service Type/Location: Integrated Prime Vendor Supply Chain... of PM FSS, does not have a current contract for the provision of Integrated Prime Vendor Supply Chain... kitting or other supply chain management services required were obtained through the DLA depot system. The...

Information Resources on Microcomputers in Libraries: Public Services. A Selected ERIC Bibliography.

ERIC Educational Resources Information Center

ERIC Clearinghouse on Information Resources, Syracuse, NY.

Twelve articles published between 1982 and 1984 and cited in "Current Index to Journals in Education" are listed in this bibliography on public service applications of microcomputers in libraries. Topics include provision of free public access to microcomputers (justification, objectives, equipment specifications, uses and software,…

Service development for intellectual disability mental health: a human rights approach.

PubMed

Evans, E; Howlett, S; Kremser, T; Simpson, J; Kayess, R; Trollor, J

2012-11-01

People with intellectual disability (ID) experience higher rates of major mental disorders than their non-ID peers, but in many countries have difficulty accessing appropriate mental health services. The aim of this paper is to review the current state of mental health services for people with ID using Australia as a case example, and critically appraise whether such services currently meet the standards set by the Convention on the Rights of Persons with Disabilities. The literature regarding the current state of mental health services for people with ID was reviewed, with a particular focus on Australia. The review highlighted a number of issues to be addressed to meet the mental health needs of people with ID to ensure that their human rights are upheld like those of all other citizens. Many of the barriers to service provision encountered in Australia are likely also to be relevant to other nations, including the culture of division between disability and mental health services, the inadequate training of both disability and mental health workers in ID mental health, and the lack of relevant epidemiological data. None of these barriers are insurmountable. Recommendations are made for adopting a human rights-based approach towards the development and provision of mental health services for people with ID. These include improved policy with measurable outcomes, improved service access via clear referral pathways and the sharing of resources across disability and mental health services, and improved service delivery through training and education initiatives for both the mental health and disability workforce. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 Blackwell Publishing Ltd.

The Role of Mechanized Services in the Provision of Information with Special Reference to the University Environment.

ERIC Educational Resources Information Center

Heim, Kathleen M.

The use, history, and role of machine-readable data base technology is discussed. First the development of data base technology is traced from its beginnings as a special resource for science and technology to its broader use in universities, with descriptions of some specific services. Next the current status of mechanized information services in…

Rationing is a reality in rural physiotherapy: a qualitative exploration of service level decision-making.

PubMed

Adams, Robyn; Jones, Anne; Lefmann, Sophie; Sheppard, Lorraine

2015-03-27

Deciding what health services are provided is a key consideration in delivering appropriate and accessible health care for rural and remote populations. Despite residents of rural communities experiencing poorer health outcomes and exhibiting higher health need, workforce shortages and maldistribution mean that rural communities do not have access to the range of services available in metropolitan centres. Where demand exceeds available resources, decisions about resource allocation are required. A qualitative approach enabled the researchers to explore participant perspectives about decisions informing rural physiotherapy service provision. Stakeholder perspectives were obtained through surveys and in-depth interviews. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of rural, regional and remote communities. Thirty-nine surveys were received from participants in eleven communities. Nineteen in-depth interviews were conducted with physiotherapist and key decision-makers. Increasing demand, organisational priorities, fiscal austerity measures and workforce challenges were identified as factors influencing both decision-making and service provision. Rationing of physiotherapy services was common to all sites of this study. Rationing of services, more commonly expressed as service prioritisation, was more evident in responses of public sector physiotherapy participants compared to private physiotherapists. However, private physiotherapists in rural areas reported capacity limits, including expertise, space and affordability that constrained service provision. The imbalance between increasing service demands and limited physiotherapy capacity meant making choices was inevitable. Decreased community access to local physiotherapy services and increased workforce stress, a key determinant of retention, are two results of such choices or decisions. Decreased access was particularly evident for adults and children requiring neurological rehabilitation and for people requiring post-acute physiotherapy. It should not be presumed that rural private physiotherapy providers will cover service gaps that may emerge from changes to public sector service provision. Clinician preference combines with capacity limits and the imperative of financial viability to negate such assumptions. This study provides insight into rural physiotherapy service provision not usually evident and can be used to inform health service planning and decision-making and education of current and future rural physiotherapists.

Sexual violence against men and boys in conflict and forced displacement: implications for the health sector.

PubMed

Chynoweth, Sarah K; Freccero, Julie; Touquet, Heleen

2017-11-01

Sexual violence against men and boys is commonplace in many conflict-affected settings and may be frequent in relation to forced displacement as well. Adolescent boys, forming the majority of unaccompanied minors globally, are a particularly vulnerable group. Yet sensitised health services for adult and adolescent male sexual violence survivors are scarce, and barriers to accessing care remain high. We describe current challenges and gaps in the provision of health care for male survivors in settings affected by conflict and forced displacement, and provide suggestions on how to improve service provision and uptake.

45 CFR 1634.10 - Transition provisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... other appropriate legal service providers in a manner consistent with the rules of ethics or... purchased by the current recipient in whole or in part with Corporation funds consistent with the...

A human rights approach to advocacy for people with dementia: A review of current provision in England and Wales.

PubMed

Dixon, Jeremy; Laing, Judy; Valentine, Christine

2018-01-01

In this article, we review current advocacy services for people with dementia in England and Wales (provided, respectively, under the Mental Capacity Act 2005 , the Mental Health Act 1983 /2007 and the Care Act 2014) through the lens of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). We examine what a human rights' approach to advocacy support would entail, and whether current frameworks in England and Wales are adequate for this approach and provide a sufficient safeguard. First, we consider how the human rights of persons with dementia have become increasingly important and the extent to which the CRPD provides an opportunity to bolster safeguards and protection. Second, we discuss cause and case advocacy, and how these advocacy models could be shaped by the CRPD to promote the rights of persons with dementia at each stage of the disease. Third, we highlight current dilemmas and challenges in the provision of advocacy support in England and Wales by focusing on case law, commissioning of services and current practice. In particular, we analyse how the different legislative schemes have given rise to some confusion about the various advocacy provisions, as well as potential for overlap and discrepancies between different regimes. We also highlight the need for further research to address important gaps in knowledge, including the scale of need, patterns of referral and attitudes to advocacy services. The article concludes by highlighting how advocacy support could be recalibrated as a universal right to promote the aims and aspirations of the CRPD, and how education is needed to address the stigma of dementia and promote the benefits of advocacy in protecting the rights of those with dementia.

Transformation by stealth: the retargeting of home care services in Finland.

PubMed

Kröger, Teppo; Leinonen, Anu

2012-05-01

This paper analyses the trends and changes that home care services for older people have undergone during the last two decades in Finland. The data used come from national social care statistics, covering the time period from 1990-2010. The results show that, in contrast to many other European nations that have expanded their home care provisions, the coverage levels in Finland have dropped dramatically during this period. Those with the highest needs do receive increased amounts of support, but others have become excluded from publicly funded home care provisions and often need to rely on family members. In most localities, public service provision is focused on personal care, and no longer covers household tasks. This major change of the character of the service is connected to three other recent trends that structure current provisions: the amalgamation of home-based social and healthcare services, the marketisation and emerging privatisation of care and the integration of informal family care into the formal care system. Overall, the changes represent weakening defamilisation, that is, decreasing public responsibility for the needs of many older people and, correspondingly, an increasing reliance on family carers. This full-scale transformation of home care has taken place without any real policy debate or major modification of legislation. No actual decision was ever made to thoroughly alter the character of home care in Finland: the transformation happened by stealth. © 2011 Blackwell Publishing Ltd.

Culturally Appropriate Career Counseling with Gay and Lesbian Clients

ERIC Educational Resources Information Center

Pope, Mark; Barret, Bob; Szymanski, Dawn M.; Chung, Y. Barry; Singaravelu, Hernia; Mclean, Ron; Sanabria, Samuel

2004-01-01

This article details the current knowledge regarding the provision of culturally appropriate career services to gay and lesbian clients. It is divided into 5 parts: (1) history and context for the delivery of career counseling services to gay and lesbian clients; (2) counselor self-preparation for working with gay and lesbian clients; (3)…

Case Management in Community Corrections: Current Status and Future Directions

ERIC Educational Resources Information Center

Day, Andrew; Hardcastle, Lesley; Birgden, Astrid

2012-01-01

Case management is commonly regarded as the foundation of effective service provision across a wide range of human service settings. This article considers the case management that is offered to clients of community corrections, identifying the distinctive features of case management in this particular setting, and reviewing the empirical evidence…

Nursing home reimbursement and the allocation of rehabilitation therapy resources.

PubMed

Murtaugh, C M; Cooney, L M; DerSimonian, R R; Smits, H L; Fetter, R B

1988-10-01

Most public funding methods for long-term care do not adequately match payment rates with patient need for services. Case-mix payment systems are designed to encourage a more efficient and equitable allocation of limited health care resources. Even nursing home case-mix payment systems, however, do not currently provide the proper incentives to match rehabilitation therapy resources to a patient's needs. We were able to determine by a review of over 8,500 patients in 65 nursing homes that certain diagnoses, partial dependence in activities of daily living (ADLs), clear mental status, and improving medical status are associated with the provision of rehabilitation services to nursing home residents. These patient characteristics are clinically reasonable predictors of the need for therapy and should be considered for use in nursing home case-mix reimbursement systems. Primary payment source also was associated with the provision of rehabilitation services even after taking into account significant patient characteristics. It is unclear how much of the variation in service use across payers is due to differences in patient need as opposed to differences in the financial incentives associated with current payment methods.

Mental health economics, health service provision, and the practice of geriatric psychiatry.

PubMed

Suh, Guk-Hee; Han, Changsu

2008-11-01

Economic evaluation is becoming more and more important as a means to assist policy makers in choosing the best intervention or treatment against a pervasive scarcity of resources relative to the demands. Health service provision and the practice of geriatric psychiatry are closely associated with costs and outcomes of health economics. Recently published literature raising unanswered questions in these areas is reviewed. Some studies on the costs, outcomes, and cost-effectiveness of certain interventions or treatments (e.g. respite care, home-visiting community service) compared with usual strategies show that these are not optimal in terms of health economics. The updated guidance by the National Institute for Health and Clinical Excellence that cholinesterase inhibitors should be used only for moderate severity dementia on the grounds of cost-effectiveness has been heavily criticized. Mental health provision for older people varies across 'developed' and 'developing' countries. Updated findings provide better understanding of recent progress and issues on mental health economics, health service provision, and the practice of geriatric psychiatry. The application of health economics to the field of mental health should make complicated issues simple and explicit. Constructive criticisms and scientific debates will hasten the development of better tools or methodologies to evaluate the cost-effectiveness of current and new interventions or treatments.

From home, to market, to headquarters, to home. Relocating health services planning and purchasing in New Zealand.

PubMed

Gauld, Robin

2002-01-01

Health sector restructuring has been in vogue, but no country has engaged in as much health sector restructuring as New Zealand where, in a decade, there have been four different public health sector structures. This article discusses New Zealand's four structures with an emphasis on relocating the critical functions of health care planning and purchasing, and on the development of the present district health board system. The four structures include: an area health board system (1989-1991) with planning and purchasing located at "home" in local areas and closely aligned with service provision; a competitive internal market system (1993-1996) which separated planning and purchasing from service provision; a centralised system with a "headquarters" controlling planning and purchasing (1997-1999) while maintaining the distance from provision; and the district health board system currently under development (1999-) which sees purchasing and planning sent home again to regions and linked closely with service provision. The present system entails the devolution of considerable responsibility to the local level, within a framework of strong central government control. Based on New Zealand's experience, the article notes that all but the market structure appear to have provided an adequate environment for effective health care planning and purchasing.

Wheelchair service provision education in academia.

PubMed

Fung, Karen H; Rushton, Paula W; Gartz, Rachel; Goldberg, Mary; Toro, Maria L; Seymour, Nicky; Pearlman, Jonathan

2017-01-01

An estimated 70 million people with disabilities need wheelchairs. To address this global crisis, the World Health Organization (WHO) proposed an eight-step wheelchair service provision model to ensure service quality regardless of resource setting. The International Society of Wheelchair Professionals (ISWP) aims to facilitate the integration of the WHO eight-step model into professional rehabilitation programmes. To develop an enhanced understanding of the current wheelchair service provision education provided in professional rehabilitation programmes worldwide. In a cross-sectional design, an online survey was distributed to ISWP contacts of educational institutions. Quantitative responses were analysed through summary statistics and qualitative answers were analysed by content analyses. When relevant, educational institutions were stratified into resource settings. Seventy-two representatives of educational institutions in 21 countries completed the survey. Wheelchair content was taught in 79% of represented institutions, of which 75% of respondents reported using original course material, 10% of respondents used WHO Wheelchair Service Training Packages and 15% of respondents used other available resources. The majority of educational institutions teaching with their own wheelchair-related course material taught ≤ 20 hours. Fourteen of the 15 respondents without wheelchair education, expressed an interest in integrating wheelchair education into their academic curricula. The majority of the educational institutions teach wheelchair education; however, there is great variability in what and how it is taught and evaluated. The results demonstrate the need for more in-depth investigation regarding the integration process of wheelchair education in educational institutions, with the ultimate goal of improving wheelchair service provision worldwide.

75 FR 47717 - Content of Periodicals Mail

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-09

... sheets. But allowing de minimis product samples will reduce the burden of the current guidelines... representatives, the Postal Service has adopted a new provision in the DMM allowing product samples in de minimis...

Valuing ecosystem services in terms of ecological risks and returns.

PubMed

Abson, David J; Termansen, Mette

2011-04-01

The economic valuation of ecosystem services is a key policy tool in stemming losses of biological diversity. It is proposed that the loss of ecosystem function and the biological resources within ecosystems is due in part to the failure of markets to recognize the benefits humans derive from ecosystems. Placing monetary values on ecosystem services is often suggested as a necessary step in correcting such market failures. We consider the effects of valuing different types of ecosystem services within an economic framework. We argue that provisioning and regulating ecosystem services are generally produced and consumed in ways that make them amenable to economic valuation. The values associated with cultural ecosystem services lie outside the domain of economic valuation, but their worth may be expressed through noneconomic, deliberative forms of valuation. We argue that supporting ecosystem services are not of direct value and that the losses of such services can be expressed in terms of the effects of their loss on the risk to the provision of the directly valued ecosystem services they support. We propose a heuristic framework that considers the relations between ecological risks and returns in the provision of ecosystem services. The proposed ecosystem-service valuation framework, which allows the expression of the value of all types of ecosystem services, calls for a shift from static, purely monetary valuation toward the consideration of trade-offs between the current flow of benefits from ecosystems and the ability of those ecosystems to provide future flows. ©2010 Society for Conservation Biology.

‘Mind the gap’ - mapping services for young people with ADHD transitioning from child to adult mental health services

PubMed Central

2013-01-01

Background Once considered to be a disorder restricted to childhood, Attention Deficit/Hyperactivity Disorder (ADHD) is now recognised to persist into adult life. However, service provision for adults with ADHD is limited. Additionally, there is little guidance or research on how best to transition young people with ADHD from child to adult services. Method We report the findings of a survey of 96 healthcare professionals working in children’s (Child and Adolescent Mental Health Services and Community Paediatrics) and adult services across five NHS Trusts within the East Midlands region of England to gain a better understanding of the current provision of services for young people with ADHD transitioning into adult mental health services. Results Our findings indicate a lack of structured guidelines on transitioning and little communication between child and adult services. Child and adult services had differing opinions on what they felt adult services should provide for ADHD cases. Adult services reported feeling ill-prepared to deal with ADHD patients, with clinicians in these services citing a lack of specific knowledge of ADHD and a paucity of resources to deal with such cases. Conclusions We discuss suggestions for further research, including the need to map the national provision of services for adults with ADHD, and provide recommendations for commissioned adult ADHD services. We specifically advocate an increase in ADHD-specific training for clinicians in adult services, the development of specialist adult ADHD clinics and greater involvement of Primary Care to support the work of generic adult mental health services in adult ADHD management. PMID:23842080

'Mind the gap'--mapping services for young people with ADHD transitioning from child to adult mental health services.

PubMed

Hall, Charlotte L; Newell, Karen; Taylor, John; Sayal, Kapil; Swift, Katie D; Hollis, Chris

2013-07-10

Once considered to be a disorder restricted to childhood, Attention Deficit/Hyperactivity Disorder (ADHD) is now recognised to persist into adult life. However, service provision for adults with ADHD is limited. Additionally, there is little guidance or research on how best to transition young people with ADHD from child to adult services. We report the findings of a survey of 96 healthcare professionals working in children's (Child and Adolescent Mental Health Services and Community Paediatrics) and adult services across five NHS Trusts within the East Midlands region of England to gain a better understanding of the current provision of services for young people with ADHD transitioning into adult mental health services. Our findings indicate a lack of structured guidelines on transitioning and little communication between child and adult services. Child and adult services had differing opinions on what they felt adult services should provide for ADHD cases. Adult services reported feeling ill-prepared to deal with ADHD patients, with clinicians in these services citing a lack of specific knowledge of ADHD and a paucity of resources to deal with such cases. We discuss suggestions for further research, including the need to map the national provision of services for adults with ADHD, and provide recommendations for commissioned adult ADHD services. We specifically advocate an increase in ADHD-specific training for clinicians in adult services, the development of specialist adult ADHD clinics and greater involvement of Primary Care to support the work of generic adult mental health services in adult ADHD management.

[Issues of provision of the safety of laserwares in the use of nanotechnologies].

PubMed

Pal'tsevIu P; Levina, A V; Kravchenko, O K

2008-01-01

Current technologies, including nanotechnologies, cannot be introduced, without applying laser equipment. For provision of the safety in the manufacture and use of up-to-date laser equipment that is characterized by new, previously unused wavelengths and exposure levels, it is necessary to develop the hygienic regulation of the arrangement and maintenance of lasers, to improve approaches to making their sanitary-and-epidemiological examination and manufacturing inspection, to design measuring instruments that permit an objective assessment of new types of laser exposures, and to develop the current means for protecting the organ of vision in service personnel.

Using plant traits to evaluate the resistance and resilience of ecosystem service provision

NASA Astrophysics Data System (ADS)

Kohler, Marina; Devaux, Caroline; Fontana, Veronika; Grigulis, Karl; Lavorel, Sandra; Leitinger, Georg; Schirpke, Uta; Tasser, Erich; Tappeiner, Ulrike

2015-04-01

Mountain grassland ecosystems are a hotspot of biodiversity and deliver a multiplicity of ecosystem services. Due to a long history of well adapted agricultural use and specific environmental conditions (e.g. slope, altitude, or climate), various types of grassland ecosystems have developed. Each of them shows specific attributes in forms of plant communities and abiotic characteristics, which lead to particular ranges of ecosystem service provision. However, ongoing climate and societal changes thread plant community composition and may lead to changes in plant traits, and therefore, the provision of ecosystem services. Currently it is not clear how vulnerable these ecosystems are to disturbances, or whether they have developed a high resilience over time. Thus, it is essential to know the ranges of resistance and resilience of an ecosystem service. We, therefore, developed a static approach based on community weighted mean plant traits and abiotic parameters to measure the boundaries of resistance and resilience of each ecosystem service separately. By calculating actual minimum and maximum amounts of ecosystem services, we define the range of resistance of an ecosystem service. We then calculate the potential amount of an ecosystem services (via simulated plant communities) by assuming that no species is lost or added to the system. By comparing actual and potential values, we can estimate whether an ecosystem service is in danger to lose its resilience. We selected different ecosystem services related to mountain grassland ecosystems, e.g. carbon storage, forage quality, forage quantity, and soil fertility. We analysed each ecosystem service for different grassland management types, covering meadows and pastures of very low land-use intensity through to grasslands of high land-use intensity. Results indicate that certain ecosystem services have a higher resilience than others (e.g. carbon storage) for all management types. The ecosystem may provide steady amounts of ecosystem services also in future when facing environmental or societal disturbances. In contrary, other services are very depending on actual conditions and are, therefore, less stable (e.g. forage quantity). When comparing ranges of resistance and resilience, the actual amount lies very close to the boundaries of the potential provision. This gives us a hint that the ecosystem service is in danger to lose its resilience and amount of ecosystem service provision when facing disturbances in future.

TRICARE; Revision of Nonparticipating Providers Reimbursement Rate; Removal of Cost Share for Dental Sealants; TRICARE Dental Program. Final rule.

PubMed

2016-03-07

This final rule revises the benefit payment provision for nonparticipating providers to more closely mirror industry practices by requiring TDP nonparticipating providers to be reimbursed (minus the appropriate cost-share) at the lesser of billed charges or the network maximum allowable charge for similar services in that same locality (region) or state. This rule also updates the regulatory provisions regarding dental sealants to clearly categorize them as a preventive service and, consequently, eliminate the current 20 percent cost-share applicable to sealants to conform with the language in the regulation to the statute.

California transportation today

DOT National Transportation Integrated Search

1979-01-16

The purpose of this report is to more fully inform members of the Legislature, other interested parties, and the public about the major issues currently impacting the provision of public transportation services and mobile source-related air quality p...

The Need for a Comprehensive Care and Education Service for Pre-School Children.

ERIC Educational Resources Information Center

Blackstone, Tessa

An argument is presented for a comprehensive and universal system of care and education for preschool children outside the family. Current institutional arrangements in the United Kingdom for government provision of education and care for young children are discussed and proposals are made for alternative ways of providing this service. It is…

Assistance with Integrity: The Search for Accountability and the Lives of People with Developmental Disabilities.

ERIC Educational Resources Information Center

O'Brien, John; O'Brien, Connie Lyle

This report discusses basic issues in the provision of residential services for people with developmental disabilities. Main points of the discussion include: (1) the service system for this population is in a crisis of accountability as meeting safety and quality requirements threatens to become counterproductive; (2) the current system is well…

Motor Neurone Disease: Disability Profile and Service Needs in an Australian Cohort

ERIC Educational Resources Information Center

Ng, Louisa; Talman, Paul; Khan, Fary

2011-01-01

Motor neurone disease (MND) places considerable burden upon patients and caregivers. This is the first study, which describes the disability profile and healthcare needs for persons with MND (pwMND) in an Australian sample from the perspective of the patients and caregivers to identify current gaps in the knowledge and service provision. A…

Assessing Ecosystem Service Provision Under Climate Change to Support Conservation and Development Planning in Myanmar

NASA Technical Reports Server (NTRS)

Mandle, Lisa; Wolny, Stacie; Bhagabati, Nirmal; Helsingen, Hanna; Hamel, Perrine; Bartlett, Ryan; Dixon, Adam; Horton, Radley M.; Lesk, Corey; Manley, Danielle;

Acquisition Reform in House and Senate Passed Versions of the FY2016 National Defense Authorization Act (H.R. 1735)

DTIC Science & Technology

2015-07-02

defense acquisitions may depend less on the extent to which provisions of the bill make substantive changes to acquisitions...1 Because the House Armed Services Committee’s focus on small business predates the current reform effort, and because small... business provisions also affect only a specific segment of the industrial base, not the overall acquisition system, such sections were excluded from

Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda

PubMed Central

Lu, Chunling; Cook, Benjamin; Desmond, Chris

2017-01-01

Background Rural healthcare facilities in low-income countries play a major role in providing primary care to rural populations. We examined the link of foreign aid with government investments and medical service provision in rural health centres in Rwanda. Methods Using the District Health System Strengthening Tool, a web-based database built by the Ministry of Health in Rwanda, we constructed two composite indices representing provision of (1) child and maternal care and (2) HIV, tuberculosis (TB) and malaria services in 330 rural health centres between 2009 and 2011. Financing variables in a healthcare centre included received funds from various sources, including foreign donors and government. We used multilevel random-effects model in regression analyses and examined the robustness of results to a range of alternative specification, including scale of dependent variables, estimation methods and timing of aid effects. Findings Both government and foreign donors increased their direct investments in the 330 rural healthcare centres during the period. Foreign aid was positively associated with government investments (0.13, 95% CI 0.06 to 0.19) in rural health centres. Aid in the previous year was positively associated with service provision for child and maternal health (0.008, 95% CI 0.002 to 0.014) and service provision for HIV, TB and malaria (0.014, 95% CI 0.004 to 0.022) in the current year. The results are robust when using fixed-effects models. Conclusions These findings suggest that foreign aid did not crowd out government investments in the rural healthcare centres. Foreign aid programmes, conducted in addition to government investments, could benefit rural residents in low-income countries through increased service provision in rural healthcare facilities. PMID:29082015

Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda.

PubMed

Lu, Chunling; Cook, Benjamin; Desmond, Chris

2017-01-01

Rural healthcare facilities in low-income countries play a major role in providing primary care to rural populations. We examined the link of foreign aid with government investments and medical service provision in rural health centres in Rwanda. Using the District Health System Strengthening Tool, a web-based database built by the Ministry of Health in Rwanda, we constructed two composite indices representing provision of (1) child and maternal care and (2) HIV, tuberculosis (TB) and malaria services in 330 rural health centres between 2009 and 2011. Financing variables in a healthcare centre included received funds from various sources, including foreign donors and government. We used multilevel random-effects model in regression analyses and examined the robustness of results to a range of alternative specification, including scale of dependent variables, estimation methods and timing of aid effects. Both government and foreign donors increased their direct investments in the 330 rural healthcare centres during the period. Foreign aid was positively associated with government investments (0.13, 95% CI 0.06 to 0.19) in rural health centres. Aid in the previous year was positively associated with service provision for child and maternal health (0.008, 95% CI 0.002 to 0.014) and service provision for HIV, TB and malaria (0.014, 95% CI 0.004 to 0.022) in the current year. The results are robust when using fixed-effects models. These findings suggest that foreign aid did not crowd out government investments in the rural healthcare centres. Foreign aid programmes, conducted in addition to government investments, could benefit rural residents in low-income countries through increased service provision in rural healthcare facilities.

7 CFR 925.63 - Termination.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... majority of the growers: Provided, That such majority has during the current marketing season produced more... the provisions of the act authorizing them cease to be in effect. ...

47 CFR 87.5 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... station providing communication between a control tower and aircraft. Automatic dependent surveillance... relevant information about the aircraft. Automatic terminal information service-broadcast (ATIS-B). The automatic provision of current, routine information to arriving and departing aircraft throughout a 24-hour...

47 CFR 87.5 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... station providing communication between a control tower and aircraft. Automatic dependent surveillance... relevant information about the aircraft. Automatic terminal information service-broadcast (ATIS-B). The automatic provision of current, routine information to arriving and departing aircraft throughout a 24-hour...

Intervention among Suicidal Men: Future Directions for Telephone Crisis Support Research.

PubMed

Hunt, Tara; Wilson, Coralie J; Woodward, Alan; Caputi, Peter; Wilson, Ian

2018-01-01

Telephone crisis support is a confidential, accessible, and immediate service that is uniquely set up to reduce male suicide deaths through crisis intervention. However, research focusing on telephone crisis support with suicidal men is currently limited. To highlight the need to address service delivery for men experiencing suicidal crisis, this perspective article identifies key challenges facing current telephone crisis support research and proposes that understanding of the role of telephone crisis helplines in supporting suicidal men may be strengthened by careful examination of the context of telephone crisis support, together with the impact this has on help-provision for male suicidal callers. In particular, the impact of the time- and information-poor context of telephone crisis support on crisis-line staff's identification of, and response to, male callers with thoughts of suicide is examined. Future directions for research in the provision of telephone crisis support for suicidal men are discussed.

Intervention among Suicidal Men: Future Directions for Telephone Crisis Support Research

PubMed Central

Hunt, Tara; Wilson, Coralie J.; Woodward, Alan; Caputi, Peter; Wilson, Ian

2018-01-01

Telephone crisis support is a confidential, accessible, and immediate service that is uniquely set up to reduce male suicide deaths through crisis intervention. However, research focusing on telephone crisis support with suicidal men is currently limited. To highlight the need to address service delivery for men experiencing suicidal crisis, this perspective article identifies key challenges facing current telephone crisis support research and proposes that understanding of the role of telephone crisis helplines in supporting suicidal men may be strengthened by careful examination of the context of telephone crisis support, together with the impact this has on help-provision for male suicidal callers. In particular, the impact of the time- and information-poor context of telephone crisis support on crisis-line staff’s identification of, and response to, male callers with thoughts of suicide is examined. Future directions for research in the provision of telephone crisis support for suicidal men are discussed. PMID:29404319

Mobile satellite regulation in the United States

NASA Technical Reports Server (NTRS)

Levin, Lon C.; Sonnenfeldt, Walter H.

1990-01-01

During the last decade, the U.S. FCC has developed the regulatory structure for the provision of mobile services via satellite. In May 1989, the FCC awarded American Mobile Satellite Corporation (AMSC) a license to provide the full range of domestic mobile satellite services in the U.S. At that time, the FCC reaffirmed the U.S. mobile satellite industry structure and spectrum allocations that had been adopted previously. Also in May 1989, the FCC authorized the Communications Satellite Corporation (COMSAT), the U.S. Signatory to Inmarsat, to provide international aeronautical satellite service via the Inmarsat system. Earlier in 1989, the FCC permitted the use of Ku-band satellites to provide messaging and tracking services. In the mid-1980's, the FCC established the Radiodetermination Satellite Service and awarded licenses. Among the mobile satellite matters currently facing the FCC are whether additional spectrum should be allocated for domestic 'generic' mobile satellite services, the regulatory structure for the provision of mobile satellite service on an interim basis before AMSC launches its dedicated satellites, and whether to authorize a low earth orbit satellite system to provide mobile data service.

Women in the Military. More Military Jobs Can Be Opened under Current Statutes. Report to Congressional Requesters.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Div. of National Security and International Affairs.

A study determined how service policies implementing the combat exclusion provisions affect the number and assignment of military women and whether service procedures unrelated to the combat exclusion limit job opportunities for women. Based on the combat exclusion and related program needs, about 1.1 million of 2.2 million military jobs were…

Towards an Understanding of Factors Influencing Early Years Professionals' Practice of Consultation with Young Children

ERIC Educational Resources Information Center

Davies, Sarah; Artaraz, Kepa

2009-01-01

Recent Government agendas in England highlight a need to involve children in policy and service design, provision and evaluation of services they use or which affect them. While consultation with older children has become more common, this is not the case for younger children. This article reports on a study exploring the current practice and…

Caught in the Middle: Child Language Brokering as a Form of Unrecognised Language Service

ERIC Educational Resources Information Center

Antonini, Rachele

2016-01-01

This paper will present the findings of a wide-scale research aimed at studying the phenomenon of Child Language Brokering (henceforth CLB) in Italy. After providing a description of recent immigration patterns and the provision of language services in Italy, and an overview of current research in this field, this study will discuss narrative data…

Anaesthesia or sedation for paediatric MRI: advantages and disadvantages.

PubMed

Arthurs, Owen J; Sury, Michael

2013-08-01

The purpose of the present review is to place the current literature into historical context of what is understood about the conceptual as well as practical differences between sedation and anaesthesia, and what the potential benefits and risks may be, where paediatric imaging is concerned. This review is timely, as there is an increasing demand for the expensive resource of anaesthesia service provision, above and beyond sedation provision. Adequate and appropriate training is the major issue in well tolerated drug administration: the practitioner must have appropriate skills to monitor and rescue the patient from general anaesthesia. There is an increasing understanding on what can be achieved with subanaesthetic doses of traditional anaesthetic drugs, as well as what can be achieved without access to anaesthetic drugs at all. The risk-benefit analysis must ultimately be taken on a patient-by-patient basis, and to this end should determine service provision and training requirements. One single method cannot be applied to all children. Many can be sedated, but others will need anaesthesia with careful airway management, and the accompanying skilled personnel. Service models should be developed and tested to ensure maximum efficiency of service delivery.

Group Therapy for School-Aged Children Who Stutter: A Survey of Current Practices

ERIC Educational Resources Information Center

Liddle, Hilary; James, Sarah; Hardman, Margaret

2011-01-01

Although group therapy is recommended for school-aged children who stutter (CWS), it is not widely researched. This study aimed to explore this provision, using a postal survey which investigated the current practices of Speech & Language Therapists (SLTs) in the UK. Seventy percent of SLT services provided some group therapy, but the level of…

77 FR 33063 - Selection and Functions of Farm Service Agency State and County Committees

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-05

...;Prices of new books are listed in the first FEDERAL REGISTER issue of each #0;week. #0; #0; #0; #0;#0... current practice and are largely unchanged from the current regulations. Obsolete references to... in use. Since the details are in the handbooks and directives, the provisions now reference the...

Towards Integrating Soil Quality Monitoring Targets as Measures of Soil Natural Capital Stocks with the Provision of Ecosystem Services

NASA Astrophysics Data System (ADS)

Taylor, M. D.; Mackay, A. D.; Dominati, E.; Hill, R. B.

2012-04-01

This paper presents the process used to review soil quality monitoring in New Zealand to better align indicators and indicator target ranges with critical values of change in soil function. Since its inception in New Zealand 15 year ago, soil quality monitoring has become an important state of the environment reporting tool for Regional Councils. This tool assists councils to track the condition of soils resources, assess the impact of different land management practices, and provide timely warning of emerging issues to allow early intervention and avoid irreversible loss of natural capital stocks. Critical to the effectiveness of soil quality monitoring is setting relevant, validated thresholds or target ranges. Provisional Target Ranges were set in 2003 using expert knowledge available and data on production responses. Little information was available at that time for setting targets for soil natural capital stocks other than those for food production. The intention was to revise these provisional ranges as further information became available and extend target ranges to cover the regulating and cultural services provided by soils. A recently developed ecosystems service framework was used to explore the feasibility of linking soil natural capital stocks measured by the current suite of soil quality indicators to the provision of ecosystem services by soils. Importantly the new approach builds on and utilises the time series data sets collected by current suite of soil quality indicators, adding value to the current effort, and has the potential to set targets ranges based on the economic and environmental outcomes required for a given farm, catchment or region. It is now timely to develop a further group of environmental indicators for measuring specific soil issues. As with the soil quality indicators, these environmental indicators would be aligned with the provision of ecosystem services. The toolbox envisaged is a set of indicators for specific soil issues with appropriate targets tied to ecosystem services and changes in critical soil function. Such indicators would be used for specific purposes for limited periods, rather than long-term, continuous monitoring. Some examples will be presented. An important step needed to successfully initiate and complete the review was assigning national oversight. Reigniting scientific interest (which had declined with the cessation of funding in 2003) and documentation of the process were other important steps. We had to extend the recently developed ecosystem service approach to accommodate the catchment scale. This required additional attributes in the framework and recognition that some of the proxies will change with scale as will the techniques to value the services. The framework was originally developed for use at the farm scale. Macroporosity, one of the two indicators used to monitor the physical condition of the soil, was used to illustrate how the ecosystem service framework could be used to link a change in the physical condition of the soil with the provision of services. The sum of the dollar values of selected soil ecosystem services were used to inform the state of soil natural capital stocks. This estimate provides a new insight into the value of the soil quality indicators and existing target ranges. Doing so will enable targets to be more closely aligned and integrated with the provision of a range of ecosystem services, going far beyond food production.

Evaluation of Drought Implications on Ecosystem Services: Freshwater Provisioning and Food Provisioning in the Upper Mississippi River Basin

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, Ping; Omani, Nina; Chaubey, Indrajeet

Drought is one of the most widespread extreme climate events with a potential to alter freshwater availability and related ecosystem services. Given the interconnectedness between freshwater availability and many ecosystem services, including food provisioning, it is important to evaluate the drought implications on freshwater provisioning and food provisioning services. Studies about drought implications on streamflow, nutrient loads, and crop yields have been increased and these variables are all process-based model outputs that could represent ecosystem functions that contribute to the ecosystem services. However, few studies evaluate drought effects on ecosystem services such as freshwater and food provisioning and quantify thesemore » services using an index-based ecosystem service approach. In this study, the drought implications on freshwater and food provisioning services were evaluated for 14 four-digit HUC (Hydrological Unit Codes) subbasins in the Upper Mississippi River Basin (UMRB), using three drought indices: standardized precipitation index (SPI), standardized soil water content index (SSWI), and standardized streamflow index (SSI). The results showed that the seasonal freshwater provisioning was highly affected by the precipitation deficits and/or surpluses in summer and autumn. A greater importance of hydrological drought than meteorological drought implications on freshwater provisioning was evident for the majority of the subbasins, as evidenced by higher correlations between freshwater provisioning and SSI12 than SPI12. Food provisioning was substantially affected by the precipitation and soil water deficits during summer and early autumn, with relatively less effect observed in winter. A greater importance of agricultural drought effects on food provisioning was evident for most of the subbasins during crop reproductive stages. Results from this study may provide insights to help make effective land management decisions in responding to extreme climate conditions in order to protect and restore freshwater provisioning and food provisioning services in the UMRB.« less

Evaluation of Drought Implications on Ecosystem Services: Freshwater Provisioning and Food Provisioning in the Upper Mississippi River Basin.

PubMed

Li, Ping; Omani, Nina; Chaubey, Indrajeet; Wei, Xiaomei

2017-05-08

Drought is one of the most widespread extreme climate events with a potential to alter freshwater availability and related ecosystem services. Given the interconnectedness between freshwater availability and many ecosystem services, including food provisioning, it is important to evaluate the drought implications on freshwater provisioning and food provisioning services. Studies about drought implications on streamflow, nutrient loads, and crop yields have been increased and these variables are all process-based model outputs that could represent ecosystem functions that contribute to the ecosystem services. However, few studies evaluate drought effects on ecosystem services such as freshwater and food provisioning and quantify these services using an index-based ecosystem service approach. In this study, the drought implications on freshwater and food provisioning services were evaluated for 14 four-digit HUC (Hydrological Unit Codes) subbasins in the Upper Mississippi River Basin (UMRB), using three drought indices: standardized precipitation index ( SPI ), standardized soil water content index ( SSWI ), and standardized streamflow index ( SSI ). The results showed that the seasonal freshwater provisioning was highly affected by the precipitation deficits and/or surpluses in summer and autumn. A greater importance of hydrological drought than meteorological drought implications on freshwater provisioning was evident for the majority of the subbasins, as evidenced by higher correlations between freshwater provisioning and SSI 12 than SPI 12. Food provisioning was substantially affected by the precipitation and soil water deficits during summer and early autumn, with relatively less effect observed in winter. A greater importance of agricultural drought effects on food provisioning was evident for most of the subbasins during crop reproductive stages. Results from this study may provide insights to help make effective land management decisions in responding to extreme climate conditions in order to protect and restore freshwater provisioning and food provisioning services in the UMRB.

Evaluation of Drought Implications on Ecosystem Services: Freshwater Provisioning and Food Provisioning in the Upper Mississippi River Basin

PubMed Central

Li, Ping; Omani, Nina; Chaubey, Indrajeet; Wei, Xiaomei

2017-01-01

Drought is one of the most widespread extreme climate events with a potential to alter freshwater availability and related ecosystem services. Given the interconnectedness between freshwater availability and many ecosystem services, including food provisioning, it is important to evaluate the drought implications on freshwater provisioning and food provisioning services. Studies about drought implications on streamflow, nutrient loads, and crop yields have been increased and these variables are all process-based model outputs that could represent ecosystem functions that contribute to the ecosystem services. However, few studies evaluate drought effects on ecosystem services such as freshwater and food provisioning and quantify these services using an index-based ecosystem service approach. In this study, the drought implications on freshwater and food provisioning services were evaluated for 14 four-digit HUC (Hydrological Unit Codes) subbasins in the Upper Mississippi River Basin (UMRB), using three drought indices: standardized precipitation index (SPI), standardized soil water content index (SSWI), and standardized streamflow index (SSI). The results showed that the seasonal freshwater provisioning was highly affected by the precipitation deficits and/or surpluses in summer and autumn. A greater importance of hydrological drought than meteorological drought implications on freshwater provisioning was evident for the majority of the subbasins, as evidenced by higher correlations between freshwater provisioning and SSI12 than SPI12. Food provisioning was substantially affected by the precipitation and soil water deficits during summer and early autumn, with relatively less effect observed in winter. A greater importance of agricultural drought effects on food provisioning was evident for most of the subbasins during crop reproductive stages. Results from this study may provide insights to help make effective land management decisions in responding to extreme climate conditions in order to protect and restore freshwater provisioning and food provisioning services in the UMRB. PMID:28481311

Evaluation of Drought Implications on Ecosystem Services: Freshwater Provisioning and Food Provisioning in the Upper Mississippi River Basin

DOE PAGES

Li, Ping; Omani, Nina; Chaubey, Indrajeet; ...

2017-05-08

Drought is one of the most widespread extreme climate events with a potential to alter freshwater availability and related ecosystem services. Given the interconnectedness between freshwater availability and many ecosystem services, including food provisioning, it is important to evaluate the drought implications on freshwater provisioning and food provisioning services. Studies about drought implications on streamflow, nutrient loads, and crop yields have been increased and these variables are all process-based model outputs that could represent ecosystem functions that contribute to the ecosystem services. However, few studies evaluate drought effects on ecosystem services such as freshwater and food provisioning and quantify thesemore » services using an index-based ecosystem service approach. In this study, the drought implications on freshwater and food provisioning services were evaluated for 14 four-digit HUC (Hydrological Unit Codes) subbasins in the Upper Mississippi River Basin (UMRB), using three drought indices: standardized precipitation index (SPI), standardized soil water content index (SSWI), and standardized streamflow index (SSI). The results showed that the seasonal freshwater provisioning was highly affected by the precipitation deficits and/or surpluses in summer and autumn. A greater importance of hydrological drought than meteorological drought implications on freshwater provisioning was evident for the majority of the subbasins, as evidenced by higher correlations between freshwater provisioning and SSI12 than SPI12. Food provisioning was substantially affected by the precipitation and soil water deficits during summer and early autumn, with relatively less effect observed in winter. A greater importance of agricultural drought effects on food provisioning was evident for most of the subbasins during crop reproductive stages. Results from this study may provide insights to help make effective land management decisions in responding to extreme climate conditions in order to protect and restore freshwater provisioning and food provisioning services in the UMRB.« less

76 FR 33242 - Certain Steel Wheels From the People's Republic of China; Notice of Postponement of Preliminary...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-08

... is currently investigating alleged subsidy programs involving loans, grants, income tax incentives, and the provision of goods or services for less than adequate remuneration. Due to the number and...

Aligning land use with land potential

USDA-ARS?s Scientific Manuscript database

Current agricultural land use is dominated by an emphasis on provisioning services by applying energy-intensive inputs through relatively uniform production systems across variable landscapes. This approach to agricultural land use is not sustainable. Integrated agricultural systems (IAS) are uphe...

Epilepsy services in Ireland: 'A survey of people with epilepsy in relation to satisfaction, preferences and information provision'.

PubMed

Bennett, Louise; Bergin, Michael; Gooney, Martina; Doherty, Colin P; Synnott, Cara; Wells, John S G

2015-07-01

A challenge facing modern health care systems is to develop and implement new models of service that deliver increased capacity while providing a higher-quality, more cost-effective service within resource constraints. Incorporating the experience of people with epilepsy must be seen as central to the effectiveness of service design and delivery. This paper, therefore, reports the views of people with epilepsy with regards to health service delivery in Ireland. A cross-sectional descriptive survey design involving both quantitative and qualitative items was administered to a convenience sample of one hundred and two people with epilepsy (n=102) attending an epilepsy specialist centre. Despite high levels of satisfaction with hospital and primary care, participants offered several suggestions to improve healthcare delivery, such as: less delay in accessing specialist care and hospital appointments; better communication; and easier access to investigatory services. Findings demonstrate that for people with epilepsy the burden of the disorder is substantial and complex encompassing social, psychological and structural difficulties. Poor information provision particularly among women is reported. Furthermore, a lack of empowerment in people with epilepsy is highlighted. This study has implications for the reform and development of epilepsy services in relation to practice, education and research. It provides a basis for an evaluation of current practice and identifies opportunities for future service reorganization to improve the quality and efficiency of healthcare provision. Copyright © 2015 Elsevier B.V. All rights reserved.

A conceptual framework to assess effectiveness in wheelchair provision.

PubMed

Kamaraj, Deepan C; Bray, Nathan; Rispin, Karen; Kankipati, Padmaja; Pearlman, Jonathan; Borg, Johan

2017-01-01

Currently, inadequate wheelchair provision has forced many people with disabilities to be trapped in a cycle of poverty and deprivation, limiting their ability to access education, work and social facilities. This issue is in part because of the lack of collaboration among various stakeholders who need to work together to design, manufacture and deliver such assistive mobility devices. This in turn has led to inadequate evidence about intervention effectiveness, disability prevalence and subsequent costeffectiveness that would help facilitate appropriate provision and support for people with disabilities. In this paper, we describe a novel conceptual framework that can be tested across the globe to study and evaluate the effectiveness of wheelchair provision. The Comparative Effectiveness Research Subcommittee (CER-SC), consisting of the authors of this article, housed within the Evidence-Based Practice Working Group (EBP-WG) of the International Society of Wheelchair Professionals (ISWP), conducted a scoping review of scientific literature and standard practices used during wheelchair service provision. The literature review was followed by a series of discussion groups. The three iterations of the conceptual framework are described in this manuscript. We believe that adoption of this conceptual framework could have broad applications in wheelchair provision globally to develop evidence-based practices. Such a perspective will help in the comparison of different strategies employed in wheelchair provision and further improve clinical guidelines. Further work is being conducted to test the efficacy of this conceptual framework to evaluate effectiveness of wheelchair service provision in various settings across the globe.

Provision of mental healthcare for children and adolescents: a worldwide view.

PubMed

Rocha, Thiago Botter-Maio; Graeff-Martins, Ana Soledade; Kieling, Christian; Rohde, Luis Augusto

2015-07-01

There has been increased attention towards the burden imposed by mental disorders on children and adolescents. The present overview explores the current state of child and adolescent mental healthcare provision around the globe. Current research indicates a concerning gap in the provision of care for the child and adolescent population. The disparities between need, demand and access to youth mental healthcare are likely to be even greater in low and- middle-income countries (LAMIC), where the proportion of children and adolescents in the population is higher. The scarcity of available resources for youth mental healthcare, especially in LAMIC, represents a major obstacle to decreasing the impact of mental disorders across the lifespan. Our review highlights the discrepancy between demands and availability of mental healthcare for youth populations throughout the world. We describe some of the potential contributors to the current state of youth mental healthcare, such as problematic access to services, implementation deficiencies and inadequacy of policies. Recent innovative strategies to reduce these barriers are also presented.

The State of Transgender Health Care: Policy, Law, and Medical Frameworks

PubMed Central

2014-01-01

I review the current status of transgender people’s access to health care in the United States and analyze federal policies regarding health care services for transgender people and the limitations thereof. I suggest a preliminary outline to enhance health care services and recommend the formulation of explicit federal policies regarding the provision of health care services to transgender people in accordance with recently issued medical care guidelines, allocation of research funding, education of health care workers, and implementation of existing nondiscrimination policies. Current policies denying medical coverage for sex reassignment surgery contradict standards of medical care and must be amended. PMID:24432926

Resource and manpower calculations for the provision of hepatobiliary surgical services in the UK.

PubMed Central

Majeed, Ali W.; Price, Charles

2004-01-01

BACKGROUND: The provision of specialist non-transplant hepatobiliary services in the UK is fragmented and there is little consensus on the manpower and resource requirements to meet the needs of defined populations. METHODS: We report our experience with a hepatobiliary service established 5 years ago in Sheffield to provide a tertiary referral service to the population of the North Trent health area and attempt to provide estimates of resource requirements based on patterns of current use. RESULTS: A total of 615 patients with hepatobiliary conditions requiring specialist treatment were referred to the service during 1997-2002. The majority of patients (69%) were referred for consideration of liver resection for colorectal liver metastases. In all, 251 resections were performed in 240 (39% of all referred) patients. The current operation rates for colorectal metastases are about 4 per 100,000 population per year and for other complex hepatobiliary procedures are also 4 per 100,000 population per year giving a total "need" of 8 procedures per 100,000 population per year. For the current population in England and Wales, this would mean 25 specialist hepatobiliary centres performing in total approximately 2000 hepatic resections for colorectal cancer metastases and 2000 other tertiary hepatobiliary procedures each year. CONCLUSIONS: Our experience supports the model of centralisation of non-transplant hepatobiliary surgical services and indicates the extent of hitherto unmet demand in our geographical area. We estimate that a minimum of two full-time specialist hepatobiliary surgeons with appropriate ancillary support are required for a typical population of 2 million people in the UK. PMID:15005925

Resource and manpower calculations for the provision of hepatobiliary surgical services in the UK.

PubMed

Majeed, Ali W; Price, Charles

2004-03-01

The provision of specialist non-transplant hepatobiliary services in the UK is fragmented and there is little consensus on the manpower and resource requirements to meet the needs of defined populations. We report our experience with a hepatobiliary service established 5 years ago in Sheffield to provide a tertiary referral service to the population of the North Trent health area and attempt to provide estimates of resource requirements based on patterns of current use. A total of 615 patients with hepatobiliary conditions requiring specialist treatment were referred to the service during 1997-2002. The majority of patients (69%) were referred for consideration of liver resection for colorectal liver metastases. In all, 251 resections were performed in 240 (39% of all referred) patients. The current operation rates for colorectal metastases are about 4 per 100,000 population per year and for other complex hepatobiliary procedures are also 4 per 100,000 population per year giving a total "need" of 8 procedures per 100,000 population per year. For the current population in England and Wales, this would mean 25 specialist hepatobiliary centres performing in total approximately 2000 hepatic resections for colorectal cancer metastases and 2000 other tertiary hepatobiliary procedures each year. Our experience supports the model of centralisation of non-transplant hepatobiliary surgical services and indicates the extent of hitherto unmet demand in our geographical area. We estimate that a minimum of two full-time specialist hepatobiliary surgeons with appropriate ancillary support are required for a typical population of 2 million people in the UK.

Implementing the optimal provision of ecosystem services

PubMed Central

Polasky, Stephen; Lewis, David J.; Plantinga, Andrew J.; Nelson, Erik

2014-01-01

Many ecosystem services are public goods whose provision depends on the spatial pattern of land use. The pattern of land use is often determined by the decisions of multiple private landowners. Increasing the provision of ecosystem services, though beneficial for society as a whole, may be costly to private landowners. A regulator interested in providing incentives to landowners for increased provision of ecosystem services often lacks complete information on landowners’ costs. The combination of spatially dependent benefits and asymmetric cost information means that the optimal provision of ecosystem services cannot be achieved using standard regulatory or payment for ecosystem services approaches. Here we show that an auction that sets payments between landowners and the regulator for the increased value of ecosystem services with conservation provides incentives for landowners to truthfully reveal cost information, and allows the regulator to implement the optimal provision of ecosystem services, even in the case with spatially dependent benefits and asymmetric information. PMID:24722635

Implementing the optimal provision of ecosystem services.

PubMed

Polasky, Stephen; Lewis, David J; Plantinga, Andrew J; Nelson, Erik

2014-04-29

Many ecosystem services are public goods whose provision depends on the spatial pattern of land use. The pattern of land use is often determined by the decisions of multiple private landowners. Increasing the provision of ecosystem services, though beneficial for society as a whole, may be costly to private landowners. A regulator interested in providing incentives to landowners for increased provision of ecosystem services often lacks complete information on landowners' costs. The combination of spatially dependent benefits and asymmetric cost information means that the optimal provision of ecosystem services cannot be achieved using standard regulatory or payment for ecosystem services approaches. Here we show that an auction that sets payments between landowners and the regulator for the increased value of ecosystem services with conservation provides incentives for landowners to truthfully reveal cost information, and allows the regulator to implement the optimal provision of ecosystem services, even in the case with spatially dependent benefits and asymmetric information.

Service provision and quality outcomes in home health for rural Medicare beneficiaries at high risk for unplanned care.

PubMed

Mroz, Tracy M; Andrilla, C Holly A; Garberson, Lisa A; Skillman, Susan M; Patterson, Davis G; Larson, Eric H

2018-06-11

Multiple barriers exist to providing home health care in rural areas. This study examined relationships between service provision and quality outcomes among rural, fee-for-service Medicare beneficiaries who received home health care between 2011 and 2013 for conditions associated with high-risk for unplanned care. More skilled nursing visits, visits by more types of providers, more timely care, and shorter lengths of stay were associated with significantly higher odds of hospital readmission and emergency department use and significantly lower odds of community discharge. Results may indicate unmeasured clinical severity and care needs among this population. Additional research regarding the accuracy of current severity measures and adequacy of case-mix adjustment for quality metrics is warranted, especially given the continued focus on value-based payment policies.

Current status of palliative care services in Indonesia: a literature review.

PubMed

Rochmawati, Erna; Wiechula, Rick; Cameron, Kate

2016-06-01

To review healthcare literature in relation to the provision of palliative care in Indonesia and to identify factors that may impact on palliative care development. People living with life-limiting illness benefit from access to palliative care services to optimize quality of life. Palliative care services are being expanded in developing countries but in Indonesia such services are in their infancy with many patients with life-limiting illnesses having access to appropriate health care compromised. Relevant healthcare databases including CINAHL, PubMed, Science Direct and Scopus were searched using the combinations of search terms: palliative care, terminal care, end-of-life care, Indonesia and nursing. A search of grey literature including Internet sites was also carried out. Nine articles were included in the review. Facilitating factors supporting the provision of palliative care included: a culture of strong familial support, government policy support, volunteering and support from regional organizations. Identified barriers to palliative care provision were a limited understanding of palliative care among healthcare professionals, the challenging geography of Indonesia and limited access to opioid medications. There are facilitators and barriers that currently impact on the development of palliative care in Indonesia. Strategies that can be implemented to improve palliative care include training of nurses and doctors in the primary care sector, integrating palliative care in undergraduate medical and nursing curriculum and educating family and community about basic care. Nurses and doctors who work in primary care can potentially play a role in supporting and educating family members providing direct care to patients with palliative needs. © 2016 International Council of Nurses.

20 CFR 653.101 - Provision of services to migrant and seasonal farmworkers (MSFWs).

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Provision of services to migrant and seasonal..., DEPARTMENT OF LABOR SERVICES OF THE EMPLOYMENT SERVICE SYSTEM Services for Migrant and Seasonal Farmworkers (MSFWs) § 653.101 Provision of services to migrant and seasonal farmworkers (MSFWs). (a) Each State...

Care for post-stroke patients at Malaysian public health centres: self-reported practices of family medicine specialists.

PubMed

Abdul Aziz, Aznida F; Mohd Nordin, Nor Azlin; Abd Aziz, Noor; Abdullah, Suhazeli; Sulong, Saperi; Aljunid, Syed M

2014-03-02

Provision of post stroke care in developing countries is hampered by discoordination of services and limited access to specialised care. Albeit shortcomings, primary care continues to provide post-stroke services in less than favourable circumstances. This paper aimed to review provision of post-stroke care and related problems among Family Medicine Specialists managing public primary health care services. A semi-structured questionnaire was distributed to 121 Family Physicians servicing public funded health centres in a pilot survey focused on improving post stroke care provision at community level. The questionnaire assessed respondents background and practice details i.e. estimated stroke care burden, current service provision and opinion on service improvement. Means and frequencies described quantitative data. For qualitative data, constant comparison method was used until saturation of themes was reached. Response rate of 48.8% was obtained. For every 100 patients seen at public healthcentres each month, 2 patients have stroke. Median number of stroke patients seen per month is 5 (IQR 2-10). 57.6% of respondents estimated total stroke patients treated per year at each centre was less than 40 patients. 72.4% lacked a standard care plan although 96.6% agreed one was needed. Patients seen were: discharged from tertiary care (88.1%), shared care plan with specialists (67.8%) and patients who developed stroke during follow up at primary care (64.4%). Follow-ups were done at 8-12 weekly intervals (60.3%) with 3.4% on 'as needed' basis. Referrals ranked in order of frequency were to physiotherapy services, dietitian and speech and language pathologists in public facilities. The FMS' perceived 4 important 'needs' in managing stroke patients at primary care level; access to rehabilitation services, coordinated care between tertiary centres and primary care using multidisciplinary care approach, a standardized guideline and family and caregiver support. Post discharge stroke care guidelines and access to rehabilitation services at primary care is needed for post stroke patients residing at home in the community.

A review and commentary of the social factors which influence stroke care: issues of inequality in qualitative literature.

PubMed

Mold, Freda; McKevitt, Christopher; Wolfe, Charles

2003-09-01

Stroke is the third most common cause of death in the UK and a major cause of adult disability. Stroke services have long been criticised for being deficient and there is evidence that some aspects of care provision vary across different population groups. While there is information about the patterns of service provision, questions remain about processes which might underlie these variations. The present paper sought to assess how well the processes which might lead to inequity in the delivery and uptake of stroke services are currently understood by reviewing the qualitative literature in the area. The review was carried out by systematically searching online literature databases, using keyword and bibliographical searches, within a particular time frame. In total, 55 articles were reviewed, including studies related to primary and secondary clinical care, as well as social care. Articles focused on both professionals' and patients' perspectives. The review reports the cultural factors and processes which have been identified as possible causes of barriers to professionals' delivering stroke services, as well as issues which influence patients' uptake of services. Issues identified in the literature were categorised into four broad thematic areas: conceptualisations of stroke illness and ageing, socio-economic factors, resource allocation and information provision. These themes are then revisited through the hypothesis that the concept of social and personal identity could cast new light on our understanding of how inequity in stroke care provision might arise. It is argued that the ways in which professionals and patients view themselves and each other influences their interaction, and in turn, the delivery and demand for services. Finally, the authors suggest areas where further research is warranted.

RESNA Wheelchair Service Provision Guide

ERIC Educational Resources Information Center

Arledge, Stan; Armstrong, William; Babinec, Mike; Dicianno, Brad E.; Digiovine, Carmen; Dyson-Hudson, Trevor; Pederson, Jessica; Piriano, Julie; Plummer, Teresa; Rosen, Lauren; Schmeler, Mark; Shea, Mary; Stogner, Jody

2011-01-01

The purpose of the Wheelchair Service Provision Guide is to provide an appropriate framework for identifying the essential steps in the provision of a wheelchair. It is designed for use by all participants in the provision process including consumers, family members, caregivers, social service and health care professionals, suppliers,…

45 CFR 400.147 - Priority in provision of services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 2 2013-10-01 2012-10-01 true Priority in provision of services. 400.147 Section 400.147 Public Welfare Regulations Relating to Public Welfare OFFICE OF REFUGEE RESETTLEMENT... Refugee Social Services Funding and Service Priorities § 400.147 Priority in provision of services. A...

45 CFR 400.147 - Priority in provision of services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Priority in provision of services. 400.147 Section 400.147 Public Welfare Regulations Relating to Public Welfare OFFICE OF REFUGEE RESETTLEMENT... Refugee Social Services Funding and Service Priorities § 400.147 Priority in provision of services. A...

45 CFR 400.147 - Priority in provision of services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 2 2014-10-01 2012-10-01 true Priority in provision of services. 400.147 Section 400.147 Public Welfare Regulations Relating to Public Welfare OFFICE OF REFUGEE RESETTLEMENT... Refugee Social Services Funding and Service Priorities § 400.147 Priority in provision of services. A...

45 CFR 400.147 - Priority in provision of services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 2 2012-10-01 2012-10-01 false Priority in provision of services. 400.147 Section 400.147 Public Welfare Regulations Relating to Public Welfare OFFICE OF REFUGEE RESETTLEMENT... Refugee Social Services Funding and Service Priorities § 400.147 Priority in provision of services. A...

45 CFR 400.147 - Priority in provision of services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 2 2011-10-01 2011-10-01 false Priority in provision of services. 400.147 Section 400.147 Public Welfare Regulations Relating to Public Welfare OFFICE OF REFUGEE RESETTLEMENT... Refugee Social Services Funding and Service Priorities § 400.147 Priority in provision of services. A...

Assessing ecosystem service provision under climate change to support conservation and development planning in Myanmar

PubMed Central

Wolny, Stacie; Bhagabati, Nirmal; Helsingen, Hanna; Hamel, Perrine; Bartlett, Ryan; Dixon, Adam; Horton, Radley; Lesk, Corey; Manley, Danielle; De Mel, Manishka; Bader, Daniel; Nay Won Myint, Sai; Myint, Win; Su Mon, Myat

2017-01-01

Inclusion of ecosystem services (ES) information into national-scale development and climate adaptation planning has yet to become common practice, despite demand from decision makers. Identifying where ES originate and to whom the benefits flow–under current and future climate conditions–is especially critical in rapidly developing countries, where the risk of ES loss is high. Here, using Myanmar as a case study, we assess where and how ecosystems provide key benefits to the country’s people and infrastructure. We model the supply of and demand for sediment retention, dry-season baseflows, flood risk reduction and coastal storm protection from multiple beneficiaries. We find that locations currently providing the greatest amount of services are likely to remain important under the range of climate conditions considered, demonstrating their importance in planning for climate resilience. Overlap between priority areas for ES provision and biodiversity conservation is higher than expected by chance overall, but the areas important for multiple ES are underrepresented in currently designated protected areas and Key Biodiversity Areas. Our results are contributing to development planning in Myanmar, and our approach could be extended to other contexts where there is demand for national-scale natural capital information to shape development plans and policies. PMID:28934282

Impact of droughts on water provision in managed alpine grasslands in two climatically different regions of the Alps.

PubMed

Leitinger, Georg; Ruggenthaler, Romed; Hammerle, Albin; Lavorel, Sandra; Schirpke, Uta; Clement, Jean-Christophe; Lamarque, Pénélope; Obojes, Nikolaus; Tappeiner, Ulrike

2015-12-01

This study analyzes the impact of droughts, compared with average climatic conditions, on the supporting ecosystem service water provision in sub-watersheds in managed alpine grasslands in two climatically different regions of the Alps, Lautaret (French Alps) and Stubai (Austrian Alps). Soil moisture was modelled in the range of 0-0.3 m. At both sites, current patterns showed that the mean seasonal soil moisture was (1) near field capacity for grasslands with low management intensity and (2) below field capacity for grasslands with higher land-use intensity. Soil moisture was significantly reduced by drought at both sites, with lower reductions at the drier Lautaret site. At the sub-watershed scale, soil moisture spatial heterogeneity was reduced by drought. Under drought conditions, the evapotranspiration to precipitation ratios at Stubai was slightly higher than those at Lautaret, indicating a dominant 'water spending' strategy of plant communities. Regarding catchment water balance, deep seepage was reduced by drought at Stubai more strongly than at Lautaret. Hence, the observed 'water spending' strategy at Stubai might have negative consequences for downstream water users. Assessing the water provision service for alpine grasslands provided evidence that, under drought conditions, evapotranspiration was influenced not only by abiotic factors but also by the water-use strategy of established vegetation. These results highlight the importance of 'water-use' strategies in existing plant communities as predictors of the impacts of drought on water provision services and related ecosystem services at both the field and catchment scale.

22 CFR 92.92 - Service of legal process under provisions of State law.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Service of legal process under provisions of... AND RELATED SERVICES Quasi-Legal Services § 92.92 Service of legal process under provisions of State law. It may be found that a State statue purporting to regulate the service of process in foreign...

14 CFR 1214.114 - Provision of services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Provisions Regarding Space Shuttle Flights of Payloads for Non-U.S. Government, Reimbursable Customers § 1214.114 Provision of services. NASA will provide, solely at its discretion, services to the extent...

14 CFR 1214.114 - Provision of services.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Provisions Regarding Space Shuttle Flights of Payloads for Non-U.S. Government, Reimbursable Customers § 1214.114 Provision of services. NASA will provide, solely at its discretion, services to the extent...

14 CFR 1214.114 - Provision of services.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Provisions Regarding Space Shuttle Flights of Payloads for Non-U.S. Government, Reimbursable Customers § 1214.114 Provision of services. NASA will provide, solely at its discretion, services to the extent...

14 CFR 1214.114 - Provision of services.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Provisions Regarding Space Shuttle Flights of Payloads for Non-U.S. Government, Reimbursable Customers § 1214.114 Provision of services. NASA will provide, solely at its discretion, services to the extent...

77 FR 47826 - Inland Waterways Users Board; Request for Nominations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-10

... above commodity categories. d. Nomination. Reflecting preceding selection criteria, the current.... Mark R. Pointon, (703) 428-6438. SUPPLEMENTARY INFORMATION: The selection, service, and appointment of... substance of those provisions is as follows: a. Selection. Representative organizations are to be selected...

10 CFR 35.80 - Provision of mobile medical service.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Provision of mobile medical service. 35.80 Section 35.80... § 35.80 Provision of mobile medical service. (a) A licensee providing mobile medical service shall— (1... to ensure compliance with the requirements in Part 20 of this chapter. (b) A mobile medical service...

Nursing Unit Environment Associated with Provision of Language Services in Pediatric Hospices.

PubMed

Lindley, Lisa C; Held, Mary L; Henley, Kristen M; Miller, Kathryn A; Pedziwol, Katherine E; Rumley, Laurie E

2017-04-01

Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services. Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1251 pediatric hospice agencies. Variable selection was guided by structural contingency theory, which posits that organizational effectiveness is dependent upon how well an organization's structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services. The majority of hospices provided translation services (74.9 %) and interpreter services (87.1 %). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services. Findings indicate that nursing unit environment predicts provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staffs who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency and ultimately reduce ethnic disparities in end-of-life care for children and their families.

Nursing unit environment associated with provision of language services in pediatric hospices

PubMed Central

Lindley, Lisa C.; Held, Mary L.; Henley, Kristen M.; Miller, Kathryn A.; Pedziwol, Katherine E.; Rumley, Laurie E.

2016-01-01

Background Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services. Methods Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1,251 pediatric hospice agencies. Variable selection was guided by Structural Contingency Theory, which posits that organizational effectiveness is dependent upon how well an organization’s structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services. Results The majority of hospices provided translation services (74.9%) and interpreter services (87.1%). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services. Conclusions Findings indicate that nursing unit environment predict provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staff who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency, and ultimately reduce ethnic disparities in end-of-life care for children and their families. PMID:27059050

14 CFR § 1214.114 - Provision of services.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Provisions Regarding Space Shuttle Flights of Payloads for Non-U.S. Government, Reimbursable Customers § 1214.114 Provision of services. NASA will provide, solely at its discretion, services to the extent...

Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services.

PubMed

Haines, Terry P; O'Brien, Lisa; Mitchell, Deb; Bowles, Kelly-Ann; Haas, Romi; Markham, Donna; Plumb, Samantha; Chiu, Timothy; May, Kerry; Philip, Kathleen; Lescai, David; McDermott, Fiona; Sarkies, Mitchell; Ghaly, Marcelle; Shaw, Leonie; Juj, Genevieve; Skinner, Elizabeth H

2015-04-02

Disinvestment from inefficient or ineffective health services is a growing priority for health care systems. Provision of allied health services over the weekend is now commonplace despite a relative paucity of evidence supporting their provision. The relatively high cost of providing this service combined with the paucity of evidence supporting its provision makes this a potential candidate for disinvestment so that resources consumed can be used in other areas. This study aims to determine the effectiveness, cost-effectiveness and safety of the current model of weekend allied health service and a new stakeholder-driven model of weekend allied health service delivery on acute medical and surgical wards compared to having no weekend allied health service. Two stepped wedge, cluster randomised trials of weekend allied health services will be conducted in six acute medical/surgical wards across two public metropolitan hospitals in Melbourne (Australia). Wards have been chosen to participate by management teams at each hospital. The allied health services to be investigated will include physiotherapy, occupational therapy, speech therapy, dietetics, social work and allied health assistants. At baseline, all wards will be receiving weekend allied health services. Study 1 intervention will be the sequential disinvestment (roll-in) of the current weekend allied health service model from each participating ward in monthly intervals and study 2 will be the roll-out of a new stakeholder-driven model of weekend allied health service delivery. The order in which weekend allied health services will be rolled in and out amongst participating wards will be determined randomly. This trial will be conducted in each of the two participating hospitals at a different time interval. Primary outcomes will be length of stay, rate of unplanned hospital readmission within 28 days and rate of adverse events. Secondary outcomes will be number of complaints and compliments, staff absenteeism, and patient discharge destination, satisfaction, and functional independence at discharge. This is the world's first application of the recently described non-inferiority (roll-in) stepped wedge trial design, and the largest investigation of the effectiveness of weekend allied health services on acute medical surgical wards to date. Australian New Zealand Clinical Trials Registry. ACTRN12613001231730 (first study) and ACTRN12613001361796 (second study). Was this trial prospectively registered?: Yes. Date registered: 8 November 2013 (first study), 12 December 2013 (second study). Anticipated completion: June 2015. Protocol version: 1. Role of trial sponsor: KP and DL are directly employed by one of the trial sponsors, their roles were: KP assisted with overall development of research design and assisted with overall project management; DL contributed to project management, administration and communications strategy.

26 CFR 1.42-11 - Provision of services.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 1 2011-04-01 2009-04-01 true Provision of services. 1.42-11 Section 1.42-11 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY INCOME TAX INCOME TAXES Credits Against Tax § 1.42-11 Provision of services. (a) General rule. The furnishing to tenants of services other than housing (whether or not the services...

26 CFR 1.42-11 - Provision of services.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 1 2014-04-01 2013-04-01 true Provision of services. 1.42-11 Section 1.42-11 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY INCOME TAX INCOME TAXES Credits Against Tax § 1.42-11 Provision of services. (a) General rule. The furnishing to tenants of services other than housing (whether or not the services...

26 CFR 1.42-11 - Provision of services.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 1 2012-04-01 2012-04-01 false Provision of services. 1.42-11 Section 1.42-11 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY INCOME TAX INCOME TAXES Credits Against Tax § 1.42-11 Provision of services. (a) General rule. The furnishing to tenants of services other than housing (whether or not the services...

A conceptual framework to assess effectiveness in wheelchair provision

PubMed Central

Kankipati, Padmaja

2017-01-01

Background Currently, inadequate wheelchair provision has forced many people with disabilities to be trapped in a cycle of poverty and deprivation, limiting their ability to access education, work and social facilities. This issue is in part because of the lack of collaboration among various stakeholders who need to work together to design, manufacture and deliver such assistive mobility devices. This in turn has led to inadequate evidence about intervention effectiveness, disability prevalence and subsequent costeffectiveness that would help facilitate appropriate provision and support for people with disabilities. Objectives In this paper, we describe a novel conceptual framework that can be tested across the globe to study and evaluate the effectiveness of wheelchair provision. Method The Comparative Effectiveness Research Subcommittee (CER-SC), consisting of the authors of this article, housed within the Evidence-Based Practice Working Group (EBP-WG) of the International Society of Wheelchair Professionals (ISWP), conducted a scoping review of scientific literature and standard practices used during wheelchair service provision. The literature review was followed by a series of discussion groups. Results The three iterations of the conceptual framework are described in this manuscript. Conclusion We believe that adoption of this conceptual framework could have broad applications in wheelchair provision globally to develop evidence-based practices. Such a perspective will help in the comparison of different strategies employed in wheelchair provision and further improve clinical guidelines. Further work is being conducted to test the efficacy of this conceptual framework to evaluate effectiveness of wheelchair service provision in various settings across the globe. PMID:28936421

General practice and the provision of information and services for physically disabled people aged 16 to 65 years.

PubMed Central

Chesson, R A; Sutherland, A M

1992-01-01

The study reported here was part of a larger survey investigating the nature and extent of disability in the Grampian region. Interviews with 212 people aged between 16 and 65 years who had a wide range of physical disabilities elicited perceptions of current and past service provision. Respondents expressed a strong need for information on disability services and reported difficulty in knowing whom to approach for this. General practitioners were the most commonly reported source of such information and low usage of the Department of Social Security, social work departments and voluntary organizations was identified. No significant relationship was found between degree of disability and frequency of consultation with a general practitioner. However, the more severe the disability the more likely it was that the general practitioner initiated contact rather than the patient. Although in general those interviewed were satisfied with medical information given regarding their diagnosis, they were more critical of information provided in relation to coping with the disorder, including that concerning benefits and services. The study confirmed the pivotal role of the general practitioner in the care of physically disabled people in the community aged between 16 and 65 years. The need to re-evaluate the role of the general practitioner in the provision of information and services is discussed. PMID:1472395

Providing Culturally Competent Care in Early Childhood Services in New Zealand. Part 1: Considering Culture [and] Part 2: Developing Dialog [and] Part 3: Parents' Experiences of Different Early Childhood Pedagogies.

ERIC Educational Resources Information Center

Terreni, Lisa; McCallum, Judi

Focusing on early childhood issues specific to New Zealand, this document is comprised of three papers exploring provision of culturally competent care in early childhood services. The first paper, "Considering Culture" (Lisa Terreni with Judi McCallum), addresses some current theories that attempt to understand "culture" and…

An Audit of Adults with Profound and Multiple Learning Disabilities within a West Midlands Community Health Trust--Implications for Service Development

ERIC Educational Resources Information Center

Gittins, Deborah; Rose, Nikki

2008-01-01

An audit was carried out to gain an overview of the profound and multiple learning disabilities (PMLD) population in a local health trust to inform current and future service provision. An overview of the issues faced in developing clear defining criteria is presented. Published definitions of PMLD were used to identify clients from data held on…

Using the Soil and Water Assessment Tool (SWAT) to model ecosystem services: A systematic review

NASA Astrophysics Data System (ADS)

Francesconi, Wendy; Srinivasan, Raghavan; Pérez-Miñana, Elena; Willcock, Simon P.; Quintero, Marcela

2016-04-01

SWAT, a watershed modeling tool has been proposed to help quantify ecosystem services. The concept of ecosystem services incorporates the collective benefits natural systems provide primarily to human beings. It is becoming increasingly important to track the impact that human activities have on the environment in order to determine its resilience and sustainability. The objectives of this paper are to provide an overview of efforts using SWAT to quantify ecosystem services, to determine the model's capability examining various types of services, and to describe the approach used by various researchers. A literature review was conducted to identify studies in which SWAT was explicitly used for quantifying ecosystem services in terms of provisioning, regulating, supporting, and cultural aspects. A total of 44 peer reviewed publications were identified. Most of these used SWAT to quantify provisioning services (34%), regulating services (27%), or a combination of both (25%). While studies using SWAT for evaluating ecosystem services are limited (approximately 1% of SWAT's peered review publications), and usage (vs. potential) of services by beneficiaries is a current model limitation, the available literature sets the stage for the continuous development and potential of SWAT as a methodological framework for quantifying ecosystem services to assist in decision-making.

Research to Develop Information Service Aids and Programs for Handicapped Individuals.

ERIC Educational Resources Information Center

Cylke, Frank Kurt; And Others

1980-01-01

Highlights current research relating to the provision of information to disabled persons, including electromechanical technology, tactile technology, and transfer devices and tools for the hearing impaired. A directory identifies pertinent organizations, information dissemination points, and publications. Six references are cited. (FM)

21 CFR 211.3 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 4 2012-04-01 2012-04-01 false Definitions. 211.3 Section 211.3 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.3 Definitions...

21 CFR 211.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 4 2011-04-01 2011-04-01 false Definitions. 211.3 Section 211.3 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.3 Definitions...

21 CFR 211.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 4 2013-04-01 2013-04-01 false Definitions. 211.3 Section 211.3 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.3 Definitions...

21 CFR 211.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 4 2014-04-01 2014-04-01 false Definitions. 211.3 Section 211.3 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.3 Definitions...

77 FR 13076 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-05

... of information under the provisions of the Paperwork Reduction Act (44 U.S.C. Chapter 35). Agency... submission (extension of a current information collection). Number of Respondents: 1. Average Hours per... information collection. The National Marine Fisheries Service (NMFS) requires longline vessel operators to...

48 CFR 52.247-6 - Financial Statement.

Code of Federal Regulations, 2010 CFR

2010-10-01

....247-6 Financial Statement. As prescribed in 47.207-1(e), insert the following provision in solicitations for transportation or for transportation-related services to ensure that offerors are prepared to... furnish the Government with a current certified statement of the offeror's financial condition and such...

48 CFR 52.247-6 - Financial Statement.

Code of Federal Regulations, 2011 CFR

2011-10-01

....247-6 Financial Statement. As prescribed in 47.207-1(e), insert the following provision in solicitations for transportation or for transportation-related services to ensure that offerors are prepared to... furnish the Government with a current certified statement of the offeror's financial condition and such...

21 CFR 211.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Definitions. 211.3 Section 211.3 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.3 Definitions...

12 CFR 1261.20 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

...: Compensation means any payment of money or the provision of any other thing of current or potential value in connection with service as a director. Compensation includes all direct and indirect payments of benefits... reasonable travel, subsistence and other related expenses incurred in connection with the performance of...

Post-traumatic stress symptoms among juvenile offenders in nigeria: implications for holistic service provisioning in juvenile justice administration.

PubMed

Atilola, Olayinka; Omigbodun, Olayinka; Bella-Awusah, Tolulope

2014-08-01

There is hardly any study examining exposure to traumatic events and post-traumatic stress disorder (PTSD) among juvenile justice populations in Nigeria or any part of sub-Saharan Africa. We examined the prevalence and trauma determinants of PTSD among a cohort of juvenile justice inmates in Nigeria, compared with a cohort of school-going adolescents. Ninety percent (90%) of the juvenile justice inmates reported exposure to at least one lifetime traumatic event with higher mean incident events, compared with 60% among the comparison group (p=.001). Juvenile justice inmates had significantly higher prevalence rate of current and lifetime PTSD than the comparison group (current: 5.8% vs. 1.4%; lifetime: 9.7% vs. 2.8%, p<.05). Mean incident traumatic event was statistically significantly higher among juvenile justice inmates who had PTSD. Posttraumatic stress symptoms are common among adolescents coming in contact with the juvenile justice system. Implications for holistic service provisioning in juvenile justice administration are discussed.

Decentralised systems - definition and drivers in the current context.

PubMed

Sharma, Ashok K; Tjandraatmadja, Grace; Cook, Stephen; Gardner, Ted

2013-01-01

This paper explores the current context for decentralised approaches in the provision of urban water services. It examines the recent history of decentralised systems' implementation in Australia and identifies its drivers. The drivers included addressing capacity constraints of centralised systems, mitigating the environmental impact of urban development, and increasing the resilience of urban water systems to episodic droughts and the projected impacts of climate change. The concepts of integrated urban water management and water sensitive urban design were prevalent in many of the innovative approaches used for the provision of decentralised urban water services. However, there remains a degree of confusion among water professionals in the terminology adopted for on-site and decentralised systems. Based on a literature review, consultation with water industry professionals and examination of decentralised urban developments in Australia, this paper has developed a generalised definition of decentralised systems for adoption across the water sector. The definition encompasses the various development scales in which decentralised systems are implemented, and reflects the new functions and characteristics inherent to those systems.

45 CFR 400.117 - Provision of care and services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Provision of care and services. 400.117 Section... Child Welfare Services § 400.117 Provision of care and services. (a) A State may provide care and... agency approved or licensed under State law. (b) If a State arranges for the care and services through a...

Grid accounting service: state and future development

NASA Astrophysics Data System (ADS)

Levshina, T.; Sehgal, C.; Bockelman, B.; Weitzel, D.; Guru, A.

2014-06-01

During the last decade, large-scale federated distributed infrastructures have been continually developed and expanded. One of the crucial components of a cyber-infrastructure is an accounting service that collects data related to resource utilization and identity of users using resources. The accounting service is important for verifying pledged resource allocation per particular groups and users, providing reports for funding agencies and resource providers, and understanding hardware provisioning requirements. It can also be used for end-to-end troubleshooting as well as billing purposes. In this work we describe Gratia, a federated accounting service jointly developed at Fermilab and Holland Computing Center at University of Nebraska-Lincoln. The Open Science Grid, Fermilab, HCC, and several other institutions have used Gratia in production for several years. The current development activities include expanding Virtual Machines provisioning information, XSEDE allocation usage accounting, and Campus Grids resource utilization. We also identify the direction of future work: improvement and expansion of Cloud accounting, persistent and elastic storage space allocation, and the incorporation of WAN and LAN network metrics.

Commissioning of specialist palliative care services in England.

PubMed

Lancaster, Harriet; Finlay, Ilora; Downman, Maxwell; Dumas, James

2018-03-01

Some failures in end-of-life care have been attributed to inconsistent provision of palliative care across England. We aimed to explore the variation in commissioning of services by Clinical Commissioning Groups (CCGs) using a data collection exercise. We sent a Freedom of Information request in the form of an open questionnaire to all 209 CCGs in England to assess their commissioning of palliative and end-of-life care services, mainly focused on the provision of specialist palliative care services. 29 CCGs provided information about the number of patients with some form of palliative care needs in their population. For specialist palliative care services, CCGs allocated budgets ranging from £51.83 to £2329.19 per patient per annum. 163 CCGs (77.90%) currently commission 7-day admission to their specialist palliative care beds. 82.84% of CCGs commission 7-day specialist palliative care services in patients' own homes and out-of-hours services rely heavily on hospice provision. 64 CCGs (31.37%) commission pain control teams, the majority of whom only operate in regular working hours. 68.14% of CCGs reported commissioning palliative care education of any sort for healthcare professionals and 44.85% of CCGs had no plans to update or review their palliative care services. The most important finding from this exercise is that the information CCGs hold about their population and services is not standardised. However, information based on data that are more objective, for example, population and total budget for palliative care, demonstrate wide variations in commissioning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

How integrated are neurology and palliative care services? Results of a multicentre mapping exercise.

PubMed

van Vliet, Liesbeth M; Gao, Wei; DiFrancesco, Daniel; Crosby, Vincent; Wilcock, Andrew; Byrne, Anthony; Al-Chalabi, Ammar; Chaudhuri, K Ray; Evans, Catherine; Silber, Eli; Young, Carolyn; Malik, Farida; Quibell, Rachel; Higginson, Irene J

2016-05-10

Patients affected by progressive long-term neurological conditions might benefit from specialist palliative care involvement. However, little is known on how neurology and specialist palliative care services interact. This study aimed to map the current level of connections and integration between these services. The mapping exercise was conducted in eight centres with neurology and palliative care services in the United Kingdom. The data were provided by the respective neurology and specialist palliative care teams. Questions focused on: i) catchment and population served; ii) service provision and staffing; iii) integration and relationships. Centres varied in size of catchment areas (39-5,840 square miles) and population served (142,000-3,500,000). Neurology and specialist palliative care were often not co-terminus. Service provisions for neurology and specialist palliative care were also varied. For example, neurology services varied in the number and type of provided clinics and palliative care services in the settings they work in. Integration was most developed in Motor Neuron Disease (MND), e.g., joint meetings were often held, followed by Parkinsonism (made up of Parkinson's Disease (PD), Multiple-System Atrophy (MSA) and Progressive Supranuclear Palsy (PSP), with integration being more developed for MSA and PSP) and least in Multiple Sclerosis (MS), e.g., most sites had no formal links. The number of neurology patients per annum receiving specialist palliative care reflected these differences in integration (range: 9-88 MND, 3-25 Parkinsonism, and 0-5 MS). This mapping exercise showed heterogeneity in service provision and integration between neurology and specialist palliative care services, which varied not only between sites but also between diseases. This highlights the need and opportunities for improved models of integration, which should be rigorously tested for effectiveness.

Improving long-term care provision: towards demand-based care by means of modularity

PubMed Central

2010-01-01

Background As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes. Methods Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software. Results Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services. Conclusion The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to elaborate on how to further enable demand-based provision of long-term care by means of modularity. PMID:20858256

Improving long-term care provision: towards demand-based care by means of modularity.

PubMed

de Blok, Carolien; Luijkx, Katrien; Meijboom, Bert; Schols, Jos

2010-09-21

As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes. Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software. Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services. The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to elaborate on how to further enable demand-based provision of long-term care by means of modularity.

Healthcare professionals' perceptions related to the provision of clinical pharmacy services in the public health sector of Mexico: a case study.

PubMed

Díaz de León-Castañeda, Christian; Gutiérrez-Godínez, Jéssica; Colado-Velázquez, Juventino Iii; Toledano-Jaimes, Cairo

2018-04-22

In Mexico, the Modelo Nacional de Farmacia Hospitalaria (MNFH, or National Hospital Pharmacy Model), published in 2009, mainly aims to promote the provision of clinical pharmacy services in private and public hospitals. However, there is little scientific documentation about the quality of these services. To explore healthcare professionals' perceptions related to the quality of clinical pharmacy services provision. A case-study based on a qualitative approach was performed at the pharmaceutical services unit at a public hospital located in Mexico City, which operates under the administrative control of the Ministry of Health. Donabedian's conceptual model was adapted to explore health care professionals' perceptions of the quality of clinical pharmacy services provision. Semi-structured interviews were carried out with pharmacists, physicians and nurses and then transcribed and analyzed via discourse analysis and codification techniques, using the software package Atlas. ti. Limitations in pharmaceutical human resources were identified as the main factor affecting coverage and quality in clinical pharmacy services provision. However, the development in pharmacy staff of technical competences and skills for clinical pharmacy service provision were recognized. Significant improvements in the rational use of medicines were associated with clinical pharmacy services provision. The perception analysis performed in this study suggested that it is necessary to increase pharmacy staff in order to improve interprofessional relationships and the quality of clinical pharmacy services provision. Copyright © 2018 Elsevier Inc. All rights reserved.

A Survey of Psychological Support Provision for People with Inflammatory Arthritis in Secondary Care in England

PubMed Central

Dures, Emma; Almeida, Celia; Caesley, Judy; Peterson, Alice; Ambler, Nicholas; Morris, Marianne; Pollock, Jon; Hewlett, Sarah

2014-01-01

Objectives The consequences of inflammatory arthritis can include depression, anxiety and low mood, reducing patients’ quality of life and increasing pressure on the healthcare system. Treatment guidelines recommend psychological support, but data are lacking on the provision available. Methods A postal survey concerning psychological support provision was sent to rheumatology units in 143 acute trusts across England. Nurses from 73 rheumatology units (51%) responded. Results Overall, 73% rated their unit's psychological support provision as ‘inadequate’ and only 4% rated it as ‘good’. Few units believed that psychological support did not fall within their remit (12%), yet only 8% had a psychologist in the team. Most units (68%) did not routinely screen patients to identify psychological difficulties. Referral to other service providers was reported in 42% of units, with 3% very satisfied with this provision. Within units, services containing elements of psychological support ranged from occupational therapy (81%) to psychology/counselling (14%). Psychological approaches used by team members ranged from shared decision making (77%) to cognitive–behavioural approaches (26%). The current barriers to providing psychological support were lack of clinical time and available training (86% and 74%, respectively), and delivery costs (74%). Future facilitators included management support (74%) and availability of skills training (74%). Conclusions Rheumatology units viewed psychological support provision as part of their remit but rated their overall provision as inadequate, despite some team members using psychological skills. To improve provision, clinicians’ training needs must be addressed and organizational support generated, and further research needs to define adequate psychological support provision from the patient perspective. © 2014 The Authors. Musculoskeletal Care published by John Wiley & Sons Ltd. PMID:24753071

A survey of psychological support provision for people with inflammatory arthritis in secondary care in England.

PubMed

Dures, Emma; Almeida, Celia; Caesley, Judy; Peterson, Alice; Ambler, Nicholas; Morris, Marianne; Pollock, Jon; Hewlett, Sarah

2014-09-01

The consequences of inflammatory arthritis can include depression, anxiety and low mood, reducing patients' quality of life and increasing pressure on the healthcare system. Treatment guidelines recommend psychological support, but data are lacking on the provision available. A postal survey concerning psychological support provision was sent to rheumatology units in 143 acute trusts across England. Nurses from 73 rheumatology units (51%) responded. Overall, 73% rated their unit's psychological support provision as 'inadequate' and only 4% rated it as 'good'. Few units believed that psychological support did not fall within their remit (12%), yet only 8% had a psychologist in the team. Most units (68%) did not routinely screen patients to identify psychological difficulties. Referral to other service providers was reported in 42% of units, with 3% very satisfied with this provision. Within units, services containing elements of psychological support ranged from occupational therapy (81%) to psychology/counselling (14%). Psychological approaches used by team members ranged from shared decision making (77%) to cognitive-behavioural approaches (26%). The current barriers to providing psychological support were lack of clinical time and available training (86% and 74%, respectively), and delivery costs (74%). Future facilitators included management support (74%) and availability of skills training (74%). Rheumatology units viewed psychological support provision as part of their remit but rated their overall provision as inadequate, despite some team members using psychological skills. To improve provision, clinicians' training needs must be addressed and organizational support generated, and further research needs to define adequate psychological support provision from the patient perspective. © 2014 The Authors. Musculoskeletal Care published by John Wiley & Sons Ltd.

31 CFR 598.406 - Provision of services.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Provision of services. 598.406 Section 598.406 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Interpretations § 598.406 Provision of services. (a) The prohibitions contained in § 598.203 apply to services...

31 CFR 598.406 - Provision of services.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Provision of services. 598.406 Section 598.406 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Interpretations § 598.406 Provision of services. (a) The prohibitions contained in § 598.203 apply to services...

31 CFR 598.406 - Provision of services.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Provision of services. 598.406 Section 598.406 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Interpretations § 598.406 Provision of services. (a) The prohibitions contained in § 598.203 apply to services...

31 CFR 598.406 - Provision of services.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Provision of services. 598.406 Section 598.406 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Interpretations § 598.406 Provision of services. (a) The prohibitions contained in § 598.203 apply to services...

Improving health worker performance of abortion services: an assessment of post-training support to providers in India, Nepal and Nigeria.

PubMed

Benson, Janie; Healy, Joan; Dijkerman, Sally; Andersen, Kathryn

2017-11-21

Health worker performance has been the focus of numerous interventions and evaluation studies in low- and middle-income countries. Few have examined changes in individual provider performance with an intervention encompassing post-training support contacts to improve their clinical practice and resolve programmatic problems. This paper reports the results of an intervention with 3471 abortion providers in India, Nepal and Nigeria. Following abortion care training, providers received in-person visits and virtual contacts by a clinical and programmatic support team for a 12-month period, designed to address their individual practice issues. The intervention also included technical assistance to and upgrades in facilities where the providers worked. Quantitative measures to assess provider performance were established, including: 1) Increase in service provision; 2) Consistent service provision; 3) Provision of high quality of care through use of World Health Organization-recommended uterine evacuation technologies, management of pain and provision of post-abortion contraception; and 4) Post-abortion contraception method mix. Descriptive univariate analysis was conducted, followed by examination of the bivariate relationships between all independent variables and the four dependent performance outcome variables by calculating unadjusted odds ratios, by country and overall. Finally, multivariate logistic regression was performed for each outcome. Providers received an average of 5.7 contacts. Sixty-two percent and 46% of providers met measures for consistent service provision and quality of care, respectively. Fewer providers achieved an increased number of services (24%). Forty-six percent provided an appropriate postabortion contraceptive mix to clients. Most providers met the quality components for use of WHO-recommended abortion methods and provision of pain management. Factors significantly associated with achievement of all measures were providers working in sites offering community outreach and those trained in intervention year two. The number of in-person contacts was significantly associated with achievement of three of four measures. Post-training support holds promise for strengthening health worker performance. Further research is needed to compare this intervention with other approaches and assess how post-training contacts could be incorporated into current health system supervision.

Hospital services and casemix in Western Australia.

PubMed

Hendrie, Delia; Boldy, Duncan

2002-01-01

The Health Department of WA currently operates as a single integrated funder and purchaser of health services for the State. Health Service Agreements defining the level of health provision are negotiated with the various health services in WA. During the latter part of the 1990s, the funding of public hospitals for acute inpatient care moved away from a historical basis to output-based funding using a casemix approach based on Diagnosis Related Groups (DRGs). Other hospital services are still mainly purchased using historical funding levels, negotiated block funding or bedday payments, with output-based funding mechanisms under investigation. WA has developed its own approach to classifying admitted patients that recognises differences in complexity of care among episodes grouped to the same DRG. WA also has a unique cost estimation model for calculating DRG cost weights, which is based on a linear estimate of the relationship between nights of stay in hospital and the cost of hospital care for each DRG. Another emerging trend in the provision of public hospital services in WA has been the greater involvement of the private sector through the contracting of private providers to operate public hospitals. While no close examination has been undertaken of the outcomes of these changes in terms of their effect on efficiency or other relevant indicators of hospital performance, current purchasing arrangements are being reviewed following recommendations made in a report by the Health Administrative Review Committee. No decision has yet been made as to future changes to the funding policy of WA public hospitals.

Gender, ageing, and injustice: social and political contexts of bioethics.

PubMed

Dodds, S

2005-05-01

There has been considerable work in bioethics addressing injustice and gender oppression in the provision of healthcare services, in the interaction between client and healthcare professional, and in allocation of healthcare services within a particular hospital or health service. There remain several sites of continued injustice that can only be addressed adequately from a broader analytical perspective, one that attends to the social and political contexts framing healthcare policy and practice. Feminist bioethicists have a strong track record in providing this kind of analysis. Using current Australian aged care and welfare policy this paper demonstrates some of the ways in which issues of gender, age, and social inequity shape bioethical debate, policy, and practice in the areas of aged care and welfare provision. The author develops an argument that demonstrates the gender injustice underlying health care and welfare policy. This argument recognises the inevitability of human dependency relations, and questions the adequacy of current political theories to address the requirements for full and equal citizenship. The author shows that an adequate analysis of the ethics of aged healthcare depends on sufficient consideration of the social and political context within which healthcare policy is framed and an adequate understanding of human dependency.

What factors influence physiotherapy service provision in rural communities? A pilot study.

PubMed

Adams, Robyn; Sheppard, Lorraine; Jones, Anne; Lefmann, Sophie

2014-06-01

To obtain stakeholder perspectives on factors influencing rural physiotherapy service provision and insights into decision making about service provision. Purposive sampling, open-ended survey questions and semi-structured interviews were used in this exploratory, qualitative study. A rural centre and its regional referral centre formed the pilot sites. Nine participant perspectives were obtained on rural physiotherapy services. Stakeholder perspectives on factors influencing rural physiotherapy service provision and service level decision making. Workforce capacity and capability, decision maker's knowledge of the role and scope of physiotherapy, consideration of physiotherapy within resource allocation decisions and proof of practice emerged as key issues. The latter three were particularly reflected in public sector participant comments. Business models and market size were identified factors in influencing private practice. Influencing factors described by participants both align and extend our understanding of issues described in the rural physiotherapy literature. Participant insights add depth and meaning to quantitative data by revealing impacts on local service provision. Available funding and facility priorities were key determinants of public sector physiotherapy service provision, with market size and business model appearing more influential in private practice. The level of self direction or choice about which services to provide, emerged as a point of difference between public and private providers. Decisions by public sector physiotherapists about service provision appear constrained by existing capacity and workload. Further research into service level decision making might provide valuable insights into rural health service delivery. © 2014 National Rural Health Alliance Inc.

Therapist, Parent, and Youth Perspectives of Treatment Barriers to Family-Focused Community Outpatient Mental Health Services

PubMed Central

Jenkins, Melissa M.; Haine-Schlagel, Rachel

2012-01-01

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups, 3 parent focus groups, and 10 youth semi-structured interviews. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate support and lack of family involvement; however, parents and therapists, in particular, identified different contributing factors to these barriers. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research. PMID:24019737

Improving the public health sector in South Africa: eliciting public preferences using a discrete choice experiment.

PubMed

Honda, Ayako; Ryan, Mandy; van Niekerk, Robert; McIntyre, Diane

2015-06-01

The introduction of national health insurance (NHI), aimed at achieving universal coverage, is the most important issue currently on the South African health policy agenda. Improvement in public sector health-care provision is crucial for the successful implementation of NHI as, regardless of whether health-care services become more affordable and available, if the quality of the services provided is not acceptable, people will not use the services. Although there has been criticism of the quality of public sector health services, limited research is available to identify what communities regard as the greatest problems with the services. A discrete choice experiment (DCE) was undertaken to elicit public preferences on key dimensions of quality of care when selecting public health facilities in South Africa. Qualitative methods were applied to establish attributes and levels for the DCE. To elicit preferences, interviews with community members were held in two South African provinces: 491 in Western Cape and 499 in Eastern Cape. The availability of necessary medicine at health facilities has the greatest impact on the probability of attending public health facilities. Other clinical quality attributes (i.e. provision of expert advice and provision of a thorough examination) are more valued than non-clinical quality of care attributes (i.e. staff attitude, treatment by doctors or nurses, and waiting time). Treatment by a doctor was less valued than all other attributes. Communities are prepared to tolerate public sector health service characteristics such as a long waiting time, poor staff attitudes and lack of direct access to doctors if they receive the medicine they need, a thorough examination and a clear explanation of the diagnosis and prescribed treatment from health professionals. These findings prioritize issues that the South African government must address in order to meet their commitment to improve public sector health-care service provision. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Entitled to What? Public Policy and the Responsibilities of Early Intervention.

ERIC Educational Resources Information Center

Brown, Wesley; Conroy, Maureen

1999-01-01

Examines early-intervention entitlements currently extended by all states. Perspectives from the legislative process, federal and state implementation, judicial interpretation, and professional views are included. Distinctions among the key provisions for differing early intervention service systems are presented, legal cases are reviewed, and…

A Survey of Mental Health Service Provision in New York State Residential Treatment Centers

ERIC Educational Resources Information Center

Baker, Amy J. L.; Fulmore, Darren; Collins, Julie

2008-01-01

Thirty-seven of 43 (86%) agencies operating child welfare residential treatment centers in New York State responded to a survey about the provision of mental health services. Questions were asked about provision of services, satisfaction with services, and suggestions for improvement in five domains: therapeutic milieu, individual therapy, group…

Age inclusive services or separate old age and working age services? A historical analysis from the formative years of old age psychiatry c.1940-1989.

PubMed

Hilton, Claire

2015-04-01

The Equality Act 2010 made it unlawful to discriminate in the provision of services on the grounds of age. This legislation is open to interpretation, but it is affecting the way older people's services are defined and provided. Historical evidence indicates that, since the 1940s, apart from psychiatrists working in dedicated old age services, most were unenthusiastic about working with mentally unwell older people and unsupportive of those who chose to do so. A historical analysis might shed light on current dilemmas about 'all age' or 'old age' services and inform decision-making on future mental health services.

47 CFR 22.711 - Provision of information to applicants.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 2 2013-10-01 2013-10-01 false Provision of information to applicants. 22.711 Section 22.711 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Rural Radiotelephone Service § 22.711 Provision of information to applicants...

47 CFR 22.711 - Provision of information to applicants.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 2 2014-10-01 2014-10-01 false Provision of information to applicants. 22.711 Section 22.711 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Rural Radiotelephone Service § 22.711 Provision of information to applicants...

47 CFR 22.711 - Provision of information to applicants.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 2 2011-10-01 2011-10-01 false Provision of information to applicants. 22.711 Section 22.711 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Rural Radiotelephone Service § 22.711 Provision of information to applicants...

47 CFR 22.711 - Provision of information to applicants.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 2 2010-10-01 2010-10-01 false Provision of information to applicants. 22.711 Section 22.711 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Rural Radiotelephone Service § 22.711 Provision of information to applicants...

Safeguarding Ecosystem Services: A Methodological Framework to Buffer the Joint Effect of Habitat Configuration and Climate Change.

PubMed

Giannini, Tereza C; Tambosi, Leandro R; Acosta, André L; Jaffé, Rodolfo; Saraiva, Antonio M; Imperatriz-Fonseca, Vera L; Metzger, Jean Paul

2015-01-01

Ecosystem services provided by mobile agents are increasingly threatened by the loss and modification of natural habitats and by climate change, risking the maintenance of biodiversity, ecosystem functions, and human welfare. Research oriented towards a better understanding of the joint effects of land use and climate change over the provision of specific ecosystem services is therefore essential to safeguard such services. Here we propose a methodological framework, which integrates species distribution forecasts and graph theory to identify key conservation areas, which if protected or restored could improve habitat connectivity and safeguard ecosystem services. We applied the proposed framework to the provision of pollination services by a tropical stingless bee (Melipona quadrifasciata), a key pollinator of native flora from the Brazilian Atlantic Forest and important agricultural crops. Based on the current distribution of this bee and that of the plant species used to feed and nest, we projected the joint distribution of bees and plants in the future, considering a moderate climate change scenario (following IPPC). We then used this information, the bee's flight range, and the current mapping of Atlantic Forest remnants to infer habitat suitability and quantify local and regional habitat connectivity for 2030, 2050 and 2080. Our results revealed north to south and coastal to inland shifts in the pollinator distribution during the next 70 years. Current and future connectivity maps unraveled the most important corridors, which if protected or restored, could facilitate the dispersal and establishment of bees during distribution shifts. Our results also suggest that coffee plantations from eastern São Paulo and southern Minas Gerais States could suffer a pollinator deficit in the future, whereas pollination services seem to be secured in southern Brazil. Landowners and governmental agencies could use this information to implement new land use schemes. Overall, our proposed methodological framework could help design novel conservational and agricultural practices that can be crucial to conserve ecosystem services by buffering the joint effect of habitat configuration and climate change.

Utilising a collective case study system theory mixed methods approach: a rural health example

PubMed Central

2014-01-01

Background Insight into local health service provision in rural communities is limited in the literature. The dominant workforce focus in the rural health literature, while revealing issues of shortage of maldistribution, does not describe service provision in rural towns. Similarly aggregation of data tends to render local health service provision virtually invisible. This paper describes a methodology to explore specific aspects of rural health service provision with an initial focus on understanding rurality as it pertains to rural physiotherapy service provision. Method A system theory-case study heuristic combined with a sequential mixed methods approach to provide a framework for both quantitative and qualitative exploration across sites. Stakeholder perspectives were obtained through surveys and in depth interviews. The investigation site was a large area of one Australian state with a mix of rural, regional and remote communities. Results 39 surveys were received from 11 locations within the investigation site and 19 in depth interviews were conducted. Stakeholder perspectives of rurality and workforce numbers informed the development of six case types relevant to the exploration of rural physiotherapy service provision. Participant perspective of rurality often differed with the geographical classification of their location. The numbers of onsite colleagues and local access to health services contributed to participant perceptions of rurality. Conclusions The complexity of understanding the concept of rurality was revealed by interview participants when providing their perspectives about rural physiotherapy service provision. Dual measures, such as rurality and workforce numbers, provide more relevant differentiation of sites to explore specific services, such rural physiotherapy service provision, than single measure of rurality as defined by geographic classification. The system theory-case study heuristic supports both qualitative and quantitative exploration in rural health services research. PMID:25066241

Utilising a collective case study system theory mixed methods approach: a rural health example.

PubMed

Adams, Robyn; Jones, Anne; Lefmann, Sophie; Sheppard, Lorraine

2014-07-28

Insight into local health service provision in rural communities is limited in the literature. The dominant workforce focus in the rural health literature, while revealing issues of shortage of maldistribution, does not describe service provision in rural towns. Similarly aggregation of data tends to render local health service provision virtually invisible. This paper describes a methodology to explore specific aspects of rural health service provision with an initial focus on understanding rurality as it pertains to rural physiotherapy service provision. A system theory-case study heuristic combined with a sequential mixed methods approach to provide a framework for both quantitative and qualitative exploration across sites. Stakeholder perspectives were obtained through surveys and in depth interviews. The investigation site was a large area of one Australian state with a mix of rural, regional and remote communities. 39 surveys were received from 11 locations within the investigation site and 19 in depth interviews were conducted. Stakeholder perspectives of rurality and workforce numbers informed the development of six case types relevant to the exploration of rural physiotherapy service provision. Participant perspective of rurality often differed with the geographical classification of their location. The numbers of onsite colleagues and local access to health services contributed to participant perceptions of rurality. The complexity of understanding the concept of rurality was revealed by interview participants when providing their perspectives about rural physiotherapy service provision. Dual measures, such as rurality and workforce numbers, provide more relevant differentiation of sites to explore specific services, such rural physiotherapy service provision, than single measure of rurality as defined by geographic classification. The system theory-case study heuristic supports both qualitative and quantitative exploration in rural health services research.

Special Education in Hawaii--Some Current Problems. Report No. 6.

ERIC Educational Resources Information Center

Hayashi, Junie

The report examines the Hawaii Department of Education's procedures and criteria in the identification and evaluation of handicapped children, as well as difficulties encountered in recruiting and maintaining qualified special services evaluation personnel. An introductory chapter notes the legislative authority for the study; provisions of Public…

21 CFR 211.1 - Scope.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 4 2013-04-01 2013-04-01 false Scope. 211.1 Section 211.1 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.1 Scope. (a) The regulations in...

21 CFR 211.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 4 2011-04-01 2011-04-01 false Scope. 211.1 Section 211.1 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.1 Scope. (a) The regulations in...

21 CFR 211.1 - Scope.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 4 2014-04-01 2014-04-01 false Scope. 211.1 Section 211.1 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.1 Scope. (a) The regulations in...

21 CFR 211.1 - Scope.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 4 2012-04-01 2012-04-01 false Scope. 211.1 Section 211.1 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS General Provisions § 211.1 Scope. (a) The regulations in...

28 CFR 36.208 - Direct threat.

Code of Federal Regulations, 2010 CFR

2010-07-01

... risk to the health or safety of others that cannot be eliminated by a modification of policies, practices, or procedures, or by the provision of auxiliary aids or services. (c) In determining whether an... individualized assessment, based on reasonable judgment that relies on current medical knowledge or on the best...

47 CFR 90.701 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Telecommunications Services. The provisions of this subpart contain additional pertinent information for current and... this subpart as “Phase I” licensees; (2) Applicants that filed initial applications for operations in the 220-222 MHz band on or before May 24, 1991 are referred to in this subpart as “Phase I” applicants...

47 CFR 90.701 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Telecommunications Services. The provisions of this subpart contain additional pertinent information for current and... this subpart as “Phase I” licensees; (2) Applicants that filed initial applications for operations in the 220-222 MHz band on or before May 24, 1991 are referred to in this subpart as “Phase I” applicants...

Childminders, Parents and Policy: Testing the Triangle of Care

ERIC Educational Resources Information Center

Brooker, Liz

2016-01-01

Childminders in England have historically been seen as marginal providers of childcare, fulfilling Bruner's description of the service as an "accordion pleat" in provision. This article outlines the history and current position of childminders in English early childhood policy, and then reports on the views on this role of childminders…

77 FR 43236 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-24

...). The Services take these efforts into account when making decisions on whether to list a species as... of information under the provisions of the Paperwork Reduction Act (44 U.S.C. Chapter 35). Agency.... Type of Request: Regular submission (extension of a current information collection). Number of...

Regulatory Enhancements, Infrastructure Modernization, and Connecticut's Interactive, Distance Learning Network.

ERIC Educational Resources Information Center

Pietras, Jesse John

This paper presents an overview of the regulatory, technological, and economic status of interactive distance learning in Connecticut as it relates to the current and future provisioning of services by the telecommunications and cable television industries. The review is predicated upon the following questions: (1) What obligations should the…

Connecticut's Evolving Interactive Distance Learning Network in the Cable and Telecommunications Industries.

ERIC Educational Resources Information Center

Pietras, Jesse John

This paper describes the state of interactive distance learning in Connecticut, particularly the current and future provision of these services by the telecommunications and cable television industries. The overview examines questions of where obligation and responsibility lie (with schools, local exchange companies, cable franchises, etc.) in…

Future socio-economic impacts and vulnerabilities

Treesearch

Balgis Osman-Elasha; Neil Adger; Maria Brockhaus; Carol J. Pierce Colfer; Brent Sohngen; Tallaat Dafalla; Linda A. Joyce; Nkem Johnson; Carmenza Robledo

2009-01-01

The projected impacts of climate change are significant, and despite the uncertainties associated with current climate and ecosystem model projections, the associated changes in the provision of forest ecosystem services are expected to be substantial in many parts of the world. These impacts will present significant social and economic challenges for affected...

78 FR 51043 - Cranberries Grown in States of Massachusetts, Rhode Island, Connecticut, New Jersey, Wisconsin...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-20

... Determination of Sales History AGENCY: Agricultural Marketing Service, USDA. ACTION: Final rule. SUMMARY: This rule revises the determination of sales history provisions currently prescribed under the cranberry...). This rule modifies sales history calculations so that they are applicable for future seasons and...

Care for post-stroke patients at Malaysian public health centres: self-reported practices of family medicine specialists

PubMed Central

2014-01-01

Background Provision of post stroke care in developing countries is hampered by discoordination of services and limited access to specialised care. Albeit shortcomings, primary care continues to provide post-stroke services in less than favourable circumstances. This paper aimed to review provision of post-stroke care and related problems among Family Medicine Specialists managing public primary health care services. Methods A semi-structured questionnaire was distributed to 121 Family Physicians servicing public funded health centres in a pilot survey focused on improving post stroke care provision at community level. The questionnaire assessed respondents background and practice details i.e. estimated stroke care burden, current service provision and opinion on service improvement. Means and frequencies described quantitative data. For qualitative data, constant comparison method was used until saturation of themes was reached. Results Response rate of 48.8% was obtained. For every 100 patients seen at public healthcentres each month, 2 patients have stroke. Median number of stroke patients seen per month is 5 (IQR 2-10). 57.6% of respondents estimated total stroke patients treated per year at each centre was less than 40 patients. 72.4% lacked a standard care plan although 96.6% agreed one was needed. Patients seen were: discharged from tertiary care (88.1%), shared care plan with specialists (67.8%) and patients who developed stroke during follow up at primary care (64.4%). Follow-ups were done at 8-12 weekly intervals (60.3%) with 3.4% on ‘as needed’ basis. Referrals ranked in order of frequency were to physiotherapy services, dietitian and speech and language pathologists in public facilities. The FMS’ perceived 4 important ‘needs’ in managing stroke patients at primary care level; access to rehabilitation services, coordinated care between tertiary centres and primary care using multidisciplinary care approach, a standardized guideline and family and caregiver support. Conclusions Post discharge stroke care guidelines and access to rehabilitation services at primary care is needed for post stroke patients residing at home in the community. PMID:24580779

Opportunities, challenges and systems requirements for developing post-abortion family planning services: Perceptions of service stakeholders in China

PubMed Central

Richards, Esther; Zhang, Weihong; Hu, Lina; Wu, Shangchun; Tolhurst, Rachel

2017-01-01

Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers’ perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces—Zhejiang, Hubei and Yunnan—were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources. PMID:29045434

Opportunities, challenges and systems requirements for developing post-abortion family planning services: Perceptions of service stakeholders in China.

PubMed

Jiang, Hong; Xu, Jieshuang; Richards, Esther; Qian, Xu; Zhang, Weihong; Hu, Lina; Wu, Shangchun; Tolhurst, Rachel

2017-01-01

Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers' perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces-Zhejiang, Hubei and Yunnan-were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources.

45 CFR 1306.30 - Provisions of comprehensive child development services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 4 2011-10-01 2011-10-01 false Provisions of comprehensive child development... Start Program Options § 1306.30 Provisions of comprehensive child development services. (a) All Head Start grantees must provide comprehensive child development services, as defined in the Head Start...

45 CFR 1306.30 - Provisions of comprehensive child development services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 4 2014-10-01 2014-10-01 false Provisions of comprehensive child development... Start Program Options § 1306.30 Provisions of comprehensive child development services. (a) All Head Start grantees must provide comprehensive child development services, as defined in the Head Start...

45 CFR 1306.30 - Provisions of comprehensive child development services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 4 2013-10-01 2013-10-01 false Provisions of comprehensive child development... Start Program Options § 1306.30 Provisions of comprehensive child development services. (a) All Head Start grantees must provide comprehensive child development services, as defined in the Head Start...

45 CFR 1306.30 - Provisions of comprehensive child development services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 4 2012-10-01 2012-10-01 false Provisions of comprehensive child development... Start Program Options § 1306.30 Provisions of comprehensive child development services. (a) All Head Start grantees must provide comprehensive child development services, as defined in the Head Start...

47 CFR 64.401 - Policies and procedures for provisioning and restoring certain telecommunications services in...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Policies and procedures for provisioning and restoring certain telecommunications services in emergencies. 64.401 Section 64.401 Telecommunication... procedures for provisioning and restoring certain telecommunications services in emergencies. The...

47 CFR 64.401 - Policies and procedures for provisioning and restoring certain telecommunications services in...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Policies and procedures for provisioning and restoring certain telecommunications services in emergencies. 64.401 Section 64.401 Telecommunication... procedures for provisioning and restoring certain telecommunications services in emergencies. The...

47 CFR 64.401 - Policies and procedures for provisioning and restoring certain telecommunications services in...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 3 2014-10-01 2014-10-01 false Policies and procedures for provisioning and restoring certain telecommunications services in emergencies. 64.401 Section 64.401 Telecommunication... procedures for provisioning and restoring certain telecommunications services in emergencies. The...

47 CFR 64.401 - Policies and procedures for provisioning and restoring certain telecommunications services in...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 3 2012-10-01 2012-10-01 false Policies and procedures for provisioning and restoring certain telecommunications services in emergencies. 64.401 Section 64.401 Telecommunication... procedures for provisioning and restoring certain telecommunications services in emergencies. The...

47 CFR 64.401 - Policies and procedures for provisioning and restoring certain telecommunications services in...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Policies and procedures for provisioning and restoring certain telecommunications services in emergencies. 64.401 Section 64.401 Telecommunication... procedures for provisioning and restoring certain telecommunications services in emergencies. The...

Bridging the Gap between Health and Social Care for Rare Diseases: Key Issues and Innovative Solutions.

PubMed

Castro, Raquel; Senecat, Juliette; de Chalendar, Myriam; Vajda, Ildikó; Dan, Dorica; Boncz, Béata

2017-01-01

Bridging the gaps between health and social care for rare diseases is not only necessary but crucial to increase the life expectancy, quality of life and autonomy of people living with a rare disease, supporting them in the full realisation of their fundamental human rights.The complexity of rare diseases, their strong relation to disability and the current unmet social and daily life needs of people living with a rare disease must not be underestimated and require urgent attention from all stakeholders involved in care provision, from healthcare to social and community services.The Commission Expert Group Recommendations to Support the Incorporation of Rare Diseases into Social Services and Policies, adopted unanimously in April 2016, by the representatives of European Member States and the other rare disease stakeholders, clearly set the tone for the need to promote measures that facilitate multidisciplinary, holistic, continuous, person-centred and participative care provision to people living with rare diseases.These recommendations, sided by other recent policy developments at European and national levels, represent an important policy step into approaching rare diseases' complex challenges in regards to holistic care provision.Innovative approaches aiming at bridging the gap between health, social and community service and support providers are currently being developed and tested in different European countries: standards of care, networks of expertise, case management services, one-stop-shop services, amongst others.These ongoing pilot approaches, presented in this chapter, have the power to inspire future policies and the effective and efficient implementation of holistic care pathways for people living with a rare disease, bringing about significant changes for patients, carers, care providers, competent authorities and the society at large.Nonetheless, the challenges to fully address this issue remain numerous and other key issues will also need to be taken into account when moving forward with the implementation of measures that aim at bridging the gaps between care providers and providing holistic care to people living with a rare disease.

Locating provisioning ecosystem services in urban forests: Forageable woody species in New York City, USA

Treesearch

Patrick T. Hurley; Marla R. Emery

2017-01-01

Scholarship on the ecosystem services provided by urban forests has focused on regulating and supporting services, with a growing body of research examining provisioning and cultural ecosystem services from farms and gardens in metropolitan areas. Using the case of New York, New York, USA, we propose a method to assess the supply of potential provisioning ecosystem...

Learners' perspectives on the provision of condoms in South African public schools.

PubMed

de Bruin, W E; Panday-Soobrayan, S

2017-12-01

A stubborn health challenge for learners in South African public schools concerns sexual and reproductive health and rights (SRHR). In 2015, the Department of Basic Education (DBE) proposed the provision of condoms and SRHR-services to learners in schools. This study aimed to contribute to the finalisation and implementation of DBE's policy by exploring learners' perspectives on the provision of condoms and SRHR-services in schools. Sixteen focus group discussions were conducted with learners (n = 116) from 33 public schools, to assess their attitudes, social influences, and needs and desires regarding condom provision and SRHR-services in schools. The majority of learners did not support condom provision in schools as they feared that it may increase sexual activity. Contrarily, they supported the provision of other SRHR-services as clinics fail to offer youth-friendly services. Learners' sexual behaviour and access to SRHR-services are strongly determined by their social environment, including traditional norms and values, and social-pressure from peers and adults. Learners' most pressing needs and desires to access condoms and SRHR-services in school concerned respect, privacy and confidentiality of such service provision. Implementation of DBE's policy must be preceded by an evidence-informed advocacy campaign to debunk myths about the risk of increased sexual activity, to advocate for why such services are needed, to shift societal norms towards open discussion of adolescent SRHR and to grapple with the juxtaposition of being legally empowered but socially inhibited to protect oneself from HIV, STIs and early pregnancy. Provision of condoms and other SRHR-services in schools must be sensitive to learners' privacy and confidentiality to minimise stigma and discrimination.

Are You Covered? Associations Between Patient Protection and Affordable Care Act Knowledge and Preventive Reproductive Service Use.

PubMed

Sawyer, Ashlee N; Kwitowski, Melissa A; Benotsch, Eric G

2018-05-01

Sexual and reproductive health conditions (eg, infections, cancers) represent public health concerns for American women. The present study examined how knowledge of the Patient Protection and Affordable Care Act (PPACA) relates to receipt of preventive reproductive health services among women. Cross-sectional online survey. Online questionnaires were completed via Amazon Mechanical Turk, a crowdsourcing website where individuals complete web-based tasks for compensation. Cisgendered women aged 18 to 44 years (N = 1083) from across the United States. Participants completed online questionnaires assessing demographics, insurance status, preventive service use, and knowledge of PPACA provisions. Chi-squares showed that receipt of well-woman, pelvic, and breast examinations, as well as pap smears, was related to insurance coverage, with those not having coverage at all during the previous year having significantly lower rates of use. Hierarchical logistic regressions determined the independent relationship between PPACA knowledge and use of health services after controlling for demographic factors and insurance status. Knowledge of PPACA provisions was associated with receiving well-woman, pelvic, and breast examinations, human papillomavirus vaccination, and sexually transmitted infections testing, after controlling for these factors. Results indicate that expanding knowledge about health-care legislation may be beneficial in increasing preventive reproductive health service use among women. Current findings provide support for increasing resources for outreach and education of the general population about the provisions and benefits of health-care legislation, as well as personal health coverage plans.

Optimal policies for simultaneous energy consumption and ancillary service provision for flexible loads under stochastic prices and no capacity reservation constraint

NASA Astrophysics Data System (ADS)

Kefayati, Mahdi; Baldick, Ross

2015-07-01

Flexible loads, i.e. the loads whose power trajectory is not bound to a specific one, constitute a sizable portion of current and future electric demand. This flexibility can be used to improve the performance of the grid, should the right incentives be in place. In this paper, we consider the optimal decision making problem faced by a flexible load, demanding a certain amount of energy over its availability period, subject to rate constraints. The load is also capable of providing ancillary services (AS) by decreasing or increasing its consumption in response to signals from the independent system operator (ISO). Under arbitrarily distributed and correlated Markovian energy and AS prices, we obtain the optimal policy for minimising expected total cost, which includes cost of energy and benefits from AS provision, assuming no capacity reservation requirement for AS provision. We also prove that the optimal policy has a multi-threshold form and can be computed, stored and operated efficiently. We further study the effectiveness of our proposed optimal policy and its impact on the grid. We show that, while optimal simultaneous consumption and AS provision under real-time stochastic prices are achievable with acceptable computational burden, the impact of adopting such real-time pricing schemes on the network might not be as good as suggested by the majority of the existing literature. In fact, we show that such price responsive loads are likely to induce peak-to-average ratios much more than what is observed in the current distribution networks and adversely affect the grid.

Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff.

PubMed

Villarosa, Amy R; Clark, Sally; Villarosa, Ariana C; Patterson Norrie, Tiffany; Macdonald, Susan; Anlezark, Jennifer; Srinivas, Ravi; George, Ajesh

2018-04-23

This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs. Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate. This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care. The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF. This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Child rights and Child and Adolescent Mental Health Services (CAMHS) in Ireland.

PubMed

Damodaran, J; Sherlock, C

2013-12-01

This paper explores children's rights in the child and adolescent mental health arena in Ireland. It begins by outlining the legal and policy contexts of both children's services and mental health policy and practice. It specifically focuses on the notion of participation as a key factor in addressing rights-based approaches in the provision of services. The article explores current practice in Child and Adolescent Mental Health Services, highlights some of the disparities in services, which result in questions about human rights. Mainly reflective in its approach, it does, however, provide data from a small scale qualitative study carried out in relation to young people diagnosed with ADHD and their perceptions of psychopharmacological approach. The issue of consent is explored as an example of how current practice approaches fall short of a rights-based framework. It concludes with recommendations for changes incorporating a more participatory and collaborative approach.

Information analytics for healthcare service discovery.

PubMed

Sun, Lily; Yamin, Mohammad; Mushi, Cleopa; Liu, Kecheng; Alsaigh, Mohammed; Chen, Fabian

2014-01-01

The concept of being 'patient-centric' is a challenge to many existing healthcare service provision practices. This paper focuses on the issue of referrals, where multiple stakeholders, such as General Practitioners (GPs) and patients, are encouraged to make a consensual decision based on patients' needs. In this paper, we present an ontology-enabled healthcare service provision, which facilitates both patients and GPs in jointly deciding upon the referral decision. In the healthcare service provision model, we define three types of profiles which represent different stakeholders' requirements. This model also comprises a set of healthcare service discovery processes: articulating a service need, matching the need with the healthcare service offerings, and deciding on a best-fit service for acceptance. As a result, the healthcare service provision can carry out coherent analysis using personalised information and iterative processes that deal with requirements which change over time.

Ecosystem service provision in a changing Europe: adapting to the impacts of combined climate and socio-economic change.

PubMed

Dunford, Robert W; Smith, Alison C; Harrison, Paula A; Hanganu, Diana

Future patterns of European ecosystem services provision are likely to vary significantly as a result of climatic and socio-economic change and the implementation of adaptation strategies. However, there is little research in mapping future ecosystem services and no integrated assessment approach to map the combined impacts of these drivers. Map changing patterns in ecosystem services for different European futures and (a) identify the role of driving forces; (b) explore the potential influence of different adaptation options. The CLIMSAVE integrated assessment platform is used to map spatial patterns in services (food, water and timber provision, atmospheric regulation, biodiversity existence/bequest, landscape experience and land use diversity) for a number of combined climatic and socio-economic scenarios. Eight adaptation strategies are explored within each scenario. Future service provision (particularly water provision) will be significantly impacted by climate change. Socio-economic changes shift patterns of service provision: more dystopian societies focus on food provision at the expense of other services. Adaptation options offer significant opportunities, but may necessitate trade-offs between services, particularly between agriculture- and forestry-related services. Unavoidable trade-offs between regions (particularly South-North) are also identified in some scenarios. Coordinating adaptation across regions and sectors will be essential to ensure that all needs are met: a factor that will become increasingly pressing under dystopian futures where inter-regional cooperation breaks down. Integrated assessment enables exploration of interactions and trade-offs between ecosystem services, highlighting the importance of taking account of complex cross-sectoral interactions under different future scenarios of planning adaptation responses.

Suicide prevention in primary care: General practitioners' views on service availability

PubMed Central

2010-01-01

Background Primary care may be a key setting for suicide prevention. However, comparatively little is known about the services available in primary care for suicide prevention. The aims of the current study were to describe services available in general practices for the management of suicidal patients and to examine GPs views on these services. We carried out a questionnaire and interview study in the North West of England. We collected data on GPs views of suicide prevention generally as well as local mental health service provision. Findings During the study period (2003-2005) we used the National Confidential Inquiry Suicide database to identify 286 general practitioners (GPs) who had registered patients who had died by suicide. Data were collected from GPs and practice managers in 167 practices. Responses suggested that there was greater availability of services and training for general mental health issues than for suicide prevention specifically. The three key themes which emerged from GP interviews were: barriers accessing primary or secondary mental health services; obstacles faced when referring a patient to mental health services; managing change within mental health care services Conclusions Health professionals have an important role to play in preventing suicide. However, GPs expressed concerns about the quality of primary care mental health service provision and difficulties with access to secondary mental health services. Addressing these issues could facilitate future suicide prevention in primary care. PMID:20920302

76 FR 61245 - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-03

...--Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International... of September 28, 2011 Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Memorandum for the Secretary of Transportation By the authority...

49 CFR 37.191 - Special provision for small mixed-service operators.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false Special provision for small mixed-service operators. 37.191 Section 37.191 Transportation Office of the Secretary of Transportation TRANSPORTATION SERVICES FOR INDIVIDUALS WITH DISABILITIES (ADA) Over-the-Road Buses (OTRBs) § 37.191 Special provision for...

[About economic aspects of provision of medical services].

PubMed

Gerasimov, P A

2014-01-01

The contradiction between economic and social components of medical services is present in any state. Initially, the state undertakes the commitment no provide citizen with equal access to medical services. However, this means to provide social equity between all members of society which not always is effective from economic point of view. The article analyzes the problems originated in public system of provision of medical services. These problems are determined by service specificity itself model of provision of medical services and public priorities in social sector.

"It's very complicated": a qualitative study of medicines management in intermediate care facilities in Northern Ireland.

PubMed

Millar, Anna N; Hughes, Carmel M; Ryan, Cristín

2015-06-02

Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery from illness and maximising independence. Older people are at increased risk of medication-related adverse events, but little is known about the provision of medicines management services in IC facilities. This study aimed to describe the current provision of medicines management services in IC facilities in Northern Ireland (NI) and to explore healthcare workers' (HCWs) and patients' views of, and attitudes towards these services and the IC concept. Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with HCWs and patients from IC facilities in NI. Interviews were conducted with 25 HCWs and 18 patients from 12 IC facilities in NI. Three themes were identified: 'concept and reality', 'setting and supply' and 'responsibility and review'. A mismatch between the concept of IC and the reality was evident. The IC facility setting dictated prescribing responsibilities and the supply of medicines, presenting challenges for HCWs. A lack of a standardised approach to responsibility for the provision of medicines management services including clinical review was identified. Whilst pharmacists were not considered part of the multidisciplinary team, most HCWs recognised a need for their input. Medicines management was not a concern for the majority of IC patients. Medicines management services are not integral to IC and medicine-related challenges are frequently encountered. Integration of pharmacists into the multidisciplinary team could potentially improve medicines management in IC.

Patients' willingness to pay for the treatment of tuberculosis in Nigeria: exploring own use and altruism.

PubMed

Ochonma, Ogbonnia G; Onwujekwe, Obinna E

2017-05-10

Although, current treatment services for Tuberculosis (TB) in Nigeria are provided free of charge in public facilities, the benefits (value) that patients attach to such service is not known. In addition, the prices that could be charged for treatment in case government and its partners withdraw from the provision of free services or inclusion of the services in health insurance plans are not known. Hence, there is a need to elicit the maximum amounts that patients are willing to pay for TB treatment services, both for themselves and for the very poor patients that may not be able to pay if some user fees are introduced (altruistic willingness to pay). A pretested interviewer-administered questionnaire was used to elicit the maximum willingness to pay (WTP) for TB treatment services from TB patients in a tertiary hospital in southeast Nigeria. WTP was elicited using the bidding game question format after a scenario was presented to the respondents. Data was analysed using tabulations. Tobit regression models were used to examine the validity of the elicited WTP for own use and altruistic WTP. The results show that those aged 30 years and below constituted more than two-fifth (43.2%) of the respondents. More than half of the respondents (52.8%) were not employed. 100 (80.0%) of the respondents were willing to pay for their own use of TB treatment services while 78(62.4%) of the respondents were willing to make altruistic contributions so that the very poor could benefit from the TB services. A Tobit regression analysis of maximum WTP for TB for own use shows that respondents were willing to pay maximum amounts at different statistically significant levels. The results equally show that altruistic WTP was positively and statistically significantly related to the employment status, distance from UNTH and global seriousness of TB. Most patients positively valued the provision of free TB services and were willing to pay for TB treatment for own use. The better-off ones were also willing to make altruistic contributions. Free provision of TB treatment services is potentially worthwhile, but there is potential scope for continuation of universal provision of TB treatment services, even if the government and donors scale down their financing of the services.

United States International Air Transport Policy, the Promise and the Reality

NASA Technical Reports Server (NTRS)

Landry, J. E.; Phillips, G.

1972-01-01

The United States international air transportation policy is discussed. The major departure of the current policy lies in the relationship between scheduled and charter services. Various provisions of the transportation charter are analyzed to show the restrictions as well as the benefits the legislation holds for commercial aviation. It is stated that a group of full service carriers can meet the full spectrum of demands for air transportation more efficiently than two or more groups.

Quality of care and contraceptive use in urban Kenya

PubMed Central

Pence, Brian W.; Curtis, Siân L.; Marshall, Stephen W.; Speizer, Ilene S.

2015-01-01

CONTEXT Family planning is highly beneficial to women’s overall health, morbidity, and mortality, particularly in developing countries. Yet, in much of sub-Saharan Africa, contraceptive prevalence remains low while unmet need for family planning remains high. It has been frequently hypothesized that the poor quality of family planning service provision in many low-income settings acts as a barrier to optimal rates of contraceptive use but this association has not been rigorously tested. METHODS Using data collected from 3,990 women in 2010, this study investigates the association between family planning service quality and current modern contraceptive use in five cities in Kenya. In addition to individual-level data, audits of select facilities and service provider interviews were conducted in 260 facilities. Within 126 higher-volume clinics, exit interviews were conducted with family planning clients. Individual and facility-level data are linked based on the source of the woman’s current method or other health service. Adjusted prevalence ratios are estimated using binomial regression and we account for clustering of observations within facilities using robust standard errors. RESULTS Solicitation of client preferences, assistance with method selection, provision of information by providers on side effects, and provider treatment of clients were all associated with a significantly increased likelihood of current modern contraceptive use and effects were often stronger among younger and less educated women. CONCLUSION Efforts to strengthen contraceptive security and improve the content of contraceptive counseling and treatment of clients by providers have the potential to significantly increase contraceptive use in urban Kenya. PMID:26308259

Mitigating Provider Uncertainty in Service Provision Contracts

NASA Astrophysics Data System (ADS)

Smith, Chris; van Moorsel, Aad

Uncertainty is an inherent property of open, distributed and multiparty systems. The viability of the mutually beneficial relationships which motivate these systems relies on rational decision-making by each constituent party under uncertainty. Service provision in distributed systems is one such relationship. Uncertainty is experienced by the service provider in his ability to deliver a service with selected quality level guarantees due to inherent non-determinism, such as load fluctuations and hardware failures. Statistical estimators utilized to model this non-determinism introduce additional uncertainty through sampling error. Inability of the provider to accurately model and analyze uncertainty in the quality level guarantees can result in the formation of sub-optimal service provision contracts. Emblematic consequences include loss of revenue, inefficient resource utilization and erosion of reputation and consumer trust. We propose a utility model for contract-based service provision to provide a systematic approach to optimal service provision contract formation under uncertainty. Performance prediction methods to enable the derivation of statistical estimators for quality level are introduced, with analysis of their resultant accuracy and cost.

75 FR 10289 - Notice of Opportunity for a Hearing on Compliance of Missouri State Plan Provisions Concerning...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-05

... provisions concerning payments for home health services comply with the requirements of the Social Security... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Notice of Opportunity for a Hearing on Compliance of Missouri State Plan Provisions Concerning Payments for Home Health...

25 CFR 23.49 - Fair and uniform provision of services.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Fair and uniform provision of services. 23.49 Section 23.49 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES INDIAN CHILD WELFARE ACT General and Uniform Grant Administration Provisions and Requirements § 23.49 Fair and uniform...

47 CFR 25.142 - Licensing provisions for the non-voice, non-geostationary mobile-satellite service.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 2 2011-10-01 2011-10-01 false Licensing provisions for the non-voice, non... Stations § 25.142 Licensing provisions for the non-voice, non-geostationary mobile-satellite service. (a... the non-voice, non-geostationary mobile-satellite service shall describe in detail the proposed non...

47 CFR 25.142 - Licensing provisions for the non-voice, non-geostationary Mobile-Satellite Service.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 2 2013-10-01 2013-10-01 false Licensing provisions for the non-voice, non... Stations § 25.142 Licensing provisions for the non-voice, non-geostationary Mobile-Satellite Service. (a... the non-voice, non-geostationary mobile-satellite service shall describe in detail the proposed non...

47 CFR 25.142 - Licensing provisions for the non-voice, non-geostationary mobile-satellite service.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 2 2012-10-01 2012-10-01 false Licensing provisions for the non-voice, non... Stations § 25.142 Licensing provisions for the non-voice, non-geostationary mobile-satellite service. (a... the non-voice, non-geostationary mobile-satellite service shall describe in detail the proposed non...

47 CFR 25.142 - Licensing provisions for the non-voice, non-geostationary mobile-satellite service.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 2 2010-10-01 2010-10-01 false Licensing provisions for the non-voice, non... Stations § 25.142 Licensing provisions for the non-voice, non-geostationary mobile-satellite service. (a... the non-voice, non-geostationary mobile-satellite service shall describe in detail the proposed non...

Age inclusive services or separate old age and working age services? A historical analysis from the formative years of old age psychiatry c.1940–1989

PubMed Central

Hilton, Claire

2015-01-01

The Equality Act 2010 made it unlawful to discriminate in the provision of services on the grounds of age. This legislation is open to interpretation, but it is affecting the way older people’s services are defined and provided. Historical evidence indicates that, since the 1940s, apart from psychiatrists working in dedicated old age services, most were unenthusiastic about working with mentally unwell older people and unsupportive of those who chose to do so. A historical analysis might shed light on current dilemmas about ‘all age’ or ‘old age’ services and inform decision-making on future mental health services. PMID:26191440

Grid accounting service: state and future development

DOE Office of Scientific and Technical Information (OSTI.GOV)

Levshina, T.; Sehgal, C.; Bockelman, B.

2014-01-01

During the last decade, large-scale federated distributed infrastructures have been continually developed and expanded. One of the crucial components of a cyber-infrastructure is an accounting service that collects data related to resource utilization and identity of users using resources. The accounting service is important for verifying pledged resource allocation per particular groups and users, providing reports for funding agencies and resource providers, and understanding hardware provisioning requirements. It can also be used for end-to-end troubleshooting as well as billing purposes. In this work we describe Gratia, a federated accounting service jointly developed at Fermilab and Holland Computing Center at Universitymore » of Nebraska-Lincoln. The Open Science Grid, Fermilab, HCC, and several other institutions have used Gratia in production for several years. The current development activities include expanding Virtual Machines provisioning information, XSEDE allocation usage accounting, and Campus Grids resource utilization. We also identify the direction of future work: improvement and expansion of Cloud accounting, persistent and elastic storage space allocation, and the incorporation of WAN and LAN network metrics.« less

Exploring views on current and future cochlear implant service delivery: the perspectives of users, parents and professionals at cochlear implant centres and in the community.

PubMed

Athalye, Sheetal; Archbold, Sue; Mulla, Imran; Lutman, Mark; Nikolopoulous, Thomas

2015-09-01

The objective of this survey was to explore the perceptions of implant users/carers and professionals across the UK about current and future cochlear implant service delivery and the challenges. Data were collected via an online questionnaire consisting of totally 22 questions. The questionnaire contained both open- and close-ended questions. Totally, seven hundred and forty-eight responses were received. In spite of the wide range of respondents, there was a broad consensus of opinion across groups. The majority of participants were satisfied with the service they currently receive, but wanted some changes. They reported their current experience of implant services to be mainly driven by decisions made by the implant team. For the future, they preferred the service to be mainly driven by decisions made jointly by the team and the user and/or parent/carer. The majority of participants wanted the cochlear implant services to be integrated into local audiology and other services such as education. Restrictions on number of candidates funded and political decisions and issues were seen as major challenges. Qualitative analysis of the open-ended responses supported the questionnaire responses. This research highlighted the benefits and limitations of the current cochlear implant service delivery as well as the potential implications for the long term. While respondents were generally happy with the current cochlear implant service provision, they expressed some concerns about the long-term sustainability and management, wanting integration into the local services, and more involvement of parents and users in decisions.

Policy Challenges and Opportunities for Rural Special Education

ERIC Educational Resources Information Center

Rude, Harvey; Miller, Kevin J.

2018-01-01

This article reviews current developments in state and national policies that affect rural special education. A brief overview of the federal role in rural education is provided, with emphasis on the implications for the provision of special education services in rural communities. A variety of challenges are identified, including (a) the variable…

The Relationship between the Financial Status of Sole Community Independent Pharmacies and Their Broader Involvement with Other Rural Providers

ERIC Educational Resources Information Center

Radford, Andrea; Slifkin, Rebecca; King, Jennifer; Lampman, Michelle; Richardson, Indira; Rutledge, Steve

2011-01-01

Purpose: To document sole community pharmacists' involvement with other local health care organizations, these pharmacies' current financial status, and to determine whether financial position was associated with the provision of pharmacy services to other local health care providers. Methods: We conducted semistructured interviews with…

The effect of flowering calendula and cuphea plants on Orius insidiosus survival and predation of Aphis glycines

USDA-ARS?s Scientific Manuscript database

Flowering oilseed crops have the potential to diversify agroecosystems currently dominated by corn and soybeans and improve the provision of ecosystem services such as pest control. Nectar and pollen feeding may increase natural enemy fitness and searching behavior, increasing their survival and pre...

Higher Education Provision in a Crowded Marketplace

ERIC Educational Resources Information Center

Schofield, Cathy; Cotton, Debby; Gresty, Karen; Kneale, Pauline; Winter, Jennie

2013-01-01

Current changes to policy around higher education in the United Kingdom are leading to an increasingly marketised system. As funding is transferred from the United Kingdom government to the individual student, universities will be required to pay more attention to marketing. This paper draws on the literature relating to marketing of services to…

78 FR 8528 - Information Collections Being Reviewed by the Federal Communications Commission Under Delegated...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

... Number: 3060-1103. Title: Section 76.41, Franchise Application Process. Type of Review: Extension of a... competitive franchises for the provision of cable services. The Commission found that the current franchising... CFR 76.41(b) requires a competitive franchise applicant to include the following information in...

75 FR 427 - Notice of Continuation of Visitor Services

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-05

... under 36 CFR 51.23. Under the provisions of current concession contracts and pending the completion of... & Golden Gate National Recreation William Hontalas. Area. LAME001-73 Rex G. Maughan & Ruth G. Maughan Area...... Lake Mead National Recreation Area LAME002-82 Lake Mead RV Village, LLC Lake Mead National Recreation...

Development of Resource Sharing Networks. Study No. 6. Towards an Australian Industry Information Newwork.

ERIC Educational Resources Information Center

National Library of Australia, Canberra.

This report describes recent progress towards the provision of SDI services, current awareness bulletins, and retrospective search facilities to the potential users in Australian industry. Particular emphasis is placed on the role of periodical literature, reports, and patent literature. A list of information bulletins available from the…

Social Work Education on Mental Health: Postmodern Discourse and the Medical Model

ERIC Educational Resources Information Center

Casstevens, W. J.

2010-01-01

This article provides a pedagogical approach to presenting alternatives along with the traditional medical model in the context of mental health treatment and service provision. Given the current influence of the medical model in community mental health, this article outlines a rationale for challenging the model and considering alternative models…

Common threads? Palliative care service developments in seven European countries.

PubMed

Clark, D; ten Have, H; Janssens, R

2000-11-01

Since the late 1960s hospice and palliative care services have been developing in many European countries. Although attention has been given to patterns of development in specific national contexts, so far we lack a comparative understanding of how these services are organized and delivered. Such a comparison poses certain practical and methodological difficulties. It does, however, allow a wider view of the current provision of palliative care in Europe, together with a consideration of implications for the future. We report on an analysis of palliative care developments in seven European countries which gave attention to early origins, patterns of provision, and structural and policy integration. We conclude that, despite different processes of development, the emergent discipline of palliative care now finds its most congenial home within the structures of the formal health care system. Accordingly, inequities between the seven countries can be more clearly identified, posing continuing challenges to policy makers and planners who operate with a European perspective.

Portage in the UK: recent developments.

PubMed

Russell, F

2007-11-01

Portage provides home-based, early intervention and support to families who have a young child with additional needs. Working in the context of the Every Child Matters agenda, the National Portage Association (NPA) aims to develop inclusive, high-quality provision. This paper reviews their recent work, presents a summary of the findings of a national survey of Portage and discusses their implications. All Portage services known to the NPA and local authorities in England were asked to complete a questionnaire and forward another to families using early years' services to evaluate the support they receive. The survey identified the extent and gaps in Portage provision and the level of unmet need. Families who contributed said they valued Portage because it helped their child and provided support for the whole family. DISCUSSION OF FINDINGS: The survey identified 31 local authorities in England, where Portage is not available. Geographical gaps were most notable in the North East and West Midlands regions. Despite a small increase in the extent of Portage provision, it is estimated that services only meet the needs of a small proportion of families that are eligible. Current work may help overcome geographical gaps through supporting the development of high-quality Portage services but, in endeavouring to meet the needs of families waiting for Portage, it is important not to diminish the quality of support already provided. Portage aims to provide flexible support for families to respond to their individual needs. Evaluating its effectiveness is problematic because of its complex nature but this survey provided an opportunity for families to share their views at a national level. Continued development work can help Portage provision become more accessible and one of the options routinely available to families who have a young child with additional needs.

Impact of droughts on water provision in managed alpine grasslands in two climatically different regions of the Alps

PubMed Central

Ruggenthaler, Romed; Hammerle, Albin; Lavorel, Sandra; Schirpke, Uta; Clement, Jean‐Christophe; Lamarque, Pénélope; Obojes, Nikolaus; Tappeiner, Ulrike

2015-01-01

Abstract This study analyzes the impact of droughts, compared with average climatic conditions, on the supporting ecosystem service water provision in sub‐watersheds in managed alpine grasslands in two climatically different regions of the Alps, Lautaret (French Alps) and Stubai (Austrian Alps). Soil moisture was modelled in the range of 0–0.3 m. At both sites, current patterns showed that the mean seasonal soil moisture was (1) near field capacity for grasslands with low management intensity and (2) below field capacity for grasslands with higher land‐use intensity. Soil moisture was significantly reduced by drought at both sites, with lower reductions at the drier Lautaret site. At the sub‐watershed scale, soil moisture spatial heterogeneity was reduced by drought. Under drought conditions, the evapotranspiration to precipitation ratios at Stubai was slightly higher than those at Lautaret, indicating a dominant ‘water spending’ strategy of plant communities. Regarding catchment water balance, deep seepage was reduced by drought at Stubai more strongly than at Lautaret. Hence, the observed ‘water spending’ strategy at Stubai might have negative consequences for downstream water users. Assessing the water provision service for alpine grasslands provided evidence that, under drought conditions, evapotranspiration was influenced not only by abiotic factors but also by the water‐use strategy of established vegetation. These results highlight the importance of ‘water‐use’ strategies in existing plant communities as predictors of the impacts of drought on water provision services and related ecosystem services at both the field and catchment scale. © 2015 The Authors. Ecohydrology published by John Wiley & Sons, Ltd. PMID:26688705

High Availability in Optical Networks

NASA Astrophysics Data System (ADS)

Grover, Wayne D.; Wosinska, Lena; Fumagalli, Andrea

2005-09-01

Call for Papers: High Availability in Optical Networks Submission Deadline: 1 January 2006 The Journal of Optical Networking (JON) is soliciting papers for a feature Issue pertaining to all aspects of reliable components and systems for optical networks and concepts, techniques, and experience leading to high availability of services provided by optical networks. Most nations now recognize that telecommunications in all its forms -- including voice, Internet, video, and so on -- are "critical infrastructure" for the society, commerce, government, and education. Yet all these services and applications are almost completely dependent on optical networks for their realization. "Always on" or apparently unbreakable communications connectivity is the expectation from most users and for some services is the actual requirement as well. Achieving the desired level of availability of services, and doing so with some elegance and efficiency, is a meritorious goal for current researchers. This requires development and use of high-reliability components and subsystems, but also concepts for active reconfiguration and capacity planning leading to high availability of service through unseen fast-acting survivability mechanisms. The feature issue is also intended to reflect some of the most important current directions and objectives in optical networking research, which include the aspects of integrated design and operation of multilevel survivability and realization of multiple Quality-of-Protection service classes. Dynamic survivable service provisioning, or batch re-provisioning is an important current theme, as well as methods that achieve high availability at far less investment in spare capacity than required by brute force service path duplication or 100% redundant rings, which is still the surprisingly prevalent practice. Papers of several types are envisioned in the feature issue, including outlook and forecasting types of treatments, optimization and analysis, new concepts for survivability, or papers on availability analysis methods or results. Customer, vendor, and researcher viewpoints and priorities will all be given consideration. Especially valuable to the community would be papers that include or provide measured data on actual reliability and availability performance of optical networking components or systems. The scope of the papers includes, but is not limited to, the following topics: Reliability and availability measurement techniques specific to optical network devices or services. Data on SRLG statistics and frequency of different actual failure causes. Real-life accounts or data on failure and repair rates or projected values for use in availability analysis. Availability analysis methods, especially for survivable networks with reconfigurable or adaptive failure-specific responses. Availability analysis and comparisons of basic schemes for survivability. Differentiated availability schemes. Design for Multiple Quality of Protection. Different schemes for on-demand survivable service provisioning. Basic comparisons or proposals of new survivability mechanisms and architectures. Concepts yielding higher than 1+1 protection switching availability at less than 100% redundancy. Survivable service provisioning in domains of optical transparency: dealing with signal impairments. To submit to this special issue, follow the normal procedure for submission to JON, indicating "Feature Issue: Optical Network Availability" in the "Comments" field of the online submission form. For all other questions relating to this feature issue, please send an e-mail to jon@osa.org, subject line "Feature Issue: Optical Network Availability." Additional information can be found on the JON website: http://www.osa-jon.org/submission/

31 CFR 538.505 - Provision of certain legal services to the Government of Sudan, persons in Sudan, or benefitting...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Licensing Policy § 538.505 Provision of certain legal services to the Government of Sudan, persons in Sudan... for the following legal services by U.S. persons to the Government of Sudan or to a person in Sudan... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Provision of certain legal services to...

34 CFR 303.345 - Provision of services before evaluation and assessment are completed.

Code of Federal Regulations, 2010 CFR

2010-07-01

... System of Early Intervention Services Individualized Family Service Plans (ifsps) § 303.345 Provision of services before evaluation and assessment are completed. Early intervention services for an eligible child... Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY...

A cross-sectional survey of the prevalence of environmental tobacco smoke preventive care provision by child health services in Australia

PubMed Central

2011-01-01

Background Despite the need for a reduction in levels of childhood exposure to environmental tobacco smoke (ETS) being a recognised public health goal, the delivery of ETS preventive care in child health service settings remains a largely unstudied area. The purpose of this study was to determine the prevalence of ETS preventive care in child health services; differences in the provision of care by type of service; the prevalence of strategies to support such care; and the association between care support strategies and care provision. Method One-hundred and fifty-one (83%) child health service managers within New South Wales, Australia completed a questionnaire in 2002 regarding the: assessment of parental smoking and child ETS exposure; the provision of parental smoking cessation and ETS-exposure reduction advice; and strategies used to support the provision of such care. Child health services were categorised based on their size and case-mix, and a chi-square analysis was performed to compare the prevalence of ETS risk assessment and ETS prevention advice between service types. Logistic regression analysis was used to examine associations between the existence of care support strategies and the provision of ETS risk assessment and ETS exposure prevention advice. Results A significant proportion of services reported that they did not assess parental smoking status (26%), and reported that they did not assess the ETS exposure (78%) of any child. Forty four percent of services reported that they did not provide smoking cessation advice and 20% reported they did not provide ETS exposure prevention advice. Community based child and family health services reported a greater prevalence of ETS preventive care compared to other hospital based units. Less than half of the services reported having strategies to support the provision of ETS preventive care. The existence of such support strategies was associated with greater odds of care provision. Conclusions The existence of major gaps in recommended ETS preventive care provision suggests a need for additional initiatives to increase such care delivery. The low prevalence of strategies that support such care delivery suggests a potential avenue to achieve this outcome. PMID:21575273

Bundling ecosystem services in the Panama Canal watershed

PubMed Central

Simonit, Silvio; Perrings, Charles

2013-01-01

Land cover change in watersheds affects the supply of a number of ecosystem services, including water supply, the production of timber and nontimber forest products, the provision of habitat for forest species, and climate regulation through carbon sequestration. The Panama Canal watershed is currently being reforested to protect the dry-season flows needed for Canal operations. Whether reforestation of the watershed is desirable depends on its impacts on all services. We develop a spatially explicit model to evaluate the implications of reforestation both for water flows and for other services. We find that reforestation does not necessarily increase water supply, but does increase carbon sequestration and timber production. PMID:23690598

Historical and cultural aspects of the provision of care at an indigenous healthcare service facility.

PubMed

Ribeiro, Aridiane Alves; Arantes, Cássia Irene Spinelli; Gualda, Dulce Maria Rosa; Rossi, Lídia Aparecida

2017-06-01

This case study aimed to interpret the underlying historical and cultural aspects of the provision of care at an indigenous healthcare service facility. This is an interpretive, case study-type research with qualitative approach, which was conducted in 2012 at the Indigenous Health Support Center (CASAI) of the State of Mato Grosso do Sul, Brazil. Data were collected by means systematic observation, documentary analyses and semi-structured interviews with ten health professionals. Data review was performed according to an approach based on social anthropology and health anthropology. The anthropological concepts of social code and ethnocentrism underpinned the interpretation of outcomes. Two categories were identified: CASAI, a space between streets and village; Ethnocentrism and indigenous health care. Healthcare practice and current social code are influenced by each other. The street social code prevails in the social environment under study. The institutional organization and professionals' appreciation of the indigenous biological body are decisive to provision of care under the streets social code perspective. Professionals' concepts evidence ethnocentrism in healthcare. Workers, however, try to adopt a relativized view vis-à-vis indigenous people at CASAI.

Medicine and abortion law: complicating the reforming profession.

PubMed

McGuinness, Sheelagh; Thomson, Michael

2015-01-01

The complicated intra-professional rivalries that have contributed to the current contours of abortion law and service provision have been subject to limited academic engagement. In this article, we address this gap. We examine how the competing interests of different specialisms played out in abortion law reform from the early twentieth-century, through to the enactment of the Abortion Act 1967, and the formation of the structures of abortion provision in the early 1970s. We demonstrate how professional interests significantly shaped the landscape of abortion law in England, Scotland, and Wales. Our analysis addresses two distinct and yet related fields where professional interests were negotiated or asserted in the journey to law reform. Both debates align with earlier analysis that has linked abortion law reform with the market development of the medical profession. We argue that these two axes of debate, both dominated by professional interests, interacted to help shape law's treatment of abortion, and continue to influence the provision of abortion services today. © The Author [2015]. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

Ecosystem service bundles for analyzing tradeoffs in diverse landscapes

PubMed Central

Raudsepp-Hearne, C.; Peterson, G. D.; Bennett, E. M.

2010-01-01

A key challenge of ecosystem management is determining how to manage multiple ecosystem services across landscapes. Enhancing important provisioning ecosystem services, such as food and timber, often leads to tradeoffs between regulating and cultural ecosystem services, such as nutrient cycling, flood protection, and tourism. We developed a framework for analyzing the provision of multiple ecosystem services across landscapes and present an empirical demonstration of ecosystem service bundles, sets of services that appear together repeatedly. Ecosystem service bundles were identified by analyzing the spatial patterns of 12 ecosystem services in a mixed-use landscape consisting of 137 municipalities in Quebec, Canada. We identified six types of ecosystem service bundles and were able to link these bundles to areas on the landscape characterized by distinct social–ecological dynamics. Our results show landscape-scale tradeoffs between provisioning and almost all regulating and cultural ecosystem services, and they show that a greater diversity of ecosystem services is positively correlated with the provision of regulating ecosystem services. Ecosystem service-bundle analysis can identify areas on a landscape where ecosystem management has produced exceptionally desirable or undesirable sets of ecosystem services. PMID:20194739

Provision of foot health services for people with rheumatoid arthritis in New South Wales: a web-based survey of local podiatrists

PubMed Central

2013-01-01

Background It is unclear if podiatric foot care for people with rheumatoid arthritis (RA) in New South Wales (NSW) meets current clinical recommendations. The objective of this study was to survey podiatrists’ perceptions of the nature of podiatric foot care provision for people who have RA in NSW. Methods An anonymous, cross-sectional survey with a web-based questionnaire was conducted. The survey questionnaire was developed according to clinical experience and current foot care recommendations. State registered podiatrists practising in the state of NSW were invited to participate. The survey link was distributed initially via email to members of the Australian Podiatry Association (NSW), and distributed further through snowballing techniques using professional networks. Data was analysed to assess significant associations between adherence to clinical practice guidelines, and private/public podiatry practices. Results 86 podiatrists participated in the survey (78% from private practice, 22% from public practice). Respondents largely did not adhere to formal guidelines to manage their patients (88%). Only one respondent offered a dedicated service for patients with RA. Respondents indicated that the primary mode of accessing podiatry was by self-referral (68%). Significant variation was observed regarding access to disease and foot specific assessments and treatment strategies. Assessment methods such as administration of patient reported outcome measures, vascular and neurological assessments were not conducted by all respondents. Similarly, routine foot care strategies such as prescription of foot orthoses, foot health advice and footwear were not employed by all respondents. Conclusions The results identified issues in foot care provision which should be explored through further research. Foot care provision in NSW does not appear to meet the current recommended standards for the management of foot problems in people who have RA. Improvements to foot care could be undertaken in terms of providing better access to examination techniques and treatment strategies that are recommended by evidence based treatment paradigms. PMID:23972081

42 CFR 24.8 - Applicability of provisions of Title 5, U.S. Code.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Applicability of provisions of Title 5, U.S. Code. 24.8 Section 24.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL SENIOR BIOMEDICAL RESEARCH SERVICE § 24.8 Applicability of provisions of Title 5, U.S. Code. (a...

42 CFR 24.8 - Applicability of provisions of Title 5, U.S. Code.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Applicability of provisions of Title 5, U.S. Code. 24.8 Section 24.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL SENIOR BIOMEDICAL RESEARCH SERVICE § 24.8 Applicability of provisions of Title 5, U.S. Code. (a...

42 CFR 24.8 - Applicability of provisions of Title 5, U.S. Code.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Applicability of provisions of Title 5, U.S. Code. 24.8 Section 24.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL SENIOR BIOMEDICAL RESEARCH SERVICE § 24.8 Applicability of provisions of Title 5, U.S. Code. (a...

42 CFR 24.8 - Applicability of provisions of Title 5, U.S. Code.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Applicability of provisions of Title 5, U.S. Code. 24.8 Section 24.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL SENIOR BIOMEDICAL RESEARCH SERVICE § 24.8 Applicability of provisions of Title 5, U.S. Code. (a...

42 CFR 24.8 - Applicability of provisions of Title 5, U.S. Code.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Applicability of provisions of Title 5, U.S. Code. 24.8 Section 24.8 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL SENIOR BIOMEDICAL RESEARCH SERVICE § 24.8 Applicability of provisions of Title 5, U.S. Code. (a...

The Provision of Services to Students with Special Needs in Canadian Academic Libraries.

ERIC Educational Resources Information Center

Goltz, Eileen

1991-01-01

Describes results of a survey of Canadian academic libraries that was conducted to determine the provision of services to the disabled, i.e., students with visual, hearing, or motor deficiencies. External resources are described, the role of library staff is emphasized, and library policy statements concerning the provision of special services are…

47 CFR 27.1213 - Designated entity provisions for BRS in Commission auctions commencing prior to January 1, 2004.

Code of Federal Regulations, 2014 CFR

2014-10-01

... COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES Broadband Radio Service and Educational Broadband Service § 27.1213 Designated entity provisions for BRS in...

47 CFR 27.1213 - Designated entity provisions for BRS in Commission auctions commencing prior to January 1, 2004.

Code of Federal Regulations, 2010 CFR

2010-10-01

... COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES Broadband Radio Service and Educational Broadband Service § 27.1213 Designated entity provisions for BRS in...

47 CFR 27.1213 - Designated entity provisions for BRS in Commission auctions commencing prior to January 1, 2004.

Code of Federal Regulations, 2013 CFR

2013-10-01

... COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES Broadband Radio Service and Educational Broadband Service § 27.1213 Designated entity provisions for BRS in...

47 CFR 27.1213 - Designated entity provisions for BRS in Commission auctions commencing prior to January 1, 2004.

Code of Federal Regulations, 2011 CFR

2011-10-01

... COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS COMMUNICATIONS SERVICES Broadband Radio Service and Educational Broadband Service § 27.1213 Designated entity provisions for BRS in...

Public long-term care insurance for the elderly in Korea: design, characteristics, and tasks.

PubMed

Seok, Jae Eun

2010-03-01

This paper examines the design and issues of the long-term care scheme in Korea: coverage, eligibility, benefit types, financing, delivery system, and role sharing of state, family, and market in long-term care. It also aims to examine the radical change and impacts on service financing, provision, and governance from the introduction of the long-term care insurance for the elderly in Korea. The first noteworthy change is that the long-term care service has transformed from the very selective service applicable only to low-income groups to a universal service for all income groups. The second notable change is that the service provision method has been changed from the provision by nonprofit organizations entrusted by the state under a monopolistic commission arrangement in the past to a new open-service provision arrangement in which free competition among service providers in service market and consumers' choice will be emphasized.

The experiences of survivors and trauma counselling service providers in northern Uganda: Implications for mental health policy and legislation.

PubMed

Liebling, H; Davidson, L; Akello, G F; Ochola, G

Previous research in northern Uganda found high levels of trauma-related difficulties amongst the conflict-affected population. There is international evidence that psychological therapy can reduce depression, as one of the psychological effects of trauma, but very limited literature regarding the experiences of trauma counselling in Sub-Saharan Africa. The current British Academy and Leverhulme-funded research investigated the experiences of service users and providers of trauma services in Kitgum and Gulu, northern Uganda. It also examined their implications for mental health policy and legislation. A decision was made to utilise qualitative methodology to highlight the in-depth experiences of participants. The researcher's carried out interviews with 10 women and 10 men survivors attending trauma services in Kitgum and Gulu. The researchers also interviewed 15 key informants in Kitgum, Gulu and Kampala including trauma counselling service providers, ministers, cultural leaders and mental health professionals. The authors report the findings of the research based on thematic analysis of the interviews. Themes included the experiences of survivors, bearing witness and instilling hope, constraints to service provision, stigma and abuse, holistic approach, service providers doing their best, specialist populations, limited understanding, training and skills development, gaps in service provision and mental health policy and legislation. The interviews resulted in a clear indication that counselling and medication was valued by service users, and that service providers felt the treatments that were provided improved depression, and increased empowerment and engagement in social activities. However, the authors argue that there was a limit to the benefits that could be achieved without using the holistic approach that the survivors requested. Thus, in cases of trauma arising from conflict, there is a clear need for the state to ensure reparation and/or justice for the atrocities witnessed by and perpetrated against survivors. This might include the provision of compensation, which would help to meet social needs and reduce feelings of shame and anger. Copyright © 2016 Elsevier Ltd. All rights reserved.

Understanding "globalization" as a determinant of health determinants: a critical perspective.

PubMed

Spiegel, Jerry M; Labonte, Ronald; Ostry, Aleck S

2004-01-01

The purpose of this article is to explain how globalization has evolved, in order to provide a context for assessing the health care restructuring that is occurring worldwide. The authors begin by defining globalization and introducing a framework for considering pathways that can affect social organization and health. They then draw attention to current trends, such as the GATS (General Agreement on Trade in Services), that promise to open health services provision to increased pressures of globalization.

Screening for coronary heart disease risk factors in retail pharmacies in Sheffield, 1992.

PubMed Central

Allison, C; Page, H; George, S

1994-01-01

OBJECTIVE--To investigate the current and likely future provision of screening services for risk factors for coronary heart disease in retail pharmacies in Sheffield. DESIGN--This was a questionnaire survey asking about screening tests currently offered, price charged per test, likely future provision of screening tests, the action respondents would take upon finding an abnormal test result, whether the pharmacy was owner-run, franchised, or part of a commercial chain, and inviting open comments from respondents. SETTING--All retail pharmacy premises on the Sheffield Family Health Services Authority list. RESULTS--Seventy seven responses were obtained to 102 questionnaires distributed. Only nine of these currently offered any screening test other than pregnancy testing, although 37 indicated that they might offer tests in the future. Thirty nine were not offering screening and had no plans to do so. Pharmacies offering or likely to offer screening tests were mainly owner-run. All pharmacists who replied to the question asking about their action upon finding abnormal result (33) reported that they would advise the patient to see a doctor. The most frequent comments made by pharmacists were about the commercial viability of screening in pharmacies and the lack of space available to ensure patient privacy and confidentiality during screening. CONCLUSIONS--Screening in retail pharmacies would probably be a commercial failure unless doctors were able to contract for screening services from pharmacies. Evidence from this study and others, however, leads us to question the desirability of this option. PMID:8189175

42 CFR 55a.106 - Provision for waiver by the Secretary.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Provision for waiver by the Secretary. 55a.106 Section 55a.106 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS PROGRAM GRANTS FOR BLACK LUNG CLINICS General Provisions § 55a.106 Provision for waiver by the Secretary...

42 CFR 55a.106 - Provision for waiver by the Secretary.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Provision for waiver by the Secretary. 55a.106 Section 55a.106 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS PROGRAM GRANTS FOR BLACK LUNG CLINICS General Provisions § 55a.106 Provision for waiver by the Secretary...

Resource requirements of inclusive urban development in India: insights from ten cities

NASA Astrophysics Data System (ADS)

Singh Nagpure, Ajay; Reiner, Mark; Ramaswami, Anu

2018-02-01

This paper develops a methodology to assess the resource requirements of inclusive urban development in India and compares those requirements to current community-wide material and energy flows. Methods include: (a) identifying minimum service level benchmarks for the provision of infrastructure services including housing, electricity and clean cooking fuels; (b) assessing the percentage of homes that lack access to infrastructure or that consume infrastructure services below the identified benchmarks; (c) quantifying the material requirements to provide basic infrastructure services using India-specific design data; and (d) computing material and energy requirements for inclusive development and comparing it with current community-wide material and energy flows. Applying the method to ten Indian cities, we find that: 1%-6% of households do not have electricity, 14%-71% use electricity below the benchmark of 25 kWh capita-month-1 4%-16% lack structurally sound housing; 50%-75% live in floor area less than the benchmark of 8.75 m2 floor area/capita; 10%-65% lack clean cooking fuel; and 6%-60% lack connection to a sewerage system. Across the ten cities examined, to provide basic electricity (25 kWh capita-month-1) to all will require an addition of only 1%-10% in current community-wide electricity use. To provide basic clean LPG fuel (1.2 kg capita-month-1) to all requires an increase of 5%-40% in current community-wide LPG use. Providing permanent shelter (implemented over a ten year period) to populations living in non-permanent housing in Delhi and Chandigarh would require a 6%-14% increase over current annual community-wide cement use. Conversely, to provide permanent housing to all people living in structurally unsound housing and those living in overcrowded housing (<5 m cap-2) would require 32%-115% of current community-wide cement flows. Except for the last scenario, these results suggest that social policies that seek to provide basic infrastructure provisioning for all residents would not dramatically increasing current community-wide resource flows.

3 CFR - Provision of Defense Articles and Services to Vetted Members of the Syrian Opposition for Use in...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 3 The President 1 2014-01-01 2014-01-01 false Provision of Defense Articles and Services to Vetted... and Related Materials, Organizations Implementing U.S. Department of State or U.S. Agency for... Determination No. 2013-15 of September 16, 2013 Provision of Defense Articles and Services to Vetted Members of...

49 CFR 39.51 - What is the general requirement for PVOs' provision of auxiliary aids and services to passengers?

Code of Federal Regulations, 2013 CFR

2013-10-01

...' provision of auxiliary aids and services to passengers? 39.51 Section 39.51 Transportation Office of the... for Passengers § 39.51 What is the general requirement for PVOs' provision of auxiliary aids and... auxiliary aids and services where necessary to afford an individual with a disability an equal opportunity...

49 CFR 39.51 - What is the general requirement for PVOs' provision of auxiliary aids and services to passengers?

Code of Federal Regulations, 2014 CFR

2014-10-01

...' provision of auxiliary aids and services to passengers? 39.51 Section 39.51 Transportation Office of the... for Passengers § 39.51 What is the general requirement for PVOs' provision of auxiliary aids and... auxiliary aids and services where necessary to afford an individual with a disability an equal opportunity...

49 CFR 39.51 - What is the general requirement for PVOs' provision of auxiliary aids and services to passengers?

Code of Federal Regulations, 2011 CFR

2011-10-01

...' provision of auxiliary aids and services to passengers? 39.51 Section 39.51 Transportation Office of the... for Passengers § 39.51 What is the general requirement for PVOs' provision of auxiliary aids and... auxiliary aids and services where necessary to afford an individual with a disability an equal opportunity...

49 CFR 39.51 - What is the general requirement for PVOs' provision of auxiliary aids and services to passengers?

Code of Federal Regulations, 2012 CFR

2012-10-01

...' provision of auxiliary aids and services to passengers? 39.51 Section 39.51 Transportation Office of the... for Passengers § 39.51 What is the general requirement for PVOs' provision of auxiliary aids and... auxiliary aids and services where necessary to afford an individual with a disability an equal opportunity...

47 CFR 64.402 - Policies and procedures for the provision of priority access service by commercial mobile radio...

Code of Federal Regulations, 2010 CFR

2010-10-01

... priority access service by commercial mobile radio service providers. 64.402 Section 64.402... RULES RELATING TO COMMON CARRIERS Procedures for Handling Priority Services in Emergencies § 64.402 Policies and procedures for the provision of priority access service by commercial mobile radio service...

Are family-oriented interventions in Portuguese genetics services a remote possibility? Professionals' views on a multifamily intervention for cancer susceptibility families.

PubMed

Mendes, Alvaro; Paneque, Milena; Sousa, Liliana

2012-10-01

This article examines genetics healthcare professionals' opinions about a multifamily psychoeducational programme for hereditary cancer susceptibility families, implemented at a Portuguese genetics service. Their views on how a family-oriented approach is envisioned to be incorporated in Portuguese genetic counselling services are also reported. Six focus groups and three individual interviews were undertaken comprising 30 professionals working in the provision of genetic counselling and genetic counsellor trainees. Participants were given a page-summary describing the intervention and asked to comment the strengths and limitations of the multifamily intervention. All interviews were fully transcribed and analysed using the constant comparison method. The qualitative analysis generated data comprising four thematic categories in relation to the professionals' views: (a) usefulness of the programme; (b) programme's methodological and practical obstacles; (c) genetics services constraints; and (d) suggestions for improving the programme and further family-oriented interventions. We reflect on the reported views examining the intervention, and on how current constraints of genetic services limit the provision of psychosocial support for cancer susceptibility families. The implications of these findings regarding the purpose of genetic counselling are discussed. Results may sensitise stakeholders and policy makers for the need to deliver family-based services in cancer genetic counselling, with adequate planning and collaborative involvement of different professionals.

A Spatially-Explicit Technique for Evaluation of Alternative ...

EPA Pesticide Factsheets

Ecosystems contribute to maintaining human well-being directly through provision of goods and indirectly through provision of services that support clean water, clean air, flood protection and atmospheric stability. Transparently accounting for biophysical attributes from which humans derive benefit is essential to support dialog among the public, resource managers, decision makers, and scientists. We analyzed the potential ecosystem goods and services production from alternative future land use scenarios in the US Tampa Bay region. Ecosystem goods and service metrics included carbon sequestration, nitrogen removal, air pollutant removal, and stormwater retention. Each scenario was compared to a 2006 baseline land use. Estimated production of denitrification services changed by 28% and carbon sequestration by 20% between 2006 and the “business as usual” scenario. An alternative scenario focused on “natural resource protection” resulted in an estimated 9% loss in air pollution removal. Stormwater retention was estimated to change 18% from 2006 to 2060 projections. Cost effective areas for conservation, almost 1588 ha, beyond current conservation lands, were identified by comparing ecosystem goods and services production to assessed land values. Our ecosystem goods and services approach provides a simple and quantitative way to examine a more complete set of potential outcomes from land use decisions. This study demonstrates an approach for spatially expli

A decade of experience with a clinical pharmacokinetics service.

PubMed

Ambrose, P J; Smith, W E; Palarea, E R

1988-09-01

The development, operation, and functions of the pharmacokinetics service at Memorial Medical Center of Long Beach (MMCLB) are described, and the data used to determine the quality and cost-effectiveness of the service are presented. Current functions of the pharmacokinetics service at MMCLB include making brief written comments about the interpretations of serum drug concentrations (SDCs) and oral recommendations to physicians on dosage adjustment; provision of written consultations with dosage recommendations; provision of drug information, education, and research; and development of drug dosing guidelines for the pharmacy and medical staff. During the 10-year existence of this service, costs have been justified on the basis of not only revenue generated by the service (in the form of "drug concentration scheduling" and "drug concentration evaluation" fees charged to patients) but also by cost savings resulting from the prevention of inappropriate, misleading, and potentially dangerous SDCs. An audit conducted in 1986 showed that the policy of having pharmacists schedule the sampling times for SDCs saves about $500,000 annually. Quality assurance has been documented by auditing compliance with and therapeutic effectiveness of dosing guidelines and by working with laboratory personnel to identify and prevent spurious SDC results and assay errors. The methods used by the pharmacokinetics service at MMCLB to document the benefits of the service have been vital in proving both its cost-effectiveness and its positive effect on patient care.

Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study.

PubMed

Dawson, Angela J; Nicolls, Rachel; Bateson, Deborah; Doab, Anna; Estoesta, Jane; Brassil, Ann; Sullivan, Elizabeth A

2017-03-14

Australian Government approval in 2012 for the use of mifepristone and misoprostol for medical termination of pregnancy (MTOP) allows general practitioners (GPs) to provide early gestation abortion in primary care settings. However, uptake of the MTOP provision by GPs appears to be low and the reasons for this have been unclear. This study investigated the provision of and referral for MTOP by GPs. We undertook descriptive-interpretive qualitative research and selected participants for diversity using a matrix. Twenty-eight semi-structured interviews and one focus group (N = 4), were conducted with 32 GPs (8 MTOP providers, 24 non MTOP providers) in New South Wales, Australia. Interviews were recorded and transcribed verbatim. A framework to examine access to abortion services was used to develop the interview questions and emergent themes identified thematically. Three main themes emerged: scope of practice; MTOP demand, care and referral; and workforce needs. Many GPs saw abortion as beyond the scope of their practice (i.e. a service others provide in specialist private clinics). Some GPs had religious or moral objections; others regarded MTOP provision as complicated and difficult. While some GPs expressed interest in MTOP provision they were concerned about stigma and the impact it may have on perceptions of their practice and the views of colleagues. Despite a reported variance in demand most MTOP providers were busy but felt isolated. Difficulties in referral to a local public hospital in the case of complications or the provision of surgical abortion were noted. Exploring the factors which affect access to MTOP in general practice settings provides insights to assist the future planning and delivery of reproductive health services. This research identifies the need for support to increase the number of MTOP GP providers and for GPs who are currently providing MTOP. Alongside these actions provision in the public sector is required. In addition, formalised referral pathways to the public sector are required to ensure timely care in the case of complications or the provision of surgical options. Leadership and coordination across the health sector is needed to facilitate integrated abortion care particularly for rural and low income women.

Evaluating the Economic Impact of Smart Care Platforms: Qualitative and Quantitative Results of a Case Study

PubMed Central

Van der Auwermeulen, Thomas; Van Ooteghem, Jan; Jacobs, An; Verbrugge, Sofie; Colle, Didier

2016-01-01

Background In response to the increasing pressure of the societal challenge because of a graying society, a gulf of new Information and Communication Technology (ICT) supported care services (eCare) can now be noticed. Their common goal is to increase the quality of care while decreasing its costs. Smart Care Platforms (SCPs), installed in the homes of care-dependent people, foster the interoperability of these services and offer a set of eCare services that are complementary on one platform. These eCare services could not only result in more quality care for care receivers, but they also offer opportunities to care providers to optimize their processes. Objective The objective of the study was to identify and describe the expected added values and impacts of integrating SCPs in current home care delivery processes for all actors. In addition, the potential economic impact of SCP deployment is quantified from the perspective of home care organizations. Methods Semistructured and informal interviews and focus groups and cocreation workshops with service providers, managers of home care organizations, and formal and informal care providers led to the identification of added values of SCP integration. In a second step, process breakdown analyses of home care provisioning allowed defining the operational impact for home care organization. Impacts on 2 different process steps of providing home care were quantified. After modeling the investment, an economic evaluation compared the business as usual (BAU) scenario versus the integrated SCP scenario. Results The added value of SCP integration for all actors involved in home care was identified. Most impacts were qualitative such as increase in peace of mind, better quality of care, strengthened involvement in care provisioning, and more transparent care communication. For home care organizations, integrating SCPs could lead to a decrease of 38% of the current annual expenses for two administrative process steps namely, care rescheduling and the billing for care provisioning. Conclusions Although integrating SCP in home care processes could affect both the quality of life of the care receiver and informal care giver, only scarce and weak evidence was found that supports this assumption. In contrast, there exists evidence that indicates the lack of the impact on quality of life of the care receiver while it increases the cost of care provisioning. However, our cost-benefit quantification model shows that integrating SCPs in home care provisioning could lead to a considerable decrease of costs for care administrative tasks. Because of this cost decreasing impact, we believe that the integration of SCPs will be driven by home care organizations instead of the care receivers themselves. PMID:27799137

Evaluating the Economic Impact of Smart Care Platforms: Qualitative and Quantitative Results of a Case Study.

PubMed

Vannieuwenborg, Frederic; Van der Auwermeulen, Thomas; Van Ooteghem, Jan; Jacobs, An; Verbrugge, Sofie; Colle, Didier

2016-10-31

In response to the increasing pressure of the societal challenge because of a graying society, a gulf of new Information and Communication Technology (ICT) supported care services (eCare) can now be noticed. Their common goal is to increase the quality of care while decreasing its costs. Smart Care Platforms (SCPs), installed in the homes of care-dependent people, foster the interoperability of these services and offer a set of eCare services that are complementary on one platform. These eCare services could not only result in more quality care for care receivers, but they also offer opportunities to care providers to optimize their processes. The objective of the study was to identify and describe the expected added values and impacts of integrating SCPs in current home care delivery processes for all actors. In addition, the potential economic impact of SCP deployment is quantified from the perspective of home care organizations. Semistructured and informal interviews and focus groups and cocreation workshops with service providers, managers of home care organizations, and formal and informal care providers led to the identification of added values of SCP integration. In a second step, process breakdown analyses of home care provisioning allowed defining the operational impact for home care organization. Impacts on 2 different process steps of providing home care were quantified. After modeling the investment, an economic evaluation compared the business as usual (BAU) scenario versus the integrated SCP scenario. The added value of SCP integration for all actors involved in home care was identified. Most impacts were qualitative such as increase in peace of mind, better quality of care, strengthened involvement in care provisioning, and more transparent care communication. For home care organizations, integrating SCPs could lead to a decrease of 38% of the current annual expenses for two administrative process steps namely, care rescheduling and the billing for care provisioning. Although integrating SCP in home care processes could affect both the quality of life of the care receiver and informal care giver, only scarce and weak evidence was found that supports this assumption. In contrast, there exists evidence that indicates the lack of the impact on quality of life of the care receiver while it increases the cost of care provisioning. However, our cost-benefit quantification model shows that integrating SCPs in home care provisioning could lead to a considerable decrease of costs for care administrative tasks. Because of this cost decreasing impact, we believe that the integration of SCPs will be driven by home care organizations instead of the care receivers themselves. ©Frederic Vannieuwenborg, Thomas Van der Auwermeulen, Jan Van Ooteghem, An Jacobs, Sofie Verbrugge, Didier Colle. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 31.10.2016.

Assistive technologies after stroke: self-management or fending for yourself? A focus group study

PubMed Central

2013-01-01

Background Assistive Technologies, defined as “electrical or mechanical devices designed to help people recover movement” have demonstrated clinical benefits in upper-limb stroke rehabilitation. Stroke services are becoming community-based and more reliant on self-management approaches. Assistive technologies could become important tools within self-management, however, in practice, few people currently use assistive technologies. This study investigated patients’, family caregivers and health professionals’ experiences and perceptions of stroke upper-limb rehabilitation and assistive technology use and identified the barriers and facilitators to their use in supporting stroke self-management. Methods A three-day exhibition of assistive technologies was attended by 204 patients, family caregivers/friends and health professionals. Four focus groups were conducted with people purposively sampled from exhibition attendees. They included i) people with stroke who had used assistive technologies (n = 5), ii) people with stroke who had not used assistive technologies (n = 6), iii) family caregivers (n = 5) and iv) health professionals (n = 6). The audio-taped focus groups were facilitated by a moderator and observer. All participants were asked to discuss experiences, strengths, weaknesses, barriers and facilitators to using assistive technologies. Following transcription, data were analysed using thematic analysis. Results All respondents thought assistive technologies had the potential to support self-management but that this opportunity was currently unrealised. All respondents considered assistive technologies could provide a home-based solution to the need for high intensity upper-limb rehabilitation. All stakeholders also reported significant barriers to assistive technology use, related to i) device design ii) access to assistive technology information and iii) access to assistive technology provision. The lack of and need for a coordinated system for assistive technology provision was apparent. A circular limitation of lack of evidence in clinical settings, lack of funded provision, lack of health professional knowledge about assistive technologies and confidence in prescribing them leading to lack of assistive technology service provision meant that often patients either received no assistive technologies or they and/or their family caregivers liaised directly with manufacturers without any independent expert advice. Conclusions Considerable systemic barriers to realising the potential of assistive technologies in upper-limb stroke rehabilitation were reported. Attention needs to be paid to increasing evidence of assistive technology effectiveness and develop clinical service provision. Device manufacturers, researchers, health professionals, service funders and people with stroke and family caregivers need to work creatively and collaboratively to develop new funding models, improve device design and increase knowledge and training in assistive technology use. PMID:23968362

Bereavement and Bereavement Care in Health and Social Care: Provision and Practice in Scotland

ERIC Educational Resources Information Center

Stephen, Audrey I.; Wimpenny, Peter; Unwin, Rachel; Work, Fiona; Dempster, Paul; MacDuff, Colin; Wilcock, Sylvia E.; Brown, Alison

2009-01-01

The interview study described here aimed to explore current views of and practice in bereavement care and identify priorities for service development in Scotland. Fifty-nine participants who worked with the bereaved in some way, or whose interest was in bereavement or bereavement care, were interviewed. They represented National Health Service…

Engaging in Continuing Education and Training: Learning Preferences of Worker-Learners in the Health and Community Services Industry

ERIC Educational Resources Information Center

Choy, Sarojni; Billett, Stephen; Kelly, Ann

2013-01-01

Current tertiary education and training provisions are designed mainly to meet the learning needs of those preparing for entry into employment and specific occupations. Yet, changing work, new work requirements, an ageing workforce and the ongoing need for employability across lengthening working lives make it imperative that this educational…

Keeping the Roses Watered: The Continuing Professional Development of Librarians in New Zealand

ERIC Educational Resources Information Center

Cossham, Amanda; Fields, Alison

2006-01-01

Continuing professional development is a necessary aspect of keeping up to date in a rapidly changing profession. Librarians are no more immune to evolutions in technology and innovation, service provision and customer expectations than any other professional group. This paper explores the current New Zealand setting and context of CPD for…

Family Wellbeing of Individuals with Autism Spectrum Disorder: A Scoping Review

ERIC Educational Resources Information Center

Tint, Ami; Weiss, Jonathan A.

2016-01-01

Families play an important role in supporting individuals with autism spectrum disorder across the lifespan. Indicators of family wellbeing can help to establish benchmarks for service provision and evaluation; however, a critical first step is a clear understanding of the construct in question. The purpose of the current scoping review was to (a)…

The Mid-Atlantic Regional Wetland Conservation Effects Assessment Project

Treesearch

Megan Lang; Greg McCarty; Mark Walbridge; Patrick Hunt; Tom Ducey; Clinton Church; Jarrod Miller; Laurel Kluber; Ali Sadeghi; Martin Rabenhorst; Amir Sharifi; In-Young Yeo; Andrew Baldwin; Margaret Palmer; Tom Fisher; Dan Fenstermaher; Sanchul Lee; Owen McDonough; Metthea Yepsen; Liza McFarland; Anne Gustafson; Rebecca Fox; Chris Palardy; William Effland; Mari-Vaughn Johnson; Judy Denver; Scott Ator; Joseph Mitchell; Dennis Whigham

2016-01-01

Wetlands impart many important ecosystem services, including maintenance of water quality, regulation of the climate and hydrological flows, and enhancement of biodiversity through the provision of food and habitat. The conversion of natural lands to agriculture has led to broad scale historic wetland loss, but current US Department of Agriculture conservation programs...

Integrated Practice in the Early Years in Australia: The Assumptions, Omissions and Contradictions of Policy Reform

ERIC Educational Resources Information Center

Macfarlane, Kym; Nolan, Andrea; Cartmel, Jennifer

2016-01-01

The aim of this article is to examine current national early years' policy reform, which emphasises the importance of service integration, national quality standards and a quality knowledge base for educators concerning the provision of early childhood education and care. Using Queensland, Australia, as an example, a policy discourse analysis…

The Provision of Counseling Services among School Psychologists: An Exploration of Training, Current Practices, and Perceptions

ERIC Educational Resources Information Center

Hanchon, Timothy A.; Fernald, Lori N.

2013-01-01

Although school psychologists have been called on in recent literature to assume a leadership role in a collective and comprehensive effort to address students' mental health needs, many practitioners find that their professional roles continue to be narrowly focused on special education-related activities, such as individualized assessment…

The Professionalization of Educational Leaders through Postgraduate Study and Professional Development Opportunities in New Zealand Tertiary Education Institutions

ERIC Educational Resources Information Center

Macpherson, Reynold

2010-01-01

This paper reports a review of the professionalization services in educational leadership available from New Zealand's tertiary institutions at a time of accelerating retirements and turnover. Case studies of current programs identified six urgent policy issues: the need for research-based provisions in early childhood education (ECE); potential…

Smartphone as a personal, pervasive health informatics services platform: literature review.

PubMed

Wac, K

2012-01-01

The article provides an overview of current trends in personal sensor, signal and imaging informatics, that are based on emerging mobile computing and communications technologies enclosed in a smartphone and enabling the provision of personal, pervasive health informatics services. The article reviews examples of these trends from the PubMed and Google scholar literature search engines, which, by no means claim to be complete, as the field is evolving and some recent advances may not be documented yet. There exist critical technological advances in the surveyed smartphone technologies, employed in provision and improvement of diagnosis, acute and chronic treatment and rehabilitation health services, as well as in education and training of healthcare practitioners. However, the most emerging trend relates to a routine application of these technologies in a prevention/wellness sector, helping its users in self-care to stay healthy. Smartphone-based personal health informatics services exist, but still have a long way to go to become an everyday, personalized healthcare-provisioning tool in the medical field and in a clinical practice. Key main challenge for their widespread adoption involve lack of user acceptance striving from variable credibility and reliability of applications and solutions as they a) lack evidence- based approach; b) have low levels of medical professional involvement in their design and content; c) are provided in an unreliable way, influencing negatively its usability; and, in some cases, d) being industry-driven, hence exposing bias in information provided, for example towards particular types of treatment or intervention procedures.

Quality Primary Care and Family Planning Services for LGBT Clients: A Comprehensive Review of Clinical Guidelines.

PubMed

Klein, David A; Malcolm, Nikita M; Berry-Bibee, Erin N; Paradise, Scott L; Coulter, Jessica S; Keglovitz Baker, Kristin; Schvey, Natasha A; Rollison, Julia M; Frederiksen, Brittni N

2018-04-01

LGBT clients have unique healthcare needs but experience a wide range of quality in the care that they receive. This study provides a summary of clinical guideline recommendations related to the provision of primary care and family planning services for LGBT clients. In addition, we identify gaps in current guidelines, and inform future recommendations and guidance for clinical practice and research. PubMed, Cochrane, and Agency for Healthcare Research and Quality electronic bibliographic databases, and relevant professional organizations' websites, were searched to identify clinical guidelines related to the provision of primary care and family planning services for LGBT clients. Information obtained from a technical expert panel was used to inform the review. Clinical guidelines meeting the inclusion criteria were assessed to determine their alignment with Institute of Medicine (IOM) standards for the development of clinical practice guidelines and content relevant to the identified themes. The search parameters identified 2,006 clinical practice guidelines. Seventeen clinical guidelines met the inclusion criteria. Two of the guidelines met all eight IOM criteria. However, many recommendations were consistent regarding provision of services to LGBT clients within the following themes: clinic environment, provider cultural sensitivity and awareness, communication, confidentiality, coordination of care, general clinical principles, mental health considerations, and reproductive health. Guidelines for the primary and family planning care of LGBT clients are evolving. The themes identified in this review may guide professional organizations during guideline development, clinicians when providing care, and researchers conducting LGBT-related studies.

Nonrandom extinction patterns can modulate pest control service decline.

PubMed

Karp, Daniel S; Moeller, Holly V; Frishkoff, Luke O

2013-06-01

Changes in biodiversity will mediate the consequences of agricultural intensification and expansion for ecosystem services. Regulating services, like pollination and pest control, generally decline with species loss. In nature, however, relationships between service provision and species richness are not always strong, partially because anthropogenic disturbances purge species from communities in nonrandom orders. The same traits that make for effective service providers may also confer resistance or sensitivity to anthropogenic disturbances, which may either temper or accelerate declines in service provision with species loss. We modeled a community of predators interacting with insect pest prey, and identified the contexts in which pest control provision was most sensitive to species loss. We found pest populations increased rapidly when functionally unique and dietary-generalist predators were lost first, with up to 20% lower pest control provision than random loss. In general, pest abundance increased most in the scenarios that freed more pest species from predation. Species loss also decreased the likelihood that the most effective service providers were present. In communities composed of species with identical traits, predators were equally effective service providers and, when competing predators went extinct, remaining community members assumed their functional roles. In more realistic trait-diverse communities, predators differed in pest control efficacy, and remaining predators could not fully compensate for the loss of their competitors, causing steeper declines in pest control provision with predator species loss. These results highlight diet breadth in particular as a key predictor of service provision, as it affects both the way species respond to and alter their environments. More generally, our model provides testable hypotheses for predicting how nonrandom species loss alters relationships between biodiversity and pest control provision.

Technologies for HIV prevention and care: challenges for health services.

PubMed

Maksud, Ivia; Fernandes, Nilo Martinez; Filgueiras, Sandra Lucia

2015-09-01

This article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), treatment as prevention (TASP) and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO) articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.

Football and dementia: A qualitative investigation of a community based sports group for men with early onset dementia.

PubMed

Carone, Laura; Tischler, Victoria; Dening, Tom

2016-11-01

This study investigates the impact of a weekly group providing sport and physical activities for men with early onset dementia established by Notts County Football in the Community (NCFC). There were three aims: to investigate the effect of early onset dementia on individuals with the condition and their carers; to examine the perceptions of current levels of service provision for people with early onset dementia; and to analyse the impact of the group. Men with dementia (n = 5) attending the sessions, their carers (n = 5), NCFC coaching staff (n = 5) and people organizing/facilitating the sessions (n = 5) were interviewed. Semi-structured interviews explored the participants' experiences of dementia, their opinions on current service provisions and on the sessions. Data were analysed using thematic analysis. Four main themes were found: loss related to the condition of dementia and its impact on relationships ('Loss'); lack of age-appropriate services for people with early onset dementia ('Lack of Resources'); enjoyment and positive anticipation related to the group for all involved ('Enjoyment and Anticipation'); and 'the Notts County Effect' which attributed the success of the sessions to the strong brand of the football club, and to personalized service in a "dementia-free" environment. The NCFC sessions provided a safe low-cost intervention with positive effects upon quality of life for both people with early onset dementia, their carers and the staff involved. This suggests that the service may be valuable to a wider range of people living in different areas. © The Author(s) 2014.

5 CFR 875.203 - Am I eligible if I separated under the FERS MRA+10 provision?

Code of Federal Regulations, 2014 CFR

2014-01-01

... FERS MRA+10 provision? 875.203 Section 875.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT....203 Am I eligible if I separated under the FERS MRA+10 provision? If you have separated from service under the FERS Minimum Retirement Age and 10 years of service (MRA+10) provision of 5 U.S.C. 8412(g...

5 CFR 875.203 - Am I eligible if I separated under the FERS MRA+10 provision?

Code of Federal Regulations, 2012 CFR

2012-01-01

... FERS MRA+10 provision? 875.203 Section 875.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT....203 Am I eligible if I separated under the FERS MRA+10 provision? If you have separated from service under the FERS Minimum Retirement Age and 10 years of service (MRA+10) provision of 5 U.S.C. 8412(g...

5 CFR 875.203 - Am I eligible if I separated under the FERS MRA+10 provision?

Code of Federal Regulations, 2013 CFR

2013-01-01

... FERS MRA+10 provision? 875.203 Section 875.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT....203 Am I eligible if I separated under the FERS MRA+10 provision? If you have separated from service under the FERS Minimum Retirement Age and 10 years of service (MRA+10) provision of 5 U.S.C. 8412(g...

5 CFR 875.203 - Am I eligible if I separated under the FERS MRA+10 provision?

Code of Federal Regulations, 2010 CFR

2010-01-01

... FERS MRA+10 provision? 875.203 Section 875.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT....203 Am I eligible if I separated under the FERS MRA+10 provision? If you have separated from service under the FERS Minimum Retirement Age and 10 years of service (MRA+10) provision of 5 U.S.C. 8412(g...

5 CFR 875.203 - Am I eligible if I separated under the FERS MRA+10 provision?

Code of Federal Regulations, 2011 CFR

2011-01-01

... FERS MRA+10 provision? 875.203 Section 875.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT....203 Am I eligible if I separated under the FERS MRA+10 provision? If you have separated from service under the FERS Minimum Retirement Age and 10 years of service (MRA+10) provision of 5 U.S.C. 8412(g...

77 FR 42513 - Sunshine Act Meetings Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-19

... LEGAL SERVICES CORPORATION Sunshine Act Meetings Notice DATE AND TIME: The Legal Services... Committee 5. Promotion & Provision for the Delivery of Legal Services Committee. 6. Operations & Regulations....C. Sec. 552b(c)(9) and (10), and the corresponding provision of the Legal Services Corporation's...

42 CFR 403.756 - Sunset provision.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Sunset provision. 403.756 Section 403.756 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 403.752 - Payment provisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment provisions. 403.752 Section 403.752 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 403.756 - Sunset provision.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Sunset provision. 403.756 Section 403.756 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 403.756 - Sunset provision.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Sunset provision. 403.756 Section 403.756 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 403.752 - Payment provisions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Payment provisions. 403.752 Section 403.752 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 403.752 - Payment provisions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Payment provisions. 403.752 Section 403.752 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 403.752 - Payment provisions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Payment provisions. 403.752 Section 403.752 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 403.756 - Sunset provision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Sunset provision. 403.756 Section 403.756 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 403.752 - Payment provisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Payment provisions. 403.752 Section 403.752 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

42 CFR 403.756 - Sunset provision.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Sunset provision. 403.756 Section 403.756 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions...

Modeling Temporal and Spatial Flows of Ecosystem Services in Chittenden County, VT

NASA Astrophysics Data System (ADS)

Voigt, B. G.; Bagstad, K.; Johnson, G.; Villa, F.

2010-12-01

This paper documents the integration of ARIES (ARtificial Intelligence for Ecosystem Services) with the land use change model UrbanSim to explore the impacts of current and future land use patterns on flood protection and water provision services in Chittenden County, VT. ARIES, an open source modeling platform, is particularly well-suited for measuring, mapping, and modeling the temporal and spatial flows of ecosystem services across the landscape, linking the areas of provision (sources) with human beneficiaries (users) through a spatially explicit agent-based modeling approach. UrbanSim is an open source agent-based land use model designed to facilitate a wide-range of scenarios based on user-specified behavioral assumptions, zoning regulations, and demographic, economic, and infrastructure (e.g. transportation, water, sewer, etc.) parameters. Ecosystem services travel through time and space and are susceptible to disruption and destruction from both natural and anthropogenic perturbations. The conversion of forested or agricultural land to urbanizing uses is replete with a long history of hydrologic impairment, habitat fragmentation, and the degradation of sensitive landscapes. Development decisions are predicated on the presence of landscape characteristics that meet the needs of developers and satisfy the desires of consumers, with minimal consideration of access to or effect on the provision of ecosystem services. The County houses nearly 25% of the state’s population and several employment centers that draw labor from throughout the region. Additionally, the County is expected to maintain modest residential and employment growth over the next 30 years, and will continue to serve as the state’s population and employment center. Expected future growth is likely to adversely affect the remaining farm and forest land in the County in the absence of policies to support sustainable development. We demonstrate how ARIES can be used to quantify changes in ecosystem service provision based on the outcomes of alternative land use change model scenarios. Stakeholder workshops were hosted to develop scenarios relevant to planning for future growth in the County, including alternative zoning regulations, road network improvements, and a range of future population projections. The results of the land use change simulations were passed to ARIES to model flood protection and water provision services for each of the alternative scenarios. We present Bayesian models of the ecosystem services as individual source, sink, and use components coupled with models of temporal and spatial flows of services across the landscape. Specific beneficiaries include homeowners, farmers, and other business property owners. The location choice decisions of residential and non-residential agents under the alternative scenarios resulted in varying access to ecosystem services depending on development density, habitat fragmentation, and the degree of hydrological impairment, among other factors. Modeled outputs include maps depicting flow paths (linking sources to beneficiaries), changes in land use, hotspot locations that are critical to sustain the flow of services across the landscape, and the demand for and supply of the modeled services.

Anticipative management for coral reef ecosystem services in the 21st century.

PubMed

Rogers, Alice; Harborne, Alastair R; Brown, Christopher J; Bozec, Yves-Marie; Castro, Carolina; Chollett, Iliana; Hock, Karlo; Knowland, Cheryl A; Marshell, Alyssa; Ortiz, Juan C; Razak, Tries; Roff, George; Samper-Villarreal, Jimena; Saunders, Megan I; Wolff, Nicholas H; Mumby, Peter J

2015-02-01

Under projections of global climate change and other stressors, significant changes in the ecology, structure and function of coral reefs are predicted. Current management strategies tend to look to the past to set goals, focusing on halting declines and restoring baseline conditions. Here, we explore a complementary approach to decision making that is based on the anticipation of future changes in ecosystem state, function and services. Reviewing the existing literature and utilizing a scenario planning approach, we explore how the structure of coral reef communities might change in the future in response to global climate change and overfishing. We incorporate uncertainties in our predictions by considering heterogeneity in reef types in relation to structural complexity and primary productivity. We examine 14 ecosystem services provided by reefs, and rate their sensitivity to a range of future scenarios and management options. Our predictions suggest that the efficacy of management is highly dependent on biophysical characteristics and reef state. Reserves are currently widely used and are predicted to remain effective for reefs with high structural complexity. However, when complexity is lost, maximizing service provision requires a broader portfolio of management approaches, including the provision of artificial complexity, coral restoration, fish aggregation devices and herbivore management. Increased use of such management tools will require capacity building and technique refinement and we therefore conclude that diversification of our management toolbox should be considered urgently to prepare for the challenges of managing reefs into the 21st century. © 2014 John Wiley & Sons Ltd.

40 CFR 63.168 - Standards: Valves in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2010 CFR

2010-07-01

... § 63.168 Standards: Valves in gas/vapor service and in light liquid service. (a) The provisions of this section apply to valves that are either in gas service or in light liquid service. (1) The provisions are... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Standards: Valves in gas/vapor service...

40 CFR 63.168 - Standards: Valves in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2011 CFR

2011-07-01

... § 63.168 Standards: Valves in gas/vapor service and in light liquid service. (a) The provisions of this section apply to valves that are either in gas service or in light liquid service. (1) The provisions are... 40 Protection of Environment 9 2011-07-01 2011-07-01 false Standards: Valves in gas/vapor service...

40 CFR 63.168 - Standards: Valves in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2013 CFR

2013-07-01

... § 63.168 Standards: Valves in gas/vapor service and in light liquid service. (a) The provisions of this section apply to valves that are either in gas service or in light liquid service. (1) The provisions are... 40 Protection of Environment 10 2013-07-01 2013-07-01 false Standards: Valves in gas/vapor service...

40 CFR 63.168 - Standards: Valves in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2014 CFR

2014-07-01

... § 63.168 Standards: Valves in gas/vapor service and in light liquid service. (a) The provisions of this section apply to valves that are either in gas service or in light liquid service. (1) The provisions are... 40 Protection of Environment 10 2014-07-01 2014-07-01 false Standards: Valves in gas/vapor service...

40 CFR 63.168 - Standards: Valves in gas/vapor service and in light liquid service.

Code of Federal Regulations, 2012 CFR

2012-07-01

... § 63.168 Standards: Valves in gas/vapor service and in light liquid service. (a) The provisions of this section apply to valves that are either in gas service or in light liquid service. (1) The provisions are... 40 Protection of Environment 10 2012-07-01 2012-07-01 false Standards: Valves in gas/vapor service...

Safeguarding Ecosystem Services: A Methodological Framework to Buffer the Joint Effect of Habitat Configuration and Climate Change

PubMed Central

Giannini, Tereza C.; Tambosi, Leandro R.; Acosta, André L.; Jaffé, Rodolfo; Saraiva, Antonio M.; Imperatriz-Fonseca, Vera L.; Metzger, Jean Paul

2015-01-01

Ecosystem services provided by mobile agents are increasingly threatened by the loss and modification of natural habitats and by climate change, risking the maintenance of biodiversity, ecosystem functions, and human welfare. Research oriented towards a better understanding of the joint effects of land use and climate change over the provision of specific ecosystem services is therefore essential to safeguard such services. Here we propose a methodological framework, which integrates species distribution forecasts and graph theory to identify key conservation areas, which if protected or restored could improve habitat connectivity and safeguard ecosystem services. We applied the proposed framework to the provision of pollination services by a tropical stingless bee (Melipona quadrifasciata), a key pollinator of native flora from the Brazilian Atlantic Forest and important agricultural crops. Based on the current distribution of this bee and that of the plant species used to feed and nest, we projected the joint distribution of bees and plants in the future, considering a moderate climate change scenario (following IPPC). We then used this information, the bee’s flight range, and the current mapping of Atlantic Forest remnants to infer habitat suitability and quantify local and regional habitat connectivity for 2030, 2050 and 2080. Our results revealed north to south and coastal to inland shifts in the pollinator distribution during the next 70 years. Current and future connectivity maps unraveled the most important corridors, which if protected or restored, could facilitate the dispersal and establishment of bees during distribution shifts. Our results also suggest that coffee plantations from eastern São Paulo and southern Minas Gerais States could suffer a pollinator deficit in the future, whereas pollination services seem to be secured in southern Brazil. Landowners and governmental agencies could use this information to implement new land use schemes. Overall, our proposed methodological framework could help design novel conservational and agricultural practices that can be crucial to conserve ecosystem services by buffering the joint effect of habitat configuration and climate change. PMID:26091014

A family-centered, community-based system of services for children and youth with special health care needs.

PubMed

Perrin, James M; Romm, Diane; Bloom, Sheila R; Homer, Charles J; Kuhlthau, Karen A; Cooley, Carl; Duncan, Paula; Roberts, Richard; Sloyer, Phyllis; Wells, Nora; Newacheck, Paul

2007-10-01

To present a conceptual definition of a family-centered system of services for children and youth with special health care needs (CYSHCN). Previous work by the Maternal and Child Health Bureau to define CYSHCN has had widespread program effects. This article similarly seeks to provide a definition of a system of services. Comprehensive literature review of systems of services and consensus panel organized to review and refine the definition. Policy research group and advisors at multiple sites. Policy researchers, content experts on CYSHCN, family representatives, and state program directors. Definition of a system of services for CYSHCN. This article defines a system of services for CYSHCN as a family-centered network of community-based services designed to promote the healthy development and well-being of these children and their families. The definition can guide discussion among policy makers, practitioners, state programs, researchers, and families for implementing the "community-based systems of services" contained in Title V of the Social Security Act. Critical characteristics of a system include coordination of child and family services, effective communication among providers and the family, family partnership in care provision, and flexibility. This definition provides a conceptual model that can help measurement development and assessment of how well systems work and achieve their goals. Currently available performance objectives for the provision of care for CYSHCN and national surveys of child health could be modified to assess systems of services in general.

Networked remote area dental services: a viable, sustainable approach to oral health care in challenging environments.

PubMed

Dyson, Kate; Kruger, Estie; Tennant, Marc

2012-12-01

This study examines the cost effectiveness of a model of remote area oral health service. Retrospective financial analysis. Rural and remote primary health services. Clinical activity data and associated cost data relating to the provision of a networked visiting oral health service by the Centre for Rural and Remote Oral Health formed the basis of the study data frameset. The cost-effectiveness of the Centre's model of service provision at five rural and remote sites in Western Australia during the calendar years 2006, 2008 and 2010 was examined in the study. Calculations of the service provision costs and value of care provided were made using data records and the Fee Schedule of Dental Services for Dentists. The ratio of service provision costs to the value of care provided was determined for each site and was benchmarked against the equivalent ratios applicable to large scale government sector models of service provision. The use of networked models have been effective in other disciplines but this study is the first to show a networked hub and spoke approach of five spokes to one hub is cost efficient in remote oral health care. By excluding special cost-saving initiatives introduced by the Centre, the study examines easily translatable direct service provision costs against direct clinical care outcomes in some of Australia's most challenging locations. This study finds that networked hub and spoke models of care can be financially efficient arrangements in remote oral health care. © 2012 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

Genetic service delivery: infrastructure, assessment and information.

PubMed

Kaye, C I

2012-01-01

Identification of genomic determinants of complex disorders such as cancer, diabetes and cardiovascular disease has prompted public health systems to focus on genetic service delivery for prevention of these disorders, adding to their previous efforts in birth defects prevention and newborn screening. This focus is consistent with previously identified obligations of the public health system as well as the core functions of public health identified by the Institute of Medicine. Models of service delivery include provision of services by the primary care provider in conjunction with subspecialists, provision of services through the medical home with co-management by genetics providers, provision of services in conjunction with disorder-specific treatment centers, and provision of services through a network of genetics clinics linked to medical homes. Whatever the model for provision of genetic services, tools to assist providers include facilities for outreach and telemedicine, information technology, just-in-time management plans, and emergency management tools. Assessment tools to determine which care is best are critical for quality improvement and development of best practices. Because the workforce of genetics providers is not keeping pace with the need for services, an understanding of the factors contributing to this lag is important, as is the development of an improved knowledge base in genomics for primary care providers. Copyright © 2012 S. Karger AG, Basel.

Developmental communication impairments in adults: outcomes and life experiences of adults and their parents.

PubMed

Clegg, Judy; Ansorge, Lydia; Stackhouse, Joy; Donlan, Chris

2012-10-01

This study identifies the outcomes and documents the longitudinal life experiences of adults who attended a specialist residential school for children with pervasive and complex developmental communication impairments. Semistructured interviews were carried out with 26 adult ex-pupils who had attended the school and the parents of 15 of the ex-pupils. Seven key themes were identified from the data, including (a) lack of appropriate support and the impact of this in early childhood, (b) advantages and disadvantages of specialist educational provision compared to mainstream and other provision, (c) changing impact of developmental communication impairments over time, (d) challenging transition away from specialist educational provision, (e) absence of appropriate support for adults with developmental communication impairments, (f) persisting impact of developmental communication impairments on social and emotional functioning in adult life, and (g) differences in perspective between the adult ex-pupils and their parents. Across the adult ex-pupils and their parents, the perceived reported benefits of early intervention, parental support, specialist educational provision, and guidance at times of transitions should inform current service provision for this vulnerable group of individuals and their families.

76 FR 20050 - Sunshine Act Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-11

... LEGAL SERVICES CORPORATION Sunshine Act Meetings Notice DATE AND TIME: The Legal Services.... Promotion & Provision for the Delivery 9 a.m. of Legal Services Committee. 2. Operations & Regulations... provisions of the Legal Services Corporation's implementing regulation, 45 CFR 1622.5(a) and (h), will not be...

Disability and employee benefits receipt: evidence from the U.S. Vocational Rehabilitation Services Program.

PubMed

Sosulski, Marya R; Donnell, Chandra; Kim, Woo Jong

2012-01-01

Studies indicate positive effects of the U.S. Vocational Rehabilitation Services (VRS) in assisting people with disabilities to find independent employment. Underemployment continues to impact access to adequate health care and other benefits. Workers with disabilities receive fewer benefits, overall. With data from the Longitudinal Study of Vocational Rehabilitation Services Program (LSVRSP), the authors compare the rates of receipt of 6 types of benefits for people with physical, mental, and sensory impairments. Although those with physical disabilities are most likely to receive benefits, all groups lack adequate access to health care, sick leave, and vacation. The authors discuss implications for services provision in the current job market.

Utility, economic rationalism and the circumscription of agency.

PubMed

Dirita, P A; Parmenter, T R; Stancliffe, R J

2008-07-01

Great strides have been achieved over the past few decades in service provision for people with intellectual disability (ID). However, there has also been a growth in the use of economic rationalism and a related rise in managerialism in forming service provision outcomes. An account of the focus on process and means of provision directed within the managerialist agenda to determine how individual authority has become subsumed within patterns of dependence. An underlying influence of utilitarianism has led to a focus on servicing the average through service provision trajectories which in turn have weakened the pace for social change and perpetuated a vulnerable conception of people with ID. There has been a qualification of the idealised intent of providing individualised support, choice and recognition of the moral worth of people with ID into relative features of equality. There remains an overriding static conception of the person with ID within funding frameworks and service provision which relies on economic and rationalist depictions of the individual.

Estimating the value of non-use benefits from small changes in the provision of ecosystem services.

PubMed

Dutton, Adam; Edwards-Jones, Gareth; Macdonald, David W

2010-12-01

The unit of trade in ecosystem services is usually the use of a proportion of the parcels of land associated with a given service. Valuing small changes in the provision of an ecosystem service presents obstacles, particularly when the service provides non-use benefits, as is the case with conservation of most plants and animals. Quantifying non-use values requires stated-preference valuations. Stated-preference valuations can provide estimates of the public's willingness to pay for a broad conservation goal. Nevertheless, stated-preference valuations can be expensive and do not produce consistent measures for varying levels of provision of a service. Additionally, the unit of trade, land use, is not always linearly related to the level of ecosystem services the land might provide. To overcome these obstacles, we developed a method to estimate the value of a marginal change in the provision of a non-use ecosystem service--in this case conservation of plants or animals associated with a given land-cover type. Our method serves as a tool for calculating transferable valuations of small changes in the provision of ecosystem services relative to the existing provision. Valuation is achieved through stated-preference investigations, calculation of a unit value for a parcel of land, and the weighting of this parcel by its ability to provide the desired ecosystem service and its effect on the ability of the surrounding land parcels to provide the desired service. We used the water vole (Arvicola terrestris) as a case study to illustrate the method. The average present value of a meter of water vole habitat was estimated at UK £ 12, but the marginal value of a meter (based on our methods) could range between £ 0 and £ 40 or more. © 2010 Society for Conservation Biology.

Institutional public private partnerships for core health services: evidence from Italy

PubMed Central

2011-01-01

Background Public-private partnerships (PPPs) are potential instruments to enable private collaboration in the health sector. Despite theoretical debate, empirical analyses have thus far tended to focus on the contractual or project dimension, overlooking institutional PPPs, i.e., formal legal entities run by proper corporate-governance mechanisms and jointly owned by public and private parties for the provision of public-health goods. This work aims to fill this gap by carrying out a comparative analysis of the reasons for the adoption of institutional PPPs and the governance and managerial features necessary to establish them as appropriate arrangements for public-health services provisions. Methods A qualitative analysis is carried out on experiences of institutional PPPs within the Italian National Health Service (Sistema Sanitario Nazionale, SSN). The research question is addressed through a contextual and comparative embedded case study design, assuming the entire population of PPPs (4) currently in force in one Italian region as the unit of analysis: (i) a rehabilitation hospital, (ii), an orthopaedic-centre, (iii) a primary care and ambulatory services facility, and (iv) a health- and social-care facility. Internal validity is guaranteed by the triangulation of sources in the data collection phase, which included archival and interview data. Results Four governance and managerial issues were found to be critical in determining the positive performance of the case examined: (i) a strategic market orientation to a specialised service area with sufficient potential demand, (ii) the allocation of public capital assets and the consistent financial involvement of the private partner, (iii) the adoption of private administrative procedures in a regulated setting while guaranteeing the respect of public administration principles, and (iv) clear regulation of the workforce to align the contracts with the organisational culture. Conclusions Findings suggests that institutional PPPs enable national health services to reap great benefits when introduced as a complement to the traditional public-service provisions for a defined set of services and goals. PMID:21504580

Institutional public private partnerships for core health services: evidence from Italy.

PubMed

Cappellaro, Giulia; Longo, Francesco

2011-04-19

Public-private partnerships (PPPs) are potential instruments to enable private collaboration in the health sector. Despite theoretical debate, empirical analyses have thus far tended to focus on the contractual or project dimension, overlooking institutional PPPs, i.e., formal legal entities run by proper corporate-governance mechanisms and jointly owned by public and private parties for the provision of public-health goods. This work aims to fill this gap by carrying out a comparative analysis of the reasons for the adoption of institutional PPPs and the governance and managerial features necessary to establish them as appropriate arrangements for public-health services provisions. A qualitative analysis is carried out on experiences of institutional PPPs within the Italian National Health Service (Sistema Sanitario Nazionale, SSN). The research question is addressed through a contextual and comparative embedded case study design, assuming the entire population of PPPs (4) currently in force in one Italian region as the unit of analysis: (i) a rehabilitation hospital, (ii), an orthopaedic-centre, (iii) a primary care and ambulatory services facility, and (iv) a health- and social-care facility. Internal validity is guaranteed by the triangulation of sources in the data collection phase, which included archival and interview data. Four governance and managerial issues were found to be critical in determining the positive performance of the case examined: (i) a strategic market orientation to a specialised service area with sufficient potential demand, (ii) the allocation of public capital assets and the consistent financial involvement of the private partner, (iii) the adoption of private administrative procedures in a regulated setting while guaranteeing the respect of public administration principles, and (iv) clear regulation of the workforce to align the contracts with the organisational culture. Findings suggests that institutional PPPs enable national health services to reap great benefits when introduced as a complement to the traditional public-service provisions for a defined set of services and goals.

1 CFR 3.1 - Information services.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 1 General Provisions 1 2011-01-01 2011-01-01 false Information services. 3.1 Section 3.1 General Provisions ADMINISTRATIVE COMMITTEE OF THE FEDERAL REGISTER GENERAL SERVICES TO THE PUBLIC § 3.1 Information services. Except in cases where the time required would be excessive, information concerning the...

1 CFR 3.1 - Information services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 1 General Provisions 1 2010-01-01 2010-01-01 false Information services. 3.1 Section 3.1 General Provisions ADMINISTRATIVE COMMITTEE OF THE FEDERAL REGISTER GENERAL SERVICES TO THE PUBLIC § 3.1 Information services. Except in cases where the time required would be excessive, information concerning the...

1 CFR 3.1 - Information services.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 1 General Provisions 1 2014-01-01 2012-01-01 true Information services. 3.1 Section 3.1 General Provisions ADMINISTRATIVE COMMITTEE OF THE FEDERAL REGISTER GENERAL SERVICES TO THE PUBLIC § 3.1 Information services. Except in cases where the time required would be excessive, information concerning the...

1 CFR 3.1 - Information services.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 1 General Provisions 1 2012-01-01 2012-01-01 false Information services. 3.1 Section 3.1 General Provisions ADMINISTRATIVE COMMITTEE OF THE FEDERAL REGISTER GENERAL SERVICES TO THE PUBLIC § 3.1 Information services. Except in cases where the time required would be excessive, information concerning the...

1 CFR 3.1 - Information services.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 1 General Provisions 1 2013-01-01 2012-01-01 true Information services. 3.1 Section 3.1 General Provisions ADMINISTRATIVE COMMITTEE OF THE FEDERAL REGISTER GENERAL SERVICES TO THE PUBLIC § 3.1 Information services. Except in cases where the time required would be excessive, information concerning the...

Provision of Personal Healthcare Services by Local Health Departments: 2008-2013.

PubMed

Luo, Huabin; Sotnikov, Sergey; Winterbauer, Nancy

2015-09-01

The scope of local health department (LHD) involvement in providing personal healthcare services versus population-based services has been debated for decades. A 2012 IOM report suggests that LHDs should gradually withdraw from providing personal healthcare services. The purpose of this study is to assess the level of LHD involvement in provision of personal healthcare services during 2008-2013 and examine the association between provision of personal healthcare services and per capita public health expenditures. Data are from the 2013 survey of LHDs and Area Health Resource Files. The number, ratio, and share of revenue from personal healthcare services were estimated. Both linear and panel fixed effects models were used to examine the association between provision of personal healthcare services and per capita public health expenditures. Data were analyzed in 2014. The mean number of personal healthcare services provided by LHDs did not change significantly in 2008-2013. Overall, personal services constituted 28% of total service items. The share of revenue from personal services increased from 16.8% in 2008 to 20.3% in 2013. Results from the fixed effect panel models show a positive association between personal healthcare services' share of revenue and per capita expenditures (b=0.57, p<0.001). A lower share of revenue from personal healthcare services is associated with lower per capita expenditures. LHDs, especially those serving <25,000 people, are highly dependent on personal healthcare revenue to sustain per capita expenditures. LHDs may need to consider strategies to replace lost revenue from discontinuing provision of personal healthcare services. Copyright © 2015 American Journal of Preventive Medicine. All rights reserved.

42 CFR 71.31 - General provisions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false General provisions. 71.31 Section 71.31 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES QUARANTINE, INSPECTION, LICENSING FOREIGN QUARANTINE Health Measures at U.S. Ports: Communicable Diseases § 71.31 General provisions. (a...

42 CFR 71.41 - General provisions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false General provisions. 71.41 Section 71.41 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES QUARANTINE, INSPECTION, LICENSING FOREIGN QUARANTINE Requirements Upon Arrival at U.S. Ports: Sanitary Inspection § 71.41 General provisions...

42 CFR 71.31 - General provisions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false General provisions. 71.31 Section 71.31 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES QUARANTINE, INSPECTION, LICENSING FOREIGN QUARANTINE Health Measures at U.S. Ports: Communicable Diseases § 71.31 General provisions. (a...

42 CFR 71.31 - General provisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false General provisions. 71.31 Section 71.31 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES QUARANTINE, INSPECTION, LICENSING FOREIGN QUARANTINE Health Measures at U.S. Ports: Communicable Diseases § 71.31 General provisions. (a...

42 CFR 71.41 - General provisions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false General provisions. 71.41 Section 71.41 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES QUARANTINE, INSPECTION, LICENSING FOREIGN QUARANTINE Requirements Upon Arrival at U.S. Ports: Sanitary Inspection § 71.41 General provisions...

42 CFR 71.41 - General provisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false General provisions. 71.41 Section 71.41 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES QUARANTINE, INSPECTION, LICENSING FOREIGN QUARANTINE Requirements Upon Arrival at U.S. Ports: Sanitary Inspection § 71.41 General provisions...

Changes in abortion service provision in Bihar and Jharkhand states, India between 2004 and 2013

PubMed Central

Singh, Kaushalendra K.; Li, Qingfeng; Fruhauf, Timothee; Tsui, Amy O.

2018-01-01

Background The Medical Termination of Pregnancy (MTP) Act of 1971 liberalized abortion laws in India. This study examines changes in abortion service provision and characteristics of abortion providers in Bihar and Jharkhand states, India between 2004 and 2013. Methods We used state-representative data from cross-sectional surveys of reproductive health service providers we conducted in 2004 (N = 1,323) and 2012/2013 (N = 1,020). We employed chi-squared tests to examine and compare abortion providers’ characteristics, and fitted separate multivariate logistic regression models for provision of surgical, medical, and any abortion services, respectively, adjusting for potential confounders to identify factors associated with abortion service provision at the two survey time points. Results Of providers interviewed in 2004 and 2012/2013, 63.7% and 84.5%, respectively, offered abortion services. Among abortion providers, 21.1% offered surgical and 10.7% offered medical abortions in 2004; 15.8% and 94.1% did so, respectively, in 2012/2013. Private providers were more likely than public providers to offer abortion services at both time points. Compared to female providers, male providers were significantly less likely to provide both surgical and medical abortions in 2004, and significantly less likely to provide surgical abortions in 2012/2013. Pharmacists and community health workers played increasingly important roles in abortion service provision, especially medical abortion, during the period. Conclusion This study documents important changes in abortion provision in the two Indian states during 2004–2013. PMID:29879132

Patient preferences for community pharmacy asthma services: a discrete choice experiment.

PubMed

Naik-Panvelkar, Pradnya; Armour, Carol; Rose, John M; Saini, Bandana

2012-10-01

Specialized community pharmacy services, involving the provision of disease state management and care by pharmacists, have been developed and trialled and have demonstrated very good health outcomes. Most of these services have been developed from a healthcare professional perspective. However, for the future uptake and long-term sustainability of these services as well as for better and sustained health outcomes for patients, it is vital to gain an understanding of patients' preferences. We can then structure healthcare services to match these preferences and needs rather than around clinical viewpoints alone. The aim of this study was to elicit patient preferences for pharmacy-based specialized asthma services using a discrete choice experiment and to explore the value/importance that patients place on the different attributes of the asthma service. The existence of preference heterogeneity in the population was also investigated. The study was conducted with asthma patients who had recently experienced a specialized asthma management service at their pharmacy in New South Wales, Australia. Pharmacists delivering the asthma service mailed out the discrete choice questionnaires to participating patients at the end of 6 months of service provision. A latent class (LC) model was used to investigate each patient's strength of preference and preference heterogeneity for several key attributes related to asthma service provision: frequency of visits, access to pharmacist, interaction with pharmacy staff, availability of a private area for consultation, provision of lung function testing, type and depth of advice provision, number of days with asthma symptoms and cost of service. Eighty useable questionnaires (of 170 questionnaires sent out) were received (response rate 47.1%). The study identified various key elements of asthma services important to patients. Further, the LC analysis revealed three classes with differing patient preferences for levels of asthma service provision. Patients in the Minimalistic Model class valued provision of lung function testing and preferred more frequent service visits. Cost of service had a negative effect on service preference for patients in this class. Patients in the Partial Model class mainly derived utility from the provision of lung function testing and comprehensive advice at the pharmacy and also wanted more frequent service visits. The Holistic Model class patients considered all attributes of the service to be important when making a choice. While the majority of the service attributes had a positive effect on preference for patients in this class, cost of service and days with symptoms of asthma had a negative effect on service preference. These patients also preferred fewer service visits. The study identified various key attributes that are important to patients with respect to community pharmacy-based asthma services. The results also demonstrate the existence of preference heterogeneity in the population. Asthma service providers need to take these findings into consideration in the design and development of future service models so as to increase their uptake and ensure their long-term sustainability.

Renewing focus on family planning service quality globally.

PubMed

Hancock, Nancy L; Stuart, Gretchen S; Tang, Jennifer H; Chibwesha, Carla J; Stringer, Jeffrey S A; Chi, Benjamin H

2016-01-01

Reducing the global unmet need for contraception is currently a priority for many governments, multi-lateral initiatives, non-governmental organizations, and donors. Evidence strongly suggests that the provision of quality family planning services can increase uptake, prevalence, and continuation of contraception. While an accepted framework to define the components of family planning service quality exists, translating this framework into assessment tools that are accessible, easily utilized, and valid for service providers has remained a challenge. We propose new approaches to improve the standardization and accessibility of family planning service quality assessment tools to simplify family planning service quality evaluation. With easier approaches to program evaluation, quality improvements can be performed more swiftly to help increase uptake and continuation of contraception to improve the health of women and their families.

You pray to your God: A qualitative analysis of challenges in the provision of safe, timely, and affordable surgical care in Uganda.

PubMed

Albutt, Katherine; Yorlets, Rachel R; Punchak, Maria; Kayima, Peter; Namanya, Didacus B; Anderson, Geoffrey A; Shrime, Mark G

2018-01-01

Five billion people lack access to safe, affordable, and timely surgical and anesthesia care. Significant challenges remain in the provision of surgical care in low-resource settings. Uganda is no exception. From September to November 2016, we conducted a mixed-methods countrywide surgical capacity assessment at 17 randomly selected public hospitals in Uganda. Researchers conducted 35 semi-structured interviews with key stakeholders to understand factors related to the provision of surgical care. The framework approach was used for thematic and explanatory data analysis. The Ugandan public health care sector continues to face significant challenges in the provision of safe, timely, and affordable surgical care. These challenges can be broadly grouped into preparedness and policy, service delivery, and the financial burden of surgical care. Hospital staff reported challenges including: (1) significant delays in accessing surgical care, compounded by a malfunctioning referral system; (2) critical workforce shortages; (3) operative capacity that is limited by inadequate infrastructure and overwhelmed by emergency and obstetric volume; (4) supply chain difficulties pertaining to provision of essential medications, equipment, supplies, and blood; (5) significant, variable, and sometimes catastrophic expenditures for surgical patients and their families; and (6) a lack of surgery-specific policies and priorities. Despite these challenges, innovative strategies are being used in the public to provide surgical care to those most in need. Barriers to the provision of surgical care are cross-cutting and involve constraints in infrastructure, service delivery, workforce, and financing. Understanding current strengths and shortfalls of Uganda's surgical system is a critical first step in developing effective, targeted policy and programming that will build and strengthen its surgical capacity.

Ghana's National Health Insurance Scheme: a national level investigation of members' perceptions of service provision.

PubMed

Dixon, Jenna; Tenkorang, Eric Y; Luginaah, Isaac

2013-08-23

Ghana's National Health Insurance Scheme (NHIS), established into law in 2003 and implemented in 2005 as a 'pro-poor' method of health financing, has made great progress in enrolling members of the general population. While many studies have focused on predictors of enrolment this study offers a novel analysis of NHIS members' perceptions of service provision at the national level. Using data from the 2008 Ghana Demographic Health Survey we analyzed the perceptions of service provision as indicated by members enrolled in the NHIS at the time of the survey (n = 3468; m = 1422; f = 2046). Ordinal Logistic Regression was applied to examine the relationship between perceptions of service provision and theoretically relevant socioeconomic and demographic variables. Results demonstrate that wealth, gender and ethnicity all play a role in influencing members' perceptions of NHIS service provision, distinctive from its influence on enrolment. Notably, although wealth predicted enrolment in other studies, our study found that compared to the poorest men and uneducated women, wealthy men and educated women were less likely to perceive their service provision as better/same (more likely to report it was worse). Wealth was not an important factor for women, suggesting that household gender dynamics supersede household wealth status in influencing perceptions. As well, when compared to Akan women, women from all other ethnic groups were about half as likely to perceive the service provision to be better/same. Findings of this study suggest there is an important difference between originally enrolling in the NHIS because one believes it is potentially beneficial, and using the NHIS and perceiving it to be of benefit. We conclude that understanding the nature of this relationship is essential for Ghana's NHIS to ensure its longevity and meet its pro-poor mandate. As national health insurance systems are a relatively new phenomenon in sub-Saharan Africa little is known about their long term viability; understanding user perceptions of service provision is an important piece of that puzzle.

Social capital, collective efficacy and the provision of social support services and amenities by municipalities in the Netherlands.

PubMed

Waverijn, Geeke; Groenewegen, Peter P; de Klerk, Mirjam

2017-03-01

Differential provision of local services and amenities has been proposed as a mechanism behind the relationship between social capital and health. The aim of this study was to investigate whether social capital and collective efficacy are related to the provision of social support services and amenities in Dutch municipalities, against a background of decentralisation of long-term care to municipalities. We used data on neighbourhood social capital, collective efficacy (the extent to which people are willing to work for the common good), and the provision of services and amenities in 2012. We included the services municipalities provide to support informal caregivers (e.g. respite care), individual services and support (e.g. domiciliary help), and general and collective services and amenities (e.g. lending point for wheelchairs). Data for social capital were collected between May 2011 and September 2012. Social capital was measured by focusing on contacts between neighbours. A social capital measure was estimated for 414 municipalities with ecometric measurements. A measure of collective efficacy was constructed based on information about the experienced responsibility for the liveability of the neighbourhood by residents in 2012, average charity collection returns in municipalities in 2012, voter turnout at the municipal elections in 2010 and the percentage of blood donors in 2012. We conducted Poisson regression and negative binomial regression to test our hypotheses. We found no relationship between social capital and the provision of services and amenities in municipalities. We found an interaction effect (coefficient = 3.11, 95% CI = 0.72-5.51, P = 0.011) of social capital and collective efficacy on the provision of support services for informal caregivers in rural municipalities. To gain more insight in the relationship between social capital and health, it will be important to study the relationship between social capital and differential provision of services and amenities more extensively and in different contexts. © 2016 John Wiley & Sons Ltd.

Community outreach library services in the UK: a case study of Wirral Hospital NHS Trust (WHNT).

PubMed

Dowse, Frances Maria; Sen, Barbara

2007-09-01

The study evaluates the Community Outreach Library Service at Wirral Hospital National Health Service Trust (WHNT). It considers the information seeking behaviour and information needs of primary care staff, and service effectiveness in meeting those needs. A literature review established the current context and areas of best practice. The investigative case study used postal questionnaires to 250 primary care staff and an interview with the Community Outreach Librarian. Themes emerged from the literature regarding information seeking behaviour, information needs, and meeting user needs through effective service delivery. Outreach services have value in terms of improving information skills and providing services at point of need. Time is a major constraint for both users and service providers. Investment is needed from appropriate funding sources to support the provision and marketing of outreach library services. Librarians benefit from sharing best practice. The continued evaluation of outreach library services is recommended.

49 CFR 37.191 - Special provision for small mixed-service operators.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 1 2014-10-01 2014-10-01 false Special provision for small mixed-service operators. 37.191 Section 37.191 Transportation Office of the Secretary of Transportation TRANSPORTATION... small mixed-service operators. (a) For purposes of this section, a small mixed-service operator is a...

49 CFR 37.191 - Special provision for small mixed-service operators.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 1 2013-10-01 2013-10-01 false Special provision for small mixed-service operators. 37.191 Section 37.191 Transportation Office of the Secretary of Transportation TRANSPORTATION... small mixed-service operators. (a) For purposes of this section, a small mixed-service operator is a...

49 CFR 37.191 - Special provision for small mixed-service operators.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 1 2011-10-01 2011-10-01 false Special provision for small mixed-service operators. 37.191 Section 37.191 Transportation Office of the Secretary of Transportation TRANSPORTATION... small mixed-service operators. (a) For purposes of this section, a small mixed-service operator is a...

49 CFR 37.191 - Special provision for small mixed-service operators.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 1 2012-10-01 2012-10-01 false Special provision for small mixed-service operators. 37.191 Section 37.191 Transportation Office of the Secretary of Transportation TRANSPORTATION... small mixed-service operators. (a) For purposes of this section, a small mixed-service operator is a...

75 FR 35989 - Facilitating the Provision of Fixed and Mobile Broadband Access, Educational and Other Advanced...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-24

...] Facilitating the Provision of Fixed and Mobile Broadband Access, Educational and Other Advanced Services in the...), clarifying the requirements necessary for Broadband Radio Service (BRS) and Educational Broadband Service (EBS) licensees to demonstrate substantial service and ensure that BRS licensees of new initial...

Community pharmacists and mental illness: a survey of service provision, stigma, attitudes and beliefs.

PubMed

Giannetti, Vincent; Caley, Charles F; Kamal, Khalid M; Covvey, Jordan R; McKee, Jerry; Wells, Barbara G; Najarian, Dean M; Dunn, Tyler J; Vadagam, Pratyusha

2018-06-04

Background Half of Americans experience mental illness during their lifetime. Significant opportunity exists for community pharmacists to deliver services to these patients; however, personal and practice-related barriers may prevent full engagement. Objective To assess the demographics, practice characteristics, service provision, stigma, attitudes and beliefs of a national sample of community pharmacists towards individuals with mental illness. Setting National random sample of 3008 community pharmacists in the USA. Method 101-item cross-sectional mailed survey questionnaire on: (1) demographics, (2) knowledge and practice characteristics, (3) provision of clinical pharmacy services, and (4) comparative opinions. Main outcome measure Scaled measures of service provision (comfort, confidence, willingness and interest) and comparative opinions (stigma, attitudes and beliefs) of mental illness, four linear regression models to predict service provision. Results A total of 239 responses were received (response rate 7.95%). Across pharmacy services, ratings for willingness/interest were higher than those for comfort/confidence. Pharmacists who reported providing medication therapy management (MTM) services for patients reported higher comfort (18.36 vs. 17.46, p < 0.05), confidence (17.73 vs. 16.01, p < 0.05), willingness (20.0 vs. 18.62, p < 0.05) and interest (19.13 vs. 17.66, p < 0.05). Pharmacists with personal experience with mental illness also resulted in higher scores across all four domains of service provision, lower levels of stigma (18.28 vs. 20.76, p < 0.05) and more positive attitudes (52.24 vs. 50.53, p < 0.01). Regression analyses demonstrated increased frequency of MTM service delivery and more positive attitudes as significantly predictive across all four models for comfort, confidence, willingness and interest. Increased delivery of pharmacy services was significantly associated with both willingness and interest to provide mental illness-specific services. Conclusion Despite willingness/interest to provide services to patients with mental illness, decreased levels of comfort/confidence remain service-related barriers for community pharmacists.

3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 3 The President 1 2014-01-01 2014-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of December 27, 2013 Provision of Aviation Insurance Coverage for Commercial...

3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 3 The President 1 2011-01-01 2011-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of September 29, 2010 Provision of Aviation Insurance Coverage for Commercial...

3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 3 The President 1 2012-01-01 2012-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of September 28, 2011 Provision of Aviation Insurance Coverage for Commercial...

3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

Code of Federal Regulations, 2013 CFR

2013-01-01

... 3 The President 1 2013-01-01 2013-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of September 27, 2012 Provision of Aviation Insurance Coverage for Commercial...

3 CFR - Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 3 The President 1 2010-01-01 2010-01-01 false Provision of Aviation Insurance Coverage for Commercial Air Carrier Service in Domestic and International Operations Presidential Documents Other Presidential Documents Memorandum of August 21, 2009 Provision of Aviation Insurance Coverage for Commercial...

78 FR 19797 - Designation & Determination Pursuant to the Foreign Missions Act; Concerning the Provision of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-02

... DEPARTMENT OF STATE [Public Notice 8266] Designation & Determination Pursuant to the Foreign Missions Act; Concerning the Provision of Application Services for Visas, Passports and Similar Documents... designate the provision of application services with respect to visas, passports and similar documents by...

29 CFR 552.108 - Child labor provisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 3 2012-07-01 2012-07-01 false Child labor provisions. 552.108 Section 552.108 Labor... OF THE FAIR LABOR STANDARDS ACT TO DOMESTIC SERVICE Interpretations § 552.108 Child labor provisions. Congress made no change in section 12 as regards domestic service employees. Accordingly, the child labor...

29 CFR 552.108 - Child labor provisions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 3 2014-07-01 2014-07-01 false Child labor provisions. 552.108 Section 552.108 Labor... OF THE FAIR LABOR STANDARDS ACT TO DOMESTIC SERVICE Interpretations § 552.108 Child labor provisions. Congress made no change in section 12 as regards domestic service employees. Accordingly, the child labor...

29 CFR 552.108 - Child labor provisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 3 2011-07-01 2011-07-01 false Child labor provisions. 552.108 Section 552.108 Labor... OF THE FAIR LABOR STANDARDS ACT TO DOMESTIC SERVICE Interpretations § 552.108 Child labor provisions. Congress made no change in section 12 as regards domestic service employees. Accordingly, the child labor...

29 CFR 552.108 - Child labor provisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Child labor provisions. 552.108 Section 552.108 Labor... OF THE FAIR LABOR STANDARDS ACT TO DOMESTIC SERVICE Interpretations § 552.108 Child labor provisions. Congress made no change in section 12 as regards domestic service employees. Accordingly, the child labor...

29 CFR 552.108 - Child labor provisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 3 2013-07-01 2013-07-01 false Child labor provisions. 552.108 Section 552.108 Labor... OF THE FAIR LABOR STANDARDS ACT TO DOMESTIC SERVICE Interpretations § 552.108 Child labor provisions. Congress made no change in section 12 as regards domestic service employees. Accordingly, the child labor...

76 FR 19792 - Notice of Intent To Award-Grant Awards for the Provision of Civil Legal Services to Eligible...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-08

... LEGAL SERVICES CORPORATION Notice of Intent To Award--Grant Awards for the Provision of Civil Legal Services to Eligible Clients in Louisiana (Service Area LA- 1) Beginning June 2011 AGENCY: Legal...: The Legal Services Corporation (LSC) hereby announces its intention to award grants and contracts to...

75 FR 62429 - Notice of Intent to Award-Grant Awards for the Provision of Civil Legal Services to Eligible Low...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-08

... LEGAL SERVICES CORPORATION Notice of Intent to Award--Grant Awards for the Provision of Civil Legal Services to Eligible Low-Income Clients Beginning January 1, 2011 AGENCY: Legal Services... economical and effective delivery of high quality civil legal services to eligible low-income clients...

[Current status and future of telemonitoring : Scenarios for telemedical care in 2025].

PubMed

Zippel-Schultz, Bettina; Schultz, Carsten; Helms, Thomas M

2017-09-01

Telemonitoring is an already realized implementation of digital transformation in the healthcare system. It has the potential to support and secure a sustainable and comprehensive provision of healthcare for a rising number of chronically ill patients, e. g. patients with chronic heart failure. Remote regions in particular can profit from the benefits of telemonitoring; however, so far telemonitoring services have not become truly established in the German healthcare market. Together with experts from politics, science and practice, a scenario analysis "Health Care System 2025 - A Place for Telemonitoring?" was carried out with the aim to examine the future development of the healthcare market and to draw conclusions for providers of telemonitoring services or devices. The scenario analysis contained two workshops and an expert survey and was supported by a scenario software. The current drivers and barriers of the diffusion of telemonitoring were identified and the most relevant factors that influence the future development of the healthcare market were discussed. Based on those influencing factors, three different scenarios were determined: (1) administrating rather than shaping, (2) safely into the future and (3) interconnected and digital world. In the subsequent consequence analysis activities were defined, which describe the necessary infrastructure, software instruments, organizational structures and provision of services and discuss possible activities, which prepare telemonitoring solutions for the future.

76 FR 42577 - Magnuson-Stevens Act Provisions; Fisheries of the Northeastern United States; Northeast...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

... comply with trip limits. However, the current system does not accurately account for the fish landed for... confirm the receipt of the TSH report via a back-up system specified by the DSM service provider. The... via a back-up system, after a time determined by the DSM provider, to confirm the receipt of the TSH...

76 FR 24444 - Magnuson-Stevens Act Provisions; Fisheries of the Northeastern United States; Northeast...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-02

... and were not sold, bartered or traded. At the time, DAS was the only effort control for the FMP, and... current system does not accurately account for the disposition of fish landed under the ``home consumption... receipt of the TSH report via a back-up system specified by the DSM service provider. While the...

An Integrative Approach to Curriculum Development in Higher Education in the USA: A Theoretical Framework

ERIC Educational Resources Information Center

Khan, Mohammad Ayub; Law, Laurie Smith

2015-01-01

The role of curriculum in higher education is sine quo non for the provision of quality and relevant educational programs and services to the current and potential learners in the USA and elsewhere in the world. Regardless of sizes, types or origins, curriculum is considered the heart and soul of all educational institutions. Curriculum is crucial…

Serving homeless Veterans in the VA Desert Pacific Healthcare Network: A needs assessment to inform quality improvement endeavors

PubMed Central

Gabrielian, Sonya; Yuan, Anita; Rubenstein, Lisa; Andersen, Ronald M.; Gelberg, Lillian

2016-01-01

This report describes a needs assessment of VA programs for homeless Veterans in Southern California and Nevada, the geographic region with the most homeless Veterans in the nation. The assessment was formulated through key informant interviews. Current service provisions are discussed, along with salient unmet needs for this vulnerable population. PMID:23974403

78 FR 48233 - Medicare Program; FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-07

... Contents I. Executive Summary A. Purpose B. Summary of the Major Provisions C. Summary of Costs, Benefits, and Transfers II. Background A. Hospice Care B. History of the Medicare Hospice Benefit C. Services... IV.C.3. We also update the FY 2014 hospice wage index with more current wage data, and the BNAF will...

Planning a Dental Workforce for the Future for the National Health Service in the United Kingdom: What Factors Should Be Accounted for?

ERIC Educational Resources Information Center

Brocklehurst, Paul; Tickle, Martin

2012-01-01

Background: The two most common models of workforce planning are the "stock and flow" and the demographic approach. The former balances future losses from a system against recruitment and retention, whilst the latter simply "grosses up" current provision based on changes to population demographics. However, such approaches…

"That Doesn't Translate": The Role of Evidence-Based Practice in Disempowering Speech Pathologists in Acute Aphasia Management

ERIC Educational Resources Information Center

Foster, Abby; Worrall, Linda; Rose, Miranda; O'Halloran, Robyn

2015-01-01

Background: An evidence-practice gap has been identified in current acute aphasia management practice, with the provision of services to people with aphasia in the acute hospital widely considered in the literature to be inconsistent with best-practice recommendations. The reasons for this evidence-practice gap are unclear; however, speech…

77 FR 65208 - Notice of Consideration of Approval of Application Regarding Proposed Indirect Transfer of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-25

..., which is currently under review. In its August 30, 2012, application, MOX Services proposes to make... of the proceeding, and is material to the findings that NRC must make to support the granting of a... permitted to make a limited appearance pursuant to the provisions of 10 CFR 2.315(a), by making an oral or...

Serving homeless veterans in the VA Desert Pacific Healthcare Network: a needs assessment to inform quality improvement endeavors.

PubMed

Gabrielian, Sonya; Yuan, Anita; Rubenstein, Lisa; Andersen, Ronald M; Gelberg, Lillian

2013-08-01

This report describes a needs assessment of VA programs for homeless Veterans in Southern California and Nevada, the geographic region with the most homeless Veterans in the nation. The assessment was formulated through key informant interviews. Current service provisions are discussed, along with salient unmet needs for this vulnerable population.

Current Provision, Recent Developments, and Future Directions for Early Childhood Intervention in Singapore

ERIC Educational Resources Information Center

Poon, Kenneth K.; Lim, Ai-Keow

2012-01-01

Singapore is a young island nation with a diverse population. Its support for young children at risk has its roots in the 1950s, but early childhood intervention (ECI) programs for young children with disabilities emerged only in the 1980s. ECI programs have proliferated in the subsequent years, offering an increasing range of service delivery…

US Army Order of Battle 1919-1941. Volume 3. The Services: Air Service, Engineers, and Special Troops, 1919-41

DTIC Science & Technology

2010-01-01

should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of...information if it does not display a currently valid OMB control number. 1. REPORT DATE 2010 2. REPORT TYPE 3. DATES COVERED 00-00-2010 to 00-00...SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT Same as Report (SAR) 18. NUMBER OF PAGES 704 19a. NAME OF RESPONSIBLE PERSON a . REPORT

What older people want: evidence from a study of remote Scottish communities.

PubMed

King, Gerry; Farmer, Jane

2009-01-01

The growing proportions of older people in rural areas have implications for the provision of health and social care services. Older people are more likely to have complex health needs compared with other age groups, requiring a full range of primary, community and acute hospital services. The provision of services to older people in rural areas is challenged by diseconomies of scale, travel costs and difficulties in attracting staff. Policy-makers are requested to include the 'voice' of older people to help provide services that match needs and context. In spite of this, what older people want from health and social care services is a neglected area of investigation. The reported study was conducted in 2005/2006 as part of a European Union Northern Periphery Programme (EU NPP) project called Our Life as Elderly. Its aims were to explore the views of those aged 55 years and over and living in remote communities about current and future health and social care service provision for older people. Evidence was to be collected that could inform policy-makers about changing or improving service delivery. This article summarises emergent themes and considers their implications. The study selected two small remote mainland Scottish Highland communities for in-depth case study. Semi-structured interviews (n = 23), 10 'informal conversations' and 4 focus groups were held with community members aged 55 years and over, in order to provide different types of qualitative data and 'layers' of data to allow reflection. Data analysis was assisted by computerised data management software and performed using the 'framework analysis' approach. Participants did not consider themselves 'old' and expressed the need for independence in older age to be supported by services. Several aspects of services that were undergoing change or restructuring were identified, including arrangements for home care services, meals provision and technological support. Participants valued elements of the traditional model of care they had been receiving: these were local, personal emphasis and continuity. They were suspicious of new arrangements perceived to emphasise technical efficiency. Health and care services were described as inter-linked with other aspects of rural living, including transport and housing (which might have to be relinquished to pay for care). Proximity to family was desired for social and domestic support only; health and related support should be from generic service providers. Community members were involved in reciprocal help-giving of many types. The findings compare with results of other studies of older rural people internationally, and generic 'principles' of service derived could guide restructuring. There may be systemic challenges to empowering older people's 'voice' in designing sustainable rural services that stem from society's views of older people, attitudes of communities to collective roles and responsibilities, and the fragmented ways that services are sometimes provided.

Provision of QoS for Multimedia Services in IEEE 802.11 Wireless Network

DTIC Science & Technology

2006-10-01

Provision of QoS for Multimedia Services in IEEE 802.11 Wireless Network. In Dynamic Communications Management (pp. 10-1 – 10-16). Meeting Proceedings...mechanisms have been used for managing a limited bandwidth link within the IPv6 military narrowband network. The detailed description of these...confirms that implemented video rate adaptation mechanism enables improvement of qaulity of video transfer. Provision of QoS for Multimedia Services in

Differential impact of current diagnosis and clinical stage on attendance at a youth mental health service.

PubMed

Cross, Shane P M; Hermens, Daniel F; Scott, Jan; Salvador-Carulla, Luis; Hickie, Ian B

2017-06-01

To examine whether clinical stage of illness and current diagnosis influence appointment behaviour in a specialized primary-level youth mental health service. Factors associated with attendance at 8697 appointments made by 828 young people (females = 497) aged 12-25 years over a 1-year period were analysed. The number of appointments made did not correlate with the rates of attendance. However, those with more severe psychiatric morbidity made significantly more appointments and missed significantly more appointments than those with less severe presentations. Impaired social functioning was the best predictor of female attendance rates, whereas age and clinical stage of illness best predicted male attendance rates. Current diagnosis rather than functional impairment appeared to influence the level of input offered by clinicians. Age, gender, severity of illness, functioning and psychological distress had differential associations with both planned treatment intensity and attendance rates. These differences are likely to have implications for service provision in this youth population. © 2016 John Wiley & Sons Australia, Ltd.

Capacity, pressure, demand, and flow: A conceptual framework for analyzing ecosystem service provision and delivery

USGS Publications Warehouse

Villamagna, Amy M.; Angermeier, Paul L.; Bennett, Elena M.

2013-01-01

Ecosystem services provide an instinctive way to understand the trade-offs associated with natural resource management. However, despite their apparent usefulness, several hurdles have prevented ecosystem services from becoming deeply embedded in environmental decision-making. Ecosystem service studies vary widely in focal services, geographic extent, and in methods for defining and measuring services. Dissent among scientists on basic terminology and approaches to evaluating ecosystem services create difficulties for those trying to incorporate ecosystem services into decision-making. To facilitate clearer comparison among recent studies, we provide a synthesis of common terminology and explain a rationale and framework for distinguishing among the components of ecosystem service delivery, including: an ecosystem's capacity to produce services; ecological pressures that interfere with an ecosystem's ability to provide the service; societal demand for the service; and flow of the service to people. We discuss how interpretation and measurement of these four components can differ among provisioning, regulating, and cultural services. Our flexible framework treats service capacity, ecological pressure, demand, and flow as separate but interactive entities to improve our ability to evaluate the sustainability of service provision and to help guide management decisions. We consider ecosystem service provision to be sustainable when demand is met without decreasing capacity for future provision of that service or causing undesirable declines in other services. When ecosystem service demand exceeds ecosystem capacity to provide services, society can choose to enhance natural capacity, decrease demand and/or ecological pressure, or invest in a technological substitute. Because regulating services are frequently overlooked in environmental assessments, we provide a more detailed examination of regulating services and propose a novel method for quantifying the flow of regulating services based on estimates of ecological work. We anticipate that our synthesis and framework will reduce inconsistency and facilitate coherence across analyses of ecosystem services, thereby increasing their utility in environmental decision-making.

Use of fees to fund local public health services in Western Massachusetts.

PubMed

Shila Waritu, A; Bulzacchelli, Maria T; Begay, Michael E

2015-01-01

Recent budget cuts have forced many local health departments (LHDs) to cut staff and services. Setting fees that cover the cost of service provision is one option for continuing to fund certain activities. To describe the use of fees by LHDs in Western Massachusetts and determine whether fees charged cover the cost of providing selected services. A cross-sectional descriptive analysis was used to identify the types of services for which fees are charged and the fee amounts charged. A comparative cost analysis was conducted to compare fees charged with estimated costs of service provision. Fifty-nine LHDs in Western Massachusetts. Number of towns charging fees for selected types of services; minimum, maximum, and mean fee amounts; estimated cost of service provision; number of towns experiencing a surplus or deficit for each service; and average size of deficits experienced. Enormous variation exists both in the types of services for which fees are charged and fee amounts charged. Fees set by most health departments did not cover the cost of service provision. Some fees were set as much as $600 below estimated costs. These results suggest that considerations other than costs of service provision factor into the setting of fees by LHDs in Western Massachusetts. Given their limited and often uncertain funding, LHDs could benefit from examining their fee schedules to ensure that the fee amounts charged cover the costs of providing the services. Cost estimates should include at least the health agent's wage and time spent performing inspections and completing paperwork, travel expenses, and cost of necessary materials.

An evaluation of the range and availability of intensive smoking cessation services in Ireland.

PubMed

Currie, L M; Keogan, S; Campbell, P; Gunning, M; Kabir, Z; Clancy, L

2010-03-01

A review of smoking cessation (SC) services in Ireland is a necessary step in improving service planning and provision. To assess the range and availability of intensive SC services in Ireland in 2006. A survey of SC service providers in Ireland was conducted. Descriptive analysis and simple linear regression analysis was used. Response rate was 86.3% (63/73). All service providers surveyed are employing evidence-based interventions; the most common form of support is individual counselling with initial sessions averaging 40 min and weekly review sessions 20 min in duration. Reaching the recommended target of treating 5.0% of smokers does not seem feasible given the current distribution of resources and there appears to be regional differences in resource allocation. While intensive SC services are available in all four Health Service Executive Areas, it would appear that there is little uniformity or consistency countrywide in the scope and structure of these services.

Do efforts to standardize, assess and improve the quality of health service provision to adolescents by government-run health services in low and middle income countries, lead to improvements in service-quality and service-utilization by adolescents?

PubMed

Chandra-Mouli, Venkatraman; Chatterjee, Subidita; Bose, Krishna

2016-02-06

Researchers and implementers working in adolescent health, and adolescents themselves question whether government-run health services in conservative and resource-constrained settings can be made adolescent friendly. This paper aims to find out what selected low and middle income country (LMIC) governments have set out to do to improve the quality of health service provision to adolescents; whether their efforts led to measurable improvements in quality and to increased health service-utilization by adolescents. We gathered normative guidance and reports from eight LMICs in Asia, Africa, Central and Eastern Europe and the Western Pacific. We analysed national quality standards for adolescent friendly health services, findings from the assessments of the quality of health service provision, and findings on the utilization of health services. Governments of LMICs have set out to improve the accessibility, acceptability, equity, appropriateness and effectiveness of health service provision to adolescents by defining standards and actions to achieve them. Their actions have led to measurable improvements in quality and to increases in health service utilisation by adolescents. With support, government-run health facilities in LMICs can improve the quality of health services and their utilization by adolescents.

From theoretical to actual ecosystem services: mapping beneficiaries and spatial flows in ecosystem service assessments

USGS Publications Warehouse

Bagstad, Kenneth J.; Villa, Ferdinando; Batker, David; Harrison-Cox, Jennifer; Voigt, Brian; Johnson, Gary W.

2014-01-01

Ecosystem services mapping and modeling has focused more on supply than demand, until recently. Whereas the potential provision of economic benefits from ecosystems to people is often quantified through ecological production functions, the use of and demand for ecosystem services has received less attention, as have the spatial flows of services from ecosystems to people. However, new modeling approaches that map and quantify service-specific sources (ecosystem capacity to provide a service), sinks (biophysical or anthropogenic features that deplete or alter service flows), users (user locations and level of demand), and spatial flows can provide a more complete understanding of ecosystem services. Through a case study in Puget Sound, Washington State, USA, we quantify and differentiate between the theoretical or in situ provision of services, i.e., ecosystems’ capacity to supply services, and their actual provision when accounting for the location of beneficiaries and the spatial connections that mediate service flows between people and ecosystems. Our analysis includes five ecosystem services: carbon sequestration and storage, riverine flood regulation, sediment regulation for reservoirs, open space proximity, and scenic viewsheds. Each ecosystem service is characterized by different beneficiary groups and means of service flow. Using the ARtificial Intelligence for Ecosystem Services (ARIES) methodology we map service supply, demand, and flow, extending on simpler approaches used by past studies to map service provision and use. With the exception of the carbon sequestration service, regions that actually provided services to people, i.e., connected to beneficiaries via flow paths, amounted to 16-66% of those theoretically capable of supplying services, i.e., all ecosystems across the landscape. These results offer a more complete understanding of the spatial dynamics of ecosystem services and their effects, and may provide a sounder basis for economic valuation and policy applications than studies that consider only theoretical service provision and/or use.

42 CFR 483.118 - Residents and applicants determined not to require NF level of services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... provision of specialized services for the mental illness or mental retardation. (2) Short term residents... provision of, specialized services for the mental illness or mental retardation. (3) For the purpose of...) Applicants who do not require NF services. If the State mental health or mental retardation authority...

Service Provision to Students: Where the Gown Best Fits

ERIC Educational Resources Information Center

Schulz, Lucy; Szekeres, Judy

2008-01-01

One of the challenges facing those responsible for service provision in universities is ensuring that service is provided at the right point in the organisation. Service delivery points can exist at the school/department level, faculty/division level or central unit/university wide level. This does not always follow organisational logic, common…

47 CFR 22.950 - Provision of service in the Gulf of Mexico Service Area (GMSA)

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 2 2010-10-01 2010-10-01 false Provision of service in the Gulf of Mexico... service in the Gulf of Mexico Service Area (GMSA) The GMSA has been divided into two areas for licensing purposes, the Gulf of Mexico Exclusive Zone (GMEZ) and the Gulf of Mexico Coastal Zone (GMCZ). This section...

47 CFR 22.950 - Provision of service in the Gulf of Mexico Service Area (GMSA)

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 2 2014-10-01 2014-10-01 false Provision of service in the Gulf of Mexico... service in the Gulf of Mexico Service Area (GMSA) The GMSA has been divided into two areas for licensing purposes, the Gulf of Mexico Exclusive Zone (GMEZ) and the Gulf of Mexico Coastal Zone (GMCZ). This section...

47 CFR 22.950 - Provision of service in the Gulf of Mexico Service Area (GMSA)

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 2 2012-10-01 2012-10-01 false Provision of service in the Gulf of Mexico... service in the Gulf of Mexico Service Area (GMSA) The GMSA has been divided into two areas for licensing purposes, the Gulf of Mexico Exclusive Zone (GMEZ) and the Gulf of Mexico Coastal Zone (GMCZ). This section...

47 CFR 22.950 - Provision of service in the Gulf of Mexico Service Area (GMSA)

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 2 2013-10-01 2013-10-01 false Provision of service in the Gulf of Mexico... service in the Gulf of Mexico Service Area (GMSA) The GMSA has been divided into two areas for licensing purposes, the Gulf of Mexico Exclusive Zone (GMEZ) and the Gulf of Mexico Coastal Zone (GMCZ). This section...

Anaerobic co-digestion of municipal food waste and sewage sludge: A comparative life cycle assessment in the context of a waste service provision.

PubMed

Edwards, Joel; Othman, Maazuza; Crossin, Enda; Burn, Stewart

2017-01-01

This study used life cycle assessment to evaluate the environmental impact of anaerobic co-digestion (AcoD) and compared it against the current waste management system in two case study areas. Results indicated AcoD to have less environmental impact for all categories modelled excluding human toxicity, despite the need to collect and pre-treat food waste separately. Uncertainty modelling confirmed that AcoD has a 100% likelihood of a smaller global warming potential, and for acidification, eutrophication and fossil fuel depletion AcoD carried a greater than 85% confidence of inducing a lesser impact than the current waste service. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

31 CFR 560.416 - Brokering services.

Code of Federal Regulations, 2012 CFR

2012-07-01

... provision of goods, services or technology, from whatever source, to or from Iran or the Government of Iran... the Government of Iran; (3) Act as broker for the provision of financing, a financial guarantee or an extension of credit by any person to Iran or the Government of Iran; (4) Act as a broker for the provision...

31 CFR 560.416 - Brokering services.

Code of Federal Regulations, 2011 CFR

2011-07-01

... provision of goods, services or technology, from whatever source, to or from Iran or the Government of Iran... the Government of Iran; (3) Act as broker for the provision of financing, a financial guarantee or an extension of credit by any person to Iran or the Government of Iran; (4) Act as a broker for the provision...

31 CFR 560.416 - Brokering services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... provision of goods, services or technology, from whatever source, to or from Iran or the Government of Iran... the Government of Iran; (3) Act as broker for the provision of financing, a financial guarantee or an extension of credit by any person to Iran or the Government of Iran; (4) Act as a broker for the provision...

A framework to assess welfare mix and service provision models in health care and social welfare: case studies of two prominent Italian regions.

PubMed

Longo, Francesco; Notarnicola, Elisabetta; Tasselli, Stefano

2015-04-09

The mechanisms through which the relationships among public institutions, private providers and families affect care and service provision systems are puzzling. How can we understand the mechanisms in these contexts? Which elements should we explore to capture the complexity of care provision? The aim of our study is to provide a framework that can help read and reframe these puzzling care provision mechanisms in a welfare mix context. First, we develop a theoretical framework for understanding how service provision occurs in care systems that are characterised by a variety of relationships between multiple actors, using an evidence-based approach that looks at both public and private expenditures and the number of users relative to the level of needs coverage and compared with declared values and political rhetoric. Second, we test this framework in two case studies built on data from two prominent Italian regions, Lombardy and Emilia-Romagna. We argue that service provision models depend on the interplay among six conceptual elements: policy values, governance rules, resources, nature of the providers, service standards and eligibility criteria. Our empirical study shows that beneath the relevant differences in values and political rhetoric between the case studies of the two Italian regions, there is a surprising isomorphism in service standards and the levels of covering the population's needs. The suggested framework appears to be effective and feasible; it fosters interdisciplinary approaches and supports policy-making discussions. This study may contribute to deepening knowledge about public care service provision and institutional arrangements, which can be used to promote more effective reforms and may advance future research. Although the framework was tested on the Italian welfare system, it can be used to assess many different systems.

47 CFR 90.363 - Grandfathering provisions for existing AVM licensees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Grandfathering provisions for existing AVM licensees. 90.363 Section 90.363 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES PRIVATE LAND MOBILE RADIO SERVICES Intelligent Transportation Systems Radio Service...

Transition to adult services - a positive step.

PubMed

Kim, Samuel; Kim, Sung Hee; McDonald, Susan; Fidler, Sarah; Foster, Caroline

2017-07-01

Following the success of antiretroviral therapy, an expanding cohort of adolescents with perinatally acquired HIV (PaHIV) is transitioning into adult care. Dedicated multidisciplinary transitional care HIV services have been established in the UK. However, published data on patient satisfaction with such services are sparse. A single centre survey of patient satisfaction was conducted in January 2014, and results compared to a previous similar survey in 2009. Patients were asked to complete a questionnaire regarding views of their care using a 7-point Likert scale. 51/96 attended within the time period and all completed the survey, compared with 21 in 2009. Ninety-two percent were satisfied with the care provided by the clinic, compared to 100% in 2009. The proportion who felt moving to their current service had a positive effect on their health increased from 68% in 2009 to 81% in 2014. Ninety-two percent were satisfied with the overall care provided by the clinic, compared to 100% in 2009. Ninety-four percent agreed that staff knew how to talk and listen to young people, 96% agreed staff were able to explain their treatments and problems clearly in a way that they could understand. Ninety-six percent felt that a clinic specifically for young people was useful. Despite a marked increase in clinic attendees and unchanged levels of service provision, patient satisfaction remained high. Patients strongly value the provision of dedicated services for young people.

National variability in provision of health services for major long-term conditions in New Zealand (a report from the ABCC NZ study).

PubMed

Connolly, Martin J; Kenealy, Timothy; Barber, P Alan; Carswell, Peter; Clinton, Janet; Dyall, Lorna; Devlin, Gerard; Doughty, Robert N; Kerse, Ngaire; Kolbe, John; Lawrenson, Ross; Moffitt, Allan; Sheridan, Nicolette

2011-10-14

Chronic illness is the leading cause of morbidity, mortality, and inequitable health outcomes in New Zealand. The ABCCNZ Stocktake aimed to identify extent of long-term conditions management evidence-based practices in stroke, cardiovascular disease, chronic obstructive pulmonary disease and congestive heart failure in New Zealand's District Health Boards (DHBs). Eleven 'dimensions' of care for long-term conditions, identified by literature review and confirmed at workshops with long-term conditions professionals, formed the basis of the Stocktake of all 21 DHBs. It comprised two questionnaires: a generic component capturing perceptions of practice; and a disease-specific component assessing service provision. Fifteen DHBs completed all or parts of the questionnaires. Data accrual was completed in July 2008. Although most DHBs had developed long-term conditions management strategies to a moderate degree, there was considerable variability of practice between DHBs. DHBs thought their PHOs had developed strategies in some areas to a low to moderate level, though cardiovascular disease provision rated more highly. Regarding disease-specific services, larger DHBs had greater long-term conditions management provision not only of tertiary services, but of standard care, leadership, self-management, case-management, and audit. There is considerable variability in perceptions of long-term conditions management service provision across DHBs. In many instances variability in actual disease-specific service provision appears to relate to DHB size.

The structural and health policy environment for delivering integrated HIV and substance use disorder treatments in Puerto Rico.

PubMed

Leff, Jared A; Hernández, Diana; Teixeira, Paul A; Castellón, Pedro C; Feaster, Daniel J; Rodriguez, Allan E; Santana-Bagur, Jorge L; De León, Sandra Miranda; Vidot, José Vargas; Metsch, Lisa R; Schackman, Bruce R

2017-03-23

HIV prevalence in Puerto Rico is nearly twice that of the mainland United States, a level that was substantially fueled by injection drug use. Puerto Rico has a longstanding history of health provision by the public sector that directly affects how HIV and substance use disorder (SUD) treatment services are provided and funded. As part of pre-implementation research for a randomized trial of a community-level intervention to enhance HIV care access for substance users in San Juan, Puerto Rico, we sought to understand the structural and health policy environment for providing HIV and SUD treatments. We conducted semi-structured qualitative interviews (n = 8) with government and program administrators in English and Spanish. Data were analyzed to identify dominant and recurrent themes. Participants discussed how lack of integration among medical and mental health service providers, lack of public transportation, and turnover in appointed government officials were barriers to integrated HIV and SUD treatment. Federal funding for support services for HIV patients was a facilitator. The Affordable Care Act has limited impact in Puerto Rico because provisions related to health insurance reform do not apply to U.S. territories. Implications for intervention design include the need to provide care coordination for services from multiple providers, who are often physically separated and working in different reimbursement systems, and the potential for mobile and patient transportation services to bridge these gaps. Continuous interaction with political leaders is needed to maintain current facilitators. These findings are relevant as the current economic crisis in Puerto Rico affects funding, and may be relevant for other settings with substance use-driven epidemics.

Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania: a cross-sectional study.

PubMed

Saronga, Happiness P; Duysburgh, Els; Massawe, Siriel; Dalaba, Maxwell A; Savadogo, Germain; Tonchev, Pencho; Dong, Hengjin; Sauerborn, Rainer; Loukanova, Svetla

2014-02-28

Cost studies are paramount for demonstrating how resources have been spent and identifying opportunities for more efficient use of resources. The main objective of this study was to assess the actual dimension and distribution of the costs of providing antenatal care (ANC) and childbirth services in selected rural primary health care facilities in Tanzania. In addition, the study analyzed determining factors of service provision efficiency in order to inform health policy and planning. This was a retrospective quantitative cross-sectional study conducted in 11 health centers and dispensaries in Lindi and Mtwara rural districts. Cost analysis was carried out using step down cost accounting technique. Unit costs reflected efficiency of service provision. Multivariate regression analysis on the drivers of observed relative efficiency in service provision between the study facilities was conducted. Reported personnel workload was also described. The health facilities spent on average 7 USD per capita in 2009. As expected, fewer resources were spent for service provision at dispensaries than at health centers. Personnel costs contributed a high approximate 44% to total costs. ANC and childbirth consumed approximately 11% and 12% of total costs; and 8% and 10% of reported service provision time respectively. On average, unit costs were rather high, 16 USD per ANC visit and 79.4 USD per childbirth. The unit costs showed variation in relative efficiency in providing the services between the health facilities. The results showed that efficiency in ANC depended on the number of staff, structural quality of care, process quality of care and perceived quality of care. Population-staff ratio and structural quality of basic emergency obstetric care services highly influenced childbirth efficiency. Differences in the efficiency of service provision present an opportunity for efficiency improvement. Taking into consideration client heterogeneity, quality improvements are possible and necessary. This will stimulate utilization of ANC and childbirth services in resource-constrained health facilities. Efficiency analyses through simple techniques such as measurement of unit costs should be made standard in health care provision, health managers can then use the performance results to gauge progress and reward efficiency through performance based incentives.

31 CFR 588.405 - Provision of services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Provision of services. 588.405 Section 588.405 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE..., accounting, financial, brokering, freight forwarding, transportation, public relations, or other services to...

Service mix in the hospital outpatient department: implications for Medicare payment reform.

PubMed Central

Miller, M E; Sulvetta, M B; Englert, E

1995-01-01

OBJECTIVE. To determine if implementation of a PPS for Medicare hospital outpatient department (HOPD) services will have distributional consequences across hospital types and regions, this analysis assesses variation in service mix and the provision of high-technology services in the HOPD. DATA. HCFA's 1990 claims file for a 5 percent random sample of Medicare beneficiaries using the HOPD was merged, by hospital provider number, with various HCFA hospital characteristic files. STUDY DESIGN. Hospital characteristics examined are urban/rural location, teaching status, disproportionate-share status, and bed size. Two analyses of HOPD services are presented: mix of services provided and the provision of high-technology services. The mix of services is measured by the percentage of services in each of 14 type-of-service categories (e.g., medical visits, advanced imaging services, diagnostic testing services). Technology provision is measured by the percentage of hospitals providing selected high-technology services. FINDINGS/CONCLUSIONS. The findings suggest that the role hospital types play in providing HOPD services warrants consideration in establishing a PPS. HOPDs in major teaching hospitals and hospitals serving a disproportionate share of the poor play an important role in providing routine visits. HOPDs in both major and minor teaching hospitals are important providers of high-technology services. Other findings have implications for the structure of an HOPD PPS as well. First, over half of the services provided in the HOPD are laboratory tests and HOPDs may have limited control over these services since they are often for patients referred from local physician offices. Second, service mix and technology provision vary markedly among regions, suggesting the need for a transition to prospective payment. Third, the organization of service supply in a region may affect service provision in the HOPD suggesting that an HOPD PPS needs to be coordinated with payment policies in competing sites of care (e.g., ambulatory surgical centers). PMID:7721585

How stakeholders frame dam removal: The role of current and anticipated future ecosystem service use

NASA Astrophysics Data System (ADS)

Reilly, Kate; Adamowski, Jan

2016-04-01

Many river restoration projects, including dam removal, are controversial and can trigger conflicts between stakeholders who are for and against the proposed project. The study of environmental conflicts suggests that differences in how stakeholders 'frame', or make sense of a situation based on their prior knowledge and experiences, can perpetuate conflicts. Understanding different stakeholders' frames, particularly how they converge, can form the basis of successful conflict resolution. In the case of dam removals, it is often assumed that emphasising increased provision of ecosystem services can be a point of convergence between those advocating for ecological restoration and those opposed to removal because of negative human impacts. However, how exactly stakeholders frame a contentious proposed dam removal and how those frames relate to ecosystem services has been little studied. Here we used the case of a potential dam removal in New Brunswick to investigate how people frame the issue and how that relates to their current and anticipated future use of ecosystem services. Based on in-depth interviews with 30 stakeholders in the area, including both people for and against dam removal, we found that both groups currently used ecosystem services and were in favour of ecosystem protection. However, they differed in how they framed the issue of the potential dam removal. The group against dam removal framed the issue as one of loss and risk - they thought that any potential benefits to the ecosystem would be outweighed by the high risk of negative social impacts caused by a loss of access to ecosystem services, such as recreation and aesthetic enjoyment. By contrast, the group in favour of the dam framed the issue as one of opportunity and justice. They thought that following a short transition period, all stakeholders would benefit from the restored river, particularly from a restored salmon fishery, improved aesthetic appeal and the long-term sustainability of an undammed river. Ultimately, we argue that increased provision of ecosystem services does not always represent a point of convergence between stakeholder groups, because both groups support ecosystem protection but differ in how they expect the benefits they derive from ecosystem services to change. Conflict resolution strategies may be better addressed by measures to mitigate the perceived loss of ecosystem services in the group against dam removal.

Involvement as inclusion? Shared decision-making in social work practice in Israel: a qualitative account.

PubMed

Levin, Lia

2015-03-01

Shared decision-making (SDM), a representation of shared knowledge and power between social workers and their clients, is gaining popularity and prevalence in social services around the world. In many senses, SDM reflects values traditionally associated with social work and service provision, such as equality and anti-discrimination. In the complex context of social problem-solving, however, the relationship between SDM, social workers and their clients is multi-faceted and deserves particular attention. The current study examined SDM and the dilemmas it entails through interviews conducted in 2012 with 77 Israeli social workers and policy makers whose responses were analysed according to the guiding principles of descriptive phenomenological content analysis and dialogical commonality. Participants' responses represent notions of hope, change, identity and choice. Findings are discussed in correspondence with current and recent trends in Israeli social services, and the social work profession in Israel. © 2014 John Wiley & Sons Ltd.

7 CFR 4288.131 - Payment provisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions Payment Provisions § 4288.131 Payment provisions. Payments to advanced biofuel producers for eligible advanced biofuel production will be determined in accordance with the provisions of...

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

Current status of psychiatric rehabilitation in Portugal: A national survey.

PubMed

Teixeira, Carina; Santos, Eduardo; Abreu, Manuel Viegas; Rogers, E Sally

2015-09-01

This article reports on the current state of psychiatric rehabilitation in Portugal. A paper-and-pencil survey was sent to 70 institutions to inquire about the provision of psychiatric rehabilitation services and programs. With a response rate of 40%, 14% of institutions indicated that supported education was provided, 36% offered nonmainstream vocational training, and 29% provided supported employment; none provided evidence-based Individual Placement and Support. Permanent group homes in the community (29%) followed by transitional group homes on institutional grounds (18%) were the most common residential services, with supported housing services (14%) offered less frequently. Finally, 93% of institutions offered occupational activities, 61% provided multifamily psychoeducation, and 36% provided single-family psychoeducation. Despite recent national initiatives promoting effective psychiatric rehabilitation services, supported employment, supported education, and supported housing are not widely implemented in Portugal. To achieve better outcomes for clients, it is critical that evidence-based and promising practices be extensively disseminated. (c) 2015 APA, all rights reserved).

25 CFR 900.196 - Do covered services include the conduct of clinical studies and investigations and the provision...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Do covered services include the conduct of clinical studies and investigations and the provision of emergency services, including the operation of emergency... Claims § 900.196 Do covered services include the conduct of clinical studies and investigations and the...

78 FR 64249 - Notice of Intent To Award-Grant Awards for the Provision of Civil Legal Services to Eligible Low...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-28

... LEGAL SERVICES CORPORATION Notice of Intent To Award--Grant Awards for the Provision of Civil Legal Services to Eligible Low-Income Clients Beginning January 1, 2014 AGENCY: Legal Services Corporation. ACTION: Announcement of intention to make FY 2014 Competitive Grant Awards. SUMMARY: The Legal...

77 FR 64551 - Notice of Intent to Award-Grant Awards for the Provision of Civil Legal Services to Eligible Low...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-22

... LEGAL SERVICES CORPORATION Notice of Intent to Award--Grant Awards for the Provision of Civil Legal Services to Eligible Low-Income Clients Beginning January 1, 2013 AGENCY: Legal Services Corporation. ACTION: Announcement of intention to make FY 2013 Competitive Grant Awards. SUMMARY: The Legal...

76 FR 68221 - Notice of Intent To Award-Grant Awards for the Provision of Civil Legal Services to Eligible Low...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-03

... LEGAL SERVICES CORPORATION Notice of Intent To Award--Grant Awards for the Provision of Civil Legal Services to Eligible Low-Income Clients Beginning January 1, 2012 AGENCY: Legal Services Corporation. ACTION: Announcement of intention to make FY 2012 Competitive Grant Awards. SUMMARY: The Legal...

Business Model Evaluation for an Advanced Multimedia Service Portfolio

NASA Astrophysics Data System (ADS)

Pisciella, Paolo; Zoric, Josip; Gaivoronski, Alexei A.

In this paper we analyze quantitatively a business model for the collaborative provision of an advanced mobile data service portfolio composed of three multimedia services: Video on Demand, Internet Protocol Television and User Generated Content. We provide a description of the provision system considering the relation occurring between tecnical aspects and business aspects for each agent providing the basic multimedia service. Such a techno-business analysis is then projected into a mathematical model dealing with the problem of the definition of incentives between the different agents involved in a collaborative service provision. Through the implementation of this model we aim at shaping the behaviour of each of the contributing agents modifying the level of profitability that the Service Portfolio yields to each of them.

Participation of patients and family members in healthcare services at the service and national levels: A lesson learned in Dublin, Ireland.

PubMed

Whiston, Lucy; Barry, Joe M; Darker, Catherine D

2017-03-01

Identify the current amount and intensity of patient and family participation at the patient, service and national levels from a diabetes and a psychiatric service perspective. Establish the current level of support for greater participation and related characteristics. Researcher-administered questionnaires were conducted with 738 patients and family members in an outpatient type 2 diabetes service and an outpatient psychiatric service, both in Dublin, Ireland. Patient and family participation at the service and national levels are restricted to the provision of information. Typically no involvement in discussions or the decision -making process is reported. The majority of participants favour greater patient participation at the service level (537/669; 80.3%) and the national level (561/651; 86.2%). Greater support for patient and family member participation is significantly associated with participant's age, service satisfaction and level of education. Patient and family participation is greatest at the patient level. The majority of patients and family members support greater participation at the service and national levels. The best way to implement participation needs to be identified. There needs to be a greater focus on participation at the service level. The role of family members also needs to be investigated further. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Ecosystem services capacity across heterogeneous forest types: understanding the interactions and suggesting pathways for sustaining multiple ecosystem services.

PubMed

Alamgir, Mohammed; Turton, Stephen M; Macgregor, Colin J; Pert, Petina L

2016-10-01

As ecosystem services supply from tropical forests is declining due to deforestation and forest degradation, much effort is essential to sustain ecosystem services supply from tropical forested landscapes, because tropical forests provide the largest flow of multiple ecosystem services among the terrestrial ecosystems. In order to sustain multiple ecosystem services, understanding ecosystem services capacity across heterogeneous forest types and identifying certain ecosystem services that could be managed to leverage positive effects across the wider bundle of ecosystem services are required. We sampled three forest types, tropical rainforests, sclerophyll forests, and rehabilitated plantation forests, over an area of 32,000m(2) from Wet Tropics bioregion, Australia, aiming to compare supply and evaluate interactions and patterns of eight ecosystem services (global climate regulation, air quality regulation, erosion regulation, nutrient regulation, cyclone protection, habitat provision, energy provision, and timber provision). On average, multiple ecosystem services were highest in the rainforests, lowest in sclerophyll forests, and intermediate in rehabilitated plantation forests. However, a wide variation was apparent among the plots across the three forest types. Global climate regulation service had a synergistic impact on the supply of multiple ecosystem services, while nutrient regulation service was found to have a trade-off impact. Considering multiple ecosystem services, most of the rehabilitated plantation forest plots shared the same ordination space with rainforest plots in the ordination analysis, indicating that rehabilitated plantation forests may supply certain ecosystem services nearly equivalent to rainforests. Two synergy groups and one trade-off group were identified. Apart from conserving rainforests and sclerophyll forests, our findings suggest two additional integrated pathways to sustain the supply of multiple ecosystem services from a heterogeneous tropical forest landscape: (i) rehabilitation of degraded forests aiming to provide global climate regulation and habitat provision ecosystem services and (ii) management intervention to sustain global climate regulation and habitat provision ecosystem services. Copyright © 2016 Elsevier B.V. All rights reserved.

Not Nearly Enough Geography! University Provision for England's Pre-Service Primary Teachers

ERIC Educational Resources Information Center

Catling, Simon

2017-01-01

Research into geography provision in primary initial teacher education [ITE] courses in the United Kingdom and worldwide is very limited. England educates pre-service primary teachers of 5-11 year olds to be "generalists" who teach the full range of curriculum subjects, including geography. This article identifies that the provision of…

Inequalities in the Provision of Paediatric Speech and Language Therapy Services across London Boroughs

ERIC Educational Resources Information Center

Pring, Tim

2016-01-01

Background: The inverse-care law suggests that fewer healthcare resources are available in deprived areas where health needs are greatest. Aims: To examine the provision of paediatric speech and language services across London boroughs and to relate provision to the level of deprivation of the boroughs. Methods & Procedures: Information on the…

How agricultural multiple ecosystem services respond to socioeconomic factors in Mengyin County, China.

PubMed

Chen, Yajuan; Yu, Zhenrong; Li, Xuedong; Li, Pengyao

2018-07-15

Provisioning services have always been the main focus of agriculture, and which have led to a decline in biodiversity and have damaged a number of other services. Agriculture should contribute to current and future food security while producing multiple ecosystem services (ES). Restoration outcomes of multiple ES were affected by different socioeconomic drivers, thus a better understanding of how multiple ES respond to socioeconomic drivers can help to restore multiple ES. This paper used rural people's perceptions of ES to quantify and map ecosystem service obtainment and demand in the Mengyin County, China. An integrative index of multiple ecosystem services (IMES) was used to effectively aggregate the values of multiple ES. The threat categorization framework is designed to communicate the degree to which the adequate and sustainable provision of multiple ES is threatened, in order to prioritize conservation actions. The results revealed that 6 townships in the Mengyin County exhibited an excessive obtainment situation (demand is less than obtainment) of multiple ES; an insufficient obtainment situation (demand is greater than obtainment) of multiple ES was mainly situated in the northern part of Mengyin County. Overall, the current state of multiple ES across Mengyin County is classified as "Endangered" classification according to application of threat categorization framework. It is necessary to restructure and manage socioeconomic factors for multiple ES. At national level, the macro decision-making (controlling population density) and the mechanisms (attracting high-quality human resources into the rural) will play an important role in promoting multiple ES management, and it is necessary to provide 3 or more years of tailored educational resources for rural residents to advance multiple ES in agricultural landscape. Development of agricultural PES programs in China that enable farmers to profit from production ES is a sustainable strategy for increasing multiple ecosystem services. Copyright © 2018 Elsevier B.V. All rights reserved.

Expedited Citizenship Through Military Service: Current Law, Policy and Issues

DTIC Science & Technology

2009-02-25

benefits specifically for immediate relatives of such personnel. The reported deaths in action of noncitizen soldiers drew attention to the immigration...benefits of aliens serving in the military. The reported deaths in action of noncitizen soldiers drew attention to provisions of the Immigration and...decision, President Clinton revoked the earlier Grenada designation.18 Military actions in Somalia, Bosnia, Kosovo, Haiti, and Panama have not been

Defense: FY2012 Budget Request, Authorization and Appropriations

DTIC Science & Technology

2012-02-13

current counterinsurgency and dismounted operations in [Iraq and Afghanistan] place service women in direct combat action with the enemy. The ...vehicles, including the EFV and a modified version of the AAV-7. However, the provision bars any other amphibious vehicle development work until the ...would allow information technology companies other than the original developer to bid for maintenance and upgrade work on the system

Predictive Validity of UAS/RPA Sensor Operator Training Qualification Measures

DTIC Science & Technology

2015-01-30

and unpredictability of the task) and personality traits (e.g., patience). Several measures have been developed to address these gaps in...other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a...medical, citizenship, and security standards and aptitude requirements (Armed Services Vocational Aptitude Battery [ASVAB]). The current study

If Only "A Rose by Any Other Name Would Smell as Sweet": A Systematic Review on the Impact of Youth Work for Young People

ERIC Educational Resources Information Center

Mundy-McPherson, Stuart; Fouche, Christa; Elliot, Kim

2012-01-01

Background: Internationally there is an increasing commitment and investment to support the provision of youth work services and ongoing debate on youth worker effectiveness. However, the evidence of the impact of youth work is currently limited and disjointed. Objective: This article reports on and critically considers the results of a systematic…

Beyond physical access: a qualitative analysis into the barriers to policy implementation and service provision experienced by persons with disabilities living in a rural context.

PubMed

Neille, Joanne; Penn, Claire

2015-01-01

Persons with disabilities make up approximately 15% of the world's population, with vulnerable communities disproportionately affected by the incidence of disability. Research reflects that persons with disabilities are vulnerable to stigma and discrimination, social isolation, and have physical barriers to accessing support services, all of which serve to perpetuate a sense of uncertainty and vulnerability within their lives. Recently a number of policies and models of intervention have been introduced intended to protect the rights of those affected by disability, yet limited research has been conducted into the lived experiences of persons with disabilities, particularly in rural contexts. This implies that little is known about the impact of the rural context on the lived experience of disability and the ways in which context impacts on the implementation of policies and practices. The current study employed a qualitative design underpinned by the principles of narrative inquiry and participant observation. Thirty adults with a variety of congenital and acquired disabilities (15 men and 15 women, ranging in age from 19 to 83 years) living in 12 rural communities in the Mpumalanga Province of South Africa were recruited through snowball sampling. Data collection comprised a combination of narrative inquiry and participant observation. Narratives were collected in SiSwati with the assistance of a SiSwati-speaking research mediator and were transcribed and translated into English. Data were analysed inductively according to the principles of thematic analysis. Findings confirmed that the experience of living with a disability in a rural area is associated with discrimination, social exclusion, and isolation and barriers to accessing services, underpinned by numerous context-specific experiences, including mortality rates, exposure to numerous and repeated forms of violence across the lifespan, and corruption and lack of transparency in the implementation of government policies and practices. These experiences are not currently reflected in the literature or in guidelines on the implementations of policies and service provision, and thus have the potential to offer novel insights into the barriers faced by persons with disabilities living in rural areas. The results of this study suggest that barriers to service provision extend beyond physical obstacles, and include a variety of sociocultural and sociopolitical barriers. By failing to take these into account, policies and current models of service provision are only able to provide limited support to persons with disabilities living in rural areas. The findings reveal narrative inquiry to be a powerful and culturally safe tool for exploring lived experience among vulnerable populations and hold significant implications for both practitioners and policy developers. Furthermore, it emerges that one-size-fits-all policies are unable to meet the needs of persons with disabilities living in rural areas. However, the implementation of site-specific needs analyses with the use of flexible and culturally appropriate tools has the potential to redress the discrepancies in policy implementation and can be used to strengthen institutional ties and referral pathways.

45 CFR 400.314 - Priority in provision of services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Priority in provision of services. 400.314 Section 400.314 Public Welfare Regulations Relating to Public Welfare OFFICE OF REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM...

45 CFR 303.7 - Provision of services in interstate IV-D cases.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ENFORCEMENT (CHILD SUPPORT ENFORCEMENT PROGRAM), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES STANDARDS FOR PROGRAM OPERATIONS § 303.7 Provision of services in interstate IV... central registry responsible for receiving, distributing and responding to inquiries on all incoming...

47 CFR 1.9047 - Special provisions relating to leases of educational broadband service spectrum.

Code of Federal Regulations, 2014 CFR

2014-10-01

... educational broadband service spectrum. 1.9047 Section 1.9047 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Grants by Random Selection Spectrum Leasing General Policies and Procedures § 1.9047 Special provisions relating to leases of educational broadband service spectrum...

47 CFR 1.9047 - Special provisions relating to leases of educational broadband service spectrum.

Code of Federal Regulations, 2010 CFR

2010-10-01

... educational broadband service spectrum. 1.9047 Section 1.9047 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Spectrum Leasing General Policies and Procedures § 1.9047 Special provisions relating to leases of educational broadband service spectrum. Licensees in the Educational...

47 CFR 1.9047 - Special provisions relating to leases of educational broadband service spectrum.

Code of Federal Regulations, 2011 CFR

2011-10-01

... educational broadband service spectrum. 1.9047 Section 1.9047 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Spectrum Leasing General Policies and Procedures § 1.9047 Special provisions relating to leases of educational broadband service spectrum. Licensees in the Educational...

47 CFR 1.9047 - Special provisions relating to leases of educational broadband service spectrum.

Code of Federal Regulations, 2013 CFR

2013-10-01

... educational broadband service spectrum. 1.9047 Section 1.9047 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Grants by Random Selection Spectrum Leasing General Policies and Procedures § 1.9047 Special provisions relating to leases of educational broadband service spectrum...

47 CFR 1.9047 - Special provisions relating to leases of educational broadband service spectrum.

Code of Federal Regulations, 2012 CFR

2012-10-01

... educational broadband service spectrum. 1.9047 Section 1.9047 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Grants by Random Selection Spectrum Leasing General Policies and Procedures § 1.9047 Special provisions relating to leases of educational broadband service spectrum...

5 CFR 731.601 - Savings provision.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Savings provision. 731.601 Section 731.601 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) SUITABILITY Savings Provision § 731.601 Savings provision. No provision of the regulations in...

5 CFR 731.601 - Savings provision.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Savings provision. 731.601 Section 731.601 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) SUITABILITY Savings Provision § 731.601 Savings provision. No provision of the regulations in...

Strengthening rehabilitation services in Indonesia: A brief situation analysis.

PubMed

Nugraha, Boya; Setyono, Garry Rahardian; Defi, Irma Ruslina; Gutenbrunner, Christoph

2018-04-18

People with disability (PWD) in Indonesia are often neglected by society. Improving their life situation towards full participation in society is crucial. As a health strategy, rehabilitation can improve func-tioning, quality of life and participation in society. However, rehabilitation services in Indonesia need improvement. Making a situation analysis of rehabilitation services and their provision in the country is a pre-requisite to taking any action towards improvement. This paper compiles available data related to disability and rehabilitation services in Indonesia, using the Rehabilitation Services Assessment Tool (RSAT) as a framework. Gaps in provision were analysed, resulting in the compilation of a list of generic recommendations to improve rehabilitation services in the country. Indonesia faces many challenges in rehabilitation services, including the health workforce and the provision of services. This situation analysis and list of generic recommendations may be used in further discussions with relevant stakeholders in the country to develop a national strategy to strengthen rehabilitation services.

Ghana’s National Health Insurance Scheme: a national level investigation of members’ perceptions of service provision

PubMed Central

2013-01-01

Background Ghana’s National Health Insurance Scheme (NHIS), established into law in 2003 and implemented in 2005 as a ‘pro-poor’ method of health financing, has made great progress in enrolling members of the general population. While many studies have focused on predictors of enrolment this study offers a novel analysis of NHIS members’ perceptions of service provision at the national level. Methods Using data from the 2008 Ghana Demographic Health Survey we analyzed the perceptions of service provision as indicated by members enrolled in the NHIS at the time of the survey (n = 3468; m = 1422; f = 2046). Ordinal Logistic Regression was applied to examine the relationship between perceptions of service provision and theoretically relevant socioeconomic and demographic variables. Results Results demonstrate that wealth, gender and ethnicity all play a role in influencing members’ perceptions of NHIS service provision, distinctive from its influence on enrolment. Notably, although wealth predicted enrolment in other studies, our study found that compared to the poorest men and uneducated women, wealthy men and educated women were less likely to perceive their service provision as better/same (more likely to report it was worse). Wealth was not an important factor for women, suggesting that household gender dynamics supersede household wealth status in influencing perceptions. As well, when compared to Akan women, women from all other ethnic groups were about half as likely to perceive the service provision to be better/same. Conclusions Findings of this study suggest there is an important difference between originally enrolling in the NHIS because one believes it is potentially beneficial, and using the NHIS and perceiving it to be of benefit. We conclude that understanding the nature of this relationship is essential for Ghana’s NHIS to ensure its longevity and meet its pro-poor mandate. As national health insurance systems are a relatively new phenomenon in sub-Saharan Africa little is known about their long term viability; understanding user perceptions of service provision is an important piece of that puzzle. PMID:23968385

Concept of a spatial data infrastructure for web-mapping, processing and service provision for geo-hazards

NASA Astrophysics Data System (ADS)

Weinke, Elisabeth; Hölbling, Daniel; Albrecht, Florian; Friedl, Barbara

2017-04-01

Geo-hazards and their effects are distributed geographically over wide regions. The effective mapping and monitoring is essential for hazard assessment and mitigation. It is often best achieved using satellite imagery and new object-based image analysis approaches to identify and delineate geo-hazard objects (landslides, floods, forest fires, storm damages, etc.). At the moment, several local/national databases and platforms provide and publish data of different types of geo-hazards as well as web-based risk maps and decision support systems. Also, the European commission implemented the Copernicus Emergency Management Service (EMS) in 2015 that publishes information about natural and man-made disasters and risks. Currently, no platform for landslides or geo-hazards as such exists that enables the integration of the user in the mapping and monitoring process. In this study we introduce the concept of a spatial data infrastructure for object delineation, web-processing and service provision of landslide information with the focus on user interaction in all processes. A first prototype for the processing and mapping of landslides in Austria and Italy has been developed within the project Land@Slide, funded by the Austrian Research Promotion Agency FFG in the Austrian Space Applications Program ASAP. The spatial data infrastructure and its services for the mapping, processing and analysis of landslides can be extended to other regions and to all types of geo-hazards for analysis and delineation based on Earth Observation (EO) data. The architecture of the first prototypical spatial data infrastructure includes four main areas of technical components. The data tier consists of a file storage system and the spatial data catalogue for the management of EO-data, other geospatial data on geo-hazards, as well as descriptions and protocols for the data processing and analysis. An interface to extend the data integration from external sources (e.g. Sentinel-2 data) is planned for the possibility of rapid mapping. The server tier consists of java based web and GIS server. Sub and main services are part of the service tier. Sub services are for example map services, feature editing services, geometry services, geoprocessing services and metadata services. For (meta)data provision and to support data interoperability, web standards of the OGC and the rest-interface is used. Four central main services are designed and developed: (1) a mapping service (including image segmentation and classification approaches), (2) a monitoring service to monitor changes over time, (3) a validation service to analyze landslide delineations from different sources and (4) an infrastructure service to identify affected landslides. The main services use and combine parts of the sub services. Furthermore, a series of client applications based on new technology standards making use of the data and services offered by the spatial data infrastructure. Next steps include the design to extend the current spatial data infrastructure to other areas and geo-hazard types to develop a spatial data infrastructure that can assist targeted mapping and monitoring of geo-hazards on a global context.

Cultural diversity and the mistreatment of older people in black and minority ethnic communities: some implications for service provision.

PubMed

Bowes, Alison; Avan, Ghizala; Macintosh, Sherry Bien

2012-07-01

Previous research on mistreatment of older people in black and minority ethnic communities has identified limited service responses and the need to consider mistreatment as an issue not only for individuals but also for families, communities, and institutions. The impact of cultural factors on understandings, experiences, and remedies for mistreatment has been debated. Drawing on empirical research in the United Kingdom involving service providers and ethnically-diverse community members, the article explores implications of cultural variation for service provision. Clear gaps exist between service provision and people experiencing mistreatment due to structural and contextual factors; cultural factors have a relatively minor impact.

Enhancement of biodiversity and ecosystem services by ecological restoration: a meta-analysis.

PubMed

Rey Benayas, José M; Newton, Adrian C; Diaz, Anita; Bullock, James M

2009-08-28

Ecological restoration is widely used to reverse the environmental degradation caused by human activities. However, the effectiveness of restoration actions in increasing provision of both biodiversity and ecosystem services has not been evaluated systematically. A meta-analysis of 89 restoration assessments in a wide range of ecosystem types across the globe indicates that ecological restoration increased provision of biodiversity and ecosystem services by 44 and 25%, respectively. However, values of both remained lower in restored versus intact reference ecosystems. Increases in biodiversity and ecosystem service measures after restoration were positively correlated. Results indicate that restoration actions focused on enhancing biodiversity should support increased provision of ecosystem services, particularly in tropical terrestrial biomes.

'Drug adherence levels are falling down again': health worker perceptions of women's service utilization before and after integration of HIV/AIDS services into general care in India.

PubMed

Shukla, Shrivridhi; Muchomba, Felix M; McCoyd, Judith L M

2018-06-01

Integrated models of HIV/AIDS service delivery are believed to have advantages over stand-alone models of care from health planners' and providers' perspectives. Integration models differ, yet there is little information about the influence of differing models on workers' beliefs about models' efficacy. Here, we examine the effect of integration of HIV care into the general health system in India. In 2014, India replaced its stand-alone model of HIV service delivery-Community Care Centers (CCCs)-with a purported integrated model that delivers HIV medical services at general hospitals and HIV psychosocial services at nearby Care and Support Centers (CSCs). We examine 15 health workers' perceptions of how change from the earlier stand-alone model to the current model impacted women's care in a district in Uttar Pradesh, India. Results indicate that (1) Women's antiretroviral (ART) adherence and utilization of psychosocial support service for HIV/AIDS suffered when services were not provided at one site; (2) Provision of inpatient care in the CCC model offered women living in poverty personal safety in accessing HIV health services and promoted chances of competent ART usage and repeat service utilization; and (3) Although integration of HIV services with the general health system was perceived to improve patient anonymity and decrease chances of HIV-related stigma and discrimination, resource shortages continued to plague the integrated system while shifting costs of time and money to the patients. Findings suggest that integration efforts need to consider the context of service provision and the gendered nature of access to HIV care.

The relationship between general population suicide rates and mental health funding, service provision and national policy: a cross-national study.

PubMed

Shah, Ajit; Bhandarkar, Ritesh; Bhatia, Gurleen

2010-07-01

The main aims were to examine the relationship between general population suicide rates and the presence of national policies on mental health, funding for mental health, and measures of mental health service provision. Data on general population suicide rates for both genders were obtained from the World Health Organization (WHO) databank available on the WHO website. Data on the presence of national policies on mental health, funding for mental health and measures of mental health service provision were obtained from the Mental Health Atlas 2005, also available on the WHO website. The main findings were: (i) there was no relationship between suicide rates in both genders and different measures of mental health policy, except they were increased in countries with mental health legislation; (ii) there was a significant positive correlation between suicide rates in both genders and the percentage of the total health budget spent on mental health; and (iii) suicide rates in both genders were higher in countries with greater provision of mental health services, including the number of psychiatric beds, psychiatrists and psychiatric nurses, and the availability of training in mental health for primary care professionals. Cross-national ecological studies using national-level aggregate data are not helpful in establishing a causal relationship (and the direction of this relationship) between suicide rates and mental health funding, service provision and national policies. The impact of introducing national policies on mental health, increasing funding for mental health services and increasing mental health service provision on suicide rates requires further examination in longitudinal within-country studies.

Health financing reform in Uganda: How equitable is the proposed National Health Insurance scheme?

PubMed

Orem, Juliet Nabyonga; Zikusooka, Charlotte Muheki

2010-10-13

Uganda is proposing introduction of the National Health Insurance scheme (NHIS) in a phased manner with the view to obtaining additional funding for the health sector and promoting financial risk protection. In this paper, we have assessed the proposed NHIS from an equity perspective, exploring the extent to which NHIS would improve existing disparities in the health sector. We reviewed the proposed design and other relevant documents that enhanced our understanding of contextual issues. We used the Kutzin and fair financing frameworks to critically assess the impact of NHIS on overall equity in financing in Uganda. The introduction of NHIS is being proposed against the backdrop of inequalities in the distribution of health system inputs between rural and urban areas, different levels of care and geographic areas. In this assessment, we find that gradual implementation of NHIS will result in low coverage initially, which might pose a challenge for effective management of the scheme. The process for accreditation of service providers during the first phase is not explicit on how it will ensure that a two-tier service provision arrangement does not emerge to cater for different types of patients. If the proposed fee-for-service mechanism of reimbursing providers is pursued, utilisation patterns will determine how resources are allocated. This implies that equity in resource allocation will be determined by the distribution of accredited providers, and checks put in place to prohibit frivolous use. The current design does not explicitly mention how these two issues will be tackled. Lastly, there is no clarity on how the NHIS will fit into, and integrate within existing financing mechanisms. Under the current NHIS design, the initial low coverage in the first years will inhibit optimal achievement of the important equity characteristics of pooling, cross-subsidisation and financial protection. Depending on the distribution of accredited providers and utilisation patterns, the NHIS could worsen existing disparities in access to services, given the fee-for-service reimbursement mechanisms currently proposed. Lastly, if equity in financing and resource allocation are not explicit objectives of the NHIS, it might inadvertently worsen the existing disparities in service provision.

47 CFR 64.1502 - Limitations on the provision of pay-per-call services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Limitations on the provision of pay-per-call services. 64.1502 Section 64.1502 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) MISCELLANEOUS RULES RELATING TO COMMON CARRIERS Interstate Pay-Per-Call and...

47 CFR 64.705 - Restrictions on charges related to the provision of operator services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... provision of operator services. 64.705 Section 64.705 Telecommunication FEDERAL COMMUNICATIONS COMMISSION... operator services shall: (1) Not bill for unanswered telephone calls in areas where equal access is available; (2) Not knowingly bill for unanswered telephone calls where equal access is not available; (3...

Service Provision for Preschool Children Who Are Deaf: Parents' Perspectives.

ERIC Educational Resources Information Center

Robinshaw, Helen; Evans, Roy

2001-01-01

Reports on data from national review of preschool service provision for deaf children and their families in the United Kingdom. Presents families' responses to early identification; information available after identification; perceptions of partnerships with professionals; and value of family-centered services for themselves, for their children,…

12 CFR 611.1125 - Treatment of associations not approving districtwide mergers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... in a districtwide merger or consolidation: (1) Discriminate in the provision of any financial service... provision of any related services that are offered by the district bank to associations and their member... to, charging different rates of interest or different prices for services, or declining to provide...

45 CFR 303.7 - Provision of services in intergovernmental IV-D cases.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ENFORCEMENT (CHILD SUPPORT ENFORCEMENT PROGRAM), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES STANDARDS FOR PROGRAM OPERATIONS § 303.7 Provision of services in intergovernmental IV-D cases. (a) General responsibilities. A State IV-D agency must: (1) Establish and use...

47 CFR 64.402 - Policies and procedures for the provision of priority access service by commercial mobile radio...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Policies and procedures for the provision of... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) MISCELLANEOUS... National Security and Emergency Preparedness personnel shall provide priority access service in accordance...

42 CFR 412.87 - Additional payment for new medical services and technologies: General provisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... technologies: General provisions. 412.87 Section 412.87 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... SERVICES Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.87 Additional...

42 CFR 412.87 - Additional payment for new medical services and technologies: General provisions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... technologies: General provisions. 412.87 Section 412.87 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... SERVICES Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.87 Additional...

42 CFR 412.87 - Additional payment for new medical services and technologies: General provisions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... technologies: General provisions. 412.87 Section 412.87 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... SERVICES Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.87 Additional...

42 CFR 412.87 - Additional payment for new medical services and technologies: General provisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... technologies: General provisions. 412.87 Section 412.87 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... SERVICES Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.87 Additional...

Opportunities in the Affordable Care Act to Advance Long-Term Services and Supports: The Role of Rehabilitation Counseling

ERIC Educational Resources Information Center

Caldwell, Joe; Alston, Reginald J.

2012-01-01

The Affordable Care Act includes many new provisions for long-term services and supports (LTSS). Among these are several new options, improvements, and incentives within Medicaid to balance service systems and expand access to home and community-based services. This article discusses some of the major provisions, implementations, and implications…

Management to Insulate Ecosystem Services from the Effects of Catchment Development

NASA Astrophysics Data System (ADS)

Gell, Peter

2018-02-01

Natural ecosystems provide amenity to human populations in the form of ecosystem services. These services are grouped into four broad categories: provisioning - food and water production; regulating - control of climate and disease; supporting - crop pollination; and cultural - spiritual and recreational benefits. Aquatic systems provide considerable service through the provision of potable water, fisheries and aquaculture production, nutrient mitigation and the psychological benefits that accrue from the aesthetic amenity provided from lakes, rivers and other wetlands. Further, littoral and riparian ecosystems, and aquifers, protect human communities from sea level encroachment, and tidal and river flooding. Catchment and water development provides critical resources for human consumption. Where these provisioning services are prioritized over others, the level and quality of production may be impacted. Further, the benefits from these provisioning services comes with the opportunity cost of diminishing regulating, supporting and cultural services. This imbalance flags concerns for humanity as it exceeds recognised safe operating spaces. These concepts are explored by reference to long term records of change in some of the world's largest river catchments and lessons are drawn that may enable other communities to consider the balance of ecosystems services in natural resource management.

Development and evaluation of a wheelchair service provision training of trainers programme

PubMed Central

2017-01-01

Background In many countries, availability of basic training and continued professional development programmes in wheelchair services is limited. Therefore, many health professionals lack access to formal training opportunities and new approaches to improve wheelchair service provision. To address this need, the World Health Organization (WHO) developed the WHO Wheelchair Service Training of Trainers Programme (WSTPt), aiming to increase the number of trainers who are well prepared to deliver the WHO Wheelchair Service Training Packages. Despite these efforts, there was no recognised method to prepare trainers to facilitate these training programmes in a standardised manner. Objectives To understand if the WSTPt is an effective mechanism to train aspiring wheelchair service provision trainers. Method An action research study was conducted using a mixed-methods approach to data collection and analysis to integrate feedback from questionnaires and focus groups from three WHO WSTPt pilots. Results Trainees were satisfied with the WHO WSTPt and the iterative process appears to have helped to improve each subsequent pilot and the final training package. Conclusion The WHO WSTPt is an effective mechanism to train wheelchair service provision trainers. This programme has potential to increase the number of trainees and may increase the number of qualified service providers. PMID:28936423

Assessment of economic viability of solid waste service provision in small settlements in developing countries: case study Rosetta, Egypt.

PubMed

Abdrabo, Mohamed Abdel-Karim

2008-12-01

Problems associated with solid waste management (SWM) service provision in developing countries are reaching an ever increasing magnitude, leading to considerable adverse impacts on the environment and quality of life of the inhabitants. Such problems are usually associated with limited managerial, technical and financial capabilities of municipal authorities. Municipal authorities in Egypt that are responsible for SWM services have always been accused of providing a less than satisfactory service, leading to huge quantities of solid waste being uncollected. This study assesses the potential for the provision of an effective and sustainable service, by estimating willingness of the residents to pay for such a service and the cost involved in its provision. The study covered the Rosetta urban centre and its adjacent areas, which are located in the northwestern part of the Nile Delta. It was found that, from an economic perspective, a viable SWM service could be provided in the study area using local funds. In order to increase the likelihood of success of such a service, it may be provided by a local firm or a cooperative to be established for that purpose.

29 CFR 4.151 - Employees covered by provisions of section 2(a).

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 4.151 Labor Office of the Secretary of Labor LABOR STANDARDS FOR FEDERAL SERVICE CONTRACTS Application of the McNamara-O'Hara Service Contract Act Employees Covered by the Act § 4.151 Employees covered by provisions of section 2(a). The provisions of sections 2(a) and 4(c) of the Act prescribe labor...

12 CFR 303.46 - Financial education programs that include the provision of bank products and services.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 4 2011-01-01 2011-01-01 false Financial education programs that include the provision of bank products and services. 303.46 Section 303.46 Banks and Banking FEDERAL DEPOSIT INSURANCE... Branches and Offices § 303.46 Financial education programs that include the provision of bank products and...

12 CFR 303.46 - Financial education programs that include the provision of bank products and services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Financial education programs that include the provision of bank products and services. 303.46 Section 303.46 Banks and Banking FEDERAL DEPOSIT INSURANCE... Branches and Offices § 303.46 Financial education programs that include the provision of bank products and...

The unmet provision of allergy services in Hong Kong impairs capability for allergy prevention-implications for the Asia Pacific region.

PubMed

Lee, Tak-Hong; Leung, Ting-Fan; Wong, Gary; Ho, Marco; Duque, Jaime Rosa; Li, Philip Hei; Lau, Chak-Sing; Lam, Wai-Fan; Wu, Adrian; Chan, Eric; Lai, Christopher; Lau, Yu-Lung

2017-12-10

There is a high and rising prevalence of many allergic diseases in the Asia Pacific, including Hong Kong, which is unmatched by a commensurate provision of clinical allergy services. In the last 3 years, the allergy profile in Hong Kong has increased due to greater public engagement and more frequent educational activities, scientific outputs and publication of local guidelines on allergy prevention, diagnosis and treatment. Two new drug allergy clinics have been established in public hospitals, and for the first time in 20 years, Hong Kong has its first trainee in adult allergy. The current ratio of allergists per head of population has improved slightly from 1:1.46 (in 2014) to 1:1.17 million, but it is still low compared to many countries. The Hong Kong community is well supported by allergy-related professional societies and patient organisations. While the recent developments indicated some progress, Hong Kong remains inadequately equipped to take advantage of the new discoveries that may prevent allergic diseases and improve public health. There are also 5-fold more paediatric allergists than adult allergists per head of population. If this unbalance remains uncorrected, continuing care for allergic children as they grow into adulthood will be an increasing problem. This review provides recommendations to improve allergy service provision and training, including the creation of Centres of Excellence in allergy to drive the growth of this specialty.

Do family-planning workers in China support provision of sexual and reproductive health services to unmarried young people?

PubMed

Tu, Xiaowen; Cui, Nian; Lou, Chaohua; Gao, Ersheng

2004-04-01

To ascertain the perspectives of family-planning service providers in eight sites in China on the provision of sexual and reproductive health services to unmarried young people. Data were drawn from a survey of 1927 family-planning workers and 16 focus group discussions conducted in eight sites in China in 1998-99. Family-planning workers recognized the need to protect the sexual health of unmarried young people and were unambiguous about the need for government agencies to provide information and education on sexual and reproductive health to unmarried young people; however, perceptions about the appropriate age for and content of such education remained conservative. While about 70% of family-planning workers were willing to provide contraceptives to unmarried young people, and about 60% approved government provision of contraceptive services to unmarried young people, only one quarter agreed that the services could be extended to senior high schools. Family-planning workers in China are ambivalent about the provision of sexual and reproductive health services to unmarried young people, which potentially poses a significant obstacle to the adoption of safe sex behaviours by young people, as well as to the provision of sexual and reproductive health information and services to young unmarried people in China. Training programmes for family-planning workers are urgently needed to address this issue.

An assessment of the impact of climate adaptation measures to reduce flood risk on ecosystem services.

PubMed

Verburg, Peter H; Koomen, Eric; Hilferink, Maarten; Pérez-Soba, Marta; Lesschen, Jan Peter

Measures of climate change adaptation often involve modification of land use and land use planning practices. Such changes in land use affect the provision of various ecosystem goods and services. Therefore, it is likely that adaptation measures may result in synergies and trade-offs between a range of ecosystems goods and services. An integrative land use modelling approach is presented to assess such impacts for the European Union. A reference scenario accounts for current trends in global drivers and includes a number of important policy developments that correspond to on-going changes in European policies. The reference scenario is compared to a policy scenario in which a range of measures is implemented to regulate flood risk and protect soils under conditions of climate change. The impacts of the simulated land use dynamics are assessed for four key indicators of ecosystem service provision: flood risk, carbon sequestration, habitat connectivity and biodiversity. The results indicate a large spatial variation in the consequences of the adaptation measures on the provisioning of ecosystem services. Synergies are frequently observed at the location of the measures itself, whereas trade-offs are found at other locations. Reducing land use intensity in specific parts of the catchment may lead to increased pressure in other regions, resulting in trade-offs. Consequently, when aggregating the results to larger spatial scales the positive and negative impacts may be off-set, indicating the need for detailed spatial assessments. The modelled results indicate that for a careful planning and evaluation of adaptation measures it is needed to consider the trade-offs accounting for the negative effects of a measure at locations distant from the actual measure. Integrated land use modelling can help land use planning in such complex trade-off evaluation by providing evidence on synergies and trade-offs between ecosystem services, different policy fields and societal demands.

Quality of antenatal care in Zambia: a national assessment

PubMed Central

2012-01-01

Background Antenatal care (ANC) is one of the recommended interventions to reduce maternal and neonatal mortality. Yet in most Sub-Saharan African countries, high rates of ANC coverage coexist with high maternal and neonatal mortality. This disconnect has fueled calls to focus on the quality of ANC services. However, little conceptual or empirical work exists on the measurement of ANC quality at health facilities in low-income countries. We developed a classification tool and assessed the level of ANC service provision at health facilities in Zambia on a national scale and compared this to the quality of ANC received by expectant mothers. Methods We analysed two national datasets with detailed antenatal provider and user information, the 2005 Zambia Health Facility Census and the 2007 Zambia Demographic and Health Survey (DHS), to describe the level of ANC service provision at 1,299 antenatal facilities in 2005 and the quality of ANC received by 4,148 mothers between 2002 and 2007. Results We found that only 45 antenatal facilities (3%) fulfilled our developed criteria for optimum ANC service, while 47% of facilities provided adequate service, and the remaining 50% offered inadequate service. Although 94% of mothers reported at least one ANC visit with a skilled health worker and 60% attended at least four visits, only 29% of mothers received good quality ANC, and only 8% of mothers received good quality ANC and attended in the first trimester. Conclusions DHS data can be used to monitor “effective ANC coverage” which can be far below ANC coverage as estimated by current indicators. This “quality gap” indicates missed opportunities at ANC for delivering effective interventions. Evaluating the level of ANC provision at health facilities is an efficient way to detect where deficiencies are located in the system and could serve as a monitoring tool to evaluate country progress. PMID:23237601