76 FR 82353 - Implementing the Provisions of the Communications Act of 1934, as Enacted by the Twenty-First...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-30

..., equipment or services must be compatible with existing peripheral devices or specialized customer premises... offer advanced communications services in or affecting interstate commerce, including resellers and...) the extent to which the service provider or manufacturer in question offers accessible services or...

Natural Library Service Zones, A Report to the North Suburban Library System.

ERIC Educational Resources Information Center

Institute of Urban Life, Chicago, IL.

The North Suburban Library System decided that the areas within its boundaries which are outside the taxed district/area supporting an existing library should be served by extending the service areas of the existing municipal, township, and district libraries, either through contract or by employing the provisions of present library district law.…

24 CFR 964.305 - Eligibility.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., conversion, or combination of vacant dwelling units in a HA development to create common areas to accommodate the provision of supportive services; (2) The renovation of existing common areas in a HA development... of facilities located near the premises of one or more HA developments to accommodate the provision...

Establishing Key Performance Indicators [KPIs] and Their Importance for the Surgical Management of Inflammatory Bowel Disease-Results From a Pan-European, Delphi Consensus Study.

PubMed

Morar, Pritesh S; Hollingshead, James; Bemelman, Willem; Sevdalis, Nick; Pinkney, Thomas; Wilson, Graeme; Dunlop, Malcolm; Davies, R Justin; Guy, Richard; Fearnhead, Nicola; Brown, Steven; Warusavitarne, Janindra; Edwards, Cathryn; Faiz, Omar

2017-10-27

Key performance indicators [KPIs] exist across a range of areas in medicine. They help to monitor outcomes, reduce variation, and drive up standards across services. KPIs exist for inflammatory bowel disease [IBD] care, but none specifically cover inflammatory bowel disease [IBD] surgical service provision. This was a consensus-based study using a panel of expert IBD clinicians from across Europe. Items were developed and fed through a Delphi process to achieve consensus. Items were ranked on a Likert scale from 1 [not important] to 5 [very important]. Consensus was defined when the inter quartile range was ≤ 1, and items with a median score > 3 were considered for inclusion. A panel of 21 experts [14 surgeons and 7 gastroenterologists] was recruited. Consensus was achieved on procedure-specific KPIs for ileocaecal and perianal surgery for Crohn's disease, [N = 10] with themes relating to morbidity [N = 7], multidisciplinary input [N = 2], and quality of life [N = 1]; and for subtotal colectomy, proctocolectomy and ileoanal pouch surgery for ulcerative colitis [N = 11], with themes relating to mortality [N = 2], morbidity [N = 8], and service provision [N = 1]. Consensus was also achieved for measures of the quality of IBD surgical service provision and quality assurance in IBD surgery. This study has provided measurable KPIs for the provision of surgical services in IBD. These indicators cover IBD surgery in general, the governance and structures of the surgical services, and separate indicators for specific subareas of surgery. Monitoring of IBD services with these KPIs may reduce variation across services and improve quality. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

Funding models in palliative care: Lessons from international experience.

PubMed

Groeneveld, E Iris; Cassel, J Brian; Bausewein, Claudia; Csikós, Ágnes; Krajnik, Malgorzata; Ryan, Karen; Haugen, Dagny Faksvåg; Eychmueller, Steffen; Gudat Keller, Heike; Allan, Simon; Hasselaar, Jeroen; García-Baquero Merino, Teresa; Swetenham, Kate; Piper, Kym; Fürst, Carl Johan; Murtagh, Fliss Em

2017-04-01

Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. To assess national models and methods for financing and reimbursing palliative care. Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest.

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.

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.

Ecosystem-Service Tradeoffs Associated with Switching from Annual to Perennial Energy Crops in Riparian Zones of the US Midwest

PubMed Central

Meehan, Timothy D.; Gratton, Claudio; Diehl, Erica; Hunt, Natalie D.; Mooney, Daniel F.; Ventura, Stephen J.; Barham, Bradford L.; Jackson, Randall D.

2013-01-01

Integration of energy crops into agricultural landscapes could promote sustainability if they are placed in ways that foster multiple ecosystem services and mitigate ecosystem disservices from existing crops. We conducted a modeling study to investigate how replacing annual energy crops with perennial energy crops along Wisconsin waterways could affect a variety of provisioning and regulating ecosystem services. We found that a switch from continuous corn production to perennial-grass production decreased annual income provisioning by 75%, although it increased annual energy provisioning by 33%, decreased annual phosphorous loading to surface water by 29%, increased below-ground carbon sequestration by 30%, decreased annual nitrous oxide emissions by 84%, increased an index of pollinator abundance by an average of 11%, and increased an index of biocontrol potential by an average of 6%. We expressed the tradeoffs between income provisioning and other ecosystem services as benefit-cost ratios. Benefit-cost ratios averaged 12.06 GJ of additional net energy, 0.84 kg of avoided phosphorus pollution, 18.97 Mg of sequestered carbon, and 1.99 kg of avoided nitrous oxide emissions for every $1,000 reduction in income. These ratios varied spatially, from 2- to 70-fold depending on the ecosystem service. Benefit-cost ratios for different ecosystem services were generally correlated within watersheds, suggesting the presence of hotspots – watersheds where increases in multiple ecosystem services would come at lower-than-average opportunity costs. When assessing the monetary value of ecosystem services relative to existing conservation programs and environmental markets, the overall value of enhanced services associated with adoption of perennial energy crops was far lower than the opportunity cost. However, when we monitized services using estimates for the social costs of pollution, the value of enhanced services far exceeded the opportunity cost. This disparity between recoverable costs and social value represents a fundamental challenge to expansion of perennial energy crops and sustainable agricultural landscapes. PMID:24223215

Ecosystem-service tradeoffs associated with switching from annual to perennial energy crops in riparian zones of the US Midwest.

PubMed

Meehan, Timothy D; Gratton, Claudio; Diehl, Erica; Hunt, Natalie D; Mooney, Daniel F; Ventura, Stephen J; Barham, Bradford L; Jackson, Randall D

2013-01-01

Integration of energy crops into agricultural landscapes could promote sustainability if they are placed in ways that foster multiple ecosystem services and mitigate ecosystem disservices from existing crops. We conducted a modeling study to investigate how replacing annual energy crops with perennial energy crops along Wisconsin waterways could affect a variety of provisioning and regulating ecosystem services. We found that a switch from continuous corn production to perennial-grass production decreased annual income provisioning by 75%, although it increased annual energy provisioning by 33%, decreased annual phosphorous loading to surface water by 29%, increased below-ground carbon sequestration by 30%, decreased annual nitrous oxide emissions by 84%, increased an index of pollinator abundance by an average of 11%, and increased an index of biocontrol potential by an average of 6%. We expressed the tradeoffs between income provisioning and other ecosystem services as benefit-cost ratios. Benefit-cost ratios averaged 12.06 GJ of additional net energy, 0.84 kg of avoided phosphorus pollution, 18.97 Mg of sequestered carbon, and 1.99 kg of avoided nitrous oxide emissions for every $1,000 reduction in income. These ratios varied spatially, from 2- to 70-fold depending on the ecosystem service. Benefit-cost ratios for different ecosystem services were generally correlated within watersheds, suggesting the presence of hotspots--watersheds where increases in multiple ecosystem services would come at lower-than-average opportunity costs. When assessing the monetary value of ecosystem services relative to existing conservation programs and environmental markets, the overall value of enhanced services associated with adoption of perennial energy crops was far lower than the opportunity cost. However, when we monitized services using estimates for the social costs of pollution, the value of enhanced services far exceeded the opportunity cost. This disparity between recoverable costs and social value represents a fundamental challenge to expansion of perennial energy crops and sustainable agricultural landscapes.

GEMSS: grid-infrastructure for medical service provision.

PubMed

Benkner, S; Berti, G; Engelbrecht, G; Fingberg, J; Kohring, G; Middleton, S E; Schmidt, R

2005-01-01

The European GEMSS Project is concerned with the creation of medical Grid service prototypes and their evaluation in a secure service-oriented infrastructure for distributed on demand/supercomputing. Key aspects of the GEMSS Grid middleware include negotiable QoS support for time-critical service provision, flexible support for business models, and security at all levels in order to ensure privacy of patient data as well as compliance to EU law. The GEMSS Grid infrastructure is based on a service-oriented architecture and is being built on top of existing standard Grid and Web technologies. The GEMSS infrastructure offers a generic Grid service provision framework that hides the complexity of transforming existing applications into Grid services. For the development of client-side applications or portals, a pluggable component framework has been developed, providing developers with full control over business processes, service discovery, QoS negotiation, and workflow, while keeping their underlying implementation hidden from view. A first version of the GEMSS Grid infrastructure is operational and has been used for the set-up of a Grid test-bed deploying six medical Grid service prototypes including maxillo-facial surgery simulation, neuro-surgery support, radio-surgery planning, inhaled drug-delivery simulation, cardiovascular simulation and advanced image reconstruction. The GEMSS Grid infrastructure is based on standard Web Services technology with an anticipated future transition path towards the OGSA standard proposed by the Global Grid Forum. GEMSS demonstrates that the Grid can be used to provide medical practitioners and researchers with access to advanced simulation and image processing services for improved preoperative planning and near real-time surgical support.

45 CFR 2540.210 - What provisions exist to ensure that Corporation-supported programs do not discriminate in the...

Code of Federal Regulations, 2013 CFR

2013-10-01

...-supported programs do not discriminate in the selection of participants and staff? 2540.210 Section 2540.210... SERVICE GENERAL ADMINISTRATIVE PROVISIONS Requirements Directly Affecting the Selection and Treatment of... in the selection of participants and staff? (a) An individual with responsibility for the operation...

Communicating for Quality in School Age Care Services

ERIC Educational Resources Information Center

Cartmel, Jennifer; Grieshaber, Susan

2014-01-01

School Age Care (SAC) services have existed in Australia for over 100 years but they have tended to take a back seat when compared with provision for school-aged children and those under school age using early childhood education and care (ECEC) services. Many SAC services are housed in shared premises and many children attending preparatory or…

Ecosystem services from a degraded peatland of Central Kalimantan: implications for policy, planning, and management.

PubMed

Law, Elizabeth A; Bryan, Bretr A; Meijaard, Erik; Mallawaarachchi, Thilak; Struebig, Matthew; Wilson, Kerrie A

2015-01-01

Increasingly, landscapes are managed for multiple objectives to balance social, economic, and environmental goals. The Ex-Mega Rice Project (EMRP) peatland in Central Kalimantan, Indonesia provides a timely example with globally significant development, carbon, and biodiversity concerns. To inform future policy, planning, and management in the EMRP, we quantified and mapped ecosystem service values, assessed their spatial interactions, and evaluated the potential provision of ecosystem services under future land-use scenarios. We focus on key policy-relevant regulating (carbon stocks and the potential for emissions reduction), provisioning (timber, crops from smallholder agriculture, palm oil), and supporting (biodiversity) services. We found that implementation of existing land-use plans has the potential to improve total ecosystem service provision. We identify a number of significant inefficiencies, trade-offs, and unintended outcomes that may arise. For example, the potential development of existing palm oil concessions over one-third of the region may shift smallholder agriculture into low-productivity regions and substantially impact carbon and biodiversity outcomes. While improved management of conservation zones may enhance the protection of carbon stocks, not all biodiversity features will be represented, and there will be a reduction in timber harvesting and agricultural production. This study highlights how ecosystem service analyses can be structured to better inform policy, planning, and management in globally significant but data-poor regions.

Plural provision of primary medical care in England, 2002-2012.

PubMed

Sheaff, Rod

2013-10-01

Health care reforms often include provider diversification, including privatization, to increase competition and thereby health care quality and efficiency. Donabedian's organizational theory implies that the consequences will vary according to the providers' ownership. The aim was to examine how far that theory applies to changes in English NHS primary medical care (general practice) since 1998, and the consequences for patterns of service provision. Framework analysis whose categories and structure reflected Donabedian's theory and its implications, populated with data from a systematic review, administrative sources and press rapportage. Two patterns of provider diversification occurred: 'native' diversification among existing providers and plural provision as providers with different types of ownership were introduced. Native diversification occurred through: extensive recruitment of salaried GPs; extending the range of services provided by general practices; introducing limited liability partnerships; establishing GPs with special clinical interests; and introducing a wider range of services for GPs to refer to. All of these had little apparent effect on competition between general practices. Plural provision involved: increased primary care provision by corporations; introducing GP-owned firms; establishing social enterprises (initially mostly out-of-hours cooperatives); and Primary Care Trusts taking over general practices. Plural provision was on a smaller scale than native diversification and appeared to go into reverse in 2011. Although the available data confirm the implications of Donabedian's theory, there are exceptions. Native diversification and plural provision policies differ in their implications for service development.

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.

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.

Funding models in palliative care: Lessons from international experience

PubMed Central

Groeneveld, E Iris; Cassel, J Brian; Bausewein, Claudia; Csikós, Ágnes; Krajnik, Malgorzata; Ryan, Karen; Haugen, Dagny Faksvåg; Eychmueller, Steffen; Gudat Keller, Heike; Allan, Simon; Hasselaar, Jeroen; García-Baquero Merino, Teresa; Swetenham, Kate; Piper, Kym; Fürst, Carl Johan; Murtagh, Fliss EM

2017-01-01

Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and methods for financing and reimbursing palliative care. Design: Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Results: Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Conclusion: Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest. PMID:28156188

Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General's Exclusion Authorities. Final rule.

PubMed

2017-01-12

This final rule amends the regulations relating to exclusion authorities under the authority of the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS or the Department). The final rule incorporates statutory changes, early reinstatement provisions, and policy changes, and clarifies existing regulatory provisions.

Trust Management and Accountability for Internet Security

ERIC Educational Resources Information Center

Liu, Wayne W.

2011-01-01

Adversarial yet interacting interdependent relationships in information sharing and service provisioning have been a pressing issue of the Internet. Such relationships exist among autonomous software agents, in networking system peers, as well as between "service users and providers." Traditional "ad hoc" security approaches effective in…

The Psychology of Coercion: Merging Airpower and Prospect Theory

DTIC Science & Technology

1998-06-01

that a fourth airpower strategy for coercion exists in airlift, where goods and services may be provided to interfere with the adversary’s objectives...objectives; decapitation or attempts to limit/eliminate decisionmaker control; and airlift or provision of goods and services to either complicate

Inequalities in the provision of paediatric speech and language therapy services across London boroughs.

PubMed

Pring, Tim

2016-07-01

The inverse-care law suggests that fewer healthcare resources are available in deprived areas where health needs are greatest. 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. Information on the employment of paediatric speech and language therapists was obtained from London boroughs by freedom-of-information requests. The relationship between the number of therapists and the index of multiple deprivation for the borough was examined. Twenty-nine of 32 boroughs responded. A positive relationship between provision and need was obtained, suggesting that the inverse-care law does not apply. However, large inequalities of provision were found particularly among the more socially deprived boroughs. In some instances boroughs had five times as many therapists per child as other boroughs. The data reveal that large differences in speech and language therapy provision exist across boroughs. The reasons for these inequalities are unclear, but the lack of comparative information across boroughs is likely to be unhelpful in planning equitable services. The use of freedom of information in assessing health inequalities is stressed and its future availability is desirable. © 2016 Royal College of Speech and Language Therapists.

5 CFR 894.102 - If I have a pre-existing dental or vision condition, may I join FEDVIP?

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false If I have a pre-existing dental or vision... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Administration and General Provisions § 894.102 If I have a pre-existing dental or vision...

5 CFR 894.102 - If I have a pre-existing dental or vision condition, may I join FEDVIP?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false If I have a pre-existing dental or vision... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Administration and General Provisions § 894.102 If I have a pre-existing dental or vision...

5 CFR 894.102 - If I have a pre-existing dental or vision condition, may I join FEDVIP?

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false If I have a pre-existing dental or vision... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Administration and General Provisions § 894.102 If I have a pre-existing dental or vision...

5 CFR 894.102 - If I have a pre-existing dental or vision condition, may I join FEDVIP?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false If I have a pre-existing dental or vision... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Administration and General Provisions § 894.102 If I have a pre-existing dental or vision...

5 CFR 894.102 - If I have a pre-existing dental or vision condition, may I join FEDVIP?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false If I have a pre-existing dental or vision... MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Administration and General Provisions § 894.102 If I have a pre-existing dental or vision...

7 CFR 4290.30 - Amendments to Act and regulations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 4290.30 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT COMPANY (âRBICâ... existing and future provisions of the Act and part 4290 of title 7 of the Code of Federal Regulations. ...

Payment Services for Global Online Systems Including Internet.

ERIC Educational Resources Information Center

Seebeck, Bill; And Others

1995-01-01

A panel of four conference presenters address issues related to paying for services provided through online systems. Discussion includes the following topics: metering devices; electronic/digital cash; working within existing banking/credit card structures; provision of payment mechanisms in countries without extensive credit card usage; and…

48 CFR 27.409 - Solicitation provisions and contract clauses

Code of Federal Regulations, 2011 CFR

2011-10-01

... section); (ii) For the acquisition of existing data, commercial computer software, or other existing data... United States (see paragraph (i)(1) of this section); (v) For architect-engineer services or construction... software, use the clause with its Alternate III. Any greater or lesser rights regarding the use...

48 CFR 27.409 - Solicitation provisions and contract clauses

Code of Federal Regulations, 2014 CFR

2014-10-01

... section); (ii) For the acquisition of existing data, commercial computer software, or other existing data... United States (see paragraph (i)(1) of this section); (v) For architect-engineer services or construction... software, use the clause with its Alternate III. Any greater or lesser rights regarding the use...

48 CFR 27.409 - Solicitation provisions and contract clauses

Code of Federal Regulations, 2012 CFR

2012-10-01

... section); (ii) For the acquisition of existing data, commercial computer software, or other existing data... United States (see paragraph (i)(1) of this section); (v) For architect-engineer services or construction... software, use the clause with its Alternate III. Any greater or lesser rights regarding the use...

48 CFR 27.409 - Solicitation provisions and contract clauses

Code of Federal Regulations, 2013 CFR

2013-10-01

... section); (ii) For the acquisition of existing data, commercial computer software, or other existing data... United States (see paragraph (i)(1) of this section); (v) For architect-engineer services or construction... software, use the clause with its Alternate III. Any greater or lesser rights regarding the use...

Redesigning a home oxygen assessment and review service.

PubMed

Wrench, Christine; Darwin, Ruth; Lawson, Rod

2015-03-01

The Sheffield home oxygen assessment and review service was developed as a nurse-led, protocol-driven service, offering high standards of care to a limited number of patients. In line with national changes to oxygen provision in 2011, the service team was approached to address inconsistencies and inequalities in the existing care pathway, with a view to becoming a fully commissioned service. This required a complete redesign of the service, using a collaborative approach to include relevant interested parties in planning and decision making. Additional support was gained through participation in the NHS Improvement lung national improvement project. This article outlines the process of service redesign, including some of the major challenges as well as the main learning points. It has led to the provision of an equitable and efficient service for all oxygen patients across the city, offering more community clinics and robust cost controls, while maintaining quality of care.

Wheelchair service provision education and training in low and lower middle income countries: a scoping review.

PubMed

McSweeney, Elizabeth; Gowran, Rosemary Joan

2017-11-01

Improving access to education and training for those providing wheelchair and seating assistive technology to meet personal posture and mobility requirements, as a basic human right, is a priority. This review considers education and training available to personnel within low and lower middle income countries (LLMIC), to ascertain where gaps in knowledge exist and identify human resource education priorities. A scoping review, mapping out existing scientific and grey literature within the field between 1993 and 2017 was conducted. The search strategy included use of online databases, manual analogue searches and key stakeholder informant advice. A content analysis process was applied to organize the literature retrieved and extract key themes. Education and training in LLMIC appears ad hoc and limited, however, there is growing recognition as to its importance, notably by the World Health Organization and nongovernmental organizations, delivering education initiatives to a number of countries, along with the development of a credentialing test. Inconsistency exists regarding personnel responsible for wheelchair provision, with no specific professional clearly recognized to oversee the system within many LLMIC. Education and training is required for all stakeholders involved in wheelchair provision. Advocating for programme development to enhance personnel skills, build capacity and ensure best practice is a priority. Pilot sites, delivering and credentialing appropriate wheelchair provision education and training within context should be considered. Measuring outcomes and transferable skills should be part of education programme delivery structures. Considering a new discipline responsible for oversight of wheelchair provision should be investigated. Implications for rehabilitation Education and training is an essential step in the wheelchair provision process in the bid to obtain an appropriate wheelchair via appropriate provision services. However, it is more than education and training; its a human rights issue. Mandatory education and training needs to be a requirement for all stakeholders involved in wheelchair provision. Key wheelchair personnel need to establish their central role in this arena. The study raises awareness as to the importance of working with governments to commit to building sustainable wheelchair provision infrastructures.

Reducing health care costs--potential and limitations of local authority health services.

PubMed

Ijsselmuiden, C B; De Beer, C

1990-08-04

Local authorities (LAs) currently provide preventive and promotive services. It is argued that, by extending the role of the LA to the provision of comprehensive services, including ambulatory and hospital curative care, both the quality and the cost-effectiveness of health care would be improved. Making health care the responsibility of the LA would minimise fragmentation, allow for the provision of a number of services that currently are neglected because they fall through the gap that exists between preventive and curative services, and result in the more effective use of personnel currently restricted to providing preventive care only. LAs offer an appropriate structure for effective community control over the health services, and are more likely to be sensitive to local needs and demands. In addition, their administrative proximity to other LA departments responsible for housing, town planning and parks and recreation allows for an effective multisectoral approach to health. The positive aspects of LA care can only be achieved in the context of racially integrated services provided by an LA elected by universal adult franchise. Smaller LAs may need to be grouped together in larger units for the purpose of achieving satisfactory economies of scale in the provision of health care.

A Study of Coordinated Service Provision and Administrative Procedures in Selected University Communities.

ERIC Educational Resources Information Center

Clemson Univ., SC. Strom Thurmond Inst. of Government and Public Affairs.

This study investigated the existence of coordinated/consolidated services between colleges and universities and their communities by surveying 27 university communities of similar size and/or characteristics to Clemson University (South Carolina). The report begins with the profiles of the universities selected: their size in acreage, enrollment,…

Elder Abuse and Neglect: Assessment Tools, Interventions, and Recommendations for Effective Service Provision

ERIC Educational Resources Information Center

Imbody, Bethany; Vandsburger, Etty

2011-01-01

With our communities rapidly aging, there is always a clear need for greater knowledge on how to serve elders. Professionals must be able to recognize cases of abuse and neglect and provide appropriate follow up services. Through reviewing recent literature, this paper surveys existing assessment tools and interventions, describes characteristics…

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.

Policy implementation in wheelchair service delivery in a rural South African setting.

PubMed

Visagie, Surona; Scheffler, Elsje; Schneider, Marguerite

2013-01-01

Wheelchairs allow users to realise basic human rights and improved quality of life. South African and international documents guide rehabilitation service delivery and thus the provision of wheelchairs. Evidence indicates that rehabilitation policy implementation gaps exist in rural South Africa. The aim of this article was to explore the extent to which wheelchair service delivery in a rural, remote area of South Africa was aligned with the South African National Guidelines on Provision of Assistive Devices, The United Nations Convention on the Rights of Persons with Disabilities and The World Health Organization Guidelines on Provision of Wheelchairs in Less-Resourced Settings. Qualitative methods were used. Data were collected through semi-structured interviews with 22 participants who were identified through purposive sampling. Content analysis of data was preformed around the construct of wheelchair service delivery. Study findings identified gaps between the guiding documents and wheelchair service delivery. Areas where gaps were identified included service aspects such as referral, assessment, prescription, user and provider training, follow up, maintenance and repair as well as management aspects such as staff support, budget and monitoring. Positive findings related to individual assessments, enthusiastic and caring staff and the provision of wheelchairs at no cost. The gaps in policy implementation can have a negative impact on users and the service provider. Inappropriate or no wheelchairs limit user function, participation and quality of life. In addition, an inappropriate wheelchair will have a shorter lifespan, requiring frequent repairs and replacements with cost implications for the service provider.

Rehabilitation Facilities in Ontario

PubMed Central

Godfrey, C. M.; Jousse, A. T.

1963-01-01

Rehabilitation centres in Ontario were surveyed and categorized as in-patient and outpatient services, specialized centres for particular diseases, and vocational retraining centres. It is evident that many gaps exist in the pattern of rehabilitation facilities and services in the province. In some areas the facilities are grouped too closely together, necessitating transport of patients from great distances. The serious shortage of trained personnel is noted. There is little provision for mentally ill patients in existing rehabilitation centres. The use of mobile clinics is discussed. There is no evidence of duplication of services among those at present available. PMID:14077812

Global Mapping of Provisioning Ecosystem Services

NASA Astrophysics Data System (ADS)

Bingham, Lisa; Straatsma, Menno; Karssenberg, Derek

2016-04-01

Attributing monetary value to ecosystem services for decision-making has become more relevant as a basis for decision-making. There are a number of problematic aspects of the calculations, including consistency of economy represented (e.g., purchasing price, production price) and determining which ecosystem subservices to include in a valuation. While several authors have proposed methods for calculating ecosystem services and calculations are presented for global and regional studies, the calculations are mostly broken down into biomes and regions without showing spatially explicit results. The key to decision-making for governments is to be able to make spatial-based decisions because a large spatial variation may exist within a biome or region. Our objective was to compute the spatial distribution of global ecosystem services based on 89 subservices. Initially, only the provisioning ecosystem service category is presented. The provisioning ecosystem service category was calculated using 6 ecosystem services (food, water, raw materials, genetic resources, medical resources, and ornaments) divided into 41 subservices. Global data sets were obtained from a variety of governmental and research agencies for the year 2005 because this is the most data complete and recent year available. All data originated either in tabular or grid formats and were disaggregated to 10 km cell length grids. A lookup table with production values by subservice by country were disaggregated over the economic zone (either marine, land, or combination) based on the spatial existence of the subservice (e.g. forest cover, crop land, non-arable land). Values express the production price in international dollars per hectare. The ecosystem services and the ecosystem service category(ies) maps may be used to show spatial variation of a service within and between countries as well as to specifically show the values within specific regions (e.g. countries, continents), biomes (e.g. coastal, forest), or hazardous regions (e.g. landslides, flood plains, war zones). A preliminary example of the provisioning ecosystem service category illustrates the valuation of deltaic regions and a second example illustrates the valuation of the subservice category of food production prices in flood zones. Future work of this research will spatially represent the calculations of the remaining three ecosystem service categories (regulating, habitat, cultural) and investigate the propagation of uncertainty of the input data to ecosystem service maps.

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.

When has service provision for transient ischaemic attack improved enough? A discrete event simulation economic modelling study.

PubMed

Barton, Pelham; Sheppard, James P; Penaloza-Ramos, Cristina M; Jowett, Sue; Ford, Gary A; Lasserson, Daniel; Mant, Jonathan; Mellor, Ruth M; Quinn, Tom; Rothwell, Peter M; Sandler, David; Sims, Don; McManus, Richard J

2017-11-25

The aim of this study was to examine the impact of transient ischaemic attack (TIA) service modification in two hospitals on costs and clinical outcomes. Discrete event simulation model using data from routine electronic health records from 2011. Patients with suspected TIA were followed from symptom onset to presentation, referral to specialist clinics, treatment and subsequent stroke. Included existing versus previous (less same day clinics) and hypothetical service reconfiguration (7-day service with less availability of clinics per day). The primary outcome of the model was the prevalence of major stroke after TIA. Secondary outcomes included service costs (including those of treating subsequent stroke) and time to treatment and attainment of national targets for service provision (proportion of high-risk patients (according to ABCD 2 score) seen within 24 hours). The estimated costs of previous service provision for 490 patients (aged 74±12 years, 48.9% female and 23.6% high risk) per year at each site were £340 000 and £368 000, respectively. This resulted in 31% of high-risk patients seen within 24 hours of referral (47/150) with a median time from referral to clinic attendance/treatment of 1.15 days (IQR 0.93-2.88). The costs associated with the existing and hypothetical services decreased by £5000 at one site and increased £21 000 at the other site. Target attainment was improved to 79% (118/150). However, the median time to clinic attendance was only reduced to 0.85 days (IQR 0.17-0.99) and thus no appreciable impact on the modelled incidence of major stroke was observed (10.7 per year, 99% CI 10.5 to 10.9 (previous service) vs 10.6 per year, 99% CI 10.4 to 10.8 (existing service)). Reconfiguration of services for TIA is effective at increasing target attainment, but in services which are already working efficiently (treating patients within 1-2 days), it has little estimated impact on clinical outcomes and increased investment may not be worthwhile. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

On Consumer Self-Direction of Attendant Care Services: An Empirical Analysis of Survey Responses.

ERIC Educational Resources Information Center

Asher, Cheryl C.; And Others

1991-01-01

The concept of attendant care--provision of personal services to severely disabled individuals--is presented. Data from a survey of about 340 out of 718 consumers of attendant care indicate the existence of a mix of consumer-oriented programs. Consumer preference for a particular program design appeared to be governed by experience. (SLD)

A Standardization Framework for Electronic Government Service Portals

NASA Astrophysics Data System (ADS)

Sarantis, Demetrios; Tsiakaliaris, Christos; Lampathaki, Fenareti; Charalabidis, Yannis

Although most eGovernment interoperability frameworks (eGIFs) cover adequately the technical aspects of developing and supporting the provision of electronic services to citizens and businesses, they do not exclusively address several important areas regarding the organization, presentation, accessibility and security of the content and the electronic services offered through government portals. This chapter extends the scope of existing eGIFs presenting the overall architecture and the basic concepts of the Greek standardization framework for electronic government service portals which, for the first time in Europe, is part of a country's eGovernment framework. The proposed standardization framework includes standards, guidelines and recommendations regarding the design, development and operation of government portals that support the provision of administrative information and services to citizens and businesses. By applying the guidelines of the framework, the design, development and operation of portals in central, regional and municipal government can be systematically addressed resulting in an applicable, sustainable and ever-expanding framework.

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.

Standardized acquisition, storing and provision of 3D enabled spatial data

NASA Astrophysics Data System (ADS)

Wagner, B.; Maier, S.; Peinsipp-Byma, E.

2017-05-01

In the area of working with spatial data, in addition to the classic, two-dimensional geometrical data (maps, aerial images, etc.), the needs for three-dimensional spatial data (city models, digital elevation models, etc.) is increasing. Due to this increased demand the acquiring, storing and provision of 3D enabled spatial data in Geographic Information Systems (GIS) is more and more important. Existing proprietary solutions quickly reaches their limits during data exchange and data delivery to other systems. They generate a large workload, which will be very costly. However, it is noticeable that these expenses and costs can generally be significantly reduced using standards. The aim of this research is therefore to develop a concept in the field of three-dimensional spatial data that runs on existing standards whenever possible. In this research, the military image analysts are the preferred user group of the system. To achieve the objective of the widest possible use of standards in spatial 3D data, existing standards, proprietary interfaces and standards under discussion have been analyzed. Since the here used GIS of the Fraunhofer IOSB is already using and supporting OGC (Open Geospatial Consortium) and NATO-STANAG (NATO-Standardization Agreement) standards for the most part of it, a special attention for possible use was laid on their standards. The most promising standard is the OGC standard 3DPS (3D Portrayal Service) with its occurrences W3DS (Web 3D Service) and WVS (Web View Service). A demo system was created, using a standardized workflow from the data acquiring, storing and provision and showing the benefit of our approach.

Geographic information systems (GIS): an emerging method to assess demand and provision for rehabilitation services.

PubMed

Passalent, Laura; Borsy, Emily; Landry, Michel D; Cott, Cheryl

2013-09-01

To illustrate the application of geographic information systems (GIS) as a tool to assess rehabilitation service delivery by presenting results from research recently conducted to assess demand and provision for community rehabilitation service delivery in Ontario, Canada. Secondary analysis of data obtained from existing sources was used to establish demand and provision profiles for community rehabilitation services. These data were integrated using GIS software. A number of descriptive maps were produced that show the geographical distribution of service provision variables (location of individual rehabilitation health care providers and location of private and publicly funded community rehabilitation clinics) in relation to the distribution of demand variables (location of the general population; location of specific populations (i.e., residents age 65 and older) and distribution of household income). GIS provides a set of tools for describing and understanding the spatial organization of the health of populations and the distribution of health services that can aid the development of health policy and answer key research questions with respect to rehabilitation health services delivery. Implications for Rehabilitation It is important to seek out alternative and innovative methods to examine rehabilitation service delivery. GIS is a computer-based program that takes any data linked to a geographically referenced location and processes it through a software system that manages, analyses and displays the data in the form of a map, allowing for an alternative level of analysis. GIS provides a set of tools for describing and understanding the spatial organization of population health and health services that can aid the development of health policy and answer key research questions with respect to rehabilitation health services delivery.

Two-Year Transitional Plan. State of Minnesota Developmental Disabilities. October 1, 1989-September 30, 1991. Accountability.

ERIC Educational Resources Information Center

Minnesota State Planning Agency, St. Paul.

The Minnesota 2-year state plan presents a review of the existing service delivery system for: (1) the provision of services to persons with developmental disabilities and their families; (2) a continuing response to priority areas specified in federal legislation; and (3) development of a work plan leading toward development of a Three-Year State…

Quality of antenatal care and client satisfaction in Kenya and Namibia.

PubMed

Do, Mai; Wang, Wenjuan; Hembling, John; Ametepi, Paul

2017-04-01

Despite much progress in maternal health service coverage, the quality of care has not seen parallel improvement. This study assessed the quality of antenatal care (ANC), an entry point to the health system for many women. The study used data from recent Service Provision Assessment (SPA) surveys of nationally representative health facilities in Kenya and Namibia. Kenya and Namibia represent the situation in much of sub-Saharan Africa, where ANC is relatively common but maternal mortality remains high. The SPA comprised an inventory of health facilities that provided ANC, interviews with ANC providers and clients, and observations of service delivery. Not applicable. Quality was measured in terms of structure and process of service provision, and client satisfaction as the outcome of service provision. Wide variations in structural and process attributes of quality of care existed in both Kenya and Namibia; however, better structural quality did not translate to better service delivery process or greater client satisfaction. Long waiting time was a common problem and was generally more serious in hospitals and health centers than in clinics and smaller facilities; it was consistently associated with lower client satisfaction. The study also indicates that the provider's technical preparedness may not be sufficient to provide good-quality services and to ensure client satisfaction. Findings highlight important program implications, including improving ANC services and promoting their use at health clinics and lower-level facilities, and ensuring that available supplies and equipment are used for service provision. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

A challenging entanglement: health care providers’ perspectives on caring for ill and injured tourists on Cozumel Island, Mexico

PubMed Central

Crooks, Valorie A.; Snyder, Jeremy

2018-01-01

ABSTRACT Purpose: Despite established knowledge that tourists often fall ill or are injured abroad, little is known about their treatment. The intent of this study was to explore health care professionals’ treatment provision experiences on Cozumel Island, Mexico. Methods: 13 semi-structured interviews were undertaken with professionals across a number of health care vocations on Cozumel Island. Interviews were transcribed and thematically analysed to determine common challenges faced in the provision of treatment for transnational tourists. Results: Three thematic challenges emerged from the data: human and physical resource deficiencies, medical (mis)perceptions held by patients and complexities surrounding remuneration of care. Health care providers employ unique strategies to mitigate these challenges. Conclusion: Although many of these challenges exist within other touristic and peripheral spaces, we suggest that the challenges experienced by Cozumel Island’s health care professionals, and their mitigation strategies, exist as part of a complex entanglement between the island’s health care sector and its dominant tourism landscape. We call on tangential tourism services to take a larger role in ensuring the ease of access to, and provision of quality health care services for tourists on Cozumel Island. PMID:29869593

A challenging entanglement: health care providers' perspectives on caring for ill and injured tourists on Cozumel Island, Mexico.

PubMed

Hoffman, Leon; Crooks, Valorie A; Snyder, Jeremy

2018-12-01

Despite established knowledge that tourists often fall ill or are injured abroad, little is known about their treatment. The intent of this study was to explore health care professionals' treatment provision experiences on Cozumel Island, Mexico. 13 semi-structured interviews were undertaken with professionals across a number of health care vocations on Cozumel Island. Interviews were transcribed and thematically analysed to determine common challenges faced in the provision of treatment for transnational tourists. Three thematic challenges emerged from the data: human and physical resource deficiencies, medical (mis)perceptions held by patients and complexities surrounding remuneration of care. Health care providers employ unique strategies to mitigate these challenges. Although many of these challenges exist within other touristic and peripheral spaces, we suggest that the challenges experienced by Cozumel Island's health care professionals, and their mitigation strategies, exist as part of a complex entanglement between the island's health care sector and its dominant tourism landscape. We call on tangential tourism services to take a larger role in ensuring the ease of access to, and provision of quality health care services for tourists on Cozumel Island.

Supporting the scientific lifecycle through cloud services

NASA Astrophysics Data System (ADS)

Gensch, S.; Klump, J. F.; Bertelmann, R.; Braune, C.

2014-12-01

Cloud computing has made resources and applications available for numerous use cases ranging from business processes in the private sector to scientific applications. Developers have created tools for data management, collaborative writing, social networking, data access and visualization, project management and many more; either for free or as paid premium services with additional or extended features. Scientists have begun to incorporate tools that fit their needs into their daily work. To satisfy specialized needs, some cloud applications specifically address the needs of scientists for sharing research data, literature search, laboratory documentation, or data visualization. Cloud services may vary in extent, user coverage, and inter-service integration and are also at risk of being abandonend or changed by the service providers making changes to their business model, or leaving the field entirely.Within the project Academic Enterprise Cloud we examine cloud based services that support the research lifecycle, using feature models to describe key properties in the areas of infrastructure and service provision, compliance to legal regulations, and data curation. Emphasis is put on the term Enterprise as to establish an academic cloud service provider infrastructure that satisfies demands of the research community through continious provision across the whole cloud stack. This could enable the research community to be independent from service providers regarding changes to terms of service and ensuring full control of its extent and usage. This shift towards a self-empowered scientific cloud provider infrastructure and its community raises implications about feasability of provision and overall costs. Legal aspects and licensing issues have to be considered, when moving data into cloud services, especially when personal data is involved.Educating researchers about cloud based tools is important to help in the transition towards effective and safe use. Scientists can benefit from the provision of standard services, like weblog and website creation, virtual machine deployments, and groupware provision using cloud based app store-like portals. And, other than in an industrial environment, researchers will want to keep their existing user profile when moving from one institution to another.

Examining public knowledge and preferences for adult preventive services coverage.

PubMed

Williams, Jessica A R; Ortiz, Selena E

2017-01-01

To examine (1) what individuals know about the existing adult preventive service coverage provisions of the Affordable Care Act (ACA), and (2) which preventive services individuals think should be covered without cost sharing. An online panel from Survey Monkey was used to obtain a sample of 2,990 adults age 18 and older in March 2015, analyzed 2015-2017. A 17-item survey instrument was designed and used to evaluate respondents' knowledge of the adult preventive services provision of the ACA. Additionally, we asked whether various preventive services should be covered. The data include age, sex, race/ethnicity, and educational attainment as well as measures of political ideology, previous insurance status, the number of chronic conditions, and usual source of care. Respondents correctly answered 38.6% of the questions about existing coverage under the ACA, while on average respondents thought 12.1 of 15 preventive services should be covered (SD 3.5). Respondents were more knowledgeable about coverage for routine screenings, such as blood pressure (63.4% correct) than potentially stigmatizing screenings, such as for alcohol misuse (28.8% correct). Blood pressure screening received the highest support of coverage (89.8%) while coverage of gym memberships received the lowest support (59.4%). Individuals with conservative ideologies thought fewer services on average should be covered, but the difference was small-around one service less than those with liberal ideologies. Overwhelmingly, individuals think that most preventive services should be covered without cost sharing. Despite several years of coverage for preventive services, there is still confusion and lack of knowledge about which services are covered.

Examining public knowledge and preferences for adult preventive services coverage

PubMed Central

Ortiz, Selena E.

2017-01-01

Introduction To examine (1) what individuals know about the existing adult preventive service coverage provisions of the Affordable Care Act (ACA), and (2) which preventive services individuals think should be covered without cost sharing. Methods An online panel from Survey Monkey was used to obtain a sample of 2,990 adults age 18 and older in March 2015, analyzed 2015–2017. A 17-item survey instrument was designed and used to evaluate respondents’ knowledge of the adult preventive services provision of the ACA. Additionally, we asked whether various preventive services should be covered. The data include age, sex, race/ethnicity, and educational attainment as well as measures of political ideology, previous insurance status, the number of chronic conditions, and usual source of care. Results Respondents correctly answered 38.6% of the questions about existing coverage under the ACA, while on average respondents thought 12.1 of 15 preventive services should be covered (SD 3.5). Respondents were more knowledgeable about coverage for routine screenings, such as blood pressure (63.4% correct) than potentially stigmatizing screenings, such as for alcohol misuse (28.8% correct). Blood pressure screening received the highest support of coverage (89.8%) while coverage of gym memberships received the lowest support (59.4%). Individuals with conservative ideologies thought fewer services on average should be covered, but the difference was small—around one service less than those with liberal ideologies. Conclusions Overwhelmingly, individuals think that most preventive services should be covered without cost sharing. Despite several years of coverage for preventive services, there is still confusion and lack of knowledge about which services are covered. PMID:29261757

30 CFR 285.117 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false [Reserved] 285.117 Section 285.117 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE RENEWABLE ENERGY ALTERNATE USES OF EXISTING FACILITIES ON THE OUTER CONTINENTAL SHELF General Provisions § 285.117 [Reserved] ...

Information for Agricultural Development.

ERIC Educational Resources Information Center

Kaungamno, E. E.

This paper describes the major international agricultural information services, sources, and systems; outlines the existing information situation in Tanzania as it relates to problems of agricultural development; and reviews the improvements in information provision resources required to support the process of agricultural development in Tanzania.…

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.

Cable Television Franchise Provisions for Schools.

ERIC Educational Resources Information Center

National Education Association, Washington, DC. Div. of Instruction and Professional Development.

The National Educational Association (NEA) makes recommendations on the services of franchised cable television stations to schools. The recommendations, in 20 areas, are then compared with existing Federal Communications Commission (FCC) regulations on each point. The recommendations include: a minimum of at least one educational access channel…

30 CFR 285.115 - Documents incorporated by reference.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Documents incorporated by reference. 285.115 Section 285.115 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE RENEWABLE ENERGY ALTERNATE USES OF EXISTING FACILITIES ON THE OUTER CONTINENTAL SHELF General Provisions...

A national survey of pain clinics within the United Kingdom and Ireland focusing on the multidisciplinary team and the incorporation of the extended nursing role.

PubMed

Kailainathan, Pungavi; Humble, Stephen; Dawson, Helen; Cameron, Fiona; Gokani, Shyam; Lidder, Gursimren

2018-02-01

Inconsistencies in the availability and quality of pain service provision have been noted nationally, as have lengthy waiting times for appointments and lack of awareness of the Pain Clinic role. The 2013 NHS England report stated that specialist pain services must offer multispecialty and multidisciplinary pain clinics. This national survey of multidisciplinary pain service provision in the United Kingdom and Ireland provides a snapshot of pain service provision in order to review and highlight what variations exist in multidisciplinary team (MDT) provision and working patterns. A common perception among clinicians is that financial pressures have led to alternate ways of staff utilisation with variable degrees of success. The survey included 143 pain clinics, focusing principally on MDT working patterns, MDT composition and adoption of the extended role. The results identified that the majority of Pain Clinics utilise the MDT approach. However, provision of critical components such as regular MDT meetings is highly variable as is the composition of the MDT itself and also working patterns of the individual clinicians. The survey reports the successful use of the extended roles for specialist nurses in follow up clinics. In contrast, the survey highlights that a large proportion of clinicians surveyed have reservations about both the effectiveness and the safety of utilising specialist nurses in the extended role to see new referrals of complex pain patients to pain clinics. This survey underlines the essential requirement for incorporation of greater MDT working locally and nationally and allocation of appropriate resources to facilitate this.

Survey of rehabilitation support for children 0-15 years in a rural part of Kenya.

PubMed

Bunning, Karen; Gona, Joseph K; Odera-Mung'ala, Victor; Newton, Charles R; Geere, Jo-Anne; Hong, Chia Swee; Hartley, Sally

2014-01-01

Information regarding the nature, availability and distribution of rehabilitation services for children with disabilities across developing countries is scarce, and data that do exist are of variable quality. If planning and development are to progress, information about service provision is vital. The aim was to establish the scope and nature of rehabilitation support available to children with disabilities (0-15 years) and their families in rural Kenya. A comprehensive sample comprising service provision in the health and special education sectors was established. Non-governmental and community-based organisations were also included. A survey of rehabilitation services was conducted through examination of service-related documentation and key informant interviews with the heads of services. Rehabilitation comprised hospital-based occupational therapy, physiotherapy and orthopaedic technology; and seven special education establishments plus an education assessment resource centre. There was one non-government organisation and one community-based organisation relevant to children with disabilities. Activities focused on assessment, diagnosis and raising community awareness. Provision was challenged by inadequate staffing, resources and transport. Government funding was supplemented variously by donations and self-sufficiency initiatives. Rehabilitation approaches appeared to be informed by professional background of practitioner, rather than the needs of child. Service documentation revealed use of inconsistent recording methods. The data highlight the challenges of rehabilitation, demanding greater investment in personnel and their training, more material resources, improved access to the community and better recording mechanisms. There needs to be greater investment in rehabilitation provision in developing countries. Consideration of community-based initiatives is required to support better access for all. In order to argue the case for improved resources, better skills and mechanisms for recording, monitoring and evaluating practice are needed.

41 CFR 51-10.160 - Communications.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 1 2011-07-01 2009-07-01 true Communications. 51-10.160 Section 51-10.160 Public Contracts and Property Management Other Provisions Relating to Public Contracts... vision or hearing, can obtain information as to the existence and location of accessible services...

Dyslexia Laws in the USA

ERIC Educational Resources Information Center

Youman, Martha; Mather, Nancy

2013-01-01

Throughout the various states of the USA, the appropriate identification of dyslexia and the timely provision of interventions are characterized by variability and inconsistency. Several states have recognized the existence of this disorder and the well-established need for services. These states have taken proactive steps to implement laws and…

Medicaid provisions and the US mental health industry composition.

PubMed

Pellegrini, Lawrence C; Rodriguez-Monguio, Rosa

2014-12-01

Medicaid is the largest payer for mental health (MH) services. This study examines associations between Medicaid provisions and the MH industry composition. Medicaid data derived from the Centers for Medicare and Medicaid Services. MH facility gross payroll and occupational employment data derived from the Bureau of Labor Statistics. State fixed-effects regression models are performed to examine associations. In the 1999-2009 period, per-capita gross payroll gains are largest for residential MH and substance abuse (SA) facilities and MH practitioner offices, followed by MH clinics and physician offices. Likewise, occupational employment gains per 100 000 people are largest for MH and SA social workers and MH counselors, followed by psychiatrists and psychologists. The Medicaid beneficiary rate is related with gross payroll gains at residential MH and SA facilities (p < 0.001) and MH clinics (p < 0.001), and with employment gains for MH and SA social workers (p < 0.001) and MH counselors (p < 0.001). Smaller effect sizes exist with MH physician offices (p < 0.05) and psychiatric hospitals' (p < 0.01) gross payroll. No statistically significant relationship exists between the Medicaid beneficiary rate and psychiatrist and psychologist employment. Medicaid provisions are related with the MH industry composition. An imbalanced MH industry may lead to inadequate management of MH disorders.

Aggregate measures of ecosystem services: Can we take the pulse of nature?

USGS Publications Warehouse

Meyerson, L.A.; Baron, Jill S.; Melillo, J.M.; Naiman, R.J.; O'Malley, R.I.; Orians, G.; Palmer, Margaret A.; Pfaff, Alexander S.P.; Running, S.W.; Sala, O.E.

2005-01-01

National scale aggregate indicators of ecosystem services are useful for stimulating and supporting a broad public discussion about trends in the provision of these services. There are important considerations involved in producing an aggregate indicator, including whether the scientific and technological capacity exists, how to address varying perceptions of the societal importance of different services, and how to communicate information about these services to both decision makers and the general public. Although the challenges are formidable, they are not insurmountable. Quantification of ecosystem services and dissemination of information to decision makers and the public is critical for the responsible and sustainable management of natural resources.

Characteristics of good quality pharmaceutical services common to community pharmacies and dispensing general practices.

PubMed

Grey, Elisabeth; Harris, Michael; Rodham, Karen; Weiss, Marjorie C

2016-10-01

In the United Kingdom, pharmaceutical services can be delivered by both community pharmacies (CPs) and dispensing doctor practices (DPs). Both must adhere to minimum standards set out in NHS regulations; however, no common framework exists to guide quality improvement. Previous phases of this research had developed a set of characteristics indicative of good pharmaceutical service provision. To ask key stakeholders to confirm, and rank the importance of, a set of characteristics of good pharmaceutical service provision. A two-round Delphi-type survey was conducted in south-west England and was sent to participants representing three stakeholder groups: DPs, CPs and patients/lay members. Participants were asked to confirm, and rank, the importance of these characteristics as representing good quality pharmaceutical services. Thirty people were sent the first round survey; 22 participants completed both rounds. Median ratings for the 23 characteristics showed that all were seen to represent important aspects of pharmaceutical service provision. Participants' comments highlighted potential problems with the practicality of the characteristics. Characteristics relating to patient safety were deemed to be the most important and those relating to public health the least important. A set of 23 characteristics for providing good pharmaceutical services in CPs and DPs was developed and attained approval from a sample of stakeholders. With further testing and wider discussion, it is hoped that the characteristics will form the basis of a quality improvement tool for CPs and DPs. © 2016 Royal Pharmaceutical Society.

Barriers to providing quality emergency obstetric care in Addis Ababa, Ethiopia: Healthcare providers' perspectives on training, referrals and supervision, a mixed methods study.

PubMed

Austin, Anne; Gulema, Hanna; Belizan, Maria; Colaci, Daniela S; Kendall, Tamil; Tebeka, Mahlet; Hailemariam, Mengistu; Bekele, Delayehu; Tadesse, Lia; Berhane, Yemane; Langer, Ana

2015-03-29

Increasing women's access to and use of facilities for childbirth is a critical national strategy to improve maternal health outcomes in Ethiopia; however coverage alone is not enough as the quality of emergency obstetric services affects maternal mortality and morbidity. Addis Ababa has a much higher proportion of facility-based births (82%) than the national average (11%), but timely provision of quality emergency obstetric care remains a significant challenge for reducing maternal mortality and improving maternal health. The purpose of this study was to assess barriers to the provision of emergency obstetric care in Addis Ababa from the perspective of healthcare providers by analyzing three factors: implementation of national referral guidelines, staff training, and staff supervision. A mixed methods approach was used to assess barriers to quality emergency obstetric care. Qualitative analyses included twenty-nine, semi-structured, key informant interviews with providers from an urban referral network consisting of a hospital and seven health centers. Quantitative survey data were collected from 111 providers, 80% (111/138) of those providing maternal health services in the same referral network. Respondents identified a lack of transportation and communication infrastructure, overcrowding at the referral hospital, insufficient pre-service and in-service training, and absence of supportive supervision as key barriers to provision of quality emergency obstetric care. Dedicated transportation and communication infrastructure, improvements in pre-service and in-service training, and supportive supervision are needed to maximize the effective use of existing human resources and infrastructure, thus increasing access to and the provision of timely, high quality emergency obstetric care in Addis Ababa, Ethiopia.

The provision of mental health services on Long Island college campuses: a pilot study.

PubMed

Sanders, Lorraine B

2007-01-01

College students, often away from home for the first time, are at risk for mental health disorders that can affect academic performance and quality of life. The purpose of this pilot study was to describe the provision of mental health services to students attending colleges on Long Island, NY and to explore information about the policies developed in regards to disclosing mental health information to a student's family in the event of crisis. A descriptive questionnaire was developed for the purpose of this study. Qualified professionals are providing mental health services to students on Long Island college campuses but few policies exist to enhance communication in the event of crisis. Nurses employed in college health centers can work with students and families towards health-promoting behaviors and to proactively plan for the management of health information in the event of a mental health crisis.

Management for Research in U.S. Universities.

ERIC Educational Resources Information Center

Woodrow, Raymond J.

A distinction is made between management for research and management of research. The former refers to the provision of a nourishing climate, sound policies supporting services of various kinds, financial systems, and organizational arrangements that will help research to flourish in a university. It exists to support the management of research, a…

30 CFR 285.118 - What are my appeal rights?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What are my appeal rights? 285.118 Section 285.118 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE RENEWABLE ENERGY ALTERNATE USES OF EXISTING FACILITIES ON THE OUTER CONTINENTAL SHELF General Provisions § 285.118...

Community Colleges: Rethinking STD Prevention for the Nontraditional College Campus

ERIC Educational Resources Information Center

Habel, Melissa A.; Becasen, Jeffrey S.; Kachur, Rachel; Eastman-Mueller, Heather; Dittus, Patricia J.

2017-01-01

As increased attention and proposed funding are being directed toward community colleges, it is important to consider the sexual and reproductive health care needs of this growing population. Existing data suggest there are significant sexual health needs among this population and often insufficient provision of services. Some community college…

76 FR 39402 - Federal Acquisition Regulation; Submission for OMB Review; OMB Circular A-119

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-06

... approved information collection requirement concerning OMB Circular A-119. Public comments are particularly...; Submission for OMB Review; OMB Circular A-119 AGENCIES: Department of Defense (DOD), General Services... public comments regarding an extension to an existing OMB clearance. SUMMARY: Under the provisions of the...

76 FR 2420 - Agency Information Collection Activities: Extension of Existing Information Collection; Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-13

... are required to comply with the affirmative action provisions of the Vietnam Era Veterans... Training Service. ACTION: 60-Day Notice of Information Collection for Review; Federal Contractor Veterans...''), 38 U.S.C. 4212(d), requires Federal contractors and subcontractors subject to the Act's affirmative...

10 CFR 1015.105 - Form of payment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... DEPARTMENT OF ENERGY (GENERAL PROVISIONS) COLLECTION OF CLAIMS OWED THE UNITED STATES General § 1015.105 Form of payment. Claims may be paid in the form of money or, when a contractual basis exists, the Government may demand the return of specific property or the performance of specific services. ...

The contribution of ecosystem services to place utility as a determinant of migration decision-making

NASA Astrophysics Data System (ADS)

Adams, Helen; Adger, W. Neil

2013-03-01

Environment migration research has sought to provide an account of how environmental risks and resources affect migration and mobility. Part of that effort has focused on the role of the environment in providing secure livelihoods through provisioning ecosystem services. However, many of the models of environment migration linkages fail to acknowledge the importance of social and psychological factors in the decision to migrate. Here, we seek to provide a more comprehensive model of migration decision-making under environmental change by investigating the attachment people form to place, and the role of the environment in creating that attachment. We hypothesize that environmental factors enter the migration decision-making process through their contribution to place utility, defined as a function of both affective and instrumental bonds to location, and that ecosystem services, the aspects of ecosystems that create wellbeing, contribute to both components of place utility. We test these ideas in four rural highland settlements in Peru sampled along an altitudinal gradient. We find that non-economic ecosystem services are important in creating place attachment and that ecological place attachment exists independently of use of provisioning ecosystem services. Individuals’ attitudes to ecosystem services vary with the type of ecosystem services available at a location and the degree of rurality. While social and economic factors are the dominant drivers of migration in these locations, a loss of non-provisioning ecosystem services leads to a decrease in place utility and commitment to place, determining factors in the decision to migrate. The findings suggest that policy interventions encouraging migration as an adaptation to environmental change will have limited success if they only focus on provisioning services. A much wider set of individuals will experience a decrease in place utility, and migration will be unable to alleviate that decrease since the factors that create it are specific to place.

Challenges for tree officers to enhance the provision of regulating ecosystem services from urban forests.

PubMed

Davies, Helen J; Doick, Kieron J; Hudson, Malcolm D; Schreckenberg, Kate

2017-07-01

Urbanisation and a changing climate are leading to more frequent and severe flood, heat and air pollution episodes in Britain's cities. Interest in nature-based solutions to these urban problems is growing, with urban forests potentially able to provide a range of regulating ecosystem services such as stormwater attenuation, heat amelioration and air purification. The extent to which these benefits are realized is largely dependent on urban forest management objectives, the availability of funding, and the understanding of ecosystem service concepts within local governments, the primary delivery agents of urban forests. This study aims to establish the extent to which British local authorities actively manage their urban forests for regulating ecosystem services, and identify which resources local authorities most need in order to enhance provision of ecosystem services by Britain's urban forests. Interviews were carried out with staff responsible for tree management decisions in fifteen major local authorities from across Britain, selected on the basis of their urban nature and high population density. Local authorities have a reactive approach to urban forest management, driven by human health and safety concerns and complaints about tree disservices. There is relatively little focus on ensuring provision of regulating ecosystem services, despite awareness by tree officers of the key role that urban forests can play in alleviating chronic air pollution, flood risk and urban heat anomalies. However, this is expected to become a greater focus in future provided that existing constraints - lack of understanding of ecosystem services amongst key stakeholders, limited political support, funding constraints - can be overcome. Our findings suggest that the adoption of a proactive urban forest strategy, underpinned by quantified and valued urban forest-based ecosystem services provision data, and innovative private sector funding mechanisms, can facilitate a change to a proactive, ecosystem services approach to urban forest management. Copyright © 2017. Published by Elsevier Inc.

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.

Anticipating the potential for positive uptake and adaptation in the implementation of a publicly funded online STBBI testing service: a qualitative analysis.

PubMed

Chabot, Cathy; Gilbert, Mark; Haag, Devon; Ogilvie, Gina; Hawe, Penelope; Bungay, Vicky; Shoveller, Jean A

2018-01-30

Online health services are a rapidly growing aspect of public health provision, including testing for sexually transmitted and other blood-borne infections (STBBI). Generally, healthcare providers, policymakers, and clients imbue online approaches with great positive potential (e.g., encouraging clients' agency; providing cost-effective services to more clients). However, the promise of online health services may vary across contexts and be perceived in negative or ambiguous ways (e.g., risks to 'gold standard' care provision; loss of provider control over an intervention; uncertainty related to budget implications). This study examines attitudes and perceptions regarding the development of a novel online STBBI testing service in Vancouver, Canada. We examine the perceptions about the intervention's potential by interviewing practitioners and planners who were engaged in the development and initial implementation of this testing service. We conducted in-depth interviews with 37 healthcare providers, administrators, policymakers, and community-based service providers engaged in the design and launch of the new online STBBI testing service. We also conducted observations during planning and implementation meetings for the new service. Thematic analysis techniques were employed to identify codes and broader discursive themes across the interview transcripts and observation notes. Some study participants expressed concern that the potential popularity of the new testing service might increase demand on existing sexual health services or become fiscally unsustainable. However, most participants regarded the new service as having the potential to improve STBBI testing in several ways, including reducing waiting times, enhancing privacy and confidentiality, appealing to more tech-savvy sub-populations, optimizing the redistribution of demands on face-to-face service provision, and providing patient-centred technology to empower clients to seek testing. Participants perceived this online STBBI testing service to have the potential to improve sexual health care provision. But, they also anticipated actions-and-reactions, revealing a need to monitor ongoing implementation dynamics. They also identified the larger, potentially system-transforming dimension of the new technology, which enables new system drivers (consumers) and reduces the amount of control health care providers have over online STBBI testing compared to conventional in-person testing.

Regional syndromes: towards a dynamical classification of social-ecological sustainability challenges

NASA Astrophysics Data System (ADS)

Dyke, James; Dearing, John; Zhang, Enlou; Rong, Wang; Zhang, Ke

2015-04-01

Schellnhuber et al (1997) first presented the concept of social-ecological syndromes as a means of mapping sustainability challenges facing modern regions to sets of sub-systems. They argued that the great diversity of global social-ecological systems could be represented as different combinations from a much smaller number of patterns of sub-systems. Here, we explore the possibility of extending this idea to an empirical and dynamical classification of system functioning, such as changes in the strength of connectivity, coupling between sub-systems and emergent phenomena. To demonstrate this approach we combine multi-decadal datasets for social, economic and biophysical changes from two contrasting regions in China. This allows us to reconstruct the evolution of system functioning in terms of regulating and provisioning ecosystem services. Climate records and political and policy time-lines provide insight about endogenous and exogenous drivers. Our findings show similar patterns in both regions of long-term trade-off between rising provisioning services and declining regulating services, but with important regional differences. In eastern China, the upward trajectory in provisioning services is strongly linked to the history of agricultural policy reforms but losses of regulating services are more an emergent phenomenon. In contrast, in southwest China, trajectories of provisioning and regulating services are both linked strongly to policy and development initiatives. In both regions, the last few years see the long term trade-off breaking down with provisioning services declining or remaining stationary while losses of regulating services continue to decline. Evidence exists in both regions that critical transitions have been crossed in some ecosystems. The strength of coupling between the socio-economic and biophysical sub-systems also remains strong and shows no sign of de-coupling in either region as required for sustainability. We discuss how our findings point the way towards the creation of a typology of syndromes that could, in principle, be applied worldwide. This approach would respect the inherent complexity and emergent properties of socio-ecological systems whilst avoiding the creation of complex models and representations that may prove to be as hard to understand as the real-world target system.

Can Integrated Water Resources Management sustain the provision of ecosystem goods and services?

NASA Astrophysics Data System (ADS)

Jewitt, Graham

Society derives a wide array of important benefits from biodiversity and the ecosystems in which it exists. These ecosystem services are essential to human existence and operate on such an overarching scale, and in such intricate and little-explored ways, that most could not be replaced by technology. Accordingly, approaches to integrated water resources management (IWRM) do not regard the ecosystem as a ;user; of water in competition with other users, but as the base from which the resource is derived and upon which development is planned. A goal of IWRM should be to maintain, and whenever necessary, restore ecosystem health and biodiversity.

Micro‐provision of Social Care Support for Marginalized Communities – Filling the Gap or Building Bridges to the Mainstream?

PubMed Central

2015-01-01

Abstract As English social care services reconstruct themselves in response to the personalization agenda, there is increased interest in the contribution of micro‐providers – very small community‐based organizations, which can work directly with individuals. These micro‐providers are assumed to be able to cater for the ‘seldom heard’ groups which have been marginalized within mainstream social care services. This article reviews recent literature from the UK published in peer‐reviewed journals from 2000 to 2013 on support provision for people with protected characteristics under the Equality Act 2010. It considers the marginalising dynamics in mainstream, statutory social care support provision, and how far local community, specialist or small‐scale services are responding to unmet need for support and advice among marginalized groups. The review found that there is a tradition of compensatory self‐organization, use of informal networks and a mobilization of social capital for all these groups in response to marginalization from mainstream, statutory services. This requires recognition and nurturing in ways that do not stifle its unique nature. Specialist and community‐based micro‐providers can contribute to a wider range of choices for people who feel larger, mainstream services are not suitable or accessible. However, the types of compensatory activity identified in the research need recognition and investment, and its existence does not imply that the mainstream should not address marginalization. PMID:27840462

Micro-provision of Social Care Support for Marginalized Communities - Filling the Gap or Building Bridges to the Mainstream?

PubMed

Needham, Catherine; Carr, Sarah

2015-12-01

As English social care services reconstruct themselves in response to the personalization agenda, there is increased interest in the contribution of micro-providers - very small community-based organizations, which can work directly with individuals. These micro-providers are assumed to be able to cater for the 'seldom heard' groups which have been marginalized within mainstream social care services. This article reviews recent literature from the UK published in peer-reviewed journals from 2000 to 2013 on support provision for people with protected characteristics under the Equality Act 2010. It considers the marginalising dynamics in mainstream, statutory social care support provision, and how far local community, specialist or small-scale services are responding to unmet need for support and advice among marginalized groups. The review found that there is a tradition of compensatory self-organization, use of informal networks and a mobilization of social capital for all these groups in response to marginalization from mainstream, statutory services. This requires recognition and nurturing in ways that do not stifle its unique nature. Specialist and community-based micro-providers can contribute to a wider range of choices for people who feel larger, mainstream services are not suitable or accessible. However, the types of compensatory activity identified in the research need recognition and investment, and its existence does not imply that the mainstream should not address marginalization.

A study on strategic provisioning of cloud computing services.

PubMed

Whaiduzzaman, Md; Haque, Mohammad Nazmul; Rejaul Karim Chowdhury, Md; Gani, Abdullah

2014-01-01

Cloud computing is currently emerging as an ever-changing, growing paradigm that models "everything-as-a-service." Virtualised physical resources, infrastructure, and applications are supplied by service provisioning in the cloud. The evolution in the adoption of cloud computing is driven by clear and distinct promising features for both cloud users and cloud providers. However, the increasing number of cloud providers and the variety of service offerings have made it difficult for the customers to choose the best services. By employing successful service provisioning, the essential services required by customers, such as agility and availability, pricing, security and trust, and user metrics can be guaranteed by service provisioning. Hence, continuous service provisioning that satisfies the user requirements is a mandatory feature for the cloud user and vitally important in cloud computing service offerings. Therefore, we aim to review the state-of-the-art service provisioning objectives, essential services, topologies, user requirements, necessary metrics, and pricing mechanisms. We synthesize and summarize different provision techniques, approaches, and models through a comprehensive literature review. A thematic taxonomy of cloud service provisioning is presented after the systematic review. Finally, future research directions and open research issues are identified.

A Study on Strategic Provisioning of Cloud Computing Services

PubMed Central

Rejaul Karim Chowdhury, Md

2014-01-01

Cloud computing is currently emerging as an ever-changing, growing paradigm that models “everything-as-a-service.” Virtualised physical resources, infrastructure, and applications are supplied by service provisioning in the cloud. The evolution in the adoption of cloud computing is driven by clear and distinct promising features for both cloud users and cloud providers. However, the increasing number of cloud providers and the variety of service offerings have made it difficult for the customers to choose the best services. By employing successful service provisioning, the essential services required by customers, such as agility and availability, pricing, security and trust, and user metrics can be guaranteed by service provisioning. Hence, continuous service provisioning that satisfies the user requirements is a mandatory feature for the cloud user and vitally important in cloud computing service offerings. Therefore, we aim to review the state-of-the-art service provisioning objectives, essential services, topologies, user requirements, necessary metrics, and pricing mechanisms. We synthesize and summarize different provision techniques, approaches, and models through a comprehensive literature review. A thematic taxonomy of cloud service provisioning is presented after the systematic review. Finally, future research directions and open research issues are identified. PMID:25032243

Information and professional support: key factors in the provision of family-centred early childhood intervention services.

PubMed

Fordham, L; Gibson, F; Bowes, J

2012-09-01

Much has been written on the principles of family-centred practice and on the service delivery methods and skills required of its practitioners. Far less has been written from the perspective of families whose children have a disability. The aims of this study were twofold: firstly to understand families' experiences of family-centred early childhood intervention services and secondly to explore other factors that might impact on these experiences. One hundred and thirty families attending two established early childhood intervention services in New South Wales, Australia completed a survey incorporating the Measure of Processes of Care-56, the Family Empowerment Scale, the Family Support Scale and the Parenting Daily Hassles Scale. Consistent with previous research using the Measure of Processes of Care-56, 'respectful and supportive care' was the domain of care families rated to occur most and 'provision of general information' was the domain they rated to occur least. Significant positive relationships existed between families' ratings of family-centred care and feelings of empowerment. Being provided with general information was strongly correlated with family empowerment. Families' social support networks played an important role but support from professionals was most strongly correlated with families' experiences of family-centred care. Finally, families whose children's early intervention services were co-ordinated by a professional experienced significantly better care. The provision of general information and professional support are key components of family-centred early childhood intervention services. © 2011 Blackwell Publishing Ltd.

Evaluation of introduction scenarios for a broadband access network

NASA Astrophysics Data System (ADS)

Bocker, Geert-Jan; Cuthbert, Laurie; Gobbi, Roberta; Inch, Robert; Sara, Lini

1995-02-01

The provision of broadband services at a reasonable cost to residential and small business customers is one of the major challenges facing operators. The introduction of cost-effective systems considering the existing infrastructure is an important study. Within the RACE project 2024 Broadband Access Facilities, the economic and evolution aspects of different introduction scenarios of a broadband access system suitable for providing these services are investigated. This paper presents the final results of this study.

[Preventive activities in primary health care: identifying the agreement among evidence-based guidelines].

PubMed

Gosalbes Soler, V; Márquez Calderón, S; Maiques Galán, A; Latour Pérez, J; Bernal Delgado, E; Puig Barberá, J; Arranz Lázaro, M

2000-01-01

The purpose of this article is to identify the agreement among evidence-based guidelines about recommendations on preventive activities in low risk adults. For which we identified, from the 1996 US Task Force on Preventive Services Guide those preventives activities classified like A or B (recommendation in favour of provision) and like D or E (recommendation against provision), excepting those D and E recommendations based on descriptives studies or expert opinions. Both preventive activities aimed at pregnant women and children and those which are not applicable to our context were excluded. Selected preventive services were compared with the range of age, sex and periodicity in which agreement with the recommendations of American College of Physicians and Canadian Task Force on Preventive Services existed. We found the following agreements. Screening activities. In favour: screening for hypercholesterolemia, hypertension, breast cancer, colorectal cancer, uterine cervix cancer, rubella, visual and hearing impairment and problem drinking. Against: cancer of prostate, lung, bladder and thyroid, and asymptomatic bacteriuria. Counseling activities. In favour: smoking, motor-vehicles injuries, alcohol consumption, unintended pregnancy. Immunizations and quimioprophylaxis. In favour: Vaccines for influenza, tetanus-diphtheria, hepatitis B and measles-mumps-rubella. Postexposure prophylaxis to hepatitis A, hepatitis B, meningococcal, rabies and tetanus. We see then, that a high degree in agreement among the main guidelines exists; about the preventive activities to perform in Primary Health Services, nevertheless we observed low fulfillment of certain preventive activities in Primary Health Services, different barriers for the accomplishment from these activities were described.

Self-Study: I Am Six Degrees from Special Ed

ERIC Educational Resources Information Center

Torres, Tera J.

2009-01-01

As a diagnostician, my primary responsibility is to conduct psychoeducational evaluations to determine the existence of a learning disability. Such a determination results in either the provisions for or the denial of special education services. In a quest to further understand my position within the schools, I conducted a deep study into this…

19 CFR 351.516 - Price preferences for inputs used in the production of goods for export.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., DEPARTMENT OF COMMERCE ANTIDUMPING AND COUNTERVAILING DUTIES Identification and Measurement of...) Benefit—(1) In general. In the case of a program involving the provision by governments or their agencies... services for use in the production of exported goods, a benefit exists to the extent that the Secretary...

31 CFR 344.3 - What provisions apply to the SLGSafe Service?

Code of Federal Regulations, 2011 CFR

2011-07-01

... documents, which may be downloaded from BPD's Web site and which may change from time to time, apply to... and other transaction requests exclusively through SLGSafe, except to the extent you establish to the satisfaction of BPD that good cause exists for you to submit such subscriptions and requests by other means...

Ethics Education in Initial Teacher Education: Pre-Service Provision in England

ERIC Educational Resources Information Center

Walters, Sue; Heilbronn, Ruth; Daly, Caroline

2018-01-01

Ethics education exists in most professions internationally, yet is less prevalent in teacher education. This article reports on research exploring how ethics education is provided in university courses of initial teacher education (ITE) in England that was conducted as the second phase of an international survey study which considered the…

Multiple Pathways to Whiteness: White Teachers' Unsteady Racial Identities

ERIC Educational Resources Information Center

Miller, Erin T.

2017-01-01

Teacher education programs in the US, recognizing the mismatch that exists in preschool provision between mostly white teachers and a very diverse intake of young children, have begun to explore ways of raising racial awareness among pre-service teachers, with the aim of improving non-white children's classroom experiences and outcomes. This paper…

New Careers and Adult Education.

ERIC Educational Resources Information Center

Rosen, Sumner M.

There is a difference between the past and the present needs of the immigrants to America's urban areas; therefore the provision of relevant programs is tied to the awareness of existing conditions. Industry has moved to the suburbs and there has been an increase in service-oriented occupations. To meet the challenge posed by the changes, we need…

Stigmatized by association: challenges for abortion service providers in Ghana.

PubMed

Aniteye, Patience; O'Brien, Beverley; Mayhew, Susannah H

2016-09-10

Unsafe abortion is an issue of public health concern and contributes significantly to maternal morbidity and mortality globally. Abortion evokes religious, moral, ethical, socio-cultural and medical concerns which mean it is highly stigmatized and this poses a threat to both providers and researchers. This study sought to explore challenges to providing safe abortion services from the perspective of health providers in Ghana. A descriptive qualitative study using in-depth interviews was conducted. The study was conducted in three (3) hospitals and five (5) health centres in the capital city in Ghana. Participants (n = 36) consisted of obstetrician/gynaecologists, nurse-midwives and pharmacists. Stigma affects provision of safe-abortion services in Ghana in a number of ways. The ambiguities in Ghanaian abortion law and lack of overt institutional support for practitioners increased reluctance to openly provide for fear of stigmatisation and legal threat. Negative provider attitudes that stigmatised women seeking abortion care were frequently driven by socio-cultural and religious norms that highly stigmatise abortion practice. Exposure to higher levels of education, including training overseas, seemed to result in more positive, less stigmatising views towards the need for safe abortion services. Nevertheless, physicians open to practicing abortion were still very concerned about stigma by association. Stigma constitutes an overarching impediment for abortion service provision. It affects health providers providing such services and even researchers who study the subject. Exposure to wider debate and education seem to influence attitudes and values clarification training may prove useful. Proper dissemination of existing guidelines and overt institutional support for provision of safe services also needs to be rolled out.

Updating fire safety standards. Final rule; affirmation.

PubMed

2011-11-16

This document affirms as final, without changes, a provision included in a final rule with request for comments that amended the Department of Veterans Affairs (VA) regulations concerning community residential care facilities, contract facilities for certain outpatient and residential services, and State home facilities. That provision established a five-year period within which all covered buildings with nursing home facilities existing as of June 25, 2001, must conform to the automatic sprinkler requirement of the 2009 edition of the National Fire Protection Association (NFPA) 101. This rule helps ensure the safety of veterans in the affected facilities.

[Ecological regulation services of Hainan Island ecosystem and their valuation].

PubMed

Ouyang, Zhiyun; Zhao, Tongqian; Zhao, Jingzhu; Xiao, Han; Wang, Xiaoke

2004-08-01

Ecosystem services imply the natural environmental conditions on which human life relies for existence, and their effectiveness formed and sustained by ecosystem and its ecological processes. In newly research reports, they were divided into four groups, i. e., provisioning services, regulation services, cultural services, and supporting services. To assess and valuate ecosystem services is the foundation of regional environmental reserve and development. Taking Hainan Island as an example and based on the structure and processes of natural ecosystem, this paper discussed the proper methods for regulation services assessment. The ecosystems were classified into 13 types including valley rain forest, mountainous rain forest, tropical monsoon forest, mountainous coppice forest, mountainous evergreen forest, tropical coniferous forest, shrubs, plantation, timber forest, windbreak forest, mangrove, savanna, and cropland, and then, the regulation services and their economic values of Hainan Island ecosystem were assessed and evaluated by terms of water-holding, soil conservancy, nutrient cycle, C fixation, and windbreak function. The economic value of the regulation services of Hainan Island ecosystem was estimated as 2035.88 x 10(8)-2153.39 x 10(8) RMB yuan, 8 times higher to its provisioning services (wood and agricultural products) which were estimated as only 254.06 x 10(8) RMB yuan. The result implied that ecosystem regulation services played an even more important role in the sustainable development of society and economy in Hainan Island.

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.

Facilitating earlier transfer of care from acute stroke services into the community.

PubMed

Robinson, Jennifer

This article outlines an initiative to reduce length of stay for stroke patients within an acute hospital and to facilitate earlier transfer of care. Existing care provision was remodelled and expanded to deliver stroke care to patients within a community bed-based intermediate care facility or intermediate care at home. This new model of care has improved the delivery of rehabilitation through alternative and innovative ways of addressing service delivery that meet the needs of the patients.

SOAP based web services and their future role in VO projects

NASA Astrophysics Data System (ADS)

Topf, F.; Jacquey, C.; Génot, V.; Cecconi, B.; André, N.; Zhang, T. L.; Kallio, E.; Lammer, H.; Facsko, G.; Stöckler, R.; Khodachenko, M.

2011-10-01

Modern state-of-the-art web services are from crucial importance for the interoperability of different VO tools existing in the planetary community. SOAP based web services assure the interconnectability between different data sources and tools by providing a common protocol for communication. This paper will point out a best practice approach with the Automated Multi-Dataset Analysis Tool (AMDA) developed by CDPP, Toulouse and the provision of VEX/MAG data from a remote database located at IWF, Graz. Furthermore a new FP7 project IMPEx will be introduced with a potential usage example of AMDA web services in conjunction with simulation models.

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

Evosystem Services: Rapid Evolution and the Provision of Ecosystem Services.

PubMed

Rudman, Seth M; Kreitzman, Maayan; Chan, Kai M A; Schluter, Dolph

2017-06-01

Evolution is recognized as the source of all organisms, and hence many ecosystem services. However, the role that contemporary evolution might play in maintaining and enhancing specific ecosystem services has largely been overlooked. Recent advances at the interface of ecology and evolution have demonstrated how contemporary evolution can shape ecological communities and ecosystem functions. We propose a definition and quantitative criteria to study how rapid evolution affects ecosystem services (here termed contemporary evosystem services) and present plausible scenarios where such services might exist. We advocate for the direct measurement of contemporary evosystem services to improve understanding of how changing environments will alter resource availability and human well-being, and highlight the potential utility of managing rapid evolution for future ecosystem services. Copyright © 2017 Elsevier Ltd. All rights reserved.

Seasonality of service provision in hip and knee surgery: a possible contributor to waiting times? A time series analysis.

PubMed

Upshur, Ross E G; Moineddin, Rahim; Crighton, Eric J; Mamdani, Muhammad

2006-03-01

The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100,000 population for all hip and knee replacements. There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p < 0.01; Bartlett-Kolmogorov-Smirnov Test = 0.31, p < 0.01) and strong (R2Autoreg = 0.85) seasonality was identified in the data. Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery.

Seasonality of service provision in hip and knee surgery: A possible contributor to waiting times? A time series analysis

PubMed Central

Upshur, Ross EG; Moineddin, Rahim; Crighton, Eric J; Mamdani, Muhammad

2006-01-01

Background The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. Methods We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100 000 population for all hip and knee replacements. Results There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p < 0.01; Bartlett-Kolmogorov-Smirnov Test = 0.31, p < 0.01) and strong (R2Autoreg = 0.85) seasonality was identified in the data. Conclusion Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery. PMID:16509992

'Know before you go': information-seeking behaviour of German patients receiving health services abroad in light of the provisions of Directive 2011/24/EU.

PubMed

Panteli, Dimitra; Wagner, Caroline; Verheyen, Frank; Busse, Reinhard

2015-07-01

While Directive 2011/24/EU on cross-border patient mobility makes specific provisions in relation to information availability and accessibility, little empirical evidence exists to guide best practice. This paper explores the information-seeking behaviour of German patients who received planned care abroad. A postal survey among German patients treated in other European countries was carried out by Techniker Krankenkasse, a major German sickness fund. The influence of certain predictors on whether patients informed themselves before travelling for care was investigated using multiple logistic regression. Types and sources of information were analysed using descriptive statistics. Information activity was contingent on patients' level of education, type of service, regularity of treatment abroad and awareness of entitlement to cross-border services. Respondents most frequently enquired about elements of reimbursement, entitlement to services and cost-saving, and consulted their sickness fund for information. Differences in both content and medium of choice were observed between patient groups. A structured and inclusive approach to information provision should be adopted. National Contact Points should collaborate with a range of stakeholders, who will vary depending on the health care system; however, patient organizations, health professionals and third-party payers should always be represented. Dynamically monitoring cross-border movements can help determine the range, medium and language of relevant information. © The Author(s) 2015.

Establishing a Public School Dysphagia Program: A Model for Administration and Service Provision

ERIC Educational Resources Information Center

Homer, Emily M.

2008-01-01

Purpose: Many school-based speech-language pathologists (SLPs) are hampered in participating in managing children with dysphagia by their school systems' lack of supportive policies and procedures. A need exists to better define the dysphagia-trained SLP's role and clarify the district's responsibility. The purpose of this article is to address…

32 CFR Appendix B to Part 57 - Procedures for the Provision of Educational Programs and Services for Children With Disabilities...

Code of Federal Regulations, 2013 CFR

2013-07-01

... child's performance, behavior, and needs during the reevaluation and the review of existing data in...) Interventions, strategies, and supports including behavior management plans to address behavior for a child... child's behavior may endanger the health, welfare, or safety of self or any other child, teacher, or...

32 CFR Appendix B to Part 57 - Procedures for the Provision of Educational Programs and Services for Children With Disabilities...

Code of Federal Regulations, 2010 CFR

2010-07-01

... child's performance, behavior, and needs during the reevaluation and the review of existing data in...) Interventions, strategies, and supports including behavior management plans to address behavior for a child... child's behavior may endanger the health, welfare, or safety of self or any other child, teacher, or...

32 CFR Appendix B to Part 57 - Procedures for the Provision of Educational Programs and Services for Children With Disabilities...

Code of Federal Regulations, 2012 CFR

2012-07-01

... child's performance, behavior, and needs during the reevaluation and the review of existing data in...) Interventions, strategies, and supports including behavior management plans to address behavior for a child... child's behavior may endanger the health, welfare, or safety of self or any other child, teacher, or...

32 CFR Appendix B to Part 57 - Procedures for the Provision of Educational Programs and Services for Children With Disabilities...

Code of Federal Regulations, 2014 CFR

2014-07-01

... child's performance, behavior, and needs during the reevaluation and the review of existing data in...) Interventions, strategies, and supports including behavior management plans to address behavior for a child... child's behavior may endanger the health, welfare, or safety of self or any other child, teacher, or...

32 CFR Appendix B to Part 57 - Procedures for the Provision of Educational Programs and Services for Children With Disabilities...

Code of Federal Regulations, 2011 CFR

2011-07-01

... child's performance, behavior, and needs during the reevaluation and the review of existing data in...) Interventions, strategies, and supports including behavior management plans to address behavior for a child... child's behavior may endanger the health, welfare, or safety of self or any other child, teacher, or...

A comparison of two coaching approaches to enhance implementation of a recovery-oriented service model.

PubMed

Deane, Frank P; Andresen, Retta; Crowe, Trevor P; Oades, Lindsay G; Ciarrochi, Joseph; Williams, Virginia

2014-09-01

Moving to recovery-oriented service provision in mental health may entail retraining existing staff, as well as training new staff. This represents a substantial burden on organisations, particularly since transfer of training into practice is often poor. Follow-up supervision and/or coaching have been found to improve the implementation and sustainment of new approaches. We compared the effect of two coaching conditions, skills-based and transformational coaching, on the implementation of a recovery-oriented model following training. Training followed by coaching led to significant sustained improvements in the quality of care planning in accordance with the new model over the 12-month study period. No interaction effect was observed between the two conditions. However, post hoc analyses suggest that transformational coaching warrants further exploration. The results support the provision of supervision in the form of coaching in the implementation of a recovery-oriented service model, and suggest the need to better elucidate the mechanisms within different coaching approaches that might contribute to improved care.

Frequency allocations for a new satellite service - Digital audio broadcasting

NASA Technical Reports Server (NTRS)

Reinhart, Edward E.

1992-01-01

The allocation in the range 500-3000 MHz for digital audio broadcasting (DAB) is described in terms of key issues such as the transmission-system architectures. Attention is given to the optimal amount of spectrum for allocation and the technological considerations relevant to downlink bands for satellite and terrestrial transmissions. Proposals for DAB allocations are compared, and reference is made to factors impinging on the provision of ground/satellite feeder links. The allocation proposals describe the implementation of 50-60-MHz bandwidths for broadcasting in the ranges near 800 MHz, below 1525 MHz, near 2350 MHz, and near 2600 MHz. Three specific proposals are examined in terms of characteristics such as service areas, coverage/beam, channels/satellite beam, and FCC license status. Several existing problems are identified including existing services crowded with systems, the need for new bands in the 1000-3000-MHz range, and variations in the nature and intensity of implementations of existing allocations that vary from country to country.

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.

Feasibility of sustainable provision of intradermal post exposure prophylaxis against rabies at primary care level –evidence from rural Haryana

PubMed Central

2014-01-01

Background Rabies is the most severe and neglected public health problem in India. Management of animal bite with post exposure prophylaxis is the only existent strategy to prevent rabies related deaths. Cost-effective and sustainable programme for provision of post exposure prophylaxis (PEP) is needed in India. Methods In this study, we have documented the experience of implementation of intra-dermal anti rabies vaccination in Animal Bite Management (ABM) clinic at Primary Health Centre (PHC). This study facility belonged to Comprehensive Rural Health Services Project, Ballabgarh in Faridabad district of Haryana. Hospital service record of ABM clinic was analyzed and various feasibility issues such as costing of services, vaccine wastage and other operational issues in providing PEP services at PHC level were documented. Results A total of 619 patients were treated in the ABM clinic. Service utilization of ABM clinic was increased by 38% in the second year of implementation. Mean age of the patients was 23.9 years (SD: 18.8) and majority (70.4%) were males. Majority (86%) of the patients received the first dose of anti-rabies vaccine within the recommended 48 hours. A total 446 vaccine vials (1 ml) were consumed of which 20.8% was contributed in vaccine wastage. User-fee (350 Indian Rupees) collected from the patients. User-fee was re-used to purchase vaccines, intradermal (ID) syringes and other consumables required to ensure regular availability of ARV services at the PHC. Conclusions This study demonstrated the cost-effective and sustainable model of provision of PEP against rabies at primary care level. ID PEP provision at primary care level not only address the unmet need of animal bite management in the community also reduces the out of pocket expenditure of the patients. PMID:24965875

Ecosystem Services from Edible Insects in Agricultural Systems: A Review

PubMed Central

Payne, Charlotte L. R.; Van Itterbeeck, Joost

2017-01-01

Many of the most nutritionally and economically important edible insects are those that are harvested from existing agricultural systems. Current strategies of agricultural intensification focus predominantly on increasing crop yields, with no or little consideration of the repercussions this may have for the additional harvest and ecology of accompanying food insects. Yet such insects provide many valuable ecosystem services, and their sustainable management could be crucial to ensuring future food security. This review considers the multiple ecosystem services provided by edible insects in existing agricultural systems worldwide. Directly and indirectly, edible insects contribute to all four categories of ecosystem services as outlined by the Millennium Ecosystem Services definition: provisioning, regulating, maintaining, and cultural services. They are also responsible for ecosystem disservices, most notably significant crop damage. We argue that it is crucial for decision-makers to evaluate the costs and benefits of the presence of food insects in agricultural systems. We recommend that a key priority for further research is the quantification of the economic and environmental contribution of services and disservices from edible insects in agricultural systems. PMID:28218635

Ecosystem Services from Edible Insects in Agricultural Systems: A Review.

PubMed

Payne, Charlotte L R; Van Itterbeeck, Joost

2017-02-17

Many of the most nutritionally and economically important edible insects are those that are harvested from existing agricultural systems. Current strategies of agricultural intensification focus predominantly on increasing crop yields, with no or little consideration of the repercussions this may have for the additional harvest and ecology of accompanying food insects. Yet such insects provide many valuable ecosystem services, and their sustainable management could be crucial to ensuring future food security. This review considers the multiple ecosystem services provided by edible insects in existing agricultural systems worldwide. Directly and indirectly, edible insects contribute to all four categories of ecosystem services as outlined by the Millennium Ecosystem Services definition: provisioning, regulating, maintaining, and cultural services. They are also responsible for ecosystem disservices, most notably significant crop damage. We argue that it is crucial for decision-makers to evaluate the costs and benefits of the presence of food insects in agricultural systems. We recommend that a key priority for further research is the quantification of the economic and environmental contribution of services and disservices from edible insects in agricultural systems.

Strong and nonlinear effects of fragmentation on ecosystem service provision at multiple scales

NASA Astrophysics Data System (ADS)

Mitchell, Matthew G. E.; Bennett, Elena M.; Gonzalez, Andrew

2015-09-01

Human actions, such as converting natural land cover to agricultural or urban land, result in the loss and fragmentation of natural habitat, with important consequences for the provision of ecosystem services. Such habitat loss is especially important for services that are supplied by fragments of natural land cover and that depend on flows of organisms, matter, or people across the landscape to produce benefits, such as pollination, pest regulation, recreation and cultural services. However, our quantitative knowledge about precisely how different patterns of landscape fragmentation might affect the provision of these types of services is limited. We used a simple, spatially explicit model to evaluate the potential impact of natural land cover loss and fragmentation on the provision of hypothetical ecosystem services. Based on current literature, we assumed that fragments of natural land cover provide ecosystem services to the area surrounding them in a distance-dependent manner such that ecosystem service flow depended on proximity to fragments. We modeled seven different patterns of natural land cover loss across landscapes that varied in the overall level of landscape fragmentation. Our model predicts that natural land cover loss will have strong and unimodal effects on ecosystem service provision, with clear thresholds indicating rapid loss of service provision beyond critical levels of natural land cover loss. It also predicts the presence of a tradeoff between maximizing ecosystem service provision and conserving natural land cover, and a mismatch between ecosystem service provision at landscape versus finer spatial scales. Importantly, the pattern of landscape fragmentation mitigated or intensified these tradeoffs and mismatches. Our model suggests that managing patterns of natural land cover loss and fragmentation could help influence the provision of multiple ecosystem services and manage tradeoffs and synergies between services across different human-dominated landscapes.

Barriers to education in cardiac rehabilitation within an Iranian society: a qualitative descriptive study.

PubMed

Alavi, Mousa; Irajpour, Alireza; Giles, Tracey; Rabiei, Katayoun; Sarrafzadegan, Nizal

2013-06-01

Cardiac rehabilitation programmes that include patient education aim to maximise physical, psychological and social functioning, and enable people with acute coronary syndrome to lead fulfilling and productive lives. Despite strong evidence for the benefits of patient education, various barriers exist that need to be addressed to ensure the effective delivery of care. This study explores patients/family members and health professionals' perceptions and experiences of the barriers to cardiac rehabilitation education in an Iranian context. A thematic analysis of in-depth interviews was undertaken using a constant comparative approach. Participants (10 health professionals, 15 patients/family members) were recruited from educational-medical centers and hospitals in Iran. Credibility and trustworthiness were grounded on four aspects: factual value, applicability, consistency and neutrality. Five major barriers to cardiac rehabilitation were identified relating to human resources, service provision, available educational services, unfavourable attitudes and collaboration gaps. Two main challenges exist to the provision of effective patient education; inadequate human resources in the hospital wards, specifically in terms of trained health care professionals and service users specific health related views and behaviours. Barriers to comprehensive patient education and cardiac rehabilitation in Iran must be addressed and urgent consideration should be given to the introduction and evaluation of education programmes to prepare health/support system professionals as well as service users, and cardiac rehabilitation services that employ a collaborative and individualised approach. This in turn may reduce the burden of CVD and improve the overall health and quality of life for people in Isfahan Iran.

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...

Determinants of efficiency in the provision of municipal street-cleaning and refuse collection services

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

Benito-Lopez, Bernardino, E-mail: benitobl@um.es; Rocio Moreno-Enguix, Maria del, E-mail: mrmoreno@um.es; Solana-Ibanez, Jose, E-mail: jsolana@um.es

Effective waste management systems can make critical contributions to public health, environmental sustainability and economic development. The challenge affects every person and institution in society, and measures cannot be undertaken without data collection and a quantitative analysis approach. In this paper, the two-stage double bootstrap procedure of is used to estimate the efficiency determinants of Spanish local entities in the provision of public street-cleaning and refuse collection services. The purpose is to identify factors that influence efficiency. The final sample comprised 1072 municipalities. In the first stage, robust efficiency estimates are obtained with Data Envelopment Analysis (DEA). We apply themore » second stage, based on a truncated-regression, to estimate the effect of a group of environmental factors on DEA estimates. The results show the existence of a significant relation between efficiency and all the variables analysed (per capita income, urban population density, the comparative index of the importance of tourism and that of the whole economic activity). We have also considered the influence of a dummy categorical variable - the political sign of the governing party - on the efficient provision of the services under study. The results from the methodology proposed show that municipalities governed by progressive parties are more efficient.« less

Determinants of efficiency in the provision of municipal street-cleaning and refuse collection services.

PubMed

Benito-López, Bernardino; Moreno-Enguix, María del Rocio; Solana-Ibañez, José

2011-06-01

Effective waste management systems can make critical contributions to public health, environmental sustainability and economic development. The challenge affects every person and institution in society, and measures cannot be undertaken without data collection and a quantitative analysis approach. In this paper, the two-stage double bootstrap procedure of Simar and Wilson (2007) is used to estimate the efficiency determinants of Spanish local entities in the provision of public street-cleaning and refuse collection services. The purpose is to identify factors that influence efficiency. The final sample comprised 1072 municipalities. In the first stage, robust efficiency estimates are obtained with Data Envelopment Analysis (DEA). We apply the second stage, based on a truncated-regression, to estimate the effect of a group of environmental factors on DEA estimates. The results show the existence of a significant relation between efficiency and all the variables analysed (per capita income, urban population density, the comparative index of the importance of tourism and that of the whole economic activity). We have also considered the influence of a dummy categorical variable - the political sign of the governing party - on the efficient provision of the services under study. The results from the methodology proposed show that municipalities governed by progressive parties are more efficient. Copyright © 2011 Elsevier Ltd. All rights reserved.

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,…

Parental views on informed consent for expanded newborn screening.

PubMed

Moody, Louise; Choudhry, Kubra

2013-09-01

An increasing array of rare inherited conditions can be detected as part of the universal newborn screening programme. The introduction and evaluation of these service developments require consideration of the ethical issues involved and appropriate mechanisms for informing parents and gaining consent if required. Exploration of parental views is needed to inform the debate and specifically consider whether more flexible protocols are needed to fit with the public perception of new developments in this context. This study has been undertaken to explore perceptions and attitudes of parents and future parents to an expanded newborn screening programme in the United Kingdom and the necessary information provision and consent processes. A mixed methods study involving focus groups (n = 29) and a web-survey (n = 142) undertaken with parents and future parents. Parents want guaranteed information provision with clear decision-making powers and an awareness of the choices available to them. The difference between existing screening provision and expanded screening was not considered to be significant enough by participants to warrant formal written, informed consent for expanded screening. It is argued that the ethical review processes need to be more flexible towards the provision of information and consent processes for service developments in newborn screening. © 2011 John Wiley & Sons Ltd.

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...

Mitigating and adapting to climate change: multi-functional and multi-scale assessment of green urban infrastructure.

PubMed

Demuzere, M; Orru, K; Heidrich, O; Olazabal, E; Geneletti, D; Orru, H; Bhave, A G; Mittal, N; Feliu, E; Faehnle, M

2014-12-15

In order to develop climate resilient urban areas and reduce emissions, several opportunities exist starting from conscious planning and design of green (and blue) spaces in these landscapes. Green urban infrastructure has been regarded as beneficial, e.g. by balancing water flows, providing thermal comfort. This article explores the existing evidence on the contribution of green spaces to climate change mitigation and adaptation services. We suggest a framework of ecosystem services for systematizing the evidence on the provision of bio-physical benefits (e.g. CO2 sequestration) as well as social and psychological benefits (e.g. improved health) that enable coping with (adaptation) or reducing the adverse effects (mitigation) of climate change. The multi-functional and multi-scale nature of green urban infrastructure complicates the categorization of services and benefits, since in reality the interactions between various benefits are manifold and appear on different scales. We will show the relevance of the benefits from green urban infrastructures on three spatial scales (i.e. city, neighborhood and site specific scales). We will further report on co-benefits and trade-offs between the various services indicating that a benefit could in turn be detrimental in relation to other functions. The manuscript identifies avenues for further research on the role of green urban infrastructure, in different types of cities, climates and social contexts. Our systematic understanding of the bio-physical and social processes defining various services allows targeting stressors that may hamper the provision of green urban infrastructure services in individual behavior as well as in wider planning and environmental management in urban areas. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

Towards a Threat Assessment Framework for Ecosystem Services.

PubMed

Maron, Martine; Mitchell, Matthew G E; Runting, Rebecca K; Rhodes, Jonathan R; Mace, Georgina M; Keith, David A; Watson, James E M

2017-04-01

How can we tell if the ecosystem services upon which we rely are at risk of being lost, potentially permanently? Ecosystem services underpin human well-being, but we lack a consistent approach for categorizing the extent to which they are threatened. We present an assessment framework for assessing the degree to which the adequate and sustainable provision of a given ecosystem service is threatened. Our framework combines information on the states and trends of both ecosystem service supply and demand, with reference to two critical thresholds: demand exceeding supply and ecosystem service 'extinction'. This framework can provide a basis for global, national, and regional assessments of threat to ecosystem services, and accompany existing assessments of threat to species and ecosystems. Copyright © 2017 Elsevier Ltd. All rights reserved.

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...

Obstacles to the take-up of mental health-care provision by adult males in rural and remote areas of Australia: A systematic review protocol.

PubMed

Stroud, Peter; Lockwood, Craig

The objective is to identify and synthesise the best available evidence on the obstacles to the take-up of health-care provision by adult rural and remote dwelling males in Australia seeking mental health services. Men's health, in general health-care practice, is defined as the global management of mental, emotional, and physical health conditions, and related risk factors, that are specific to men in order to promote and generate optimal health.Research and practice tends to suggest that health-care and mental-health care practitioners seem to be confronted with obstacles such as distance clients need to travel and rurality in delivering care to adult rural males. Possible issues might be whether, or to what extent, care providers are conscious of these obstacles. Another issue might be how care providers work with these obstacles in practice, and whether or not they may, also to some extent, share some of the responsibility for the existence of these obstacles, on their own, or in conjunction with other factors which might be said to exist purely in the rural context. There is also a need to explore the contributions to obstacles from the adult rural male side as well. There may also be factors at work in the particular unique nature of rural and remote health-care and mental-health care as well, which could also be involved in the creation of obstacles.The structure and functioning of rural care available to adult males of all cultural backgrounds and the obstacles to the take-up of that care represents an area which warrants further exploration and understanding. A foundation paper in this field by Karoski suggests that obstacles exist in health-care provision, particularly in the field of mental-health care to adult males. Other research suggests that, while obstacles in service provision are common to all areas, some obstacles are more significant for rural and remote areas.The reasons for framing this review in terms of the adult rural and remote male (ARRM) context is as follows. Research suggests there is a consensus that Australian rural male health is a unique social problem, and there appears to be a possible perception that the state and national health systems may have failed ARRM's. This research also discusses that ARRM's respond differently and uniquely, compared to their international counterparts, and this might be especially true in the case of Australian Indigenous populations. There is a suggestion in the research that the Australian rural health-care environment is unique because of its mix of ARRM's among a population which includes culturally and linguistically diverse populations, local Indigenous people as well as people of Anglo-Saxon descent. Some research suggests that there are unique complexities confronting the ARRM population mix when access to health-care is considered. Research also suggests unique complexities might exist in the mix of care provision, delivery systems, and funding arrangements in the ARRM context. An interesting area of research in terms of social capital, and moral distress, suggests the Australian context might be unique in terms of its formal and informal care structures and arrangements.. Moral distress is believed to represent an issue in the professional delivery of quality health-care Other research considers the notion of structural disadvantage in the provision of, and access to, care services for ARRM's. Structural disadvantage refers to the dearth of asset-based community development opportunities that play a role in health-care provision.A screening search of Pubmed, Cinahl, the Cochrane Library and the JBI Systematic Review Library did not identify published systematic reviews, or active protocols in this topic of research. Therefore this systematic review will help address this gap. Obstacle: A barrier to the utilisation of health-care/mental-health care.Take-up: The accessing of health-care/mental-health care services.Health-care: Services which promote, maintain, and preserve health, life, and well-being.Mental-Health care: The assessment, diagnosis and treatment of people who are experiencing psychological and situational stressors which create mental-health conditions and disorders such as depression and anxiety.Provision: Professional services for health-care/mental-health care provided by Doctors, Nurses, Medical Specialists, Psychologists, Social Workers, Psychotherapists, and other care providers.Rural and Remote: This term can be conceptualised as a set of characteristics which can impact on the way a health-care service can be delivered and includes: geographical isolation from major population centres of Australia; greater distances; lower socioeconomic status; lower educational levels; higher proportion of Indigenous people; specific occupational health safety and welfare risks; a relatively close relationship with nature; specific cultural attitudes; poor access to services; and, smaller population centres where there is a distinctive occupational profile dominated by primary and resource production.

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...

What's scale got to do with it? Models for urban tree canopy

Treesearch

Dexter H. Locke; Shawn M. Landry; Morgan Grove; Rinku Roy Chowdhury

2016-01-01

The uneven provisioning of ecosystem services has important policy implications; yet the spatial heterogeneity of tree canopy remains understudied. Private residential lands are important to the future of Philadelphia’s urban forest because a majority of the existing and possible tree canopy is located on residential land uses. This article examines the spatial...

75 FR 47678 - Northern Plains Railroad, Inc.-Lease Exemption-Soo Line Railroad Company

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-06

... North Dakota (referred to as the Wheat Lines). NPR has operated the Wheat Lines pursuant to an existing... provide for NPR's continued lease of and provision of rail service on the Wheat Lines.\\2\\ Pursuant to the Agreements, NPR will renew its lease of the Wheat Lines extending: (a) From milepost 309.69 at Thief River...

Malta: Health system review.

PubMed

Azzopardi Muscat, Natasha; Calleja, Neville; Calleja, Antoinette; Cylus, Jonathan

2014-01-01

This analysis of the Maltese health system reviews the developments in its organization and governance, health financing, health-care provision, health reforms and health system performance. The health system in Malta consists of a public sector, which is free at the point of service and provides a comprehensive basket of health services for all its citizens, and a private sector, which accounts for a third of total health expenditure and provides the majority of primary care. Maltese citizens enjoy one of the highest life expectancies in Europe. Nevertheless, non-communicable diseases pose a major concern with obesity being increasingly prevalent among both adults and children. The health system faces important challenges including a steadily ageing population, which impacts the sustainability of public finances. Other supply constraints stem from financial and infrastructural limitations. Nonetheless, there exists a strong political commitment to ensure the provision of a healthcare system that is accessible, of high quality, safe and also sustainable. This calls for strategic investments to underpin a revision of existing processes whilst shifting the focus of care away from hospital into the community. World Health Organization 2014 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

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...

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...

Scaling up delivery of contraceptive implants in sub-Saharan Africa: operational experiences of Marie Stopes International

PubMed Central

Duvall, Susan; Thurston, Sarah; Weinberger, Michelle; Nuccio, Olivia; Fuchs-Montgomery, Nomi

2014-01-01

Contraceptive implants offer promising opportunities for addressing the high and growing unmet need for modern contraceptives in sub-Saharan Africa. Marie Stopes International (MSI) offers implants as one of many family planning options. Between 2008 and 2012, MSI scaled up voluntary access to implants in 15 sub-Saharan African countries, from 80,041 implants in 2008 to 754,329 implants in 2012. This 9-fold increase amounted to more than 1.7 million implants delivered cumulatively over the 5-year period. High levels of client satisfaction were attained alongside service provision scale up by using existing MSI service delivery channels—mobile outreach, social franchising, and clinics—to implement strategies that broadened access for underserved clients and maintained service quality. Use of adaptive and context-specific service delivery models and attention to key operational components, including sufficient numbers of trained providers, strong supply chains, diverse financing mechanisms, and implant removal services, underpinned our service delivery efforts. Accounting for 70% of the implants delivered by MSI in 2012, mobile outreach services through dedicated MSI provider teams played a central role in scale-up efforts, fueled in part by the provision of free or heavily subsidized services. Social franchising also demonstrated promise for future program growth, along with MSI clinics. Continued high growth in implant provision between 2011 and 2012 in all sub-Saharan African countries indicates the region's capacity for further service delivery expansion. Meeting the expected rising demand for implants and ensuring long-term sustainable access to the method, as part of a comprehensive method mix, will require continued use of appropriate service delivery models, effective operations, and ongoing collaboration between the private, public, and nongovernmental sectors. MSI's experience can be instructive for future efforts to ensure contraceptive access and choice in sub-Saharan Africa, especially as the global health community works to achieve its Family Planning 2020 (FP2020) commitments to expand family planning access to 120 million new users. PMID:25276564

Scaling up delivery of contraceptive implants in sub-Saharan Africa: operational experiences of Marie Stopes International.

PubMed

Duvall, Susan; Thurston, Sarah; Weinberger, Michelle; Nuccio, Olivia; Fuchs-Montgomery, Nomi

2014-02-01

Contraceptive implants offer promising opportunities for addressing the high and growing unmet need for modern contraceptives in sub-Saharan Africa. Marie Stopes International (MSI) offers implants as one of many family planning options. Between 2008 and 2012, MSI scaled up voluntary access to implants in 15 sub-Saharan African countries, from 80,041 implants in 2008 to 754,329 implants in 2012. This 9-fold increase amounted to more than 1.7 million implants delivered cumulatively over the 5-year period. High levels of client satisfaction were attained alongside service provision scale up by using existing MSI service delivery channels-mobile outreach, social franchising, and clinics-to implement strategies that broadened access for underserved clients and maintained service quality. Use of adaptive and context-specific service delivery models and attention to key operational components, including sufficient numbers of trained providers, strong supply chains, diverse financing mechanisms, and implant removal services, underpinned our service delivery efforts. Accounting for 70% of the implants delivered by MSI in 2012, mobile outreach services through dedicated MSI provider teams played a central role in scale-up efforts, fueled in part by the provision of free or heavily subsidized services. Social franchising also demonstrated promise for future program growth, along with MSI clinics. Continued high growth in implant provision between 2011 and 2012 in all sub-Saharan African countries indicates the region's capacity for further service delivery expansion. Meeting the expected rising demand for implants and ensuring long-term sustainable access to the method, as part of a comprehensive method mix, will require continued use of appropriate service delivery models, effective operations, and ongoing collaboration between the private, public, and nongovernmental sectors. MSI's experience can be instructive for future efforts to ensure contraceptive access and choice in sub-Saharan Africa, especially as the global health community works to achieve its Family Planning 2020 (FP2020) commitments to expand family planning access to 120 million new users.

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.

Building an award-winning women's health ambulatory service and beyond.

PubMed

Allen, Lisa W; Maxwell, Susan; Greene, John F

2003-01-01

Many barriers exist for the provision of high-quality health care to inner-city minority women. The barriers include access to care, compliance problems, financial concerns, system navigation issues, as well as language barriers. This article describes the transition of the Women's Ambulatory Health Services at Hartford Hospital from a traditional clinic model to a culturally sensitive private practice model. The road to transition was paved by valuable input from staff as well as patients. The final product was a much more efficient, inviting model that catered to the needs of the community.

NASA/DOD Aerospace Knowledge Diffusion Research Project. Paper 13: The information-seeking habits and practices of engineers

NASA Technical Reports Server (NTRS)

Pinelli, Thomas E.

1991-01-01

It is argued that only by maximizing the research and development process can the United States maintain and possibly capture its international competitive edge. Key to this goal is the provision of information services and products which meet the information needs of engineers. Evidence exists which indicates that traditional information services and products may, in fact, not be meeting the information needs of engineers. The primary reason for this deficiency is three fold. First, the specific information needs of engineers are neither well known nor well understood. Second, what is known about the information seeking habits and practices of engineers has not been applied to existing engineering information services. Third, the information professionals continue to over-emphasize technology instead of concentrating on the quality of the information itself and the ability of the information to meet the needs of the user.

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

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.

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...

Barriers to delivering mental health services in Georgia with an economic and financial focus: informing policy and acting on evidence.

PubMed

Sulaberidze, Lela; Green, Stuart; Chikovani, Ivdity; Uchaneishvili, Maia; Gotsadze, George

2018-02-13

Whilst there is recognition that the global burden of disease associated with mental health disorders is significant, the economic resources available, especially in Low and Middle Income Countries, are particularly scarce. Identifying the economic (system) and financial (individual) barriers to delivering mental health services and assessing the opportunities for reform can support the development of strategies for change. A mixed methods study was developed, which engaged with a range of stakeholders from mental health services, including key informants, service managers, healthcare professional and patients and their care-takers. Data generated from interviews and focus groups were analysed using an existing framework that outlines a range of economic and financial barriers to improving mental health practice. In addition, the study utilised health financing and programmatic data. The analysis identified a variety of local economic barriers, including: the inhibition of the diversification of the mental health workforce and services due to inflexible resources; the variable and limited provision of services across the country; and the absence of mechanisms to assess the delivery and quality of existing services. The main financial barriers identified were related to out-of pocket payments for purchasing high quality medications and transportation to access mental health services. Whilst scarcity of financial resources exists in Georgia, as in many other countries, there are clear opportunities to improve the effectiveness of the current mental health programme. Addressing system-wide barriers could enable the delivery of services that aim to meet the needs of patients. The use of existing data to assess the implementation of the mental health programme offers opportunities to benchmark and improve services and to support the appropriate commissioning and reconfiguration of services.

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.

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...

Assessment of the water supply:demand ratios in a Mediterranean basin under different global change scenarios and mitigation alternatives.

PubMed

Boithias, Laurie; Acuña, Vicenç; Vergoñós, Laura; Ziv, Guy; Marcé, Rafael; Sabater, Sergi

2014-02-01

Spatial differences in the supply and demand of ecosystem services such as water provisioning often imply that the demand for ecosystem services cannot be fulfilled at the local scale, but it can be fulfilled at larger scales (regional, continental). Differences in the supply:demand (S:D) ratio for a given service result in different values, and these differences might be assessed with monetary or non-monetary metrics. Water scarcity occurs where and when water resources are not enough to meet all the demands, and this affects equally the service of water provisioning and the ecosystem needs. In this study we assess the value of water in a Mediterranean basin under different global change (i.e. both climate and anthropogenic changes) and mitigation scenarios, with a non-monetary metric: the S:D ratio. We computed water balances across the Ebro basin (North-East Spain) with the spatially explicit InVEST model. We highlight the spatial and temporal mismatches existing across a single hydrological basin regarding water provisioning and its consumption, considering or not, the environmental demand (environmental flow). The study shows that water scarcity is commonly a local issue (sub-basin to region), but that all demands are met at the largest considered spatial scale (basin). This was not the case in the worst-case scenario (increasing demands and decreasing supply), as the S:D ratio at the basin scale was near 1, indicating that serious problems of water scarcity might occur in the near future even at the basin scale. The analysis of possible mitigation scenarios reveals that the impact of global change may be counteracted by the decrease of irrigated areas. Furthermore, the comparison between a non-monetary (S:D ratio) and a monetary (water price) valuation metrics reveals that the S:D ratio provides similar values and might be therefore used as a spatially explicit metric to valuate the ecosystem service water provisioning. © 2013.

Policy silences: why Canada needs a National First Nations, Inuit and Métis health policy.

PubMed

Lavoie, Josée G

2013-12-27

Despite attempts, policy silences continue to create barriers to addressing the healthcare needs of First Nations, Inuit and Métis. The purpose of this article is to answer the question, if what we have in Canada is an Aboriginal health policy patchwork that fails to address inequities, then what would a Healthy Aboriginal Health Policy framework look like? The data collected included federal, provincial and territorial health policies and legislation that contain Aboriginal, First Nation, Inuit and/or Métis-specific provisions available on the internet. Key websites included the Parliamentary Library, federal, provincial and territorial health and Aboriginal websites, as well as the Department of Justice Canada, Statistics Canada and the Aboriginal Canada Portal. The Indian Act gives the Governor in Council the authority to make health regulations. The First Nations and Inuit Health Branch (FNIHB) of Health Canada historically provided health services to First Nations and Inuit, as a matter of policy. FNIHB's policies are few, and apply only to Status Indians and Inuit. Health legislation in 2 territories and 4 provinces contain no provision to clarify their responsibilities. In provinces where provisions exist, they broadly focus on jurisdiction. Few Aboriginal-specific policies and policy frameworks exist. Generally, these apply to some Aboriginal peoples and exclude others. Although some Aboriginal-specific provisions exist in some legislation, and some policies are in place, significant gaps and jurisdictional ambiguities remain. This policy patchwork perpetuates confusion. A national First Nation, Inuit and Métis policy framework is needed to address this issue.

Administrative Subpoenas in Criminal Investigations: A Sketch

DTIC Science & Technology

2006-03-17

administrative subpoenas primarily or exclusive for use in a criminal investigation in cases involving health care fraud, child abuse , Secret Service...no explicit prohibition on disclosure of the existence or specifics of a subpoena issued under this authority. Health Care, Child Abuse , and...investigations. It is an amalgam of three relatively recent statutory provisions — one, the original, dealing with health care fraud; one with child abuse offenses

Impact of service provision platforms on maternal and newborn health in conflict areas and their acceptability in Pakistan: a systematic review.

PubMed

Lassi, Zohra S; Aftab, Wafa; Ariff, Shabina; Kumar, Rohail; Hussain, Imtiaz; Musavi, Nabiha B; Memon, Zahid; Soofi, Sajid B; Bhutta, Zulfiqar A

2015-01-01

Various models and strategies have been implemented over the years in different parts of the world to improve maternal and newborn health (MNH) in conflict affected areas. These strategies are based on specific needs and acceptability of local communities. This paper has undertaken a systematic review of global and local (Pakistan) information from conflict areas on platforms of health service provision in the last 10 years and information on acceptability from local stakeholders on effective models of service delivery; and drafted key recommendations for improving coverage of health services in conflict affected areas. The literature search revealed ten studies that described MNH service delivery platforms. The results from the systematic review showed that with utilisation of community outreach services, the greatest impacts were observed in skilled birth attendance and antenatal consultation rates. Facility level services, on the other hand, showed that labour room services for an internally displaced population (IDP) improved antenatal care coverage, contraceptive prevalence rate and maternal mortality. Consultative meetings and discussions conducted in Quetta and Peshawar (capitals of conflict affected provinces) with relevant stakeholders revealed that no systematic models of MNH service delivery, especially tailored for conflict areas, are available. During conflict, even previously available services and infrastructure suffered due to various barriers specific to times of conflict and unrest. A number of barriers that hinder MNH services were discussed. Suggestions for improving MNH services in conflict areas were also laid down by participants. The review identified some important steps that can be undertaken to mitigate the effects of conflict on MNH services, which include: improve provision and access to infrastructure and equipment; development and training of healthcare providers; and advocacy at different levels for free access to healthcare services and for the introduction of the programme model in existing healthcare system. The obligation is enormous, however, for a sustainable programme, it is important to work closely with both the IDP and host community, and collaborating with the government and non-government organisations.

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…

The role of hydrological and water quality models in the application of the ecosystem services framework for the EU Water Framework Directive

NASA Astrophysics Data System (ADS)

Hallouin, Thibault; Bruen, Michael; Feeley, Hugh B.; Christie, Michael; Bullock, Craig; Kelly, Fiona; Kelly-Quinn, Mary

2017-04-01

The hydrological cycle is intimately linked with environmental processes that are essential for human welfare in many regards including, among others, the provision of safe water from surface and subsurface waterbodies, rain-fed agricultural production, or the provision of aquatic-sourced food. As well as being a receiver of these natural benefits, the human population is also a manager of the water and other natural resources and, as such, can affect their future sustainable provision. With global population growth and climate change, both the dependence of the human population on water resources and the threat they pose to these resources are likely to intensify so that the sustainability of the coupled natural and human system is threatened. In the European Union, the Water Framework Directive is driving policy and encouraging member states to manage their water resources wisely in order to maintain or restore ecological quality. To this end, the ecosystem services framework can be a useful tool to link the requirements in terms of ecological status into more tangible descriptors, that is the ecosystem services. In the ESManage Project, existing environmental system models such as hydrological models and water quality models are used as the basis to quantify the provision of many hydrological and aquatic ecosystem services by constructing indicators for the ecosystem services from the modelled environmental variables. By allowing different management options and policies to be compared, these models can be a valuable source of information for policy makers when they are used for climate and land use scenario analyses. Not all hydrological models developed for flood forecasting are suitable for this application and inappropriate models can lead to questionable conclusions. This paper demonstrates the readily available capabilities of a specially developed catchment hydrological model coupled with a water quality model to quantify a wide range of biophysically quantifiable water-related ecosystem services such as water provision (river flows, groundwater recharge and vegetation transpiration), flood regulation or nutrient and sediment retention. This combination of models will be used to carry out scenario analyses on IPCC climate change scenarios as well as various land use scenarios. Results will be presented for a test catchment in the Republic of Ireland.

Implementation of data security and data privacy provisions will bring sweeping changes to laboratory service providers.

PubMed

Boothe, J F

2000-01-01

The Health Insurance Portability and Accountability Act included substantial changes involving handling of health information by establishing national standards for electronic transactions, data privacy, and data security. The first final rule for electronic transaction standards was published August 17, 2000. The remaining final rules are expected to be published in Winter 2000. Providers, such as clinical laboratories, will have 26 months from the data of publication to comply. The civil monetary fines for noncompliance are substantial. This article will review the key provisions of the data security and data privacy proposed rules. These provisions will touch virtually every aspect of electronic claims submissions, electronic data transactions, and the electronic storage of medical information. The proposed rules will require a coordinated approach by providers to develop the policies and procedures, and the technical and physical infrastructure to protect health information. Moreover, providers will need to identify a privacy officer, to review existing privacy policies to compare the proposed rule with any existing state laws to determine which may be more stringent, and to develop new policies to address the particular requirements of the final rule.

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...

Assessing Iranian adolescent girls' needs for sexual and reproductive health information.

PubMed

Mosavi, Seyed Abbas; Babazadeh, Raheleh; Najmabadi, Khadijeh Mirzaii; Shariati, Mohammad

2014-07-01

To explore the views and experiences of adolescent girls and key adults regarding the necessity of providing sexual and reproductive health (SRH) information and services for adolescent girls in Iran. This was a qualitative study; the data were coded and categorized in content analysis by MAXQDA10 and were gathered through focus groups with adolescent girls and their mothers and semi-structured interviews with school counselors, sociologists, health providers, state and nongovernmental directors of health programs, clergy, and health policy makers in the Iranian cities of Mashhad, Tehran, Shahroud, and Qom. There were six main reasons for the need to provide SRH services for adolescent girls: a lack of adequate knowledge about SRH, easy access to inaccurate information sources, cultural and social changes, increasing risky sexual behaviors among adolescents, religion's emphasis on sex training of children and adolescents, and the existence of cultural taboos. Most participants confirmed the necessity of providing SRH services for adolescent girls, so instead of talking about provision or non-provision of these services, it is important for policy makers to plan and provide SRH services that can be consistent with cultural and religious values for adolescent girls. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

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.

The Cost of Providing Combined Prevention and Treatment Services, Including ART, to Female Sex Workers in Burkina Faso

PubMed Central

Cianci, Fiona; Sweeney, Sedona; Konate, Issouf; Nagot, Nicolas; Low, Andrea; Mayaud, Philippe; Vickerman, Peter

2014-01-01

Background Female Sex workers (FSW) are important in driving HIV transmission in West Africa. The Yerelon clinic in Burkina Faso has provided combined preventative and therapeutic services, including anti-retroviral therapy (ART), for FSWs since 1998, with evidence suggesting it has decreased HIV prevalence and incidence in this group. No data exists on the costs of such a combined prevention and treatment intervention for FSW. This study aims to determine the mean cost of service provision per patient year for FSWs attending the Yerelon clinic, and identifies differences in costs between patient groups. Methods Field-based retrospective cost analyses were undertaken using top-down and bottom-up costing approaches for 2010. Expenditure and service utilisation data was collated from primary sources. Patients were divided into groups according to full-time or occasional sex-work, HIV status and ART duration. Patient specific service use data was extracted. Costs were converted to 2012 US$. Sensitivity analyses considered removal of all research costs, different discount rates and use of different ART treatment regimens and follow-up schedules. Results Using the top-down costing approach, the mean annual cost of service provision for FSWs on or off ART was US$1098 and US$882, respectively. The cost for FSWs on ART reduced by 29%, to US$781, if all research-related costs were removed and national ART monitoring guidelines were followed. The bottom-up patient-level costing showed the cost of the service varied greatly across patient groups (US$505–US$1117), primarily due to large differences in the costs of different ART regimens. HIV-negative women had the lowest annual cost at US$505. Conclusion Whilst FSWs may require specialised services to optimise their care and hence, the public health benefits, our study shows that the cost of ART provision within a combined prevention and treatment intervention setting is comparable to providing ART to other population groups in Africa. PMID:24950185

Timing of Clinical Billing Reimbursement for a Local Health Department.

PubMed

McCullough, J Mac

2016-01-01

A major responsibility of a local health department (LHD) is to assure public health service availability throughout its jurisdiction. Many LHDs face expanded service needs and declining budgets, making billing for services an increasingly important strategy for sustaining public health service provision. Yet, little practice-based data exist to guide practitioners on what to expect financially, especially regarding timing of reimbursement receipt. This study provides results from one LHD on the lag from service delivery to reimbursement receipt. Reimbursement records for all transactions at Maricopa County Department of Public Health immunization clinics from January 2013 through June 2014 were compiled and analyzed to determine the duration between service and reimbursement. Outcomes included daily and cumulative revenues received. Time to reimbursement for Medicaid and private payers was also compared. Reimbursement for immunization services was received a median of 68 days after service. Payments were sometimes taken back by payers through credit transactions that occurred a median of 333 days from service. No differences in time to reimbursement between Medicaid and private payers were found. Billing represents an important financial opportunity for LHDs to continue to sustainably assure population health. Yet, the lag from service provision to reimbursement may complicate budgeting, especially in initial years of new billing activities. Special consideration may be necessary to establish flexibility in the budget-setting processes for services with clinical billing revenues, because funds for services delivered in one budget period may not be received in the same period. LHDs may also benefit from exploring strategies used by other delivery organizations to streamline billing processes.

The costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa.

PubMed

Lince-Deroche, Naomi; Fetters, Tamara; Sinanovic, Edina; Devjee, Jaymala; Moodley, Jack; Blanchard, Kelly

2017-01-01

Despite a liberal abortion law, access to safe abortion services in South Africa is challenging for many women. Medication abortion was introduced in 2013, but its reach remains limited. We aimed to estimate the costs and cost effectiveness of providing first-trimester medication abortion and manual vacuum aspiration (MVA) services to inform planning for first-trimester service provision in South Africa and similar settings. We obtained data on service provision and outcomes from an operations research study where medication abortion was introduced alongside existing MVA services in public hospitals in KwaZulu-Natal province. Clinical data were collected through interviews with first-trimester abortion clients and summaries completed by nurses performing the procedures. In parallel, we performed micro-costing at three of the study hospitals. Using a model built in Excel, we estimated the average cost per medical and surgical procedure and determined the cost per complete abortion performed. Results are presented in 2015 US dollars. A total of 1,129 women were eligible for a first trimester abortion at the three study sites. The majority (886, 78.5%) were eligible to choose their abortion procedure; 94.1% (n = 834) chose medication abortion. The total average cost per medication abortion was $63.91 (52.32-75.51). The total average cost per MVA was higher at $69.60 (52.62-86.57); though the cost ranges for the two procedures overlapped. Given average costs, the cost per complete medication abortion was lower than the cost per complete MVA despite three (0.4%) medication abortion women being hospitalized and two (0.3%) having ongoing pregnancies at study exit. Personnel costs were the largest component of the total average cost of both abortion methods. This analysis supports the scale-up of medication abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication abortion with MVA as a back-up, without increasing costs.

Status of Occupational Health and Safety and Related Challenges in Expanding Economy of Tanzania.

PubMed

Mrema, Ezra J; Ngowi, Aiwerasia V; Mamuya, Simon H D

2015-01-01

Occupational health and safety is related with economic activities undertaken in the country. As the economic activities grow and expand, occupational injuries and diseases are more likely to increase among workers in different sectors of economy such as agriculture, mining, transport, and manufacture. This may result in high occupational health and safety services demand, which might be difficult to meet by developing countries that are prioritizing economic expansion without regard to their impact on occupational health and safety. To describe the status of occupational health and safety in Tanzania and outline the challenges in provision of occupational health services under the state of an expanding economy. Tanzania's economy is growing steadily, with growth being driven by communications, transport, financial intermediation, construction, mining, agriculture, and manufacturing. Along with this growth, hazards emanating from work in all sectors of the economy have increased and varied. The workers exposed to these hazards suffer from illness and injuries and yet they are not provided with adequate occupational health services. Services are scanty and limited to a few enterprises that can afford it. Existing laws and regulations are not comprehensive enough to cover the entire population. Implementation of legislation is weak and does not protect the workers. Most Tanzanians are not covered by the occupational health and safety law and do not access occupational health services. Thus an occupational health and safety services strategy, backed by legislations and provided with the necessary resources (competent experts, financial and technological resources), is a necessity in Tanzania. The existing legal provisions require major modifications to meet international requirements and standards. OHS regulations and legislations need refocusing, revision, and strengthening to cover all working population. Capacities should be improved through training and research to enable enforcement. Finally the facilities and resources should be made available for OHS services to match with the growing economy. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

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...

76 FR 47068 - Approval and Promulgation of Air Quality Implementation Plans; Delaware; Section 110(a)(2...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-04

... concerns involving provisions in existing SIPs and with EPA's statements in other proposals that it would...) Existing provisions related to excess emissions during periods of start-up, shutdown, or malfunction (SSM... (ii) existing provisions related to ``director's variance'' or ``director's discretion'' that purport...

Evaluating the hydrological functioning and the supply of water provisioning services to support the ecosystem-water-food-energy nexus in the Arno river basin

NASA Astrophysics Data System (ADS)

Pacetti, Tommaso; Willaarts, Barbara; Caporali, Enrica; Schroeder Esselbach, Boris

2017-04-01

Water, flowing in a basin, underpins key provisioning ecosystem services like freshwater supply, food and energy production. River basin management largely determines the type of water-related ecosystem services (WES) that are provided and the extent to which trade-offs and synergies might arise. Gaining insights on the ecohydrological behavior of a basin and on the conflicting anthropic pressures on the available water resources allows to identify the most important WES, as well as the existence of WES supply and demand hotspots. This information is crucial for water resources management and, in the context of the European Union, also required to comply with the requirements of the Water Framework Directive (WFD). The purpose of this research is to quantify the provisioning WES in the upstream part of the Arno river basin (Central Italy) and identify WES hotspots and fluxes. Current information on how water is allocated in the Arno basin remains scarce, despite the increasing water demand by some sectors, particularly irrigation, and a number of emerging conflicts among users. It is expected that research outputs can support the improvement of the existing management framework, moving from the classical DPSIR (Driving forces, Pressure, State, Impact e Response) approach, where impacts must be reduced or mitigated, to a more proactive framework to support the sustainability of the Arno basin and meet the different policy goals. The eco-hydrological model SWAT (Soil Water Assessment Tool) is applied to spatially quantify the provision of WES. The preliminary results of this research indicate that the highest amount of water yield, i.e. net amount of water that contributes to streamflow and represents the main blue water fund, originates in the northern part of the basin, characterized by forest areas. In contrast, the southern part of the basin, which is mainly agriculturally used, gives a minor contribution to the overall water yield, in direct proportion to the precipitation. In order to highlight the role of green water in irrigated land, potential green water funds are also estimated on the basis of the available soil water content simulated by SWAT. The water provisioning for the different sectorial uses, which represent the actual flow of the ecosystem services, have been estimated for every sector at the subbasin or municipality scale: agriculture is the most water intensive sector followed by industrial, domestic and hydropower water use. Comparing the water withdrawals and the water yield, WES supply (mainly located in the northern part of the basin) and demand hotspots (mainly in the central and southern part of the basin) are identified. This analysis framework highlights WES fluxes that connect supply and demand areas and supports the understanding of the tradeoffs between different water users, aiming at the improvement of the WES provision within the water resources system.

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.

Pharmacies as providers of expanded health services for people who inject drugs: a review of laws, policies, and barriers in six countries.

PubMed

Hammett, Theodore M; Phan, Son; Gaggin, Julia; Case, Patricia; Zaller, Nicholas; Lutnick, Alexandra; Kral, Alex H; Fedorova, Ekaterina V; Heimer, Robert; Small, Will; Pollini, Robin; Beletsky, Leo; Latkin, Carl; Des Jarlais, Don C

2014-06-17

People who inject drugs (PWID) are underserved by health providers but pharmacies may be their most accessible care settings. Studies in the U.S., Russia, Vietnam, China, Canada and Mexico employed a three-level (macro-, meso-, and micro-) model to assess feasibility of expanded pharmacy services for PWID. Studies employed qualitative and quantitative interviews, review of legal and policy documents, and information on the knowledge, attitudes, and practices of key stakeholders. Studies produced a mixed assessment of feasibility. Provision of information and referrals by pharmacies is permissible in all study sites and sale and safe disposal of needles/syringes by pharmacies is legal in almost all sites, although needle/syringe sales face challenges related to attitudes and practices of pharmacists, police, and other actors. Pharmacy provision of HIV testing, hepatitis vaccination, opioid substitution treatment, provision of naloxone for drug overdose, and abscess treatment, face more serious legal and policy barriers. Challenges to expanded services for drug users in pharmacies exist at all three levels, especially the macro-level characterized by legal barriers and persistent stigmatization of PWID. Where deficiencies in laws, policies, and community attitudes block implementation, stakeholders should advocate for needed legal and policy changes and work to address community stigma and resistance. Laws and policies are only as good as their implementation, so attention is also needed to meso- and micro- levels. Policies, attitudes, and practices of police departments and pharmacy chains as well as knowledge, attitudes, and practices of individual PWID, individual pharmacies, and police officers should support rather than undermine positive laws and expanded services. Despite the challenges, pharmacies remain potentially important venues for delivering health services to PWID.

Pharmacies as providers of expanded health services for people who inject drugs: a review of laws, policies, and barriers in six countries

PubMed Central

2014-01-01

Background People who inject drugs (PWID) are underserved by health providers but pharmacies may be their most accessible care settings. Methods Studies in the U.S., Russia, Vietnam, China, Canada and Mexico employed a three-level (macro-, meso-, and micro-) model to assess feasibility of expanded pharmacy services for PWID. Studies employed qualitative and quantitative interviews, review of legal and policy documents, and information on the knowledge, attitudes, and practices of key stakeholders. Results Studies produced a mixed assessment of feasibility. Provision of information and referrals by pharmacies is permissible in all study sites and sale and safe disposal of needles/syringes by pharmacies is legal in almost all sites, although needle/syringe sales face challenges related to attitudes and practices of pharmacists, police, and other actors. Pharmacy provision of HIV testing, hepatitis vaccination, opioid substitution treatment, provision of naloxone for drug overdose, and abscess treatment, face more serious legal and policy barriers. Discussion Challenges to expanded services for drug users in pharmacies exist at all three levels, especially the macro-level characterized by legal barriers and persistent stigmatization of PWID. Where deficiencies in laws, policies, and community attitudes block implementation, stakeholders should advocate for needed legal and policy changes and work to address community stigma and resistance. Laws and policies are only as good as their implementation, so attention is also needed to meso- and micro- levels. Policies, attitudes, and practices of police departments and pharmacy chains as well as knowledge, attitudes, and practices of individual PWID, individual pharmacies, and police officers should support rather than undermine positive laws and expanded services. Despite the challenges, pharmacies remain potentially important venues for delivering health services to PWID. PMID:24938376

Evaluating the usability of a single UK community acquired brain injury (ABI) rehabilitation service website: implications for research methodology and website design.

PubMed

Newby, Gavin; Groom, Christina

2010-04-01

Information provision is an important resource for those living with acquired brain injury (ABI) and their families. Web-based health information services are now common additions to health service provision. Ideally, they should be easy to use and provide useful, relevant and accurate information. ABI injuries do not affect individuals in the same way, and survivors can have a wide range of abilities and impairments. Therefore, any informational resource intended for this group should take account of their needs and help to compensate for their limitations. This pilot study recruited a group of individuals with ABI (of a median Extended Glasgow Outcome Scale rating of "lower moderate disability") who were clients of a UK National Health Service rehabilitation service and asked them to assess a specialised website provided by that service and hosted by their employing Primary Care Trust organisation. Participants completed a practical task and then gave their opinions on various aspects of website design, and content. They were also asked to suggest improvements and recommend additions. Overall the results were favourable. However, improvements in the legibility, layout and writing style were identified. There were also requests to add more information on the existing topics and add additional topics. The discussion also evaluates the utility of the methodology and the implications of the results for others considering constructing their own website.

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.

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.

[Evaluation of ecosystem provisioning service and its economic value].

PubMed

Wu, Nan; Gao, Ji-Xi; Sudebilige; Ricketts, Taylor H; Olwero, Nasser; Luo, Zun-Lan

2010-02-01

Aiming at the fact that the current approaches of evaluating the efficacy of ecosystem provisioning service were lack of spatial information and did not take the accessibility of products into account, this paper established an evaluation model to simulate the spatial distribution of ecosystem provisioning service and its economic value, based on ArcGIS 9. 2 and taking the supply and demand factors of ecosystem products into account. The provision of timber product in Laojunshan in 2000 was analyzed with the model. In 2000, the total physical quantity of the timber' s provisioning service in Laojunshan was 11.12 x 10(4) m3 x a(-1), occupying 3.2% of the total increment of timber stock volume. The total provisioning service value of timber was 6669.27 x 10(4) yuan, among which, coniferous forest contributed most (90.41%). Due to the denser distribution of populations and roads in the eastern area of Laojunshan, some parts of the area being located outside of conservancy district, and forests being in scattered distribution, the spatial distribution pattern of the physical quantity of timber's provisioning service was higher in the eastern than in the western area.

Palestinian mothers' perceptions of child mental health problems and services

PubMed Central

THABET, ABDEL AZIZ; EL GAMMAL, HOSSAM; VOSTANIS, PANOS

2006-01-01

The aim of this study was to explore Palestinian mothers' perceptions of child mental health problems and their understanding of their causes; to determine Palestinian mothers' awareness of existing services and sources of help and support; to identify professionals in the community whom Palestinian mothers would consult if their child had mental health problems; and to establish their views on ways of increasing awareness of child mental health issues and services. Checklists exploring the above issues were completed by 249 Palestinian mothers living in refugee camps in the Gaza Strip. Palestinian mothers equally perceived emotional, behavioural and psychotic symptoms as suggestive of mental ill health in childhood. Mothers perceived multiple causes of child mental health problems, including family problems, parental psychiatric illness and social adversity. A substantial proportion (42.6%) had knowledge of local child mental health care services. Overall, mothers preferred Western over traditional types of treatment, and were keen to increase mental health awareness within their society. Despite a different cultural tradition, Palestinian mothers appear open to a range of services and interventions for child mental health problems. As in other non-Western societies, child mental health service provision should be integrated with existing primary health care, schools, and community structures. PMID:16946953

Community-based post-stroke service provision and challenges: a national survey of managers and inter-disciplinary healthcare staff in Ireland.

PubMed

Hickey, Anne; Horgan, Frances; O'Neill, Desmond; McGee, Hannah

2012-05-06

The extent of stroke-related disability typically becomes most apparent after patient discharge to the community. As part of the Irish National Audit of Stroke Care (INASC), a national survey of community-based allied health professionals and public health nurses was conducted. The aim was to document the challenges to service availability for patients with stroke in the community and to identify priorities for service improvement. The study was a cross-sectional tailored interview survey with key managerial and service delivery staff. As comprehensive listings of community-based health professionals involved in stroke care were not available, a cascade approach to information gathering was adopted. Representative regional managers for services incorporating stroke care (N = 7) and disciplinary allied health professional and public health nurse managers (N = 25) were interviewed (94% response rate). Results indicated a lack of formal, structured community-based services for stroke, with no designated clinical posts for stroke care across disciplines nationally. There was significant regional variation in availability of allied health professionals. Considerable inequity was identified in patient access to stroke services, with greater access, where available, for older patients (≥ 65 years). The absence of a stroke strategy and stroke prevalence statistics were identified as significant impediments to service planning, alongside organisational barriers limiting the recruitment of additional allied health professional staff, and lack of sharing of discipline-specific information on patients. This study highlighted major gaps in the provision of inter-disciplinary team community-based services for people with stroke in one country. Where services existed, they were generic in nature, rarely inter-disciplinary in function and deficient in input from salient disciplines. Challenges to optimal care included the need for strategic planning; increased funding of healthcare staff; increased team resources and teamwork; and removal of service provision barriers based on age. There were notably many challenges beyond funding. Similar evaluations in other healthcare systems would serve to provide comparative lessons to serve to tackle this underserved aspect of care for patients with stroke and their families.

75 FR 26832 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-12

..., Inc. to Clarify, Eliminate, Revise, or Delete Certain Out-Dated or Obsolete Rules May 6, 2010... its rules by clarifying existing provisions, eliminating superfluous provisions, and revising or... rules in order to clarify existing provisions, eliminate superfluous provisions, delete certain out...

Multihazard risk analysis and disaster planning for emergency services as a basis for efficient provision in the case of natural hazards - case study municipality of Au, Austria

NASA Astrophysics Data System (ADS)

Maltzkait, Anika; Pfurtscheller, Clemens

2014-05-01

Multihazard risk analysis and disaster planning for emergency services as a basis for efficient provision in the case of natural hazards - case study municipality of Au, Austria A. Maltzkait (1) & C. Pfurtscheller (1) (1) Institute for Interdisciplinary Mountain Research (IGF), Austrian Academy of Sciences, Innsbruck, Austria The extreme flood events of 2002, 2005 and 2013 in Austria underlined the importance of local emergency services being able to withstand and reduce the adverse impacts of natural hazards. Although for legal reasons municipal emergency and crisis management plans exist in Austria, they mostly do not cover risk analyses of natural hazards - a sound, comparable assessment to identify and evaluate risks. Moreover, total losses and operational emergencies triggered by natural hazards have increased in recent decades. Given sparse public funds, objective budget decisions are needed to ensure the efficient provision of operating resources, like personnel, vehicles and equipment in the case of natural hazards. We present a case study of the municipality of Au, Austria, which was hardly affected during the 2005 floods. Our approach is primarily based on a qualitative risk analysis, combining existing hazard plans, GIS data, field mapping and data on operational efforts of the fire departments. The risk analysis includes a map of phenomena discussed in a workshop with local experts and a list of risks as well as a risk matrix prepared at that workshop. On the basis for the exact requirements for technical and non-technical mitigation measures for each natural hazard risk were analysed in close collaboration with members of the municipal operation control and members of the local emergency services (fire brigade, Red Cross). The measures includes warning, evacuation and, technical interventions with heavy equipment and personnel. These results are used, first, to improve the municipal emergency and crisis management plan by providing a risk map, and a list of risks and, second, to check if the local emergency forces can cope with the different risk scenarios using locally available resources. The emergency response plans will identify possible resource deficiencies in personnel, vehicles and equipment. As qualitative methods and data are used, uncertainties in the study emerged in finding definitions for safety targets, in the construction of the different risk scenarios, in the inherent uncertainty beyond the probability of occurrence and the intensity of natural hazards, also in the case of the expectable losses. Finally, we used available studies and expert interviews to develop objective rules for investment decisions for the fire departments and the Red Cross to present an empirically sound basis for the efficient provision of intervention in the case of natural hazards for the municipality of Au. Again, the regulations for objective provision were developed in close collaboration with the emergency services.

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.

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.

Role of the private sector in the provision of immunization services in low- and middle-income countries.

PubMed

Levin, Ann; Kaddar, Miloud

2011-07-01

The authors conducted a literature review on the role of the private sector in low- and middle-income countries. The review indicated that relatively few studies have researched the role of the private sector in immunization service delivery in these countries. The studies suggest that the private sector is playing different roles and functions according to economic development levels, the governance structure and the general presence of the private sector in the health sector. In some countries, generally low-income countries, the private for-profit sector is contributing to immunization service delivery and helping to improve access to traditional EPI vaccines. In other countries, particularly middle-income countries, the private for-profit sector often acts to facilitate early adoption of new vaccines and technologies before introduction and generalization by the public sector. The not-for-profit sector plays an important role in extending access to traditional EPI vaccines, particularly in low-income countries. Not-for-profit facilities are situated in rural as well as urban areas and are more likely to be coordinated with public services than the private for-profit sector. Although numerous studies on non-governmental organizations (NGOs) suggest that the extent of NGO provision of immunization services in low- and middle-income countries is substantial, the contribution of this sector is poorly documented, leading to a lack of recognition of its role at national and global levels. Studies on quality of immunization service provision at private health facilities suggest that it is sometimes inadequate and needs to be monitored. Although some articles on public-private collaboration exist, little was found on the extent to which governments are effectively interacting with and regulating the private sector. The review revealed many geographical and thematic gaps in the literature on the role and regulation of the private sector in the delivery of immunization services in low- and middle-income countries.

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.

The provision of assistive technology products and services for people with dementia in the United Kingdom.

PubMed

Gibson, Grant; Newton, Lisa; Pritchard, Gary; Finch, Tracy; Brittain, Katie; Robinson, Louise

2016-07-01

In this review we explore the provision of assistive technology products and services currently available for people with dementia within the United Kingdom. A scoping review of assistive technology products and services currently available highlighted 171 products or product types and 331 services. In addition, we assimilated data on the amount and quality of information provided by assistive technology services alongside assistive technology costs. We identify a range of products available across three areas: assistive technology used 'by', 'with' and 'on' people with dementia. Assistive technology provision is dominated by 'telecare' provided by local authorities, with services being subject to major variations in pricing and information provision; few currently used available resources for assistive technology in dementia. We argue that greater attention should be paid to information provision about assistive technology services across an increasingly mixed economy of dementia care providers, including primary care, local authorities, private companies and local/national assistive technology resources. © The Author(s) 2014.

[The Marketing of Healthcare Services in ENT-Clinics].

PubMed

Teschner, M; Lenarz, T

2016-07-01

The provision of healthcare services in Germany is based on fundamental principles of solidarity and is highly regulated. The question arises which conditions exist for marketing for healthcare services in ENT-clinics in Germany. The marketing options will be elicited using environmentally analytical considerations. The objectives can be achieved using measures derived from external instruments (service policy, pricing policy, distribution policy or communications policy) or from an internal instrument (human resources policy). The policy environment is particularly influenced by the regulatory framework, which particularly restricts the scope for both the pricing and communications policies. All measures must, however, reflect ethical frameworks, which are regarded as the fundamental premise underlying healthcare services and may be at odds with economic factors. Scope for flexibility in pricing exists only within the secondary healthcare market, and even there only to a limited extent. The significance of price in the marketing of healthcare services is thus very low. If marketing activities are to succeed, a market analysis must be carried out exploring the relevant factors for each individual provider. However, the essential precondition for the marketing of healthcare services is trust. The marketing of healthcare services differs from that of business management-oriented enterprises in other branches of economy. In the future the importance of marketing activities will increase. © Georg Thieme Verlag KG Stuttgart · New York.

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...

Developing stroke-specific vocational rehabilitation: a soft systems analysis of current service provision

PubMed Central

Radford, Kathryn; Grant, Mary; Terry, Jane

2014-01-01

Purpose: This study aimed to clarify the existing service provision of stroke-specific vocational rehabilitation (VR) in one English county, in order to facilitate future service development. Method: Using soft systems methodology, services in Health, Social Care, Department of Work and Pensions, the voluntary and private sectors, which were identified as supporting return to work after stroke, were mapped using a mixed-methodology approach. Results: A lack of a sanctioned VR pathway meant access to support relied on brokered provision and tacit knowledge. The timing of an intervention was complex and there was a substantial degree of unmet need for mild stroke patients. VR was seen as “non-essential” due to competing commissioning priorities. Service providers from all sectors lacked training and cross-sector partnerships were tenuous and provider roles unclear. Conclusions: Stroke-specific VR should be delivered by an integrated, cross-sector multi-disciplinary team and integrated commissioning between health and other sectors is necessary. Although early intervention is important, support later on in the recovery process is also necessary. Service providers need adequate training to meet the needs of stroke survivors wishing to return to work and better awareness of best practice guidelines. Business cases which demonstrate the efficacy and cost-effectiveness of VR are vital. Implications for Rehabilitation The timeliness of a vocational rehabilitation (VR) intervention is complex; services need to be responsive to the changing needs of the stroke survivor throughout their recovery process and have better mechanisms to ensure re-entry into the stroke pathway is possible. Return to work is a recognised health outcome; health services need to develop better mechanisms for interagency/cross sector working and liaison with employers and not assume that VR is beyond their remit. Therapists and non-health service providers should receive sufficient training to meet the needs of stroke survivors wishing to return to work. Rehabilitation teams must decide how to implement national guidance within existing resources and what training is needed to deploy SSVR. The lack of a sanctioned pathway results in disorganised and patchy provision of VR for stroke survivors; mild stroke patients can fall through the net and receive little or no support. The journey back to work commences at the point of stroke. Mechanisms for identifying acute stroke survivors who were working at onset and for assessing the impact of the stroke on their work need to be put in place. The entire MDT has a role to play. In the absence of a VR specialist, even patients without obvious disability should be referred for ongoing rehabilitation with detailed work assessment and signposted to employment specialists e.g. disability employment advisors EARLY after stroke. Health-based VR interventions can influence work return and job retention. However, therapists must routinely measure work outcomes to inform their business case and be encouraged to demonstrate these outcomes to local commissioners. Commissioners should consider emerging evidence of early VR interventions on reduced length of stay, health and social care resource use and the wider health benefits of maintaining employment. PMID:23692389

Developing stroke-specific vocational rehabilitation: a soft systems analysis of current service provision.

PubMed

Sinclair, Emma; Radford, Kathryn; Grant, Mary; Terry, Jane

2014-01-01

This study aimed to clarify the existing service provision of stroke-specific vocational rehabilitation (VR) in one English county, in order to facilitate future service development. Using soft systems methodology, services in Health, Social Care, Department of Work and Pensions, the voluntary and private sectors, which were identified as supporting return to work after stroke, were mapped using a mixed-methodology approach. A lack of a sanctioned VR pathway meant access to support relied on brokered provision and tacit knowledge. The timing of an intervention was complex and there was a substantial degree of unmet need for mild stroke patients. VR was seen as "non-essential" due to competing commissioning priorities. Service providers from all sectors lacked training and cross-sector partnerships were tenuous and provider roles unclear. Stroke-specific VR should be delivered by an integrated, cross-sector multi-disciplinary team and integrated commissioning between health and other sectors is necessary. Although early intervention is important, support later on in the recovery process is also necessary. Service providers need adequate training to meet the needs of stroke survivors wishing to return to work and better awareness of best practice guidelines. Business cases which demonstrate the efficacy and cost-effectiveness of VR are vital. Implications for Rehabilitation The timeliness of a vocational rehabilitation (VR) intervention is complex; services need to be responsive to the changing needs of the stroke survivor throughout their recovery process and have better mechanisms to ensure re-entry into the stroke pathway is possible. Return to work is a recognised health outcome; health services need to develop better mechanisms for interagency/cross sector working and liaison with employers and not assume that VR is beyond their remit. Therapists and non-health service providers should receive sufficient training to meet the needs of stroke survivors wishing to return to work. Rehabilitation teams must decide how to implement national guidance within existing resources and what training is needed to deploy SSVR. The lack of a sanctioned pathway results in disorganised and patchy provision of VR for stroke survivors; mild stroke patients can fall through the net and receive little or no support. The journey back to work commences at the point of stroke. Mechanisms for identifying acute stroke survivors who were working at onset and for assessing the impact of the stroke on their work need to be put in place. The entire MDT has a role to play. In the absence of a VR specialist, even patients without obvious disability should be referred for ongoing rehabilitation with detailed work assessment and signposted to employment specialists e.g. disability employment advisors EARLY after stroke. Health-based VR interventions can influence work return and job retention. However, therapists must routinely measure work outcomes to inform their business case and be encouraged to demonstrate these outcomes to local commissioners. Commissioners should consider emerging evidence of early VR interventions on reduced length of stay, health and social care resource use and the wider health benefits of maintaining employment.

Provision of integrated psychosocial services for cancer survivors post-treatment

PubMed Central

Recklitis, Christopher J; Syrjala, Karen L

2018-01-01

Meeting the psychosocial needs of patients with cancer has been recognised as a priority within oncology care for several decades. Many approaches that address these needs have been developed and described; however, until recently much of this work had focused on patients during treatment and end-of-life care. With continued improvement in therapies, the population of cancer survivors who can expect to live for 5 or more years after cancer diagnosis has increased dramatically, as have associated concerns about how to meet their medical, psychosocial, and health behaviour needs after treatment. Guidelines and models for general survivorship care routinely address psychosocial needs, and similar guidelines for psychosocial care of patients with cancer are being extended to address the needs of survivors. In this Series paper, we summarise the existing recommendations for the provision of routine psychosocial care to survivors, as well as the challenges present in providing this care. We make specific recommendations for the integration of psychosocial services into survivorship care. PMID:28049576

Equity in access to health care provision under the medicare security for small scale entrepreneurs in Dar es Salaam.

PubMed

Urassa, J A E

2012-03-01

The main objective of this study was to assess equity in access to health care provision under the Medicare Security for Small Scale Entrepreneurs (SSE). Methodological triangulation was used to an exploratory and randomized cross- sectional study in order to supplement information on the topic under investigation. Questionnaires were administered to 281 respondents and 6 Focus Group Discussions (FGDs) were held with males and females. Documentary review was also used. For quantitative aspect of the study, significant associations were measured using confidence intervals (95% CI) testing. Qualitative data were analyzed with assistance of Open code software. The results show that inequalities in access to health care services were found in respect to affordability of medical care costs, distance from home to health facilities, availability of drugs as well as medical equipments and supplies. As the result of existing inequalities some of clients were not satisfied with the provided health services. The study concludes by drawing policy and research implications of the findings.

Can the real opportunity cost stand up: displaced services, the straw man outside the room.

PubMed

Eckermann, Simon; Pekarsky, Brita

2014-04-01

In current literature, displaced services have been suggested to provide a basis for determining a threshold value for the effects of a new technology as part of a reimbursement process when budgets are fixed. We critically examine the conditions under which displaced services would represent an economically meaningful threshold value. We first show that if we assume that the least cost-effective services are displaced to finance a new technology, then the incremental cost-effectiveness ratio (ICER) of the displaced services (d) only coincides with that related to the opportunity cost of adopting that new technology, the ICER of the most cost-effective service in expansion (n), under highly restrictive conditions-namely, complete allocative efficiency in existing provision of health care interventions. More generally, reimbursement of new technology with a fixed budget comprises two actions; adoption and financing through displacement and the effect of reimbursement is the net effect of these two actions. In order for the reimbursement process to be a pathway to allocative efficiency within a fixed budget, the net effect of the strategy of reimbursement is compared with the most cost-effective alternative strategy for reimbursement: optimal reallocation, the health gain maximizing expansion of existing services financed by the health loss minimizing contraction. The shadow price of the health effects of a new technology, βc = (1/n + 1/d - 1/m)(-1), accounts for both imperfect displacement (the ICER of the displaced service, d < m, the ICER of the least cost-effective of the existing services in contraction) and the allocative inefficiency (n < m) characteristic of health systems.

Systematic review of interventions to increase the provision of care for chronic disease risk behaviours in mental health settings: review protocol.

PubMed

Fehily, Caitlin; Bartlem, Kate; Wiggers, John; Wolfenden, Luke; Regan, Timothy; Dray, Julia; Bailey, Jacqueline; Bowman, Jenny

2018-04-30

People with a mental illness experience a higher morbidity and mortality from chronic diseases relative to the general population. A higher prevalence of risk behaviours, including tobacco smoking, poor nutrition, harmful alcohol consumption and physical inactivity, is a substantial contributor to this health inequity. Clinical practice guidelines recommend that mental health services routinely provide care to their clients to address these risk behaviours. Such care may include the following elements: ask, assess, advise, assist and arrange (the '5As'), which has been demonstrated to be effective in reducing risk behaviours. Despite this potential, the provision of such care is reported to be low internationally and in Australia, and there is a need to identify effective strategies to increase care provision. The proposed review will examine the effectiveness of interventions which aimed to increase care provision (i.e. increase the proportion of clients receiving or clinicians providing the 5As) for the chronic disease risk behaviours of clients within the context of mental health service delivery. Eligible studies will be any quantitative study designs with a comparison group and which report on the effectiveness of an intervention strategy (including delivery arrangements, financial arrangements, governance arrangements and implementation strategies) to increase care provision specifically for chronic disease risk behaviours (tobacco smoking, poor nutrition, harmful alcohol consumption and physical inactivity). Screening for studies will be conducted across seven electronic databases: PsycINFO, MEDLINE, Excerpta Medica database (EMBASE), Psychology and Behavioural Sciences Collection, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Two authors will independently screen studies for eligibility and extract data from included studies. Where studies are sufficiently homogenous, meta-analysis will be performed. Where considerable heterogeneity exists (I 2  ≥ 75), narrative synthesis will be used. This review will be the first to synthesise evidence for the effectiveness of intervention approaches to facilitate care provision for chronic disease risk behaviours in the context of mental health service delivery. The results have the potential to inform the development of evidenced-based approaches to address the health inequities experienced by this population group. PROSPERO CRD42017074360 .

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...

40 CFR 790.24 - Criteria for determining whether a consensus exists concerning the provisions of a draft consent...

Code of Federal Regulations, 2010 CFR

2010-07-01

... consensus exists concerning the provisions of a draft consent agreement. 790.24 Section 790.24 Protection of... Rules § 790.24 Criteria for determining whether a consensus exists concerning the provisions of a draft... included in the consent agreement. (2) A draft consent agreement is considered inadequate by other...

Law, policy and the use of non-physicians in family planning service delivery.

PubMed

Paxman, J M

1979-04-01

A great deal of attention is being devoted to the use of nonphysicians to provide such fertility control services as contraception, sterilization, and abortion. Legal obstacles exist, however, which must be overcome before the role of nonphysicians can be expanded. Such obstacles include medical practice statutes, nursing and midwifery legislation, and laws and regulations directly related to such fertility control measures as the provision of contraceptions and the performance of sterilizations. On the other hand, the following 3 main approaches have been used to permit increased participation of nonphysicians: delegation of tasks by physicians, liberal interpretation of existing laws, and authorization. Thus, the important elements in expanding the roles of nonphysicians are 1) authorization; 2) training; 3) qualification; 4) supervision; and 5) opportunities for referrals to physicians. The ultimate role of paramedicals will depend upon the continued simplification of technology, the results of research on the quality of care which they can provide, the attitudes of the medical profession, and the elimination of the legal ambiguities and obstacles which exist.

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

Alcohol service provision for older people in an area experiencing high alcohol use and health inequalities.

PubMed

McCabe, Karen E; Ling, Jonathan; Wilson, Graeme B; Crosland, Ann; Kaner, Eileen F S; Haighton, Catherine A

2016-03-01

UK society is ageing. Older people who drink alcohol, drink more than those from previous generations, drink more frequently than other age groups and are more likely to drink at home and alone. Alcohol problems in later life however are often under-detected and under-reported meaning older people experiencing alcohol problems have high levels of unmet need. This study sought to identify existing services within South of Tyne, North East England to capture the extent of service provision for older drinkers and identify any gaps. The Age UK definition of 'older people' (aged 50 and over) was used. Services were contacted by telephone, managers or their deputy took part in semi-structured interviews. Forty six service providers were identified. Only one provided a specific intervention for older drinkers. Others typically provided services for age 18+. Among providers, there was no definitive definition of an older person. Data collection procedures within many organisations did not enable them to confirm whether older people were accessing services. Where alcohol was used alongside other drugs, alcohol use could remain unrecorded. To enable alcohol services to meet the needs of older people, greater understanding is needed of the patterns of drinking in later life, the experiences of older people, the scale and scope of the issue and guidance as to the most appropriate action to take. An awareness of the issues related to alcohol use in later life also needs to be integrated into commissioning of other services that impact upon older people. © Royal Society for Public Health 2015.

Metropolitian area network services comprised of virtual local area networks running over hybrid fiber-coax and asynchronous transfer mode technologies

NASA Astrophysics Data System (ADS)

Biedron, William S.

1995-11-01

Since 1990 there has been a rapid increase in the demand for communication services, especially local and wide area network (LAN/WAN) oriented services. With the introduction of the DFB laser transmitter, hybrid-fiber-coax (HFC) cable plant designs, ATM transport technologies and rf modems, new LAN/WAN services can now be defined and marketed to residential and business customers over existing cable TV systems. The term metropolitan area network (MAN) can be used to describe this overall network. This paper discusses the technical components needed to provision these services as well as provides some perspectives on integration issues. Architecture at the headend and in the backbone is discussed, as well as specific service definitions and the technology issues associated with each. The TCP/IP protocol is suggested as a primary protocol to be used throughout the MAN.

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...

A Review of Healthcare Service and Education Provision of Autism Spectrum Condition in Mainland China

ERIC Educational Resources Information Center

Sun, Xiang; Allison, Carrie; Auyeung, Bonnie; Baron-Cohen, Simon; Brayne, Carol

2013-01-01

Little is known about the current situation regarding Autism Spectrum Conditions in mainland China. Electronic databases and bibliographies were searched to identify literature on service provision for ASC in both English and Chinese databases. 14 studies and 6 reports were reviewed. The findings of identified papers on service provision were…

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.

Administrative Subpoenas and National Security Letters in Criminal and Intelligence Investigations: A Sketch

DTIC Science & Technology

2005-04-15

exclusive for use in a criminal investigation in cases involving health care fraud, child abuse , Secret Service protection, controlled substance cases...explicit prohibition on disclosure of the existence or specifics of a subpoena issued under this authority. Health Care, Child Abuse & Presidential...investigations. It is an amalgam is three relatively recent statutory provisions — one, the original, dealing with health care fraud; one with child abuse offenses

Multiple ecosystem services landscape index: a tool for multifunctional landscapes conservation.

PubMed

Rodríguez-Loinaz, Gloria; Alday, Josu G; Onaindia, Miren

2015-01-01

The contribution of ecosystems to human well-being has been widely recognised. Taking into account existing trade-offs between ecosystem services (ES) at the farm scale and the dependence of multiple ES on processes that take place at the landscape scale, long-term preservation of multifunctional landscapes must be a priority. Studies carried out from such perspective, and those that develop appropriate indicators, could provide useful tools for integrating ES in landscape planning. In this study we propose a new integrative environmental indicator based on the ES provided by the landscape and named "multiple ecosystem services landscape index" (MESLI). Because synergies and trade-offs between ES are produced at regional or local levels, being different from those perceived at larger scales, MESLI was developed at municipality level. Furthermore, in order to identify main drivers of change in ES provision at the landscape scale an analysis of the relationship between the environmental and the socioeconomic characteristics of the municipalities was carried out. The study was located in the Basque Country and the results demonstrated that the MESLI index is a good tool to measure landscape multifunctionality at local scales. It is effective evaluating landscapes, distinguishing between municipalities based on ES provision, and identifying the drivers of change and their effects. This information about ES provisioning at the local level is usually lacking; therefore, MESLI would be very useful for policy-makers and land managers because it provides relevant information to local scale decision-making. Copyright © 2014 Elsevier Ltd. All rights reserved.

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.

Impacts of market and organizational characteristics on hospital efficiency and uncompensated care.

PubMed

Hsieh, Hui-Min; Clement, Dolores G; Bazzoli, Gloria J

2010-01-01

Hospitals have confronted a difficult financial environment given many factors, including expansion of managed care, changes in public policy, growing market competition for certain services, and growth in the number of uninsured. Policy makers have expressed concern that hospitals may forgo providing care to the indigent as a means to reduce costs and become more efficient when faced with financial pressures. This article examined the effects of environmental pressures on two dimensions of hospital performance: hospital efficiency and uncompensated care provision. Longitudinal data for the Commonwealth of Virginia from 1998 to 2004 were analyzed. Data Envelopment Analysis and bivariate probit were used to examine the factors associated with efficiency and uncompensated care. The results indicated that a positive relationship between hospital efficiency and uncompensated care provision exists. That is, hospitals that are categorized as efficient are likely to provide more uncompensated care. We also found that hospitals tended to provide more uncompensated care when increased demand for these services occurred in a market. Increases in Medicare or Medicaid patient share reduced the provision of uncompensated care. In relation to hospital efficiency, the results indicated that HMO penetration and Medicaid patient share reduced hospital efficiency. This study found that efficient hospitals tend to provide more uncompensated care over time. The findings also suggest that hospitals alter their efficiency and provision of uncompensated care in response to a number of environmental pressures, but it may depend on the type of pressures or uncertainties encountered.

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...

Soil Functional Zone Management: A Vehicle for Enhancing Production and Soil Ecosystem Services in Row-Crop Agroecosystems.

PubMed

Williams, Alwyn; Kane, Daniel A; Ewing, Patrick M; Atwood, Lesley W; Jilling, Andrea; Li, Meng; Lou, Yi; Davis, Adam S; Grandy, A Stuart; Huerd, Sheri C; Hunter, Mitchell C; Koide, Roger T; Mortensen, David A; Smith, Richard G; Snapp, Sieglinde S; Spokas, Kurt A; Yannarell, Anthony C; Jordan, Nicholas R

2016-01-01

There is increasing global demand for food, bioenergy feedstocks and a wide variety of bio-based products. In response, agriculture has advanced production, but is increasingly depleting soil regulating and supporting ecosystem services. New production systems have emerged, such as no-tillage, that can enhance soil services but may limit yields. Moving forward, agricultural systems must reduce trade-offs between production and soil services. Soil functional zone management (SFZM) is a novel strategy for developing sustainable production systems that attempts to integrate the benefits of conventional, intensive agriculture, and no-tillage. SFZM creates distinct functional zones within crop row and inter-row spaces. By incorporating decimeter-scale spatial and temporal heterogeneity, SFZM attempts to foster greater soil biodiversity and integrate complementary soil processes at the sub-field level. Such integration maximizes soil services by creating zones of 'active turnover', optimized for crop growth and yield (provisioning services); and adjacent zones of 'soil building', that promote soil structure development, carbon storage, and moisture regulation (regulating and supporting services). These zones allow SFZM to secure existing agricultural productivity while avoiding or minimizing trade-offs with soil ecosystem services. Moreover, the specific properties of SFZM may enable sustainable increases in provisioning services via temporal intensification (expanding the portion of the year during which harvestable crops are grown). We present a conceptual model of 'virtuous cycles', illustrating how increases in crop yields within SFZM systems could create self-reinforcing feedback processes with desirable effects, including mitigation of trade-offs between yield maximization and soil ecosystem services. Through the creation of functionally distinct but interacting zones, SFZM may provide a vehicle for optimizing the delivery of multiple goods and services in agricultural systems, allowing sustainable temporal intensification while protecting and enhancing soil functioning.

Soil Functional Zone Management: A Vehicle for Enhancing Production and Soil Ecosystem Services in Row-Crop Agroecosystems

PubMed Central

Williams, Alwyn; Kane, Daniel A.; Ewing, Patrick M.; Atwood, Lesley W.; Jilling, Andrea; Li, Meng; Lou, Yi; Davis, Adam S.; Grandy, A. Stuart; Huerd, Sheri C.; Hunter, Mitchell C.; Koide, Roger T.; Mortensen, David A.; Smith, Richard G.; Snapp, Sieglinde S.; Spokas, Kurt A.; Yannarell, Anthony C.; Jordan, Nicholas R.

2016-01-01

There is increasing global demand for food, bioenergy feedstocks and a wide variety of bio-based products. In response, agriculture has advanced production, but is increasingly depleting soil regulating and supporting ecosystem services. New production systems have emerged, such as no-tillage, that can enhance soil services but may limit yields. Moving forward, agricultural systems must reduce trade-offs between production and soil services. Soil functional zone management (SFZM) is a novel strategy for developing sustainable production systems that attempts to integrate the benefits of conventional, intensive agriculture, and no-tillage. SFZM creates distinct functional zones within crop row and inter-row spaces. By incorporating decimeter-scale spatial and temporal heterogeneity, SFZM attempts to foster greater soil biodiversity and integrate complementary soil processes at the sub-field level. Such integration maximizes soil services by creating zones of ‘active turnover’, optimized for crop growth and yield (provisioning services); and adjacent zones of ‘soil building’, that promote soil structure development, carbon storage, and moisture regulation (regulating and supporting services). These zones allow SFZM to secure existing agricultural productivity while avoiding or minimizing trade-offs with soil ecosystem services. Moreover, the specific properties of SFZM may enable sustainable increases in provisioning services via temporal intensification (expanding the portion of the year during which harvestable crops are grown). We present a conceptual model of ‘virtuous cycles’, illustrating how increases in crop yields within SFZM systems could create self-reinforcing feedback processes with desirable effects, including mitigation of trade-offs between yield maximization and soil ecosystem services. Through the creation of functionally distinct but interacting zones, SFZM may provide a vehicle for optimizing the delivery of multiple goods and services in agricultural systems, allowing sustainable temporal intensification while protecting and enhancing soil functioning. PMID:26904043

Innovation and motivation in public health professionals.

PubMed

García-Goñi, Manuel; Maroto, Andrés; Rubalcaba, Luis

2007-12-01

Innovations in public health services promote increases in the health status of the population. Therefore, it is a major concern for health policy makers to understand the drivers of innovation processes. This paper focuses on the differences in behaviour of managers and front-line employees in the pro-innovative provision of public health services. We utilize a survey conducted on front-line employees and managers in public health institutions across six European countries. The survey covers topics related to satisfaction, or attitude towards innovation or their institution. We undertake principal components analysis and analysis of variance, and estimate a multinomial ordered probit model to analyse the existence of different behaviour in managers and front-line employees with respect to innovation. Perception of innovation is different for managers and front-line employees in public health institutions. While front-line employees' attitude depends mostly on the overall performance of the institution, managers feel more involved and motivated, and their behaviour depends more on individual and organisational innovative profiles. It becomes crucial to make both managers and front-line employees at public health institutions feel participative and motivated in order to maximise the benefits of technical or organisational innovative process in the health services provision.

Pharmacy waste, fraud, and abuse in health care reform.

PubMed

Carpenter, Laura A; Edgar, Zachary; Dang, Christopher

2011-01-01

To describe the new Medicare and Medicaid waste, fraud, and abuse provisions of the Affordable Care Act (H. R. 3590) and Health Care and Education Affordability Reconciliation Act of 2010 (H. R. 4872), the preexisting law modified by H. R. 3590 and H. R. 4872, and applicable existing and proposed regulations. Waste, fraud, and abuse are substantial threats to the efficiency of the health care system. To combat these activities, the Department of Health and Human Services and Centers for Medicare & Medicaid Services promulgate and enforce guidelines governing the proper assessment and billing for Medicare and Medicaid services. These guidelines have a number of provisions that can catch even well-intentioned providers off guard, resulting in substantial fines. H. R. 3590 and H. R. 4872 augment preexisting waste, fraud, and abuse laws and regulations. This article reviews the new waste, fraud, and abuse laws and regulations to apprise pharmacists of the substantial changes affecting their practice. H. R. 3590 and H. R. 4872 modify screening requirements for providers; modify liability and penalties for the antikickback statute, federal False Claims Act, remuneration, and Stark Law; and create or extend auditing and management programs. Properly navigating these changes will be important in keeping pharmacies in compliance.

Incentives in financing mental health care in Austria.

PubMed

Zechmeister, Ingrid; Oesterle, August; Denk, Peter; Katschnig, Heinz

2002-09-01

In Austria, financing health care -and even more so mental health care- is characterized by a mix of federal and provincial responsibilities, lack of uniformity in service provision and service providers, and diverse funding arrangements. The division between financing structures for health care and social care makes the situation even more complex. This state of affairs results in various, partly counterproductive and sometimes paradoxical financial incentives and disincentives for the providers, recipients and financiers of mental health services. In several provinces of Austria, recent reform plans in mental health care have focused strongly on establishing community-based and patient-oriented mental health care. One of the main challenges in implementing this new policy is the re-allocation of resources. The authors hypothesize that the existing structure of mental health care financing, with its incentives and disincentives, constitutes an obstacle to patient-oriented community-based mental health care. Analyzing the characteristics of the overall mental health care financing system in one Austrian province, Lower Austria, will provide a better understanding of actor-relationships and inherent incentives and highlight implications for the process of deinstitutionalization. The authors used an analytical framework based on the principal-agent theory, empirical evidence, and information on financial, organizational and legal structures to identify the characteristics of actor-relationships and the position of single actors within the system. The article shows how incentives are linked to existing constellations of actors involved in mental health care financing and identifies significant power relations. As a consequence, incentives and disincentives within the financing system result in hospital- centered and supply-oriented mental health care in Lower Austria. The current system of financing mental health care provides an obstacle to the provision of patient-oriented and community-based mental care. This is due to existing constellations and power relations among the actors where, most importantly, patients are the weakest party in the patient-payer-provider triangle. Balancing power relations will be a significant prerequisite for alternative financing systems. IMPLICATIONS FOR HEALTH POLICIES AND FURTHER RESEARCH: If a community and needs-based mental health care system is to be established in Austria, the financing structures have to be changed accordingly. Applying a principal-agent framework is useful for identifying key aspects in mental health care financing in relation to the provision of services. Further research is needed to help develop alternative financing mechanisms that support community-based and patient-oriented mental health care systems.

An analysis of use of crowd medical services at an English football league club.

PubMed

Leary, Alison; Greenwood, Peter; Hedley, Barry; Agnew, Jim; Thompson, Desmond; Punshon, Geoffrey

2008-07-01

Although crowd medical services in English league football are common, there is little data examining the use of such services. The aim of this study was to provide detailed data by examining the usage of the Crowd Medical Service at a First Division Football Club (Millwall FC) over six Football League seasons. This usage has implications in terms of resources, provision of level of service and training needs of staff. A prospective data collection form was designed and used to capture all episodes of care over the length of six football league seasons, each approximately 9 months in duration which resulted in a census of activity. This included episodes that did not normally require detailed documentation for statutory purposes, such as informal advice. There were 445 episodes of care recorded over 146 home games. Over six years presentation was consistent. This gives a mean of 3.14 episodes per game (2.7-4.1). There is little research in this area and so it is difficult to compare uptake with other clubs. The episodes of care were broadly grouped into medical (67.0%) or injury (33.0%). Most of those presenting did so with non-emergent (pre-existing) medical problems or minor injuries. Staff (for example Stewards) made up 44% of consultations. One hundred and eight people had a primary and secondary reason for presenting. Such episodes are more time consuming and in turn have an impact on resources. Some stated they had presented because of ease of access to the service, they found access to their General Practitioner (GP) difficult or were not registered with a GP at all. The principal focus of a crowd medical service is to manage a major incident and medically emergent spectators. The majority of presentations were minor injuries and pre-existing medical conditions. In addition staff make up a significant proportion of the users. Some re-focussing of guidance is therefore necessary if these results are typical of English League Football. In turn this reflects a need for more education in the management of minor injuries and chronic disease management and recognition in training and service provision.

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...

Cross-Cultural Considerations regarding Inclusion and Service Provision for Children with Disabilities in India

ERIC Educational Resources Information Center

Browning, Ellen R.; Caro, Patricia; Shastry, Sunita P.

2011-01-01

Providing services for children with disabilities has been a part of the culture of India for generations. However service provision has been within the context of family and community rather than in the public sector and thus has been inclusive by its very nature. This article describes current educational provisions and practices in India for…

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

Creating a strategic management plan for magnetic resonance imaging (MRI) provision.

PubMed

Szczepura, A; Clark, M

2000-09-01

We were commissioned by the West Midlands NHS Regional Specialized Services Group (RSSG) to formulate a strategic plan for the management of Magnetic Resonance Imaging (MRI) within the West Midlands, UK. We needed to establish whether an increase in MRI provision was required, and if so to develop criteria to shape both the nature and location of MRI provision. We found that the UK had relatively low MRI provision per capita by international standards, and that the West Midlands region of the UK had less than the UK average level of MRI provision per capita. Within the region there was a 'mixed economy' of MRI provision involving fixed site scanners owned by the NHS and private companies, and private sector mobile MRI provision. There was little evidence of inappropriate MRI use, but considerable evidence of under-provision. Most MRI scanners in the region were heavily utilized, and average waiting times for MRI frequently exceeded guidelines (of a maximum 13-week wait for non-urgent MRI scans). Projections from NHS Trusts, MRI suppliers, and experts in the MRI field, led us to the conclusion that demand for MRI was likely to grow by between 12.5 and 18.5% per annum. This implies that 8-14 additional MRI scanners might be required within the West Midlands over the next 5 years, to meet existing, and rising demand for MRI. We therefore developed criteria (outlined in the paper) to enhance the productive and allocative efficiency of the deployment of MRI provision, whilst improving the configuration of MRI with reference to geographical equality of access to MRI.

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...

The Development of a Quality Management Framework for Evaluating Medical Device Reprocessing Practice in Healthcare Facilities.

PubMed

Lorv, Bailey; Horodyski, Robin; Welton, Cynthia; Vail, John; Simonetto, Luca; Jokanovic, Danilo; Sharma, Richa; Mahoney, Angela Rea; Savoy-Bird, Shay; Bains, Shalu

2017-01-01

There is increasing awareness of the importance of medical device reprocessing (MDR) for the provision of safe patient care. Although industry service standards are available to guide MDR practices, there remains a lack of published key performance indicators (KPIs) and targets that are necessary to evaluate MDR quality for feedback and improvement. This article outlines the development of an initial framework that builds on established guidelines and includes service standards, KPIs and targets for evaluating MDR operations. This framework can support healthcare facilities in strengthening existing practices and enables a platform for collaboration towards better MDR performance management.

Service Provision for Autism in Mainland China: A Service Providers' Perspective

ERIC Educational Resources Information Center

Sun, Xiang; Allison, Carrie; Auyeung, Bonnie; Matthews, Fiona E.; Murray, Stuart; Baron-Cohen, Simon; Brayne, Carol

2013-01-01

Qualitative semi-structured interviews were conducted with service providers regarding the current healthcare provision and education services for children with Autism Spectrum Conditions (ASC) and their families in mainland China. 10 service providers described the current policy and identified unmet needs within current practice. Providers…

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.

[Realities of the prophylactic health care of workers in Poland].

PubMed

Kopias, Jerzy A

2015-01-01

The Polish occupational health system (OHS), existing over the past 17 years, has recently been contested as never before. Critical voices pertain to both legislative and executive aspects of the system, in which key roles are played by employers and occupational medicine service. There are some reasons for making a hypothesis that relevant norms are not always respected by the main actors. The data on the observance of norms by entities responsible for providing workers with prophylactic health care were analyzed. They were obtained from the existing external resources and materials collected during the implementation of tasks assigned by the Ministry of Health. Legal norms, which constitute OHS in Poland are generally neither respected by the employers, nor by the representatives of occupational medicine service. Nearly half (45-47%) of employers infringe provisions relating to medical examinations of workers. Such a degree of non-observance of respective laws would have not been the case if it was not for the attitudes and "silent approval" of many (but not all) occupational physicians. Laws defining the responsibilities of occupational medicine service units on one hand, and of employers on the other, are for many reasons infringed by both groups. The data analyses indicate that the Polish OHS is, to a large extent, not acceptable and should be replaced with another one founded on other assumptions and responsive to contemporary occupational health challenges. New provisions should be formulated on the basis of merit and guided by socially accepted norms. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Conservation of soil organic carbon, biodiversity and the provision of other ecosystem services along climatic gradients in West Africa

NASA Astrophysics Data System (ADS)

Marks, E.; Aflakpui, G. K. S.; Nkem, J.; Poch, R. M.; Khouma, M.; Kokou, K.; Sagoe, R.; Sebastiã, M.-T.

2009-08-01

Terrestrial carbon resources are major drivers of development in West Africa. The distribution of these resources co-varies with ecosystem type and rainfall along a strong Northeast-Southwest climatic gradient. Soil organic carbon, a strong indicator of soil quality, has been severely depleted in some areas by human activities, which leads to issues of soil erosion and desertification, but this trend can be altered with appropriate management. There is significant potential to enhance existing soil carbon stores in West Africa, with benefits at the global and local scale, for atmospheric CO2 mitigation as well as supporting and provisioning ecosystem services. Three key factors impacting carbon stocks are addressed in this review: climate, biotic factors, and human activities. Climate risks must be considered in a framework of global change, especially in West Africa, where landscape managers have few resources available to adapt to climatic perturbations. Among biotic factors, biodiversity conservation paired with carbon conservation may provide a pathway to sustainable development, and biodiversity conservation is also a global priority with local benefits for ecosystem resilience, biomass productivity, and provisioning services such as foodstuffs. Finally, human management has largely been responsible for reduced carbon stocks, but this trend can be reversed through the implementation of appropriate carbon conservation strategies in the agricultural sector, as shown by multiple studies. Owing to the strong regional climatic gradient, country-level initiatives will need to consider carbon sequestration approaches for multiple ecosystem types. Given the diversity of environments, global policies must be adapted and strategies developed at the national or sub-national levels to improve carbon storage above and belowground. Initiatives of this sort must act locally at farmer scale, and focus on ecosystem services rather than on carbon sequestration solely.

A practical approach to Events Medicine provision.

PubMed

Smith, Susan P; Cosgrove, Joseph F; Driscoll, Peter J; Smith, Andrew; Butler, John; Goode, Peter; Waldmann, Carl; Vallis, Christopher J; Topham, Fiona; Mythen, Michael Monty

2017-08-01

In the past three decades, mass casualty incidents have occurred worldwide at multiple sporting events and other mass gatherings. Organisational safety and healthcare provision can consequently be scrutinised post-event. Within the UK, such incidents in the 1980s provided incentives to improve medical services and subsequent high profile UK-based international sporting events (London Olympics and Paralympics 2012, Glasgow Commonwealth Games 2014, Rugby World Cup 2015) added a further catalyst for developing services. Furthermore in the aftermath of the abandoned France versus Germany association football match at the Stade de France ( Paris Terrorist Attacks, November 2015) and the 2016 UK report from HM Coroner on the Hillsborough Inquest , medical cover at sporting events is being further reviewed. Doctors providing spectator cover therefore need to have an awareness of their likely roles at sporting venues. Formal guidance exists in many countries for the provision of such cover but remains generic even though Events Medicine is increasingly recognised as a necessary service. The current evidence base is limited with best practice examples often anecdotally cited by acute care specialists (eg, emergency medicine) who provide cover. This article is therefore intended to present an overview for doctors of the knowledge and skills required to treat ill and injured spectators and enable them to adequately risk-assess venues in cooperation with other health and safety providers, including preparation for a major incident. It also gives guidance on how activity can be adequately assessed and how doctors can have management roles in Events Medicine. 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/.

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...

Mobile satellite communications in the 1990's

NASA Astrophysics Data System (ADS)

Singh, Jai

1992-07-01

The evolution of Inmarsat global services from a single market and single service of the 1980's to all of the key mobile markets and a wide range of new terminals and services in the 1990's is described. An overview of existing mobile satellite services, as well as new services under implementation for introduction in the near and longer term, including a handheld satellite phone (Inmarsat-P), is provided. The initiative taken by Inmarsat in the integration of its global mobile satellite services with global navigation capability derived from GPS (Global Positioning System) and the GLONASS (Russian GPS) navigation satellite systems and the provision of an international civil overlay for GPS/GLONASS integrity and augmentation is highlighted. To complete the overview of the development of mobile satellite services in the 1990's, the known national and regional mobile satellite system plans and the various recent proposals for both orbiting and geostationary satellite systems for proving handheld satellite phone and/or data messaging services are described.

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...

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...

Implementing microbicides in low income countries

PubMed Central

Gengiah, Tanuja; Karim, Quarraisha Abdool

2012-01-01

The magnitude of the global HIV epidemic is determined by women from lower income countries, specifically sub-Saharan Africa. Microbicides offer women who are unable to negotiate safe sex practices a self-initiated HIV prevention method. Of note, is its potential to yield significant public health benefits even with relatively conservative efficacy, coverage and user adherence estimates, making microbicides an effective intervention to invest scarce health care resources. Existing health care delivery systems provide an excellent opportunity to identify women at highest risk for infection and to also provide an access point to initiate microbicide use. Innovative quality improvement approaches, which strengthen existing sexual reproductive health services and include HIV testing, and linkages to care and treatment services provide an opportunity to lay the foundations for wide-scale provision of microbicides. The potential to enhance health outcomes in women and infants and potentially impact rates of new HIV infection may soon be realised. PMID:22498040

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.

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...

Family Violence Prevention and Services Programs. Final rule.

PubMed

2016-11-02

This rule will better prevent and protect survivors of family violence, domestic violence, and dating violence, by clarifying that all survivors must have access to services and programs funded under the Family Violence Prevention and Services Act. More specifically, the rule enhances accessibility and non-discrimination provisions, clarifies confidentiality rules, promotes coordination among community-based organizations, State Domestic Violence Coalitions, States, and Tribes, as well as incorporates new discretionary grant programs. Furthermore, the rule updates existing regulations to reflect statutory changes made to the Family Violence Prevention and Services Act, and updates procedures for soliciting and awarding grants. The rule also increases clarity and reduces potential confusion over statutory and regulatory standards. The rule codifies standards already used by the program in the Funding Opportunity Announcements and awards, in technical assistance, in reporting requirements, and in sub-regulatory guidance.

A BSc level option in biomedical electronics.

PubMed

Gergely, S

1979-01-01

1. The application of electronic instruments in medical diagnosis and therapy is well established. 2. There is a demand for electronic engineers both in industry and in the Health Service at all ranges of educational attainment. 3. It is possible to identify a set of objectives for a first degree course in Biomedical Electronics. An important element of this course should be the provision of practical experience in industry and in hospitals. 4. Such courses are available both in Europe and in the United States. Although the postgraduate course provision was satisfactory in the UK in the early seventies, only one full time undergraduate course was in operation. 5. A sandwich course can be designed in Biomedical Electronics as a major option of an existing BSc course in Electrical and Electronic Engineering. Provision can be made for entering and leaving the option. The option can be arranged to follow the guidelines laid down by the IEE for exemption from its educational requirements. 6. The option described started at the Lanchester Polytechnic in Coventry in September 1977.

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.

Establishing a clinical cardiac MRI service.

PubMed

O'Regan, D P; Schmitz, S A

2006-03-01

After several years of research development cardiovascular MRI has evolved into a widely accepted clinical tool. It offers important diagnostic and prognostic information for a variety of clinical indications, which include ischaemic heart disease, cardiomyopathies, valvular dysfunction and congenital heart disorders. It is a safe non-invasive technique that employs a variety of imaging sequences optimized for temporal or spatial resolution, tissue-specific contrast, flow quantification or angiography. Cardiac MRI offers specific advantages over conventional imaging techniques for a significant number of patients. The demand for cardiac MRI studies from cardiothoracic surgeons, cardiologists and other referrers is likely to continue to rise with pressure for more widespread local service provision. Setting up a cardiac MRI service requires careful consideration regarding funding issues and how it will be integrated with existing service provision. The purchase of cardiac phased array coils, monitoring equipment and software upgrades must also be considered, as well as the training needs of those involved. The choice of appropriate imaging protocols will be guided by operator experience, clinical indication and equipment capability, and is likely to evolve as the service develops. Post-processing and offline analysis form a significant part of the time taken to report studies and an efficient method of providing quantitative reports is an important requirement. Collaboration between radiologists and cardiologists is needed to develop a successful service and multi-disciplinary meetings are key component of this. This review will explore these issues from our perspective of a new clinical cardiac MRI service operating over its first year in a teaching hospital imaging department.

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.

The costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa

PubMed Central

Devjee, Jaymala; Moodley, Jack

2017-01-01

Background Despite a liberal abortion law, access to safe abortion services in South Africa is challenging for many women. Medication abortion was introduced in 2013, but its reach remains limited. We aimed to estimate the costs and cost effectiveness of providing first-trimester medication abortion and manual vacuum aspiration (MVA) services to inform planning for first-trimester service provision in South Africa and similar settings. Methods We obtained data on service provision and outcomes from an operations research study where medication abortion was introduced alongside existing MVA services in public hospitals in KwaZulu-Natal province. Clinical data were collected through interviews with first-trimester abortion clients and summaries completed by nurses performing the procedures. In parallel, we performed micro-costing at three of the study hospitals. Using a model built in Excel, we estimated the average cost per medical and surgical procedure and determined the cost per complete abortion performed. Results are presented in 2015 US dollars. Results A total of 1,129 women were eligible for a first trimester abortion at the three study sites. The majority (886, 78.5%) were eligible to choose their abortion procedure; 94.1% (n = 834) chose medication abortion. The total average cost per medication abortion was $63.91 (52.32–75.51). The total average cost per MVA was higher at $69.60 (52.62–86.57); though the cost ranges for the two procedures overlapped. Given average costs, the cost per complete medication abortion was lower than the cost per complete MVA despite three (0.4%) medication abortion women being hospitalized and two (0.3%) having ongoing pregnancies at study exit. Personnel costs were the largest component of the total average cost of both abortion methods. Conclusion This analysis supports the scale-up of medication abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication abortion with MVA as a back-up, without increasing costs. PMID:28369061

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...

76 FR 76180 - Notice of Realty Action: Termination of Segregation, Opening of Public Lands; Montana

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-06

...] Notice of Realty Action: Termination of Segregation, Opening of Public Lands; Montana AGENCY: Bureau of... generally, subject to valid existing rights, the provisions of existing withdrawals, other segregations of..., subject to valid existing rights, the provision of existing withdrawals, other segregations of record, and...

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

Modeling and Analysis of Hybrid Cellular/WLAN Systems with Integrated Service-Based Vertical Handoff Schemes

NASA Astrophysics Data System (ADS)

Xia, Weiwei; Shen, Lianfeng

We propose two vertical handoff schemes for cellular network and wireless local area network (WLAN) integration: integrated service-based handoff (ISH) and integrated service-based handoff with queue capabilities (ISHQ). Compared with existing handoff schemes in integrated cellular/WLAN networks, the proposed schemes consider a more comprehensive set of system characteristics such as different features of voice and data services, dynamic information about the admitted calls, user mobility and vertical handoffs in two directions. The code division multiple access (CDMA) cellular network and IEEE 802.11e WLAN are taken into account in the proposed schemes. We model the integrated networks by using multi-dimensional Markov chains and the major performance measures are derived for voice and data services. The important system parameters such as thresholds to prioritize handoff voice calls and queue sizes are optimized. Numerical results demonstrate that the proposed ISHQ scheme can maximize the utilization of overall bandwidth resources with the best quality of service (QoS) provisioning for voice and data services.

76 FR 40258 - Approval and Promulgation of Implementation Plans; State of NE

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-08

... the CAA and EPA's policies addressing such excess emissions (``SSM''); and (ii) existing provisions... believes that some states may have existing SIP approved SSM provisions that are contrary to the CAA and... State provisions with regard to excess emissions during SSM of operations at facilities.'' EPA further...

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.

Autonomous Preference-Aware Information Services Integration for High Response in Integrated Faded Information Field Systems

NASA Astrophysics Data System (ADS)

Lu, Xiaodong; Mori, Kinji

The market and users' requirements have been rapidly changing and diversified. Under these heterogeneous and dynamic situations, not only the system structure itself, but also the accessible information services would be changed constantly. To cope with the continuously changing conditions of service provision and utilization, Faded Information Field (FIF) has been proposed, which is a agent-based distributed information service system architecture. In the case of a mono-service request, the system is designed to improve users' access time and preserve load balancing through the information structure. However, with interdependent requests of multi-service increasing, adaptability and timeliness have to be assured by the system. In this paper, the relationship that exists among the correlated services and the users' preferences for separate and integrated services is clarified. Based on these factors, the autonomous preference-aware information services integration technology to provide one-stop service for users multi-service requests is proposed. As compared to the conventional system, we show that proposed technology is able to reduce the total access time.

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...

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...

Terminology, the importance of defining.

PubMed

van Mil, J W Foppe; Henman, Martin

2016-06-01

Multiple terms and definitions exist to describe specific aspects of pharmacy practice and service provision. This commentary explores the reasons for different interpretations of words and concepts in pharmaceutical care and pharmacy practice research. Reasons for this variation can be found in language, culture, profession and may also depend on developments over time. A list of words is provided where the authors think that currently multiple interpretations are possible. To make sure that the reader understands the essence, it seems imperative that authors include a definition of the topics that they actually study in their papers, and that they clearly cite existing definitions or refer to collections of definitions such as existing glossaries. It is important that presenters, authors and reviewers of pharmacy practice papers pay more attention to this aspect of describing studies.

Semi-automated software service integration in virtual organisations

NASA Astrophysics Data System (ADS)

Afsarmanesh, Hamideh; Sargolzaei, Mahdi; Shadi, Mahdieh

2015-08-01

To enhance their business opportunities, organisations involved in many service industries are increasingly active in pursuit of both online provision of their business services (BSs) and collaborating with others. Collaborative Networks (CNs) in service industry sector, however, face many challenges related to sharing and integration of their collection of provided BSs and their corresponding software services. Therefore, the topic of service interoperability for which this article introduces a framework is gaining momentum in research for supporting CNs. It contributes to generation of formal machine readable specification for business processes, aimed at providing their unambiguous definitions, as needed for developing their equivalent software services. The framework provides a model and implementation architecture for discovery and composition of shared services, to support the semi-automated development of integrated value-added services. In support of service discovery, a main contribution of this research is the formal representation of services' behaviour and applying desired service behaviour specified by users for automated matchmaking with other existing services. Furthermore, to support service integration, mechanisms are developed for automated selection of the most suitable service(s) according to a number of service quality aspects. Two scenario cases are presented, which exemplify several specific features related to service discovery and service integration aspects.

A Context-Aware S-Health Service System for Drivers.

PubMed

Chang, Jingkun; Yao, Wenbin; Li, Xiaoyong

2017-03-17

As a stressful and sensitive task, driving can be disturbed by various factors from the health condition of the driver to the environmental variables of the vehicle. Continuous monitoring of driving hazards and providing the most appropriate business services to meet actual needs can guarantee safe driving and make great use of the existing information resources and business services. However, there is no in-depth research on the perception of a driver's health status or the provision of customized business services in case of various hazardous situations. In order to constantly monitor the health status of the drivers and react to abnormal situations, this paper proposes a context-aware service system providing a configurable architecture for the design and implementation of the smart health service system for safe driving, which can perceive a driver's health status and provide helpful services to the driver. With the context-aware technology to construct a smart health services system for safe driving, this is the first time that such a service system has been implemented in practice. Additionally, an assessment model is proposed to mitigate the impact of the acceptable abnormal status and, thus, reduce the unnecessary invocation of the services. With regard to different assessed situations, the business services can be invoked for the driver to adapt to hazardous situations according to the services configuration model, which can take full advantage of the existing information resources and business services. The evaluation results indicate that the alteration of the observed status in a valid time range T can be tolerated and the frequency of the service invocation can be reduced.

A Context-Aware S-Health Service System for Drivers

PubMed Central

Chang, Jingkun; Yao, Wenbin; Li, Xiaoyong

2017-01-01

As a stressful and sensitive task, driving can be disturbed by various factors from the health condition of the driver to the environmental variables of the vehicle. Continuous monitoring of driving hazards and providing the most appropriate business services to meet actual needs can guarantee safe driving and make great use of the existing information resources and business services. However, there is no in-depth research on the perception of a driver’s health status or the provision of customized business services in case of various hazardous situations. In order to constantly monitor the health status of the drivers and react to abnormal situations, this paper proposes a context-aware service system providing a configurable architecture for the design and implementation of the smart health service system for safe driving, which can perceive a driver’s health status and provide helpful services to the driver. With the context-aware technology to construct a smart health services system for safe driving, this is the first time that such a service system has been implemented in practice. Additionally, an assessment model is proposed to mitigate the impact of the acceptable abnormal status and, thus, reduce the unnecessary invocation of the services. With regard to different assessed situations, the business services can be invoked for the driver to adapt to hazardous situations according to the services configuration model, which can take full advantage of the existing information resources and business services. The evaluation results indicate that the alteration of the observed status in a valid time range T can be tolerated and the frequency of the service invocation can be reduced. PMID:28304330

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

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.

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.

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.

What is consumerism and has it had an impact on health visiting provision? A literature review.

PubMed

Almond, P

2001-09-01

This paper analyses the concept of consumerism drawing on methods of concept analysis. It attempts to identify who the actual consumers of health visiting are before examining whether consumerism and the consumer's voice has had an impact on health visiting provision. Patients and clients are increasingly being referred to as consumers, but the term seems to be used simply as substitute for patient, client or service user. Consumerism is a complex concept and the extent of its usage in the context of health visiting has not been fully explored. An integrative review of a range of literature relating to consumerism is presented. A focused analysis of consumer views of child health clinics is used to illustrate the concept of consumerism. Elements of concept analysis methods such as formulating a model case and a definition are used to illustrate the concept further. The review suggests that consumerism is an outdated concept and has been replaced by other less emotive terms such as partnership and participation. The apparent lack of impact of consumerism research in health visiting is argued by examining empirical evidence relating to child health clinics. Consumerism has had relatively little impact on improving child health clinics although high levels of consumer satisfaction with the overall service exist. More methodologically sound studies are needed to explore users' views of health visiting services and to implement findings to maintain or improve services.

From vision to reality--managing change in the provision of library and information services to nurses, midwives, health visitors and PAMs: (professions allied to medicine) a case study of the North Thames experience with the Inner London Consortium.

PubMed

Godbolt, S; Williamson, J; Wilson, A

1997-06-01

One of the North Thames' pioneering consortia, the Inner London Consortium (ILC) is a complex body which includes NHS Trusts with teaching hospital university connections, community-based Trusts and general hospital acute Trusts. Within the consortium there are 12,000 trained nurses, midwives, health visitors and other professional staff working in the professions allied to medicine (PAMs), all of whom require access to and provision of appropriate library information services. In 1994, taking into account experiences elsewhere in the Region and nationally, it became clear that library issues were complex and would become acute with the move of nursing libraries from ILC Trust sites over a very short timescale. A report on the issues commissioned by the Consortium recommended that a library project, which built on existing NHS Trust PGMDE funded library resources and moved these to a multidisciplinary base to serve the consortium membership, be implemented. The objective of providing access to library information services for nurses and PAMs was achieved. Successes that emerged from the implementation included: The registration in Trust libraries of almost 12 000 new members within the initial 6-month monitoring period. The development of service level agreements and standards for the delivery of services to these new user groups. This paper describes the processes behind these significant and complex changes.

76 FR 2160 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-12

... Exchange's rules also expressly set forth reciprocity provisions.\\6\\ In other words, the Exchange is... exchanges that employ a similar program under their rules. Reciprocity provisions also exist for the $2.50... reciprocity provision, the Exchange's existing strike setting programs demonstrate the intent [[Page 2161

GP and nurses' perceptions of how after hours care for people receiving palliative care at home could be improved: a mixed methods study.

PubMed

Tan, Heather M; O'Connor, Margaret M; Miles, Gail; Klein, Britt; Schattner, Peter

2009-09-14

Primary health care providers play a dominant role in the provision of palliative care (PC) in Australia but many gaps in after hours service remain. In some rural areas only 19% of people receiving palliative care achieve their goal of dying at home. This study, which builds on an earlier qualitative phase of the project, investigates the gaps in care from the perspective of general practitioners (GPs) and PC nurses. Questionnaires, developed from the outcomes of the earlier phase, and containing both structured and open ended questions, were distributed through Divisions of General Practice (1 urban, 1 rural, 1 mixed) to GPs (n = 524) and through a special interest group to palliative care nurses (n = 122) in both rural and urban areas. Questionnaires were returned by 114 GPs (22%) and 52 nurses (43%). The majority of GPs were associated with a practice which provided some after hours services but PC was not a strong focus for most. This was reflected in low levels of PC training, limited awareness of the existence of after hours triage services in their area, and of the availability of Enhanced Primary Care (EPC) Medicare items for care planning for palliative patients. However, more than half of both nurses and GPs were aware of accessible PC resources.Factors such as poor communication and limited availability of after hours services were identified the as most likely to impact negatively on service provision. Strategies considered most likely to improve after hours services were individual patient protocols, palliative care trained respite carers and regular multidisciplinary meetings that included the GP. While some of the identified gaps can only be met by long term funding and policy change, educational tools for use in training programs in PC for health professionals, which focus on the utilisation of EPC Medicare items in palliative care planning, the development of advance care plans and good communication between members of multidisciplinary teams, which include the GP, may enhance after hours service provision for patients receiving palliative care at home. The role of locums in after PC is an area for further research.

Using social media for support and feedback by mental health service users: thematic analysis of a twitter conversation.

PubMed

Shepherd, Andrew; Sanders, Caroline; Doyle, Michael; Shaw, Jenny

2015-02-19

Internet based social media websites represent a growing space for interpersonal interaction. Research has been conducted in relation to the potential role of social media in the support of individuals with physical health conditions. However, limited research exists exploring such utilisation by individuals with experience of mental health problems. It could be proposed that access to wider support networks and knowledge could be beneficial for all users, although this positive interpretation has been challenged. The present study focusses on a specific discussion as a case study to assess the role of the website www.twitter.com as a medium for interpersonal communication by individuals with experience of mental disorder and possible source of feedback to mental health service providers. An electronic search was performed to identify material contributing to an online conversation entitled #dearmentalhealthprofessionals. Output from the search strategy was combined in such a way that repeated material was eliminated and all individual material anonymised. The remaining textual material was reviewed and combined in a thematic analysis to identify common themes of discussion. 515 unique communications were identified relating to the specified conversation. The majority of the material related to four overarching thematic headings: The impact of diagnosis on personal identity and as a facilitator for accessing care; Balance of power between professional and service user; Therapeutic relationship and developing professional communication; and Support provision through medication, crisis planning, service provision and the wider society. Remaining material was identified as being direct expression of thanks, self-referential in its content relating to the on-going conversation or providing a link to external resources and further discussion. The present study demonstrates the utility of online social media as both a discursive space in which individuals with experience of mental disorder may share information and develop understanding, and a medium of feedback to mental health service providers. Further research is required to establish potential individual benefit from the utilisation of such networks, its suitability as a means of service provision feedback and the potential role for, and user acceptability of, mental health service providers operating within the space.

ARTES: the future of satellite telecommunication

NASA Astrophysics Data System (ADS)

González-Blázquez, Angel; Detain, Dominique

2005-08-01

Throughout its 30-year existence, ESA has played a key role by providing telecommunications infrastructures that have allowed the in-orbit validation, qualification and demonstration of equipment, technology and services. In the past, this has been achieved through the provision of dedicated satellites like OTS, Marecs, Olympus and Artemis, as well as by the implementation of piggy-back payloads on other ESA or commercial satellites. Today, due to the importance of satellite telecommunications, ESA continues to support this sector mainly through its ARTES - Advanced Research in Telecommunications - Programme.

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.

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.

Accessibility and quality of secondary care rheumatology services for people with inflammatory arthritis: a regional survey.

PubMed

Sandhu, R S; Treharne, G J; Justice, E A; Jordan, A C; Saravana, S; Obrenovic, K; Erb, N; Kitas, G D; Rowe, I F

2007-12-01

Secondary care rheumatology services for patients with inflammatory arthritis (IA) in the West Midlands were audited using Arthritis and Musculoskeletal Alliance (ARMA) standards of care. Questionnaires were analysed from 1,715 patients in 11 rheumatology departments. ARMA standards recommend full multidisciplinary team assessment; referral rates to nurse specialists (52.3%), physiotherapists (48.7%) and occupational therapists (36.5%) were, however, lower than expected. Attendance at existing hospital-led education groups was rare (8.9%), awareness of existing helplines was moderate (59.2%) but the proportion of patients reporting satisfaction with advice about their disease was high (80.5%). Significant variations were found between departments. For patients with IA < 2 years (n = 236), 84.5% were seen by a rheumatologist within the ARMA standard of 12 weeks of referral; diagnosis of a type of IA was made at the first rheumatology appointment in 66.4%; 82.8% of rheumatoid arthritis patients had commenced disease-modifying drugs, although time to commencement varied across departments. This study raises issues regarding provision of rheumatology services, prioritisation of patient referral and patient education.

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...

Providing Written Language Services in the Schools: The Time Is Now

ERIC Educational Resources Information Center

Fallon, Karen A.; Katz, Lauren A.

2011-01-01

Purpose: The current study was conducted to investigate the provision of written language services by school-based speech-language pathologists (SLPs). Specifically, the study examined SLPs' knowledge, attitudes, and collaborative practices in the area of written language services as well as the variables that impact provision of these services.…

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...

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...

76 FR 36400 - Third-Party Provision of Ancillary Services; Accounting and Financial Reporting for New Electric...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-22

...-000 and AD10-13-000] Third-Party Provision of Ancillary Services; Accounting and Financial Reporting... current accounting and reporting requirements as applied to electric storage. As such, the Commission... the technologies used for such provision; and the adequacy of current accounting and reporting...

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.

CelOWS: an ontology based framework for the provision of semantic web services related to biological models.

PubMed

Matos, Ely Edison; Campos, Fernanda; Braga, Regina; Palazzi, Daniele

2010-02-01

The amount of information generated by biological research has lead to an intensive use of models. Mathematical and computational modeling needs accurate description to share, reuse and simulate models as formulated by original authors. In this paper, we introduce the Cell Component Ontology (CelO), expressed in OWL-DL. This ontology captures both the structure of a cell model and the properties of functional components. We use this ontology in a Web project (CelOWS) to describe, query and compose CellML models, using semantic web services. It aims to improve reuse and composition of existent components and allow semantic validation of new models.

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.

Protecting Adolescents' Right to Seek Treatment for Sexually Transmitted Diseases without Parental Consent: The Arizona Experience with Senate Bill 1309

PubMed Central

Goodwin, Kimberly D.; Taylor, Melanie M.; Brown, Erin C. Fuse; Winscott, Michelle; Scanlon, Megan; Hodge, James G.; Mickey, Tom; England, Bob

2012-01-01

In 2010, Senate Bill 1309 included language to repeal an existing Arizona law that enables minors younger than 18 years of age to seek diagnosis and treatment of sexually transmitted diseases (STDs) without parental consent. Numerous implications were identified that would have stemmed from parental consent provisions originally proffered in Senate Bill 1309. These implications included diminished access to essential health services among minors, exacerbated existing health disparities, increased health-care spending costs, and thwarted efforts to curb the spread of STDs. Lastly, minors would have been deprived of existing privacy protections concerning their STD-related medical information. This case study describes how collaborative advocacy efforts resulted in the successful amendment of Senate Bill 1309 to avert the negative sexual and reproductive health outcomes among adolescents stemming from the potential repeal of their existing legal right to seek STD treatment without parental consent. PMID:22547855

Protecting adolescents' right to seek treatment for sexually transmitted diseases without parental consent: the Arizona experience with Senate Bill 1309.

PubMed

Goodwin, Kimberly D; Taylor, Melanie M; Brown, Erin C Fuse; Winscott, Michelle; Scanlon, Megan; Hodge, James G; Mickey, Tom; England, Bob

2012-01-01

In 2010, Senate Bill 1309 included language to repeal an existing Arizona law that enables minors younger than 18 years of age to seek diagnosis and treatment of sexually transmitted diseases (STDs) without parental consent. Numerous implications were identified that would have stemmed from parental consent provisions originally proffered in Senate Bill 1309. These implications included diminished access to essential health services among minors, exacerbated existing health disparities, increased health-care spending costs, and thwarted efforts to curb the spread of STDs. Lastly, minors would have been deprived of existing privacy protections concerning their STD-related medical information. This case study describes how collaborative advocacy efforts resulted in the successful amendment of Senate Bill 1309 to avert the negative sexual and reproductive health outcomes among adolescents stemming from the potential repeal of their existing legal right to seek STD treatment without parental consent.

Health of grey nomads: On the move and under the health sector radar.

PubMed

Raven, Melissa

2016-06-01

Grey nomads - older people driving long distances recreationally and staying in caravans, tents or motor homes - are common on Australian highways. Although grey nomads report many benefits from their travels, there is anecdotal evidence that they impose a significant burden on rural/remote health services, including general practitioners, pharmacists and hospitals. There have been calls for better resourcing and service provision, but little reference to solid evidence on which to base this. This literature review is the first to integrate existing evidence for a health audience. Australia. Narrative literature search and synthesis. There is very little published information about the health and health service utilisation of grey nomads, and almost none in the medical literature. One key exception, a survey at a caravan park in the Kimberley region, found that, like other older Australians, many grey nomads have chronic diseases, and they have high rates of medication use. However, other studies have found that they generally view themselves as relatively healthy. There is some evidence of inadequate preparation for travelling. Issues include lack of health summaries, inadequate medication supplies and suboptimal vaccination. Some experience emergencies, sometimes resulting in hospital admissions. Overall, they place a poorly documented burden on rural/remote services. There is a need for further research on the health of grey nomads, their use of self-care strategies, and their uptake of health services both on the road and at home, to inform the provision of health services and optimise their well-being and health care utilisation. © 2015 National Rural Health Alliance Inc.

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.

Improving the physical health of people with severe mental illness: boundaries of care provision.

PubMed

Ehrlich, Carolyn; Kendall, Elizabeth; Frey, Nicolette; Kisely, Steve; Crowe, Elizabeth; Crompton, David

2014-06-01

There is compelling evidence that the physical health of people with severe mental illness is poor. Health-promotion guidelines have been recommended as a mechanism for improving the physical health of this population. However, there are significant barriers to the adoption of evidence-based guidelines in practice. The purpose of this research was to apply existing implementation theories to examine the capability of the health system to integrate physical health promotion into mental health service delivery. Data were collected within a regional city in Queensland, Australia. Fifty participants were interviewed. The core theme that emerged from the data was that of 'care boundaries' that influenced the likelihood of guidelines being implemented. Boundaries existed around the illness, care provision processes, sectors, the health-care system, and society. These multilevel boundaries, combined with participants' ways of responding to them, impacted on capability (i.e. the ability to integrate physical health promotion into existing practices). Participants who were able to identify strategies to mediate these boundaries were better positioned to engage with physical health-promotion practice. Thus, the implementation of evidence-based guidelines depended heavily on the capability of the workforce to develop and adopt boundary-mediating strategies. © 2013 Australian College of Mental Health Nurses Inc.

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.

A Workflow-based Intelligent Network Data Movement Advisor with End-to-end Performance Optimization

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

Zhu, Michelle M.; Wu, Chase Q.

2013-11-07

Next-generation eScience applications often generate large amounts of simulation, experimental, or observational data that must be shared and managed by collaborative organizations. Advanced networking technologies and services have been rapidly developed and deployed to facilitate such massive data transfer. However, these technologies and services have not been fully utilized mainly because their use typically requires significant domain knowledge and in many cases application users are even not aware of their existence. By leveraging the functionalities of an existing Network-Aware Data Movement Advisor (NADMA) utility, we propose a new Workflow-based Intelligent Network Data Movement Advisor (WINDMA) with end-to-end performance optimization formore » this DOE funded project. This WINDMA system integrates three major components: resource discovery, data movement, and status monitoring, and supports the sharing of common data movement workflows through account and database management. This system provides a web interface and interacts with existing data/space management and discovery services such as Storage Resource Management, transport methods such as GridFTP and GlobusOnline, and network resource provisioning brokers such as ION and OSCARS. We demonstrate the efficacy of the proposed transport-support workflow system in several use cases based on its implementation and deployment in DOE wide-area networks.« less

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.

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

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...

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.

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.

SLA-aware differentiated QoS in elastic optical networks

NASA Astrophysics Data System (ADS)

Agrawal, Anuj; Vyas, Upama; Bhatia, Vimal; Prakash, Shashi

2017-07-01

The quality of service (QoS) offered by optical networks can be improved by accurate provisioning of service level specifications (SLSs) included in the service level agreement (SLA). A large number of users coexisting in the network require different services. Thus, a pragmatic network needs to offer a differentiated QoS to a variety of users according to the SLA contracted for different services at varying costs. In conventional wavelength division multiplexed (WDM) optical networks, service differentiation is feasible only for a limited number of users because of its fixed-grid structure. Newly introduced flex-grid based elastic optical networks (EONs) are more adaptive to traffic requirements as compared to the WDM networks because of the flexibility in their grid structure. Thus, we propose an efficient SLA provisioning algorithm with improved QoS for these flex-grid EONs empowered by optical orthogonal frequency division multiplexing (O-OFDM). The proposed algorithm, called SLA-aware differentiated QoS (SADQ), employs differentiation at the level of routing, spectrum allocation, and connection survivability. The proposed SADQ aims to accurately provision the SLA using such multilevel differentiation with an objective to improve the spectrum utilization from the network operator's perspective. SADQ is evaluated for three different CoSs under various traffic demand patterns and for different ratios of the number of requests belonging to the three considered CoSs. We propose two new SLA metrics for the improvement of functional QoS requirements, namely, security, confidentiality and survivability of high class of service (CoS) traffic. Since, to the best of our knowledge, the proposed SADQ is the first scheme in optical networks to employ exhaustive differentiation at the levels of routing, spectrum allocation, and survivability in a single algorithm, we first compare the performance of SADQ in EON and currently deployed WDM networks to assess the differentiation capability of EON and WDM networks under such differentiated service environment. The proposed SADQ is then compared with two existing benchmark routing and spectrum allocation (RSA) schemes that are also designed under EONs. Simulations indicate that the performance of SADQ is distinctly better in EON than in WDM network under differentiated QoS scenario. The comparative analysis of the proposed SADQ with the considered benchmark RSA strategies designed under EON shows the improved performance of SADQ in EON paradigm for offering differentiated services as per the SLA.

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…

Post Rape Care Provision to Minors in Kenya: An Assessment of Health Providers' Knowledge, Attitudes, and Practices.

PubMed

Wangamati, Cynthia Khamala; Gele, Abdi Ali; Sundby, Johanne

2017-03-01

Child sexual abuse (CSA) is a major global health challenge. Extant literature in Kenya indicates an alarming rate of sexually abused minors presenting to poorly equipped health facilities with untrained health providers for post rape care. National guidelines on management of sexual violence have been in existence since 2004; however, little is known on the impact of these guidelines on post rape care provision to minors. Therefore, the study aims to assess the knowledge, attitudes, and practices of health providers with regard to post rape care provision in a Kenyan District health facility. The study used a triangulation of different qualitative methods: review of 42 health records of minors seeking post rape care, 15 in-depth interviews, and informal conversations with health providers. Findings indicate that the Kenyan national guidelines on management of sexual violence were nonexistent in the health facility. Consequently, health providers possessed limited knowledge on post rape care administration. The limited knowledge translated to poor collection and preservation of evidence, inadequate psychosocial support, and clinical care. In addition, rape myth attitudes and religious beliefs contributed to survivor blaming and provider hesitance in provision of legal abortion care, respectively. To facilitate provision of quality post rape care, policy makers and health institutions' managers need to avail protocols in line with evidence-based best practices to guide health providers in post rape care administration. In addition, there is need for rigorous training and supervision of health professionals to ensure better service provision.

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

Families at risk of poor parenting: a model for service delivery, assessment, and intervention.

PubMed

Ayoub, C; Jacewitz, M M

1982-01-01

The At Risk Parent Child Program is a multidisciplinary network agency designed for the secondary prevention of poor parenting and the extremes of child abuse and neglect. This model system of service delivery emphasizes (1) the coordination of existing community resources to access a target population of families at risk of parenting problems, (2) the provision of multiple special services in a neutral location (ambulatory pediatric clinic), and (3) the importance of intensive individual contact with a clinical professional who serves as primary therapist, social advocate and service coordinator for client families. Identification and assessment of families is best done during prenatal and perinatal periods. Both formal and informal procedures for screening for risk factors are described, and a simple set of at risk criteria for use by hospital nursing staff is provided. Preventive intervention strategies include special medical, psychological, social and developmental services, offered in an inpatient; outpatient, or in-home setting. Matching family needs to modality and setting of treatment is a major program concern. All direct services to at risk families are supplied by professionals employed within existing local agencies (hospital, public health department, state guidance center, and medical school pediatric clinic). Multiple agency involvement allows a broad-based screening capacity which allows thousands of families routine access to program services. The administrative center of the network stands as an independent, community-funded core which coordinates and monitors direct clinical services, and provides local political advocacy for families at risk of parenting problems.

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.

A Belief-based Trust Model for Dynamic Service Selection

NASA Astrophysics Data System (ADS)

Ali, Ali Shaikh; Rana, Omer F.

Provision of services across institutional boundaries has become an active research area. Many such services encode access to computational and data resources (comprising single machines to computational clusters). Such services can also be informational, and integrate different resources within an institution. Consequently, we envision a service rich environment in the future, where service consumers can intelligently decide between which services to select. If interaction between service providers/users is automated, it is necessary for these service clients to be able to automatically chose between a set of equivalent (or similar) services. In such a scenario trust serves as a benchmark to differentiate between service providers. One might therefore prioritize potential cooperative partners based on the established trust. Although many approaches exist in literature about trust between online communities, the exact nature of trust for multi-institutional service sharing remains undefined. Therefore, the concept of trust suffers from an imperfect understanding, a plethora of definitions, and informal use in the literature. We present a formalism for describing trust within multi-institutional service sharing, and provide an implementation of this; enabling the agent to make trust-based decision. We evaluate our formalism through simulation.

ESA situational awareness of space weather

NASA Astrophysics Data System (ADS)

Luntama, Juha-Pekka; Glover, Alexi; Keil, Ralf; Kraft, Stefan; Lupi, Adriano

2016-07-01

ESA SSA Period 2 started at the beginning of 2013 and will last until the end of 2016. For the Space Weather Segment, transition to Period 2 introduced an increasing amount of development of new space weather service capability in addition to networking existing European assets. This transition was started already towards the end of SSA Period 1 with the initiation of the SSA Space Weather Segment architecture definition studies and activities enhancing existing space weather assets. The objective of Period 2 has been to initiate SWE space segment developments in the form of hosted payload missions and further expand the federated service network. A strong focus has been placed on demonstration and testing of European capabilities in the range of SWE service domains with a view to establishing core products which can form the basis of SWE service provision during SSA Period 3. This focus has been particularly addressed in the SSA Expert Service Centre (ESC) Definition and Development activity that was started in September 2015. This presentation will cover the current status of the SSA SWE Segment and the achievements during SSA Programme Periods 1 and 2. Particular attention is given to the federated approach that allow building the end user services on the best European expertise. The presentation will also outline the plans for the Space Weather capability development in the framework of the ESA SSA Programme in 2017-2020.

Regional differences in echocardiography provision in New Zealand--results from the 2013 SCANZ Workforce Survey.

PubMed

Buckley, Belinda A; Poppe, Katrina; Farnworth, Mark J; Whalley, Gillian

2015-01-30

Abstract Healthcare may be unevenly distributed based on geographic location. This study aimed to identify whether regional differences in echocardiography provision exist and, if so, to explore key causes. In March 2013, 18 public hospitals with a sonographer-led echocardiography service were surveyed, all of which provided data. Questions related to characteristics of the sonographer workforce, echocardiogram volumes and workflows. Information on District Health Board (DHB) population was obtained from public access websites. Multivariable linear regression was performed using the following variables: ethnicity, age, socioeconomic status, type of centre, sonographer full-time equivalent (FTE) and number/proportion of trainees to determine their potential contribution to echocardiogram volume. 1748 echocardiograms were performed per 100,000 population (mean) with significant differences seen amongst DHBs but not between tertiary surgical and regional centres (surgical median 1802, regional median 1658, p=0.18). Regional disparity in the population-based cardiac sonographer workforce size was observed and the number of scans performed per sonographer was higher in larger centres. In multivariable modelling, the DHB population-based scan volume was predicted by: socioeconomic status (top two quintiles of deprivation status increased scans by 75 per 100,000 population, p=0.02) and age (age 20 to 65 years increased scans by 131 per 100,000 population, p=0.06). Regional differences in echocardiography services in New Zealand exist as evidenced by marked regional disparity in both population-based echo volumes and cardiac sonographer workforce size.

How are service users instructed to measure home furniture for provision of minor assistive devices?

PubMed

Atwal, Anita; Mcintyre, Anne; Spiliotopoulou, Georgia; Money, Arthur; Paraskevopulos, Ioannis

2017-02-01

Measurements play a vital role in providing devices that meet the individual needs of users. There is increasing evidence of devices being abandoned. The reasons for this are complex but one key factor that plays a role in non-use of equipment is the lack of fit between the device, environment and person. In addition, the abandonment of devices can be seen as a waste of public money. The aim of this paper is to examine the type, the readability, and the content of existing guidance in relation to measuring home furniture. An online national survey involving health and social care trusts in the UK. We conducted a synthesis of leaflets associated with measurement of furniture to identify existing guidance. The content and readability of this guidance was then evaluated. From the 325 responses received, 64 therapists reported using guidance. From the 13 leaflets that were analysed, 8 leaflets were found to meet Level 3 Adult Literacy Standards (age 9-11). There were differences in the way in which the measurement of furniture items occurred within the leaflets with no measurement guidance reported for baths. There is a need to standardize guidance to ensure that measurements are reliable. Implications for Rehabilitation Our research has highlighted the need to confirm and agree measurement techniques for home furniture in the provision of assistive devices. Inaccurate guidance can lead to abandonment of devices. Inaccurate guidance could prevent service users from not participating within the self-assessment process for devices.

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.

45 CFR 260.74 - How do existing welfare reform waivers affect the application of the Federal time-limit provisions?

Code of Federal Regulations, 2010 CFR

2010-10-01

... application of the Federal time-limit provisions? 260.74 Section 260.74 Public Welfare Regulations Relating to....74 How do existing welfare reform waivers affect the application of the Federal time-limit provisions? (a)(1) If a State is implementing a time-limit component under a waiver, in accordance with this...

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...

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.

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.

The psychiatric hospital and its place in a mental health service

PubMed Central

Tooth, Geoffrey

1958-01-01

Modern methods of treatment of mental disease enable the average length of stay in hospital to be drastically reduced. The former overcrowding is therefore disappearing; in fact, it should be possible to contemplate a reduction in the size of the hospitals, particularly if new admissions are kept to a minimum by the provision of efficient out-patient clinics and of adequate geriatric and domiciliary nursing services. Taking recent trends in England and Wales as his starting point, the author outlines ways in which a modern mental health service might be built up around existing facilities under a variety of conditions. He advocates that, as far as possible, the treatment of mental disease should be integrated into general medicine, and emphasises the need for close co-operation between psychiatrists, family doctors, and the staff of general hospitals. PMID:13585081

7 CFR 457.152 - Hybrid seed corn crop insurance provisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 6 2014-01-01 2014-01-01 false Hybrid seed corn crop insurance provisions. 457.152... corn crop insurance provisions. The Hybrid Seed Corn Crop Insurance Provisions for the 1998 and... policies Hybrid Seed Corn Crop Provisions If a conflict exists among the policy provisions, the order of...

7 CFR 457.152 - Hybrid seed corn crop insurance provisions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 6 2013-01-01 2013-01-01 false Hybrid seed corn crop insurance provisions. 457.152... corn crop insurance provisions. The Hybrid Seed Corn Crop Insurance Provisions for the 1998 and... policies Hybrid Seed Corn Crop Provisions If a conflict exists among the policy provisions, the order of...

7 CFR 457.152 - Hybrid seed corn crop insurance provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 6 2011-01-01 2011-01-01 false Hybrid seed corn crop insurance provisions. 457.152... corn crop insurance provisions. The Hybrid Seed Corn Crop Insurance Provisions for the 1998 and... policies Hybrid Seed Corn Crop Provisions If a conflict exists among the policy provisions, the order of...

7 CFR 457.152 - Hybrid seed corn crop insurance provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 6 2012-01-01 2012-01-01 false Hybrid seed corn crop insurance provisions. 457.152... corn crop insurance provisions. The Hybrid Seed Corn Crop Insurance Provisions for the 1998 and... policies Hybrid Seed Corn Crop Provisions If a conflict exists among the policy provisions, the order of...

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...

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.

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

Adapting services to the needs of children and families with complex migration experiences: The Toulouse University Hospital's intercultural consultation.

PubMed

Sturm, Gesine; Guerraoui, Zohra; Bonnet, Sylvie; Gouzvinski, Françoise; Raynaud, Jean-Philippe

2017-08-01

This article presents the recently created intercultural consultation at the Medical and Psychological Health Care Service (CMP) of the University Hospital la Grave at Toulouse. The approach of the intercultural consultation was elaborated in response to the increasing diversity of children and families using the service in Toulouse. It is also based on local research that indicates the difficulties service providers encounter when trying to establish a solid therapeutic alliance with families with complex migration backgrounds who accumulate different disadvantaging factors. The intercultural consultation adapts existing models of culture-sensitive consultations in child mental health care in France and Canada to the local context in Toulouse. We describe the underlying principles of the intercultural consultation work, the therapeutic and mediation techniques used, and the way the work is integrated into the global service provision of the CMP. The process is illustrated with a case study followed by a discussion of the innovations.

The Isis Centre: a counselling service within the National Health Service.

PubMed Central

Agulnik, P; Holroyd, P; Mandelbrote, B

1976-01-01

A new centre has been established to provide readily accessible counselling, consultation, and mental health information. People may refer themselves or are recommended to attend by general practitioners or other agencies. The counsellors have varied backgrounds in paramedical or counselling services, and they are supported by psychiatrists. Of a sample of 100 clients, four were referred to one of the team's psychiatrists and 33 visited the centre only once. The centre's staff aim to adopt a flexible approach to the client and his problems, and formal psychiatric categories have not been found useful. Provision is made for people who want to solve their problems by discussion rather than medication and those for whom the existing psychiatric services may have little time to spare. Consequently, the approach adopted by the Isis Centre, whereby many people benefit from psychotherapy yet the psychiatrist deals directly with only a few selected cases, contributes towards meeting the great need for psychiatric services and using the psychiatrist's skills more effectively. PMID:947421

Human Trafficking Identification and Service Provision in the Medical and Social Service Sectors.

PubMed

Schwarz, Corinne; Unruh, Erik; Cronin, Katie; Evans-Simpson, Sarah; Britton, Hannah; Ramaswamy, Megha

2016-06-01

The medical sector presents a unique opportunity for identification and service to victims of human trafficking. In this article, we describe local and site-specific efforts to develop an intervention tool to be used in an urban hospital's emergency department in the midwestern United States. In the development of our tool, we focused on both identification and intervention to assist trafficked persons, through a largely collaborative process in which we engaged local stakeholders for developing site-specific points of intervention. In the process of developing our intervention, we highlight the importance of using existing resources and services in a specific community to address critical gaps in coverage for trafficked persons. For example, we focus on those who are victims of labor trafficking, in addition to those who are victims of sex trafficking. We offer a framework informed by rights-based approaches to anti-trafficking efforts that addresses the practical challenges of human trafficking victim identification while simultaneously working to provide resources and disseminate services to those victims.

18 CFR 358.4 - Non-discrimination requirements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... provisions relating to the sale or purchase of open access transmission service, if the tariff provisions do... relating to the sale or purchase of open access transmission service in a fair and impartial manner that...

Medicare and Medicaid programs; rural hospitals: provision of long-term care services (swing-bed provision); flexibility in application of standards--Health Care Financing Administration. Interim final rule with comment period.

PubMed

1982-07-20

These regulations implement sections 904 and 949 of Pub. L. 96-499, the Omnibus Reconciliation Act of 1980. Under section 904 (the swing-bed provision), certain small, rural hospitals may use their inpatient facilities to furnish skilled nursing facility (SNF) services to Medicare and Medicaid beneficiaries, and intermediate care facility (ICF) services to Medicaid beneficiaries. These hospitals will be reimbursed at rates appropriate for those services, which are generally lower than hospital rates. This statutory provision is intended to encourage the most efficient and effective use of inpatient hospital beds for delivery of either hospital or SNF and ICF services. Under section 949, rural hospitals of 50 or fewer beds may be exempted from certain personnel standards in the conditions of participation for hospitals. This exemption applies only to the extent that it does not jeopardize or adversely affect the health and safety of patients.

[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.

Employment relationships in Victorian public hospitals: the Kennett years.

PubMed

Stanton, P

2000-01-01

From 1992 to 1999, the Kennett government in Victoria moved to competitive market models of service delivery and the measurement of service provision through casemix funding. Public hospital managers were given greater accountability for the costs and provision of service delivery and a new range of service providers, many from the private sector, entered the public health market. The decentralisation of the industrial relations system led to new developments in bargaining that brought both opportunities and problems. In the Victorian public health system there was an increasing emphasis on decentralisation in both service provision and employment relations. In this paper I suggest that there were contradictions in these developments for government, and new challenges and difficulties for employers, employees and trade unions.

The research of service provision based on service-oriented architecture for NGN

NASA Astrophysics Data System (ADS)

Jie, Yin; Nian, Zhou; Qian, Mao

2007-11-01

Service convergence is an important characteristic of NGN(Next Generation Networking). How to integrate the service capabilities of telecommunication network and Internet. At first, this article puts forward the concepts and characteristics of SOA (Service-Oriented Architecture) and Web Service, then discusses relationship between them. Secondly, combined with five kinds of Service Provision in NGN, A service platform architecture design of NGN and a service development mode based on SOA are brought up. At last, a specific example is analyzed with BPEL (Business Process Execution Language) in order to describe service development flow based on SOA for NGN.

75 FR 27322 - Capacity Building Program for Traditionally Underserved Populations-Technical Assistance for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-14

... improve the provision of vocational rehabilitation (VR) services to, and the employment outcomes of... foundation of the VR process and service provision; (2) the application of Federal rules, regulations, and... AIVRS grantees are among the many State VR agency partners eligible to receive services from the TACE...

34 CFR 361.50 - Written policies governing the provision of services for individuals with disabilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 2 2013-07-01 2013-07-01 false Written policies governing the provision of services for individuals with disabilities. 361.50 Section 361.50 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF...

34 CFR 361.50 - Written policies governing the provision of services for individuals with disabilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true Written policies governing the provision of services for individuals with disabilities. 361.50 Section 361.50 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE...

34 CFR 361.50 - Written policies governing the provision of services for individuals with disabilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 2 2014-07-01 2013-07-01 true Written policies governing the provision of services for individuals with disabilities. 361.50 Section 361.50 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE...

34 CFR 361.50 - Written policies governing the provision of services for individuals with disabilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 2 2012-07-01 2012-07-01 false Written policies governing the provision of services for individuals with disabilities. 361.50 Section 361.50 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF...

34 CFR 364.43 - What requirements apply to the provision of State IL services?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true What requirements apply to the provision of State IL services? 364.43 Section 364.43 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE...

34 CFR 364.43 - What requirements apply to the provision of State IL services?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false What requirements apply to the provision of State IL services? 364.43 Section 364.43 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE...

42 CFR 5a.1 - Statutory basis and purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Statutory basis and purpose. 5a.1 Section 5a.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS RURAL... the Public Health Service Act. These provisions define “underserved rural community” for purposes of...

42 CFR 5a.1 - Statutory basis and purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Statutory basis and purpose. 5a.1 Section 5a.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS RURAL... the Public Health Service Act. These provisions define “underserved rural community” for purposes of...

42 CFR 5a.1 - Statutory basis and purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Statutory basis and purpose. 5a.1 Section 5a.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS RURAL... the Public Health Service Act. These provisions define “underserved rural community” for purposes of...

Provision of Mental Health Services in South African Substance Abuse Treatment Facilities

ERIC Educational Resources Information Center

Myers, Bronwyn; Fakier, Nuraan

2009-01-01

To date, South African research has not examined mental health service provision in substance abuse treatment facilities, even though these services improve client retention and treatment outcomes. To describe the extent to which substance abuse treatment facilities in Gauteng and KwaZulu-Natal provinces provide clients with mental health services…

18 CFR 367.1110 - Account 111, Accumulated provision for amortization of service company property.

Code of Federal Regulations, 2010 CFR

2010-04-01

... THE PUBLIC 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... (§ 367.4040), for the current amortization of limited-term service company property investments. (2...

36 CFR 1501.1 - Cross reference to National Park Service regulations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false Cross reference to National... NATIONAL MEMORIAL TRUST GENERAL PROVISIONS § 1501.1 Cross reference to National Park Service regulations... (the Trust) adopts by cross reference the provisions of the National Park Service in 36 CFR chapter I...

36 CFR 1501.1 - Cross reference to National Park Service regulations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 36 Parks, Forests, and Public Property 3 2014-07-01 2014-07-01 false Cross reference to National... NATIONAL MEMORIAL TRUST GENERAL PROVISIONS § 1501.1 Cross reference to National Park Service regulations... (the Trust) adopts by cross reference the provisions of the National Park Service in 36 CFR chapter I...

31 CFR 515.572 - Authorization of transactions incident to the provision of travel services, carrier services, and...

Code of Federal Regulations, 2011 CFR

2011-07-01

... who use their services information showing compliance with the relevant remittance provisions of this.... Note to paragraph (a)(3): A suggested form for the collection of information showing compliance with... state of applicant's organization, if a juridical entity, the address of its principal place of business...

14 CFR 93.30 - Assignment provisions for domestic and U.S./Canada transborder service.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Assignment provisions for domestic and U.S./Canada transborder service. 93.30 Section 93.30 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION... domestic and U.S./Canada transborder service. (a) Whenever the FAA has determined that sufficient Arrival...

20 CFR 203.1 - Statutory provisions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... property used in the employer's operations, other personal services the rendition of which is integrated... THE ACT § 203.1 Statutory provisions. The term “employee” means (1) any individual in the service of... local lodge or division defined as an employer in sub-section (a) only if he was in the service of or in...

20 CFR 203.1 - Statutory provisions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... property used in the employer's operations, other personal services the rendition of which is integrated... THE ACT § 203.1 Statutory provisions. The term “employee” means (1) any individual in the service of... local lodge or division defined as an employer in sub-section (a) only if he was in the service of or in...

15 CFR 270.204 - Provision of additional resources and services needed by a Team.

Code of Federal Regulations, 2013 CFR

2013-01-01

... services needed by a Team. 270.204 Section 270.204 Commerce and Foreign Trade Regulations Relating to... CONSTRUCTION SAFETY TEAMS NATIONAL CONSTRUCTION SAFETY TEAMS Investigations § 270.204 Provision of additional resources and services needed by a Team. The Director will determine the appropriate resources that a Team...

15 CFR 270.204 - Provision of additional resources and services needed by a Team.

Code of Federal Regulations, 2014 CFR

2014-01-01

... services needed by a Team. 270.204 Section 270.204 Commerce and Foreign Trade Regulations Relating to... CONSTRUCTION SAFETY TEAMS NATIONAL CONSTRUCTION SAFETY TEAMS Investigations § 270.204 Provision of additional resources and services needed by a Team. The Director will determine the appropriate resources that a Team...

15 CFR 270.204 - Provision of additional resources and services needed by a Team.

Code of Federal Regulations, 2012 CFR

2012-01-01

... services needed by a Team. 270.204 Section 270.204 Commerce and Foreign Trade Regulations Relating to... CONSTRUCTION SAFETY TEAMS NATIONAL CONSTRUCTION SAFETY TEAMS Investigations § 270.204 Provision of additional resources and services needed by a Team. The Director will determine the appropriate resources that a Team...

15 CFR 270.204 - Provision of additional resources and services needed by a Team.

Code of Federal Regulations, 2010 CFR

2010-01-01

... services needed by a Team. 270.204 Section 270.204 Commerce and Foreign Trade Regulations Relating to... CONSTRUCTION SAFETY TEAMS NATIONAL CONSTRUCTION SAFETY TEAMS Investigations § 270.204 Provision of additional resources and services needed by a Team. The Director will determine the appropriate resources that a Team...

15 CFR 270.204 - Provision of additional resources and services needed by a Team.

Code of Federal Regulations, 2011 CFR

2011-01-01

... services needed by a Team. 270.204 Section 270.204 Commerce and Foreign Trade Regulations Relating to... CONSTRUCTION SAFETY TEAMS NATIONAL CONSTRUCTION SAFETY TEAMS Investigations § 270.204 Provision of additional resources and services needed by a Team. The Director will determine the appropriate resources that a Team...

42 CFR 5a.1 - Statutory basis and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Statutory basis and purpose. 5a.1 Section 5a.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS RURAL... the Public Health Service Act. These provisions define “underserved rural community” for purposes of...

42 CFR 5a.1 - Statutory basis and purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Statutory basis and purpose. 5a.1 Section 5a.1 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS RURAL... the Public Health Service Act. These provisions define “underserved rural community” for purposes of...

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.

Five-year forward view: lessons from emergency care at the extremes of age.

PubMed

Minhas, J S; Minhas, D; Coats, T; Banerjee, J; Roland, D

2018-03-01

Objective The progressive rise in demand on NHS emergency care resources is partly attributable to increases in attendances of children and older people. A quality gap exists in the care provision for the old and the young. The Five Year Forward View suggested new models of care but that the "answer is not one-size-fits-all". This article discusses the urgent need for person-centred outcome measures to bridge the gap that exists between demand and provision. Design This review is based on evidence gathered from literature searching across several platforms using a variety of search terms to account for the obvious heterogeneity, drawing on key 'think-tank' evidence. Settings Qualitative and quantitative studies examining approaches to caring for individuals at the extremes of age. Participants Individuals at the extremes of age (infants and older people). Main Outcome Measures Understanding similarities and disparities in the care of individuals at the extremes of age in an emergency and non-emergency context. Results There exists several similarities and disparities in the care of individuals at the extremes of age. The increasing burden of health disease on the economy must acknowledge the challenges that exist in managing patients in emergency settings at the extremes of age and build systems to acknowledge the traits these individuals exhibit. Conclusion Commissioners of services must optimise the models of care delivery by appreciating the similarities and differences between care requirements in these two large groups seeking emergency care.

42 CFR 137.167 - What cost principles must a Self-Governance Tribe follow when participating in self-governance...

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Operational Provisions Audits and Cost Principles § 137.167 What... modified by: (a) Section 106 (k) of the Act [25 U.S.C. 450j-1], (b) Other provisions of law, or (c) Any...

A survey of mobile phone use in the provision of palliative care services in the African region and priorities for future development.

PubMed

Allsop, Matthew J; Namisango, Eve; Powell, Richard A

2018-01-01

Introduction Palliative care (PC) services in the African region need to adapt to manage rising numbers of patients with cancer or other life-limiting conditions. Mobile phone use in healthcare delivery (mHealth) is at an early stage of development for PC, but may provide new approaches to supporting patients regionally, particularly those with non-communicable diseases. Methods We conducted an online survey of 51 PC providers across 21 countries in the African region to identify: (i) current mHealth use in PC service delivery; (ii) potential barriers to mHealth use; and (iii) provider priorities for research development. Results mHealth approaches were reported across 71.4% of services in which respondents were based. Barriers to mHealth research include patients not having access to phones, mobile network access, and limited access to expertise and hardware required for mHealth. Research priorities were identified which included exploring ways of incorporating mHealth into patient care and ensuring access and relevance of mHealth for patients and health professionals. Discussion mHealth approaches are present across PC services in the African region, but so too are barriers to their use. Further work is required to explore how existing mHealth activities might be further developed and aligned with priority areas for PC development. Crucially, user engagement that seeks to understand the preferences and priorities of patients with PC needs, their caregivers, and those involved in the provision of PC should remain central to these efforts.

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.

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.

Contracting out of health services in developing countries.

PubMed

McPake, B; Banda, E E

1994-03-01

Contracting out is emerging as a common policy issue in a number of developing countries. The theoretical case for contracting out suggests many advantages in combining public finance with private provision. However, practical difficulties such as those of ensuring that competition takes place between potential contractors, that competition leads to efficiency and that contracts and the process of contracting are effectively managed, suggest that such advantages may not always be realized. Most countries are likely only to contemplate restricted contracting of small-scale non-clinical services in the short term. Prerequisites of more extensive models appear to be the development of information systems and human resources to that end. Some urban areas of larger countries may have the existing preconditions for more successful large-scale contracting.

The evaluation of the National Long Term Care Demonstration. 4. Case management under channeling.

PubMed Central

Phillips, B R; Kemper, P; Applebaum, R A

1988-01-01

The channeling demonstration involved provision of comprehensive case management and direct service expansion. This article considers the former. Under both models, comprehensive case management was implemented largely as intended; moreover, channeling substantially increased the receipt of comprehensive care management. However, channeling was not a pure test of the effect of comprehensive case management: roughly 10-20 percent of control group members received comparable case management services. This was particularly the case for the financial control model. Thus, the demonstration was not a test of case management compared to no case management; rather, it compared channeling case management to the existing community care system, which already was providing comprehensive case management to some of the population eligible for channeling. PMID:3130331

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.

Examining Physical Activity Service Provision to Culturally and Linguistically Diverse (CALD) Communities in Australia: A Qualitative Evaluation

PubMed Central

Caperchione, Cristina M.; Kolt, Gregory S.; Mummery, W. Kerry

2013-01-01

Strong evidence exists for the role of physical activity in preventing and managing a range of chronic health conditions. A particular challenge in promoting physical activity as a health strategy exists in culturally and linguistically diverse (CALD) groups, as such groups demonstrate high risk for a range of non-communicable diseases. The aim of this research was to examine the perspective of multicultural health service providers for CALD groups with respect to the physical activity services/initiatives on offer, access barriers to these services, and ideas for future service delivery in this area. Semi-structured interviews were conducted with 15 multicultural health service providers across the capital cities of the three most populous states in Australia (New South Wales, Queensland, and Victoria), and thematic content analysis was used to examine the data. Findings indicated that the majority of physical activity initiatives were associated with organizations offering other social services for CALD communities but were greatly restrained by resources. As well, it was found that most services were not designed by taking into account specific cultural requirements for CALD communities or their cultural expectations. Common barriers identified to service uptake were classified as socio-cultural (e.g., gender, language, context of health) and environmental (e.g., transportation) in nature. These findings should be utilized when planning future physical activity and health promotion initiatives for increasing CALD participation. In particular, programs need to be culturally tailored to the specific expectations of CALD groups, addressing cultural safety and sensitivity, and should be in partnership with other organizations to extend the reach and capacity. PMID:23638145