Investigating Pre-Service Science Teachers' Critical Thinking Dispositions and Problem Solving Skills in Terms of Different Variables

ERIC Educational Resources Information Center

Yenice, Nilgun

2011-01-01

This study was conducted to examine pre-service science teachers' critical thinking dispositions and problem solving skills based on gender, grade level and graduated high school variables. Also relationship between pre-service science teachers' critical thinking dispositions and problem solving skills was examined based on gender, grade level and…

Effects of service provider attitudes and employment status on citizenship behaviors and customers' attitudes and loyalty behavior.

PubMed

Payne, Stephanie C; Webber, Sheila Simsarian

2006-03-01

The relationship among job satisfaction, affective commitment, service-oriented organizational citizenship behaviors (OCBs), customer satisfaction, and customer loyalty were examined for a sample of 249 hairstylists and 1 of their corresponding customers. Employee satisfaction was positively related to service-oriented OCBs, customer satisfaction, and customer loyalty, whereas affective commitment was not related to these outcomes. The extent to which the predictor variables interacted with one another and the role of employment status on these relationships was also explored. High levels of job satisfaction or affective commitment resulted in more service-oriented OCBs for employees and self-employed workers, whereas high levels of both resulted in more service-oriented OCBs for owners.

Availability and Quality of Family Planning Services in the Democratic Republic of the Congo: High Potential for Improvement.

PubMed

Mpunga, Dieudonné; Lumbayi, J P; Dikamba, Nelly; Mwembo, Albert; Ali Mapatano, Mala; Wembodinga, Gilbert

2017-06-27

To determine the availability and quality of family planning services within health facilities throughout the Democratic Republic of the Congo (DRC). Data were collected for the cross-sectional study from April 2014 to June 2014 by the Ministry of Public Health. A total of 1,568 health facilities that reported data to the National Health Information System were selected by multistage random sampling in the 11 provinces of the DRC existing at that time. Data were collected through interviews, document review, and direct observation. Two dependent variables were measured: availability of family planning services (consisting of a room for services, staff assigned to family planning, and evidence of client use of family planning) and quality of family planning services (assessed as "high" if the facility had at least 1 trained staff member, family planning service delivery guidelines, at least 3 types of methods, and a sphygmomanometer, or "low" if the facility did not meet any of these 4 criteria). Pearson's chi-square test and odds ratios (ORs) were used to test for significant associations, using the alpha significance level of .05. We successfully surveyed 1,555 facilities (99.2%) of those included in the sample. One in every 3 facilities (33%) offered family planning services as assessed by the index of availability, of which 20% met all 4 criteria for providing high-quality services. Availability was greatest at the highest level of the health system (hospitals) and decreased incrementally with each health system level, with disparities between provinces and urban and rural areas. Facilities in urban areas were more likely than in rural areas to meet the standard for high-quality services ( P <.001). Public facilities were less likely than private facilities to have high-quality services ( P =.02). Among all 1,555 facilities surveyed, 14% had at least 3 types of methods available at the time of the survey; the most widely available methods were male condoms, combined oral contraceptive pills, and progestin-only injectable contraceptives. Availability and quality of family planning services in health facilities in the DRC remain low, with inequitable distribution of services throughout the country. To improve access to and use of family planning, efforts should focus on improving availability and quality at lower health system levels and in rural areas where the majority of the population lives. © Mpunga et al.

Towards Dynamic Service Level Agreement Negotiation:An Approach Based on WS-Agreement

NASA Astrophysics Data System (ADS)

Pichot, Antoine; Wäldrich, Oliver; Ziegler, Wolfgang; Wieder, Philipp

In Grid, e-Science and e-Business environments, Service Level Agreements are often used to establish frameworks for the delivery of services between service providers and the organisations hosting the researchers. While this high level SLAs define the overall quality of the services, it is desirable for the end-user to have dedicated service quality also for individual services like the orchestration of resources necessary for composed services. Grid level scheduling services typically are responsible for the orchestration and co-ordination of resources in the Grid. Co-allocation e.g. requires the Grid level scheduler to co-ordinate resource management systems located in different domains. As the site autonomy has to be respected negotiation is the only way to achieve the intended co-ordination. SLAs emerged as a new way to negotiate and manage usage of resources in the Grid and are already adopted by a number of management systems. Therefore, it is natural to look for ways to adopt SLAs for Grid level scheduling. In order to do this, efficient and flexible protocols are needed, which support dynamic negotiation and creation of SLAs. In this paper we propose and discuss extensions to the WS-Agreement protocol addressing these issues.

Service user involvement for mental health system strengthening in India: a qualitative study.

PubMed

Samudre, Sandesh; Shidhaye, Rahul; Ahuja, Shalini; Nanda, Sharmishtha; Khan, Azaz; Evans-Lacko, Sara; Hanlon, Charlotte

2016-07-28

There is a wide recognition that involvement of service users and their caregivers in health system policy and planning processes can strengthen health systems; however, most evidence and experience has come from high-income countries. This study aimed to explore baseline experiences, barriers and facilitators to service user-caregiver involvement in the emerging mental health system in India, and stakeholders' perspectives on how greater involvement could be achieved. A qualitative study was conducted in Sehore district of Madhya Pradesh, India. In-depth interviews (n = 27) and a focus group discussion were conducted among service users, caregivers and their representatives at district, state and national levels and policy makers, service providers and mental health researchers. The topic guide explored the baseline situation in India, barriers and facilitators to service user and caregiver involvement in the following aspects of mental health systems: policy-making and planning, service development, monitoring and quality control, as well as research. Framework analysis was employed. Respondents spoke of the limited involvement of service users and caregivers in the current Indian mental health system. The major reported barriers to this involvement were (1) unmet treatment and economic needs arising from low access to mental health services coupled with the high burden of illness, (2) pervasive stigmatising attitudes operating at the level of service user, caregiver, community, healthcare provider and healthcare administrators, and (3) entrenched power differentials between service providers and service users. Respondents prioritised greater involvement of service users in the planning of their own individual-level mental health care before considering involvement at the mental health system level. A stepwise progression was endorsed, starting from needs assessment, through empowerment and organization of service users and caregivers, leading finally to meaningful involvement. Societal and system level barriers need to be addressed in order to facilitate the involvement of service users and caregivers to strengthen the Indian mental health system. Shifting from a largely 'provider-centric' to a more 'user-centric' model of mental health care may be a fundamental first step to sustainable user involvement at the system level.

Problems and Countermeasures of Zhejiang High-Tech Enterprises Industry-University-Institute Cooperation in China

NASA Astrophysics Data System (ADS)

Zhou, Qing; Mao, Chong-Feng; Hou, Lin

Industry-university-institute cooperation is an important means to accelerate technical development and achievements for high-tech enterprises. Considering that Zhejiang high-tech enterprises existed some problems which included low cooperative level, single distribution, weak secondary R&D ability, obvious risk and so on, government should play an guiding role on improving information service system, enhancing cooperative level, promoting scientific intermediary service organization system construction, and building better environment for Industry-university-institute cooperation.

Appraised leadership styles, psychosocial work factors, and musculoskeletal pain among public employees.

PubMed

Fjell, Ylva; Osterberg, Mia; Alexanderson, Kristina; Karlqvist, Lena; Bildt, Carina

2007-10-01

The main aim of this study was to explore the associations between appraised leadership styles, psychosocial work factors and musculoskeletal pain among subordinates in four different public service sectors from an epidemiological perspective. A cross-sectional questionnaire study was conducted; data from 2,403 public sector employees in subordinate positions (86% women) were analysed. The appraised leadership styles were measured through items from a modified version of the CPE questionnaire (C change, P production/structure, E employee/relation). The structure validity of the CPE-model was examined by principal component analysis (PCA). Univariate and multivariate analyses of associations between levels of musculoskeletal pain and appraised leadership styles and with psychosocial work factors were conducted. Odds ratios (ORs) with confidence intervals (CIs) of 95% were used as a measure of associations. There were small variations in the appraisals of the immediate manager among the subordinates. However, the associations between musculoskeletal pain and leadership styles varied according to sector. Poor appraisals (low scores) on "change" and "employee relation" dimensions were associated with high levels of musculoskeletal pain in two sectors: home and health care services. In the domestic catering services, poor appraisals of managers in the "production/structure" dimension had the strongest association with high levels of pain. In general, poor appraisals of the "change" dimension was most strongly associated with high levels of musculoskeletal pain. "High work demands" had the strongest association with high levels of pain, particularly among the men. Poor appraisals of managers and their leadership styles were associated with high levels of musculoskeletal pain among both female and male subordinates in different public service sectors. There is therefore a great need of further studies of the mechanisms behind the relationships between the leadership styles and their impact on health among the genders.

Unmet needs for healthcare and social support services in patients with Huntington's disease: a cross-sectional population-based study.

PubMed

van Walsem, Marleen R; Howe, Emilie I; Iversen, Kristin; Frich, Jan C; Andelic, Nada

2015-09-28

In order to plan and improve provision of comprehensive care in Huntington's disease (HD), it is critical to understand the gaps in healthcare and social support services provided to HD patients. Research has described utilization of healthcare services in HD in Europe, however, studies systematically examining needs for healthcare services and social support are lacking. This study aims to identify the level and type of met and unmet needs for health and social care services among patients with HD, and explore associated clinical and socio-demographic factors. Eighty-six patients with a clinical diagnosis of HD living in the South-Eastern region of Norway were recruited. Socio-demographic and clinical characteristics were collected. The Needs and Provision Complexity Scale (NPCS) was used to assess the patients' needs for healthcare and social services. Functional ability and disease stage was assessed using the UHDRS Functional assessment scales. In order to investigate factors determining the level of total unmet needs and the level of unmet needs for Health and personal care and Social care and support services, multivariate logistic regression models were used. A high level of unmet needs for health and personal care and social support services were found across all five disease stages, but most marked in disease stage III. The middle phase (disease stage III) and advanced phase (disease stages IV and V) of HD increased odds of having a high level of total unmet needs by 3.5 times and 1.4 times respectively, compared with the early phase (disease stages I and II). Similar results were found for level of unmet needs in the domain Health and personal care. Higher education tended to decrease odds of high level of unmet needs in this domain (OR = 0.48) and increase odds of higher level of unmet needs in the domain of Social care and support (OR = 1.3). Patients reporting needs on their own tended to decrease odds of having unmet needs in Health and personal care (OR = 0.57). Needs for healthcare and social services in patients with HD should be assessed in a systematic manner, in order to provide adequate comprehensive care during the course of disease.

XML-based data model and architecture for a knowledge-based grid-enabled problem-solving environment for high-throughput biological imaging.

PubMed

Ahmed, Wamiq M; Lenz, Dominik; Liu, Jia; Paul Robinson, J; Ghafoor, Arif

2008-03-01

High-throughput biological imaging uses automated imaging devices to collect a large number of microscopic images for analysis of biological systems and validation of scientific hypotheses. Efficient manipulation of these datasets for knowledge discovery requires high-performance computational resources, efficient storage, and automated tools for extracting and sharing such knowledge among different research sites. Newly emerging grid technologies provide powerful means for exploiting the full potential of these imaging techniques. Efficient utilization of grid resources requires the development of knowledge-based tools and services that combine domain knowledge with analysis algorithms. In this paper, we first investigate how grid infrastructure can facilitate high-throughput biological imaging research, and present an architecture for providing knowledge-based grid services for this field. We identify two levels of knowledge-based services. The first level provides tools for extracting spatiotemporal knowledge from image sets and the second level provides high-level knowledge management and reasoning services. We then present cellular imaging markup language, an extensible markup language-based language for modeling of biological images and representation of spatiotemporal knowledge. This scheme can be used for spatiotemporal event composition, matching, and automated knowledge extraction and representation for large biological imaging datasets. We demonstrate the expressive power of this formalism by means of different examples and extensive experimental results.

Restriction of therapy mainly explains lower thrombolysis rates in reduced stroke service levels.

PubMed

Gumbinger, Christoph; Reuter, Björn; Hacke, Werner; Sauer, Tamara; Bruder, Ingo; Diehm, Curt; Wiethölter, Horst; Schoser, Karin; Daffertshofer, Michael; Neumaier, Stephan; Drewitz, Elke; Rode, Susanne; Kern, Rolf; Hennerici, Michael G; Stock, Christian; Ringleb, Peter

2016-05-24

To assess the influence of preexisting disabilities, age, and stroke service level on standardized IV thrombolysis (IVT) rates in acute ischemic stroke (AIS). We investigated standardized IVT rates in a retrospective registry-based study in 36,901 patients with AIS from the federal German state Baden-Wuerttemberg over a 5-year period. Patients admitted within 4.5 hours after stroke onset were selected. Factors associated with IVT rates (patient-level factors and stroke service level) were assessed using robust Poisson regression modeling. Interactions between factors were considered to estimate risk-adjusted mortality rates and potential IVT rates by service level (with stroke centers as benchmark). Overall, 10,499 patients (28.5%) received IVT. The IVT rate declined with service level from 44.0% (stroke center) to 13.1% (hospitals without stroke unit [SU]). Especially patients >80 years of age and with preexisting disabilities had a lower chance of being treated with IVT at lower stroke service levels. Interactions between stroke service level and age group, preexisting disabilities, and stroke severity (all p < 0.0001) were observed. High IVT rates seemed not to increase mortality. Estimated potential IVT rates ranged between 41.9% and 44.6% depending on stroke service level. Differences in IVT rates among stroke service levels were mainly explained by differences administering IVT to older patients and patients with preexisting disabilities. This indicates considerable further potential to increase IVT rates. Our findings support guideline recommendations to admit acute stroke patients to SUs. © 2016 American Academy of Neurology.

Research of three level match method about semantic web service based on ontology

NASA Astrophysics Data System (ADS)

Xiao, Jie; Cai, Fang

2011-10-01

An important step of Web service Application is the discovery of useful services. Keywords are used in service discovery in traditional technology like UDDI and WSDL, with the disadvantage of user intervention, lack of semantic description and low accuracy. To cope with these problems, OWL-S is introduced and extended with QoS attributes to describe the attribute and functions of Web Services. A three-level service matching algorithm based on ontology and QOS in proposed in this paper. Our algorithm can match web service by utilizing the service profile, QoS parameters together with input and output of the service. Simulation results shows that it greatly enhanced the speed of service matching while high accuracy is also guaranteed.

Accessibility of Catering Service Venues and Adolescent Drinking in Beijing, China.

PubMed

Lu, Shijun; Du, Songming; Ren, Zhoupeng; Zhao, Jing; Chambers, Christina; Wang, Jinfeng; Ma, Guansheng

2015-06-26

This study assessed the association between accessibility of catering service venues and adolescents' alcohol use over the previous 30 days. The data were collected from cross-sectional surveys conducted in 2014, 2223 students at 27 high schools in Chaoyang and Xicheng districts, Beijing using self-administered questionnaires to collect the adolescents information on socio-demographic characteristics and recent alcohol experiences. The accessibility of, and proximity to, catering service venues were summarized by weights, which were calculated by multiplication of the type-weight and the distance-weight. All sampled schools were categorized into three subgroups (low, middle, and high geographic density) based on the tertile of nearby catering service venues, and a multi-level logistic regression analysis was performed to explore variance between the school levels. Considering the setting characteristics, the catering service venues weighted value was found to account for 8.6% of the school level variance of adolescent alcohol use. The odds ratios (OR) and 95% confidence intervals (CI) of drinking over the past 30-days among adolescents with medium and high accessibility of catering service venues were 1.17 (0.86, 1.57) and 1.47 (1.06, 2.02), respectively (p < 0.001 for trend test). This study addressed a gap in the adolescent drinking influence by the catering service venues around schools in China. Results suggest that the greater accessibility of catering service venues around schools is associated with a growing risk of recent drinking.

Accessibility of Catering Service Venues and Adolescent Drinking in Beijing, China

PubMed Central

Lu, Shijun; Du, Songming; Ren, Zhoupeng; Zhao, Jing; Chambers, Christina; Wang, Jinfeng; Ma, Guansheng

2015-01-01

This study assessed the association between accessibility of catering service venues and adolescents’ alcohol use over the previous 30 days. The data were collected from cross-sectional surveys conducted in 2014, 2223 students at 27 high schools in Chaoyang and Xicheng districts, Beijing using self-administered questionnaires to collect the adolescents information on socio-demographic characteristics and recent alcohol experiences. The accessibility of, and proximity to, catering service venues were summarized by weights, which were calculated by multiplication of the type-weight and the distance-weight. All sampled schools were categorized into three subgroups (low, middle, and high geographic density) based on the tertile of nearby catering service venues, and a multi-level logistic regression analysis was performed to explore variance between the school levels. Considering the setting characteristics, the catering service venues weighted value was found to account for 8.6% of the school level variance of adolescent alcohol use. The odds ratios (OR) and 95% confidence intervals (CI) of drinking over the past 30-days among adolescents with medium and high accessibility of catering service venues were 1.17 (0.86, 1.57) and 1.47 (1.06, 2.02), respectively (p < 0.001 for trend test). This study addressed a gap in the adolescent drinking influence by the catering service venues around schools in China. Results suggest that the greater accessibility of catering service venues around schools is associated with a growing risk of recent drinking. PMID:26132475

Incorporating threat in hotspots and coldspots of biodiversity and ecosystem services.

PubMed

Schröter, Matthias; Kraemer, Roland; Ceauşu, Silvia; Rusch, Graciela M

2017-11-01

Spatial prioritization could help target conservation actions directed to maintain both biodiversity and ecosystem services. We delineate hotspots and coldspots of two biodiversity conservation features and five regulating and cultural services by incorporating an indicator of 'threat', i.e. timber harvest profitability for forest areas in Telemark (Norway). We found hotspots, where high values of biodiversity, ecosystem services and threat coincide, ranging from 0.1 to 7.1% of the area, depending on varying threshold levels. Targeting of these areas for conservation follows reactive conservation approaches. In coldspots, high biodiversity and ecosystem service values coincide with low levels of threat, and cover 0.1-3.4% of the forest area. These areas might serve proactive conservation approaches at lower opportunity cost (foregone timber harvest profits). We conclude that a combination of indicators of biodiversity, ecosystem services and potential threat is an appropriate approach for spatial prioritization of proactive and reactive conservation strategies.

Rates of trauma-informed counseling at substance abuse treatment facilities: reports from over 10,000 programs.

PubMed

Capezza, Nicole M; Najavits, Lisa M

2012-04-01

Trauma-informed treatment increasingly is recognized as an important component of service delivery. This study examined differences in treatment-related characteristics of facilities that offer moderate or high levels of trauma-informed counseling versus those that offer no or low levels of such counseling. Responses from 13,223 substance abuse treatment facilities surveyed in 2009 by the National Survey of Substance Abuse Treatment Services (NSSATS) were used. A majority (66.6%) of facilities reported using trauma counseling sometimes or always or often. Facilities that provided moderate or high levels of trauma counseling were more likely to provide additional treatment services, such as disease testing and specialized group therapy, as well as child care, employment counseling, and other ancillary services. A majority of facilities reported provision of trauma counseling. Additional training and resources may be needed for programs that reported low rates of trauma counseling.

A Strategic Decision Matrix for Analyzing Food Service Operations at Air Force Bases

DTIC Science & Technology

2006-12-01

substitute product can replace your product, for example high - fructose corn syrup can substitute for sugar. Substitutes may negatively affect...dining facility closed and receive BAS. Customers can be happy with customer service and the quality of the food (a high customer satisfaction level...Services squadron may achieve significant cost savings by pursuing the NAF MOA but must also weigh the dollar savings against the threat of high

A Lane-Level LBS System for Vehicle Network with High-Precision BDS/GPS Positioning

PubMed Central

Guo, Chi; Guo, Wenfei; Cao, Guangyi; Dong, Hongbo

2015-01-01

In recent years, research on vehicle network location service has begun to focus on its intelligence and precision. The accuracy of space-time information has become a core factor for vehicle network systems in a mobile environment. However, difficulties persist in vehicle satellite positioning since deficiencies in the provision of high-quality space-time references greatly limit the development and application of vehicle networks. In this paper, we propose a high-precision-based vehicle network location service to solve this problem. The major components of this study include the following: (1) application of wide-area precise positioning technology to the vehicle network system. An adaptive correction message broadcast protocol is designed to satisfy the requirements for large-scale target precise positioning in the mobile Internet environment; (2) development of a concurrence service system with a flexible virtual expansion architecture to guarantee reliable data interaction between vehicles and the background; (3) verification of the positioning precision and service quality in the urban environment. Based on this high-precision positioning service platform, a lane-level location service is designed to solve a typical traffic safety problem. PMID:25755665

A spatial model to quantify the mortality impact of service delivery in Sub-Saharan Africa: an ecological design utilizing data from South Africa

PubMed Central

2013-01-01

Background Sub Saharan Africa is confronted with a wide range of interlinked health and economic problems that include high levels of mortality and poor service delivery. The objective of the paper is to develop a spatial model for Sub-Saharan Africa that can quantify the mortality impact of (poor) service delivery at sub-district level in order to integrate related health and local level policy interventions. In this regard, an expanded composite service delivery index was developed, and the data were analysed using a Bayesian Poisson spatial model. Results The results indicate significant differences in the risk of mortality and poor service delivery at sub-district level. In particular, the results indicate clusters of high mortality and poor service delivery in two of the bigger, poorer provinces with large rural communities. Conversely, two of the wealthier provinces have lower levels of mortality and higher levels of service delivery, but income inequality is more widespread. The bivariate and multivariate models, moreover, reflect significant positive linkages (p < 0.01) between increased mortality and poor service delivery after adjusting for HIV/AIDS, income inequality, population density and the protective influence of metropolitan areas. Finally, the hypothesized provision of a basket of services reduced the mortality rate in South Africa’s 248 sub-districts by an average of 5.3 (0.3-15.4) deaths per 1000. Conclusion The results indicate that the model can accurately plot mortality and service delivery “hotspots’ at sub-district level, as well as explain their associations and causality. A mortality reduction index shows that mortality in the highest risk sub-districts can be reduced by as much as 15.4 deaths per 1000 by providing a range of basic services. The ability to use the model in a wider SSA context and elsewhere is also feasible given the innovative use of available databases. Finally, the paper illustrates the importance of developing policy in SSA that can simultaneously solve both economic and health problems. PMID:23425437

A spatial model to quantify the mortality impact of service delivery in Sub-Saharan Africa: an ecological design utilizing data from South Africa.

PubMed

Sartorius, Kurt; Sartorius, Benn K D

2013-02-20

Sub Saharan Africa is confronted with a wide range of interlinked health and economic problems that include high levels of mortality and poor service delivery. The objective of the paper is to develop a spatial model for Sub-Saharan Africa that can quantify the mortality impact of (poor) service delivery at sub-district level in order to integrate related health and local level policy interventions. In this regard, an expanded composite service delivery index was developed, and the data were analysed using a Bayesian Poisson spatial model. The results indicate significant differences in the risk of mortality and poor service delivery at sub-district level. In particular, the results indicate clusters of high mortality and poor service delivery in two of the bigger, poorer provinces with large rural communities. Conversely, two of the wealthier provinces have lower levels of mortality and higher levels of service delivery, but income inequality is more widespread. The bivariate and multivariate models, moreover, reflect significant positive linkages (p < 0.01) between increased mortality and poor service delivery after adjusting for HIV/AIDS, income inequality, population density and the protective influence of metropolitan areas. Finally, the hypothesized provision of a basket of services reduced the mortality rate in South Africa's 248 sub-districts by an average of 5.3 (0.3-15.4) deaths per 1000. The results indicate that the model can accurately plot mortality and service delivery "hotspots' at sub-district level, as well as explain their associations and causality. A mortality reduction index shows that mortality in the highest risk sub-districts can be reduced by as much as 15.4 deaths per 1000 by providing a range of basic services. The ability to use the model in a wider SSA context and elsewhere is also feasible given the innovative use of available databases. Finally, the paper illustrates the importance of developing policy in SSA that can simultaneously solve both economic and health problems.

Contextual Predictors of Mental Health Service Use Among Children Open to Child Welfare

PubMed Central

Leslie, Laurel K.; Landsverk, John; Barth, Richard P.; Burns, Barbara J.; Gibbons, Robert D.; Slymen, Donald J.; Zhang, Jinjin

2006-01-01

Background Children involved with child welfare systems are at high risk for emotional and behavioral problems. Many children with identified mental health problems do not receive care, especially ethnic/minority children. Objective To examine how patterns of specialty mental health service use among children involved with child welfare vary as a function of the degree of coordination between local child welfare and mental health agencies. Design Specialty mental health service use for 1 year after contact with child welfare was examined in a nationally representative cohort of children aged 2 to 14 years. Predictors of service use were modeled at the child/family and agency/county levels. Child- and agency-level data were collected between October 15,1999, and April 30, 2001. Setting Ninety-seven US counties. Participants A total of 2823 child welfare cases (multiple informants) from the National Survey of Child and Adolescent Well-being and agency-level key informants from the participating counties. Main Outcome Measures Specialty mental health service use during the year after contact with the child welfare system. Results Only 28.3% of children received specialty mental health services during the year, although 42.4% had clinical-level Child Behavior Checklist scores. Out-of-home placement, age, and race/ethnicity were strong predictors of service use rates, even after controlling for Child Behavior Checklist scores. Increased coordination between local child welfare and mental health agencies was associated with stronger relationships between Child Behavior Checklist scores and service use and decreased differences in rates of service use between white and African American children. Conclusions Younger children and those remaining in their homes could benefit from increased specialty mental health services. They have disproportionately low rates of service use, despite high levels of need. Increases in interagency coordination may lead to more efficient allocation of service resources to children with the greatest need and to decreased racial/ethnic disparities. PMID:15583113

Oregon School-Based Health Centers, 1992-1994 Services Report.

ERIC Educational Resources Information Center

Nystrom, Robert J.

This report describes the activities of Oregon's 25 high school-based health centers between 1992 and 1994. Information is provided on funding sources, services offered (including general medical services and reproductive health, mental health, health promotion services, and hours of operation), staffing (including levels of staffing and…

An Examination of Organizations' Frontline Service Employee Development Practices

ERIC Educational Resources Information Center

Ellinger, Alexander E.; Elmadag, Ayse Banu; Ellinger, Andrea D.

2007-01-01

Firms with the ability to provide superior customer service can accrue significant competitive advantage and research suggests that frontline service employees' (FLSEs) actions have a considerable influence on the success of service operations. Yet, the high level of customer defections consistently attributed to poor and indifferent service…

[How are consumers, service and market factors related to customer loyalty in medical service? Targeting the medical consumer in a city].

PubMed

Lee, Sunhee; Kim, Hyunmi; Kim, Juhye; Ha, Gwiyeom

2008-09-01

This study was performed to explore customer loyalty and the related factors. 900 households (a 1% sample) were randomly selected from the total population of K city located in Kangwon province. An interview survey was performed with using a structured questionnaire for the subjects (923 persons) who had used medical service during the year before the survey, and the survey was done September, 2002. When comparing the relating factors related with customer loyalty according to the sociodemographic characteristics, the older group showed a significantly higher level of recognition for service quality, service reputation, internal customers.attitudes and switching cost. The lower income group showed a higher level of recognition for service quality, service image and switching cost. The lower educated group showed a higher level of recognition for service reputation, service image and internal customers.attitudes. The higher educated group showed a higher level of recognition for perceived risk, and seeking variety. In addition, the expert group or the service and manufacturing workers group showed a higher level of recognition for service involvement. On multiple regression analysis, internal customers' attitudes, service image, service reputation, service quality, switching cost, and substitutability showed significant relations with customer loyalty. This study showed that customer loyalty was significantly influenced by service factors like internal customers' attitudes, service image, service reputation, and service quality, and by market factors like switching cost, and substitutability. The results of this study can be used as a baseline for developing strategies to create and keep customers with high loyalty.

General practitioner services in primary care groups in England: is there inequity between service availability and population need?

PubMed

Baker, D; Hann, M

2001-06-01

This study examined the coverage of minor surgery, child health surveillance and chronic disease management for asthma and diabetes in relation to population need and key organisational features of general practice in the 481 primary care groups (PCGs) in England. PCG-level summary scores were developed to estimate the relative availability of all four services and their relative importance in discriminating between high and low levels of service provision. The coverage of services was widespread and, in such circumstances, there was no systematic evidence of poorer service availability for PCGs with higher population need (the 'inverse care' law). Rather this relation was localised, being most predominant for PCGs covering London and its suburbs. In these PCGs, there was no association between indicators of lack of capacity, such as single-handed practice, and levels of service provision.

Skill sharing and delegation practice in two Queensland regional allied health cancer care services: a comparison of tasks.

PubMed

Passfield, Juanine; Nielsen, Ilsa; Brebner, Neil; Johnstone, Cara

2017-07-24

Objective Delegation and skill sharing are emerging service strategies for allied health (AH) professionals working in Queensland regional cancer care services. The aim of the present study was to describe the consistency between two services for the types and frequency of tasks provided and the agreement between teams in the decision to delegate or skill share clinical tasks, thereby determining the potential applicability to other services. Methods Datasets provided by two similar services were collated. Descriptive statistical analyses were used to assess the extent of agreement. Results In all, 214 tasks were identified as being undertaken by the services (92% agreement). Across the services, 70 tasks were identified as high frequency (equal to or more frequently than weekly) and 29 as not high frequency (46% agreement). Of the 68 tasks that were risk assessed, agreement was 66% for delegation and 60% for skill sharing, with high-frequency and intervention tasks more likely to be delegated. Conclusions Strong consistency was apparent for the clinical tasks undertaken by the two cancer care AH teams, with moderate agreement for the frequency of tasks performed. The proportion of tasks considered appropriate for skill sharing and/or delegation was similar, although variation at the task level was apparent. Further research is warranted to examine the range of factors that affect the decision to skill share or delegate. What is known about the topic? There is limited research evidence regarding the use of skill sharing and delegation service models for AH in cancer care services. In particular, the extent to which decisions about task safety and appropriateness for delegation or skill sharing can be generalised across services has not been investigated. What does this paper add? This study investigated the level of clinical task consistency between two similar AH cancer care teams in regional centres. It also examined the level of agreement with regard to delegation and skill sharing to provide an indication of the level of local service influence on workforce and service model decisions. What are the implications for practitioners? Local factors have a modest influence on delegation and skill sharing decisions of AH teams. Practitioners need to be actively engaged in decision making at the local level to ensure the clinical service model meets local needs. However, teams should also capitalise on commonalities between settings to limit duplication of training and resource development through collaborative networks.

Small rural emergency services can electronically collect accurate episode-level data: A cross-sectional study.

PubMed

Dawson, Samantha L; Baker, Tim; Salzman, Scott

2015-04-01

There is little evidence that useful electronic data could be collected at Australian small rural emergency services. If in future their funding model changed to the Activity-Based Funding model, then they would need to collect and submit more data. We determine whether it is possible to collect episode-level data at six small rural emergency services and quantify the accuracy of eight fields. A prospective cross-sectional study. South-West Victoria, Australia. Six small rural emergency services. We collected and audited episode-level emergency data from participating services between 1 February 2011 and 31 January 2012. A random sample of these data were audited monthly. Research assistants located at each service supported data entry and audited data accuracy for four hours per week. Rates for data completeness, accuracy and total accuracy were calculated using audit data. Episode-level data were collected for 20 224 presentations across six facilities. The audit dataset consisted of 8.5% (1504/17 627) of presentations from five facilities. For all fields audited, the accuracy of entered data was high (>93%).Triage category was deemed appropriate for 95.9% (95% confidence interval (CI): 94.9-96.9%) of the patient records reviewed. Some procedures were missing (28.7%, 95%CI: 27.2-30.3%). No significant improvement in data accuracy over 12 months was observed. All six services collected useful episode-level data for 12-months with four hours per week of assistance. Data entry accuracy was high for all fields audited, and data entry completeness was low for procedures. © 2015 National Rural Health Alliance Inc.

Virtual in-service training from the librarians' point of view in libraries of medical sciences universities in Tehran.

PubMed

Mohaghegh, Niloofar; Raiesi Dehkordi, Puran; Alibeik, MohammadReza; Ghashghaee, Ahmad; Janbozorgi, Mojgan

2016-01-01

Background: In-service training courses are one of the most available programs that are used to improve the quantity and quality level of the staff services in various organizations, including libraries and information centers. With the advent of new technologies in the field of education, the problems and shortcomings of traditional in-service training courses were replaced with virtual ones. This study aimed to evaluate the virtual in-service training courses from the librarians' point of view in libraries of state universities of medical sciences in Tehran. Methods: This was a descriptive- analytical study. The statistical population consisted of all librarians at libraries of universities of medical sciences in Tehran. Out of 103 librarians working in the libraries under the study, 93 (90%) participated in this study. Data were collected, using a questionnaire. Results: The results revealed that 94/6% of librarians were satisfied to participate in virtual in-service training courses. In this study, only 45 out of 93 participants said that the virtual in-service courses were held in their libraries. Of the participants, 75.6% were satisfied with the length of training courses, and one month seemed to be adequate time duration for the librarians to be more satisfied. The satisfaction level of the individuals who participated in in-service courses of the National Library was moderate to high. A total of 84.4% participants announced that the productivity level of the training courses was moderate to high. The most important problem with which the librarians were confronted in virtual in-service training was the "low speed of the internet and inadequate computer substructures". Conclusion: Effectiveness of in-service training courses from librarians' point of view was at an optimal level in the studied libraries.

Virtual in-service training from the librarians' point of view in libraries of medical sciences universities in Tehran

PubMed Central

Mohaghegh, Niloofar; Raiesi Dehkordi, Puran; Alibeik, MohammadReza; Ghashghaee, Ahmad; Janbozorgi, Mojgan

2016-01-01

Background: In-service training courses are one of the most available programs that are used to improve the quantity and quality level of the staff services in various organizations, including libraries and information centers. With the advent of new technologies in the field of education, the problems and shortcomings of traditional in-service training courses were replaced with virtual ones. This study aimed to evaluate the virtual in-service training courses from the librarians' point of view in libraries of state universities of medical sciences in Tehran. Methods: This was a descriptive- analytical study. The statistical population consisted of all librarians at libraries of universities of medical sciences in Tehran. Out of 103 librarians working in the libraries under the study, 93 (90%) participated in this study. Data were collected, using a questionnaire. Results: The results revealed that 94/6% of librarians were satisfied to participate in virtual in-service training courses. In this study, only 45 out of 93 participants said that the virtual in-service courses were held in their libraries. Of the participants, 75.6% were satisfied with the length of training courses, and one month seemed to be adequate time duration for the librarians to be more satisfied. The satisfaction level of the individuals who participated in in-service courses of the National Library was moderate to high. A total of 84.4% participants announced that the productivity level of the training courses was moderate to high. The most important problem with which the librarians were confronted in virtual in-service training was the "low speed of the internet and inadequate computer substructures". Conclusion: Effectiveness of in-service training courses from librarians’ point of view was at an optimal level in the studied libraries. PMID:28491833

Pre-Service Science Teachers' Reflective Thinking Skills toward Problem Solving

ERIC Educational Resources Information Center

Can, Sendil

2015-01-01

The purpose of the present study is to investigate the pre-service science teachers' reflective thinking skills toward problem solving and the effects of gender, grade level, academic achievement, type of graduated high school and father and mother's education level on these skills. The study was conducted through the survey method with the…

Spatial Skill Profile of Mathematics Pre-Service Teachers

NASA Astrophysics Data System (ADS)

Putri, R. O. E.

2018-01-01

This study is aimed to investigate the spatial intelligence of mathematics pre-service teachers and find the best instructional strategy that facilitates this aspect. Data were collected from 35 mathematics pre-service teachers. The Purdue Spatial Visualization Test (PSVT) was used to identify the spatial skill of mathematics pre-service teachers. Statistical analysis indicate that more than 50% of the participants possessed spatial skill in intermediate level, whereas the other were in high and low level of spatial skill. The result also shows that there is a positive correlation between spatial skill and mathematics ability, especially in geometrical problem solving. High spatial skill students tend to have better mathematical performance compare to those in two other levels. Furthermore, qualitative analysis reveals that most students have difficulty in manipulating geometrical objects mentally. This problem mostly appears in intermediate and low-level spatial skill students. The observation revealed that 3-D geometrical figures is the best method that can overcome the mentally manipulation problem and develop the spatial visualization. Computer application can also be used to improve students’ spatial skill.

The Association Between Higher Social Support and Lower Depressive Symptoms Among Aging Services Clients is Attenuated at Higher Levels of Functional Impairment

PubMed Central

Van Orden, Kimberly A.; Yan, Li; Podgorski, Carol A.; Conwell, Yeates

2015-01-01

Objective Adults seeking services from the Aging Services Provider Network (ASPN) are at risk for depression. ASPN clients also have high prevalence of both functional impairments and social morbidities. Study of the relationships between these factors may inform the development of interventions for depression in this service setting. Methods We interviewed 373 older adults accessing ASPN services and assessed depression symptom severity, functional impairment (instrumental activities of daily living and activities of daily living), and social support. Results Lower social support and greater functional impairment were associated with greater depressive symptoms. At a high level of functional impairment, the inverse associations between indices of social support and depressive symptoms were attenuated. Conclusions Results suggest that older adults with more severe functional impairment may benefit somewhat less from increased social support with respect to depression symptom severity. PMID:25663607

Mental health, service use and social capital among Indian-Australians: findings of a wellbeing survey.

PubMed

Maheshwari, Rajesh; Steel, Zachary

2012-10-01

Indian-Australians represent a distinct immigrant group both demographically and culturally. Yet, despite an expanding body of research on transcultural mental health in Australia, there is a paucity of studies regarding mental health of Indian-Australians. This paper explores the extent of psychological morbidity and related service use in a representative sample of Indian-Australians. It further examines the association of mental health with social participation and networking in this ethnic community. Measures to assess current levels of psychological distress, functional disability, service use, and social capital were administered in a random sample of 71 Indian-Australian family groups living in Sydney. Amongst participants, 15% reported high to very high levels of psychological distress. Psychological distress was associated with increased days of functional disability and higher levels of functional impairment, and an increased likelihood of a GP consultation. However, 91% of participants with identifiable mental health needs did not seek any mental health consultation. Social capital was not found to be a significant predictor of psychological health or service use in this sample. Psychological morbidity in the Indian-Australian community is associated with high levels of functional disability, both in number of days and extent of severity, but only a small proportion seeks mental health help.

77 FR 45471 - White House Initiative on Educational Excellence for African Americans

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-01

... safe and healthy environments, and have access to high-level, rigorous course work and support services...-rounded education in safe and healthy environments, as well as access to support services, which will... system. African Americans lack equal access to highly effective teachers and principals, safe schools...

Mobilization for HIV Voluntary Counseling and Testing Services in Vietnam: Clients' Risk Behaviors, Attitudes and Willingness to Pay.

PubMed

Nguyen, Long Hoang; Tran, Bach Xuan; Nguyen, Nhung Phuong; Phan, Huong Thu Thi; Bui, Trang Thu; Latkin, Carl A

2016-04-01

A multi-site survey was conducted on a sample of 365 clients to assess their willingness to pay for HIV voluntary counseling and testing (VCT) services in Ha Noi and Nam Dinh province, two epicenters of Vietnam. By using contingent valuation technique, the results showed that most of respondents (95.1 %) were willing to pay averagely 155 (95 % CI 132-177) thousands Vietnam Dong (~US $7.75, 2013) for a VCT service. Clients who were female, had middle income level, and current opioid users were willing to pay less; meanwhile clients who had university level of education were willing to pay more for a VCT service. The results highlighted the high rate of willingness to pay for the service at a high amount by VCT clients. These findings contribute to the implementation of co-payment scheme for VCT services toward the financial sustainability of HIV/AIDS programs in Vietnam.

A Study of Teachers' Perceptions of School-Level Factors Affecting Transition Services

ERIC Educational Resources Information Center

Lazaroff, Kurt Charles

2013-01-01

The purpose of this study was to explore teacher perceptions of providing transition services to high school students with special needs and to understand the variables that act as facilitators or barriers to providing those services. A qualitative research method was used to understand the perceptions of school personnel of transition services in…

Quality Assessment of University Studies as a Service: Dimensions and Criteria

ERIC Educational Resources Information Center

Pukelyte, Rasa

2010-01-01

This article reviews a possibility to assess university studies as a service. University studies have to be of high quality both in their content and in the administrative level. Therefore, quality of studies as a service is an important constituent part of study quality assurance. When assessing quality of university studies as a service, it is…

NEXUS - Resilient Intelligent Middleware

NASA Astrophysics Data System (ADS)

Kaveh, N.; Hercock, R. Ghanea

Service-oriented computing, a composition of distributed-object computing, component-based, and Web-based concepts, is becoming the widespread choice for developing dynamic heterogeneous software assets available as services across a network. One of the major strengths of service-oriented technologies is the high abstraction layer and large granularity level at which software assets are viewed compared to traditional object-oriented technologies. Collaboration through encapsulated and separately defined service interfaces creates a service-oriented environment, whereby multiple services can be linked together through their interfaces to compose a functional system. This approach enables better integration of legacy and non-legacy services, via wrapper interfaces, and allows for service composition at a more abstract level especially in cases such as vertical market stacks. The heterogeneous nature of service-oriented technologies and the granularity of their software components makes them a suitable computing model in the pervasive domain.

Measuring change in health status of older adults at the population level: the transition probability model.

PubMed

Moineddin, Rahim; Nie, Jason X; Wang, Li; Tracy, C Shawn; Upshur, Ross E G

2010-11-09

The current demographic transition will lead to increasing demands on health services. However, debate exists as to the role age plays relative to co-morbidity in terms of health services utilization. While age has been identified as a critical factor in health services utilization, health services utilization is not simply an outcome of ill health, nor is it an inevitable outcome of aging. Most data on health service utilization studies assess utilization at one point in time, and does not examine transitions in health service utilization. We sought to measure health services utilization and to investigate patterns in the transition of levels of utilization and outcomes associated with different levels of utilization. We conducted a population-based retrospective cohort study of all Ontario residents aged 65+ eligible for public healthcare coverage from January 1998-December 2006. The main outcome measure was total number of utilization events. The total is computed by summing, on a per annum basis, the number of family physician visits, specialist visits, Emergency Department visits, drug claims, lab claims, X-rays, CT scans, MRI scans, and inpatient admissions. Three categories of utilization were created: low, moderate, and high. There is heterogeneity in health services utilization across the late lifespan. Utilization increased consistently in the 9-year study period. The probability of remaining at the high utilization category when the person was in the high category the previous year was more than 0.70 for both males and females and for all age groups. Overall healthcare utilization increases more rapidly among the high users compared to the low users. There was negligible probability for moving from high to low utilization category. Probability of death increased exponentially as age increased. Older adults in the low utilization category had the lowest probability of death. The number of male nonagenarians increased more rapidly than female nonagenarians. There are measurable and identifiable differences in the patterns of health services utilization among older adults. This data will permit clinicians and policy makers to tailor interventions appropriate to the risk class of patients.

The impact of technological intensity of service provision on physician expenditures: an exploratory investigation.

PubMed

Roham, Mehrdad; Gabrielyan, Anait R; Archer, Norman P; Grignon, Michel L; Spencer, Byron G

2014-10-01

Advances in technology and subsequent changes in clinical practice can lead to increases in healthcare costs. Our objective is to assess the impact that changes in the technological intensity of physician-provided health services have had on the age pattern of both the volume of services provided and the average expenditures associated with them. We based our analysis on age-sex-specific patient-level administrative records of diagnoses and treatments. These records include virtually all physician services provided in the province of Ontario, Canada in a 10-year span ending in 2004 and their associated costs. An algorithm is developed to classify services and their costs into three levels of technological intensity. We find that while the overall age-standardized level and cost of services per capita have decreased, the volume and cost of high technologically intensive treatments have increased, especially among older patients. Copyright © 2013 John Wiley & Sons, Ltd.

Availability and Quality of Family Planning Services in the Democratic Republic of the Congo: High Potential for Improvement

PubMed Central

Mpunga, Dieudonné; Lumbayi, JP; Dikamba, Nelly; Mwembo, Albert; Ali Mapatano, Mala; Wembodinga, Gilbert

2017-01-01

Objective: To determine the availability and quality of family planning services within health facilities throughout the Democratic Republic of the Congo (DRC). Methods: Data were collected for the cross-sectional study from April 2014 to June 2014 by the Ministry of Public Health. A total of 1,568 health facilities that reported data to the National Health Information System were selected by multistage random sampling in the 11 provinces of the DRC existing at that time. Data were collected through interviews, document review, and direct observation. Two dependent variables were measured: availability of family planning services (consisting of a room for services, staff assigned to family planning, and evidence of client use of family planning) and quality of family planning services (assessed as “high” if the facility had at least 1 trained staff member, family planning service delivery guidelines, at least 3 types of methods, and a sphygmomanometer, or “low” if the facility did not meet any of these 4 criteria). Pearson's chi-square test and odds ratios (ORs) were used to test for significant associations, using the alpha significance level of .05. Results: We successfully surveyed 1,555 facilities (99.2%) of those included in the sample. One in every 3 facilities (33%) offered family planning services as assessed by the index of availability, of which 20% met all 4 criteria for providing high-quality services. Availability was greatest at the highest level of the health system (hospitals) and decreased incrementally with each health system level, with disparities between provinces and urban and rural areas. Facilities in urban areas were more likely than in rural areas to meet the standard for high-quality services (P<.001). Public facilities were less likely than private facilities to have high-quality services (P=.02). Among all 1,555 facilities surveyed, 14% had at least 3 types of methods available at the time of the survey; the most widely available methods were male condoms, combined oral contraceptive pills, and progestin-only injectable contraceptives. Conclusion: Availability and quality of family planning services in health facilities in the DRC remain low, with inequitable distribution of services throughout the country. To improve access to and use of family planning, efforts should focus on improving availability and quality at lower health system levels and in rural areas where the majority of the population lives. PMID:28588047

Effects of Three Levels of Early Intervention Services on Children Prenatally Exposed to Cocaine

ERIC Educational Resources Information Center

Claussen, Angelika H.; Scott, Keith G.; Mundy, Peter C.; Katz, Lynne F.

2004-01-01

Cocaine use during pregnancy is a high-risk indicator for adverse developmental outcomes. Three levels of intervention (center, home, and primary care) were compared in a full service, birth to age 3, early intervention program serving children exposed to cocaine prenatally. Data were collected on 130 children from urban, predominantly poor,…

Job and Life Stress and Strain Outcomes among Service and Clerical Workers.

ERIC Educational Resources Information Center

Dytell, Rita Scher

The National Institute for Occupational Safety and Health has ranked 130 jobs in terms of the level of stress they engender. According to this ranking, clerical and service workers are in occupations which engender very high levels of stress. This study examined the relative contribution of a variety of occupational and nonoccupational sources of…

Social Networking, Microlending, and Translation in the Spanish Service-Learning Classroom

ERIC Educational Resources Information Center

Faszer-McMahon, Debra

2013-01-01

This small-scale study analyzes the use of service-learning pedagogy via non-profit translation in the intermediate-level language classroom. Forty-three students at the intermediate-high level in three Spanish classes in Greensburg, Pennsylvania served as part of a translation team for the non-profit organization Kiva, which helps to fund…

Are Posttraumatic Stress Symptoms Related to Mental Health Service Use? A Prospective Study of Danish Soldiers Deployed to Afghanistan.

PubMed

Madsen, Trine; Andersen, Søren Bo; Karstoft, Karen-Inge

2016-10-01

Investigating the use of mental health services by combat veterans can help illuminate utilization and unmet needs of this population. The aims of this study were to estimate the use of mental health services and to examine how such use is associated with self-reported symptoms of posttraumatic stress disorder (PTSD) in soldiers before and after deployment to Afghanistan. Prospectively, 703 Danish soldiers who deployed from January 2009 to August 2009 were followed up with 6 assessments from predeployment to 2.5 years postdeployment in 2012. At assessments, the soldiers responded to a comprehensive questionnaire including a measure of PTSD symptoms (the PTSD Checklist-Civilian version). These self-reported data were combined with individual-level records of receiving psychotherapy from the Military Psychological Division at the Danish Defense and psychiatric treatment from the Danish registers. The prevalence of PTSD symptoms increased over time, and almost 10% of the sample reported high levels of PTSD symptoms 2.5 years postdeployment. Overall, 37% of the soldiers utilized mental health services; 6% utilized psychiatric services, and 12.4% redeemed a prescription for psychiatric medicine. Approximately one-third received psychotherapy at the Military Psychological Division. In those reporting high PTSD symptomatology, 83% utilized 1 or more types of mental health service. At predeployment and homecoming, high PTSD symptomatology was significantly (P < .01) associated with attending psychotherapy, but not with psychiatric treatment or redemption of psychiatric medicine. With time, more soldiers report high PTSD symptoms. Among Danish soldiers with high symptomatology, the utilization of mental health services was high. Most frequently, soldiers with high PTSD symptomatology received psychotherapy at the Military Psychological Division and less frequently received psychiatric treatment. © Copyright 2016 Physicians Postgraduate Press, Inc.

Service employees give as they get: internal service as a moderator of the service climate-service outcomes link.

PubMed

Ehrhart, Karen Holcombe; Witt, L A; Schneider, Benjamin; Perry, Sara Jansen

2011-03-01

We lend theoretical insight to the service climate literature by exploring the joint effects of branch service climate and the internal service provided to the branch (the service received from corporate units to support external service delivery) on customer-rated service quality. We hypothesized that service climate is related to service quality most strongly when the internal service quality received is high, providing front-line employees with the capability to deliver what the service climate motivates them to do. We studied 619 employees and 1,973 customers in 36 retail branches of a bank. We aggregated employee perceptions of the internal service quality received from corporate units and the local service climate and external customer perceptions of service quality to the branch level of analysis. Findings were consistent with the hypothesis that high-quality internal service is necessary for branch service climate to yield superior external customer service quality. PsycINFO Database Record (c) 2011 APA, all rights reserved.

County Context and Mental Health Service Utilization by Older Hispanics.

PubMed

Kim, Kyeongmo

2018-04-16

Although older Hispanics experience high rates of depression, they tend to underuse mental health services. The study examined the association between county characteristics and mental health service use among older Hispanics, controlling for individual characteristics. The study used the 2008-2012 Medical Expenditure Panel Study and linked county-level data from the 2013-2014 Area Health Resources Files and the 2008-2012 Chronic Conditions Data Warehouse, using the Federal Information Processing Standard county code. The sample includes 1,143 community-dwelling Hispanics ages 60 years or older (Level 1) and 156 counties (Level 2) where the sample resides. The single dichotomous measure of mental health service utilization was based on whether or not the respondent met one or more of three conditions: (1) the respondent received care from a mental health professional, (2) received a service including mental health counseling or psychotherapy, or (3) received a service that was related to the International Classification of Diseases. Multilevel logistic regression analysis was used to examine the role of county context. The proportion of older adults and the existence of community mental health centers at the county-level were associated with mental health services use among this population. At the individual-level, education and mental health status were also associated with using mental health services. The county context plays an important role in understanding mental health services use among older Hispanics, indicating the need for intervention strategies at the county level.

Variation in psychotropic drug use in nursing homes.

PubMed

Castle, N G

1998-01-01

Numerous studies of health service use reveal considerable variation in the degree of services provided. In this article the variation in psychotropic drug use in nursing homes is examined. First, a descriptive analysis of nursing homes with and without high levels of psychotropic drug use is provided. Second, an analysis of the determinants of high levels of psychotropic drug use in nursing homes is provided. Factors such as ownership, staffing levels, having special care units, case-mix intensity, competitiveness of the nursing home market, and the state Medicaid reimbursement rate structure are examined. The results of these analyses are discussed in terms of their policy issues.

78 FR 49831 - Endangered and Threatened Wildlife and Plants; Proposed Designation of Critical Habitat for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-15

... Service (NPS) for the Florida leafwing and the pine rockland ecosystem, in general. Sea Level Rise... habitat. In the best case scenario, which assumes low sea level rise, high financial resources, proactive... human population. In the worst case scenario, which assumes high sea level rise, low financial resources...

Remote mission specialist - A study in real-time, adaptive planning

NASA Technical Reports Server (NTRS)

Rokey, Mark J.

1990-01-01

A high-level planning architecture for robotic operations is presented. The remote mission specialist integrates high-level directives with low-level primitives executable by a run-time controller for command of autonomous servicing activities. The planner has been designed to address such issues as adaptive plan generation, real-time performance, and operator intervention.

The Customer Comes First: Implementing a Customer Service Program at the University of Minnesota, Twin Cities Libraries

ERIC Educational Resources Information Center

Bayer, Jerrie; Llewellyn, Steven

2011-01-01

Library customers have more remote information choices than ever before, so we must ensure that when they do come to the library, they experience a welcoming environment, a high standard of service, and receive equitable levels of service across campus. Developing a customer service program was a logical next step to reinforce the ongoing…

Parenting stress and salivary cortisol in parents of children with autism spectrum disorder: Longitudinal variations in the context of a service dog's presence in the family.

PubMed

Fecteau, Stéphanie-M; Boivin, Louise; Trudel, Marcel; Corbett, Blythe A; Harrell, Frank E; Viau, Robert; Champagne, Noël; Picard, Frédéric

2017-02-01

A significant portion of parents of children with autism spectrum disorder report high levels of stress related to parenting responsibilities, which have been linked to abnormal cortisol patterns. This study seeks to better understand the parents' adaptation to caregiving demands and use of a service dog, by taking into account longitudinal variations in salivary cortisol and perception of parental stress. Salivary cortisol was collected one day per week for 15 weeks by 98 primary caregivers of children with ASD. Overall, parents perceived high levels of stress at baseline. Mean morning cortisol increase was below expected levels for healthy adults, and perception of stress predicted morning cortisol activity. Hypocorticolism related to chronic stress may be present in parents of children with ASD. Longitudinal analysis revealed that the presence of a service dog in the family had an effect on parenting stress, wakening and morning cortisol levels. Copyright © 2016 Elsevier B.V. All rights reserved.

Lack of increase of serum adiponectin concentrations with a moderate weight loss during six months on a high-caloric diet in military service among a young male Finnish population.

PubMed

Mousavinasab, Firoozeh; Tähtinen, Tuula; Jokelainen, Jari; Koskela, Pentti; Vanhala, Mauno; Oikarinen, Jorma; Keinänen-Kiukaanniemi, Sirkka

2005-02-01

An increase of insulin resistance and a worsening of lipid profile during 6 mo of military service in young male Finnish population has previously been shown by us. The present study demonstrates unfavorable changes of serum adiponectin concentrations and their association with weight loss in these particular circumstances. Adiponectin in a range of 4.3-21.2 microg/mL was present in the serum samples and had a significant negative correlation with weight, body mass index, waist to hip ratio, and insulin. Fasting serum lipids and plasma insulin significantly increased and serum adiponectin levels significantly decreased during the military service. Even the subjects with a 5-10% decrease in body weight showed the same result. In cases with more than 10% weight reduction and a significant decrease of fasting insulin concentration, the total and low density lipoprotein cholesterol significantly increased and adiponectin concentration tended to decreased. Only in severely obese cases (BMI >/= 30 kg/m2) with more than 10% decrease in body mass index adiponectin levels tended to increase, although not statistically significantly. This study shows that serum adiponectin concentrations decreased during a 6 mo high-caloric diet in military service, and even a moderate weight reduction induced by high-energy expenditure in exercise during service did not increase its levels.

Racial/ethnic disparities in the use of mental health services in poverty areas.

PubMed

Chow, Julian Chun-Chung; Jaffee, Kim; Snowden, Lonnie

2003-05-01

This study examined racial/ethnic disparities in mental health service access and use at different poverty levels. We compared demographic and clinical characteristics and service use patterns of Whites, Blacks, Hispanics, and Asians living in low-poverty and high-poverty areas. Logistic regression models were used to assess service use patterns of minority racial/ethnic groups compared with Whites in different poverty areas. Residence in a poverty neighborhood moderates the relationship between race/ethnicity and mental health service access and use. Disparities in using emergency and inpatient services and having coercive referrals were more evident in low-poverty than in high-poverty areas. Neighborhood poverty is a key to understanding racial/ethnic disparities in the use of mental health services.

Community Service during the First Year of College: What Is the Role of Past Behavior?

ERIC Educational Resources Information Center

Cruce, Ty M.; Moore, John V., III

2012-01-01

This longitudinal multi-institution study examines the effects of students' involvement in high school service clubs and their level of civic-mindedness when entering college on their propensity and intentions to volunteer during college. The level of civic-mindedness was measured by a self-rating of their ability to work effectively with others…

Compositional diversity of rehabilitated tropical lands supports multiple ecosystem services and buffers uncertainties

PubMed Central

Knoke, Thomas; Paul, Carola; Hildebrandt, Patrick; Calvas, Baltazar; Castro, Luz Maria; Härtl, Fabian; Döllerer, Martin; Hamer, Ute; Windhorst, David; Wiersma, Yolanda F.; Curatola Fernández, Giulia F.; Obermeier, Wolfgang A.; Adams, Julia; Breuer, Lutz; Mosandl, Reinhard; Beck, Erwin; Weber, Michael; Stimm, Bernd; Haber, Wolfgang; Fürst, Christine; Bendix, Jörg

2016-01-01

High landscape diversity is assumed to increase the number and level of ecosystem services. However, the interactions between ecosystem service provision, disturbance and landscape composition are poorly understood. Here we present a novel approach to include uncertainty in the optimization of land allocation for improving the provision of multiple ecosystem services. We refer to the rehabilitation of abandoned agricultural lands in Ecuador including two types of both afforestation and pasture rehabilitation, together with a succession option. Our results show that high compositional landscape diversity supports multiple ecosystem services (multifunction effect). This implicitly provides a buffer against uncertainty. Our work shows that active integration of uncertainty is only important when optimizing single or highly correlated ecosystem services and that the multifunction effect on landscape diversity is stronger than the uncertainty effect. This is an important insight to support a land-use planning based on ecosystem services. PMID:27292766

Compositional diversity of rehabilitated tropical lands supports multiple ecosystem services and buffers uncertainties.

PubMed

Knoke, Thomas; Paul, Carola; Hildebrandt, Patrick; Calvas, Baltazar; Castro, Luz Maria; Härtl, Fabian; Döllerer, Martin; Hamer, Ute; Windhorst, David; Wiersma, Yolanda F; Curatola Fernández, Giulia F; Obermeier, Wolfgang A; Adams, Julia; Breuer, Lutz; Mosandl, Reinhard; Beck, Erwin; Weber, Michael; Stimm, Bernd; Haber, Wolfgang; Fürst, Christine; Bendix, Jörg

2016-06-13

High landscape diversity is assumed to increase the number and level of ecosystem services. However, the interactions between ecosystem service provision, disturbance and landscape composition are poorly understood. Here we present a novel approach to include uncertainty in the optimization of land allocation for improving the provision of multiple ecosystem services. We refer to the rehabilitation of abandoned agricultural lands in Ecuador including two types of both afforestation and pasture rehabilitation, together with a succession option. Our results show that high compositional landscape diversity supports multiple ecosystem services (multifunction effect). This implicitly provides a buffer against uncertainty. Our work shows that active integration of uncertainty is only important when optimizing single or highly correlated ecosystem services and that the multifunction effect on landscape diversity is stronger than the uncertainty effect. This is an important insight to support a land-use planning based on ecosystem services.

The role of maternal education and nonmaternal care services in the prevention of children's physical aggression problems.

PubMed

Côté, Sylvana M; Boivin, Michel; Nagin, Daniel S; Japel, Christa; Xu, Qian; Zoccolillo, Mark; Junger, Marianne; Tremblay, Richard E

2007-11-01

Physical violence is an important health problem, and low maternal education is a significant risk for the development of chronic physical aggression (PA). We hypothesized that nonmaternal care (NMC) services could prevent the development of childhood PA problems, depending on the age at which the services are initiated. Method Children who followed a trajectory of atypically frequent PA between 17 and 60 months of age among a population sample of 1691 Canadian families were identified. Maternal education and NMC were considered in predicting group membership while controlling for confounding family characteristics. Children of mothers with low education levels (ie, no high school diploma) were less likely to receive NMC. Those who did receive such care had significantly lower risk of a high PA trajectory. Results from logistic regressions indicated that NMC reduced the risk of high PA, especially when initiated before age 9 months (odds ratio, 0.20; 95% confidence interval, 0.05-0.90). Children of mothers who graduated from high school were less at risk of PA problems, and NMC had no additional protective effect. Nonmaternal care services to children of mothers with low levels of education could substantially reduce their risk of chronic PA, especially if provided soon after birth. Because children most likely to benefit from NMC services are less likely to receive them, special measures encouraging the use of NMC services among high-risk families are needed.

Women in the Navy: Performance, Health, and Motherhood.

DTIC Science & Technology

1979-05-01

quite similar on the pre- service variables of age and level of schooling : the average age at time of service entry was 20.4 years and the average years...of education achieved was 12.3. Less than three percent of these women had not completed high school whereas 18 percent had attended college for one...standards required of women for service eligibility, i.e., a high school diploma and above average aptitude scores. Percentages of disciplinary sep

Bridging the Silos of Service Delivery for High-Need, High-Cost Individuals.

PubMed

Sherry, Melissa; Wolff, Jennifer L; Ballreich, Jeromie; DuGoff, Eva; Davis, Karen; Anderson, Gerard

2016-12-01

Health care reform efforts that emphasize value have increased awareness of the importance of nonmedical factors in achieving better care, better health, and lower costs in the care of high-need, high-cost individuals. Programs that care for socioeconomically disadvantaged, high-need, high-cost individuals have achieved promising results in part by bridging traditional service delivery silos. This study examined 5 innovative community-oriented programs that are successfully coordinating medical and nonmedical services to identify factors that stimulate and sustain community-level collaboration and coordinated care across silos of health care, public health, and social services delivery. The authors constructed a conceptual framework depicting community health systems that highlights 4 foundational factors that facilitate community-oriented collaboration: flexible financing, shared leadership, shared data, and a strong shared vision of commitment toward delivery of person-centered care.

Teledermatology: quality assessment by user satisfaction and clinical efficiency.

PubMed

Klaz, Itay; Wohl, Yonit; Nathansohn, Nir; Yerushalmi, Nir; Sharvit, Sharon; Kochba, Ilan; Brenner, Sarah

2005-08-01

The Israel Defense Forces implemented a pilot teledermatology service in primary clinics. To assess user satisfaction and clinical short-term effectiveness of a computerized store and forward teledermatology service in urban and rural units. A multi-center prospective uncontrolled cohort pilot trial was conducted for a period of 6 months. Primary care physicians referred patients to a board-certified dermatologist using text email accompanied by digital photographs. Diagnosis, therapy and management were sent back to the referring PCP. Patients were asked to evaluate the level of the CSAFTD service, effect of the service on accessibility to dermatologists, respect for privacy, availability of drugs, health improvement and overall satisfaction. PCPs assessed the quality of the teledermatology consultations they received, the contribution to their knowledge, and their overall satisfaction. Tele-diagnosis alone was possible for 95% (n=413) of 435 CSAFTD referrals; 22% (n=95) of referrals also required face-to-face consultation, Satisfaction with CSAFTD was high among patients in both rural and urban clinics, with significantly higher scores in rural units. Rural patients rated the level of service, accessibility and overall satisfaction higher than did urban patients. PCPs were satisfied with the quality of the service and its contribution to their knowledge. Rural physicians rated level of service and overall satisfaction higher than did urban physicians. Tele-referrals were completed more efficiently than referral for face-to-face appointments. CSAFTD provided efficient, high quality medical service to rural and urban military clinics in the IDF.

Factors associated with maternal healthcare services utilization in nine high focus states in India: a multilevel analysis based on 14 385 communities in 292 districts.

PubMed

Singh, Prashant Kumar; Kumar, Chandan; Rai, Rajesh Kumar; Singh, Lucky

2014-08-01

Studies have often ignored examining the role of community- and district-level factors in the utilization of maternity healthcare services, particularly in Indian contexts. The Social Determinants of Health framework emphasizes the role of governance and government policies, the measures for which are rarely incorporated in single-level individual analysis. This study examines factors associated with maternal healthcare utilization in nine high focus states in India, which shares more than half of the total maternal deaths in the country; accounting for individual-, household-, community- and district-level characteristics. The required data are extracted from the third round of the nationally representative District Level Household and Facility Survey conducted during 2007-08. Multilevel analyses were applied to three maternity outcomes, namely, four or more antenatal care visits, skilled birth attendance and post-natal care after birth. Results show that along with individual-/household-level factors, community and district-level factors influence the pattern of utilization of maternal healthcare services significantly. At the community level, the odds of maternal healthcare utilization were lower in rural areas and in communities with a high concentration of poor and illiterate women. Moreover, the average population coverage of primary health centres (PHCs), availability of labour room in PHC and percentage of registered pregnancies were significant factors at the district level that influenced the use of maternity care services. The study also found a strong association between the extent of previous use of maternal healthcare and its effect on subsequent usage patterns. This study highlights the role of strengthening public health infrastructure at district level in the study area, and promoting awareness about available healthcare services and subsidized schemes in the community. To reach out to rural and underprivileged communities and to apply a participatory approach from the programme officials are issues to delve into. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Food security among individuals experiencing homelessness and mental illness in the At Home/Chez Soi Trial.

PubMed

O'Campo, Patricia; Hwang, Stephen W; Gozdzik, Agnes; Schuler, Andrée; Kaufman-Shriqui, Vered; Poremski, Daniel; Lazgare, Luis Ivan Palma; Distasio, Jino; Belbraouet, Slimane; Addorisio, Sindi

2017-08-01

Individuals experiencing homelessness are particularly vulnerable to food insecurity. The At Home/Chez Soi study provides a unique opportunity to first examine baseline levels of food security among homeless individuals with mental illness and second to evaluate the effect of a Housing First (HF) intervention on food security in this population. At Home/Chez Soi was a 2-year randomized controlled trial comparing the effectiveness of HF compared with usual care among homeless adults with mental illness, stratified by level of need for mental health services (high or moderate). Logistic regressions tested baseline associations between food security (US Food Security Survey Module), study site, sociodemographic variables, duration of homelessness, alcohol/substance use, physical health and service utilization. Negative binomial regression determined the impact of the HF intervention on achieving levels of high or marginal food security over an 18-month follow-up period (6 to 24 months). Community settings at five Canadian sites (Moncton, Montreal, Toronto, Winnipeg and Vancouver). Homeless adults with mental illness (n 2148). Approximately 41 % of our sample reported high or marginal food security at baseline, but this figure varied with gender, age, mental health issues and substance use problems. High need participants who received HF were more likely to achieve marginal or high food security than those receiving usual care, but only at the Toronto and Moncton sites. Our large multi-site study demonstrated low levels of food security among homeless experiencing mental illness. HF showed promise for improving food security among participants with high levels of need for mental health services, with notable site differences.

Ethical sensitivity, burnout, and job satisfaction in emergency nurses.

PubMed

Palazoğlu, Cansu Atmaca; Koç, Zeliha

2017-01-01

Rising levels of burnout and decreasing job satisfaction can inhibit healthcare professionals from providing high-quality care due to a corresponding decrease in their ethical sensitivity. This study aimed to determine the relationship between the level of ethical sensitivity in emergency service nurses and their levels of burnout and job satisfaction. This research employed a descriptive and cross-sectional design. Participants and research context: This study was conducted with a sample of 236 nurses, all of whom worked in emergency service between 24 July 2015 and 28 April 2016. Data were collected using the Moral Sensitivity Questionnaire, Maslach Burnout Inventory, and Minnesota Job Satisfaction Scale. Ethical considerations: This study was approved by the Institutional Ethics Review Board of Ondokuz Mayıs University. There was a weak and negative correlation (r = -0.158, p = 0.015) between Moral Sensitivity Questionnaire and Maslach Burnout Inventory scores. There was also a weak and negative correlation (r = -0.335, p < 0.001) between the Maslach Burnout Inventory and Minnesota Job Satisfaction Scale scores. Decreased job satisfaction and increased burnout levels among emergency service nurses might result in them indulging in improper practices, frequently facing ethical problems, and a decrease in the overall quality of service in hospitals. In order for emergency service nurses to recognize ethical problems and make the most accurate decisions, a high level of ethical sensitivity is critical. In this respect, it is suggested that continuing education after graduation and training programs should be organized.

Structural relationships between work environment and service quality perceptions as a function of customer contact intensity: implications for human service strategy.

PubMed

Scotti, Dennis J; Harmon, Joel; Behson, Scott J

2009-01-01

This study assesses the importance of customer-contact intensity at the service encounter level as a determinant of service quality assessments. Using data from the U.S. Department of Veterans Affairs, it shows that performance-driven human resources practices play an important role as determinants of employee customer orientation and service capability in both high-contact (outpatient healthcare) and low-contact (benefits claim processing) human service contexts. However, there existed significant differences across service delivery settings in the salience of customer orientation and the congruence between employee and customer perceptions of service quality, depending on the intensity of customer contact. In both contexts, managerial attention to high-performance work systems and customer-orientation has the potential to favorably impact perceptions of service quality, amplify consumer satisfaction, and enhance operational efficiency.

Elementary Pre-Service Teachers: Can They Experience Mathematics Teaching Anxiety without Having Mathematics Anxiety?

ERIC Educational Resources Information Center

Brown, Amy Bingham; Westenskow, Arla; Moyer-Packenham, Patricia S.

2011-01-01

Elementary pre-service teachers report high levels of mathematics anxiety (MA), but the construct less widely addressed is their mathematics teaching anxiety (MTA). This study investigated the frequency with which MA stemming from prior experiences leads to MTA. Fifty-three elementary pre-service teachers' written reflections were analyzed, using…

Food Preparation and Service. An Introductory Course for Food Services Careers.

ERIC Educational Resources Information Center

Douma, Elaine L.

Intended for use in a comprehensive senior high school, this curriculum guide for an introductory laboratory course focuses on the development of abilities, attitudes, and personal qualities which would lead to job success at the entry level in the food service industry, including in the areas of cooking, waitressing, supermarkets, and similar…

Cultural and Recreational Services. Industry Training Monograph No. 16.

ERIC Educational Resources Information Center

Dumbrell, Tom

Australia's cultural and recreational services industry encompasses radio and television broadcasting, motion pictures, theatre, music, other performing arts, and sports and services to sports. Only 2.5% of the nation's labor force is employed in the industry. The sector has a particularly high level of part-time employment (over 40%). Employment…

Making abortions safe: a matter of good public health policy and practice.

PubMed Central

Berer, M.

2000-01-01

Globally, abortion mortality accounts for at least 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together. Preventing mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives. This article examines the changes in policy and health service provision required to make abortions safe. It is based on a wide-ranging review of published and unpublished sources. In order to be effective, public health measures must take into account the reasons why women have abortions, the kind of abortion services required and at what stages of pregnancy, the types of abortion service providers needed, and training, cost and counselling issues. The transition from unsafe to safe abortions demands the following: changes at national policy level; abortion training for service providers and the provision of services at the appropriate primary level health service delivery points; and ensuring that women access these services instead of those of untrained providers. Public awareness that abortion services are available is a crucial element of this transition, particularly among adolescent and single women, who tend to have less access to reproductive health services generally. PMID:10859852

Services to Status Offenders and Delinquents under Title XX.

ERIC Educational Resources Information Center

Nelson, Gary M.

1982-01-01

Found that states prohibiting institutionalization of status offenders and juvenile delinquents were no more likely to provide high levels of child foster care and protective services under Title XX than states not prohibiting institutionalization. (Author)

Barriers and facilitators to intraorganizational collaboration in public health: Relational coordination across public health services targeting individuals and populations.

PubMed

McCullough, J Mac; Eisen-Cohen, Eileen; Lott, Breanne

2018-05-09

Modern public health emphasizes population-focused services, which may require collaborative work both across and within organizations. Studies have explored interorganizational collaborations, but there are little data regarding collaborations within public health organizations. We measured intraorganizational collaboration and identified barriers and facilitators to collaboration within a large public health department through a mixed-methods study. Our study occurred at the Maricopa County (Arizona) Department of Public Health, the third largest local public health jurisdiction in the United States. To measure collaboration, we surveyed staff using the relational coordination tool. To identify barriers and facilitators to collaboration, we performed key informant interviews with department personnel. Relational coordination scores varied according to the focus of the service; clinical services had significantly lower levels of relational coordination than population-focused services (p < .01). We found high levels of mutual respect and lower levels of shared knowledge across services. Facilitators to collaboration included purposive cross-program meetings around specific topics, the organization's structure and culture, and individuals' social identities. Barriers included raised expectations for collaboration, low slack resources, member's self-interest, and trust. The relational coordination of services varied significantly according to the focus of the service. Population-focused public health services had higher levels of relational coordination than individually focused services. Collaboration was facilitated and impeded by both well-known and potentially emergent factors, such as purposive cross-service meetings and organizational culture. Population-focused services possessed higher levels of collaboration than individually focused services. Intraorganizational collaboration for improved population health relies on deliberate support from senior management and structured activities to increase shared knowledge and mutual respect.

The influences of patient's satisfaction with medical service delivery, assessment of medical service, and trust in health delivery system on patient's life satisfaction in China.

PubMed

Tang, Liyang

2012-09-14

Patient's satisfaction with medical service delivery/assessment of medical service/trust in health delivery system may have significant influence on patient's life satisfaction in China's health delivery system/in various kinds of hospitals.The aim of this study was to test whether and to what extent patient's satisfaction with medical service delivery/patient's assessments of various major aspects of medical service/various major aspects of patient's trust in health delivery system influenced patient's life satisfaction in China's health delivery system/in various kinds of hospitals. This study collaborated with National Bureau of Statistics of China to carry out a 2008 national urban resident household survey in 17 provinces, autonomous regions, and municipalities directly under the central government (N = 3,386), and specified ordered probit models were established to analyze dataset from this household survey. The key considerations in generating patient's life satisfaction involved patient's overall satisfaction with medical service delivery, assessment of doctor-patient communication, assessment of medical cost, assessment of medical treatment process, assessment of medical facility and hospital environment, assessment of waiting time for medical service, trust in prescription, trust in doctor, and trust in recommended medical examination. But the major considerations in generating patient's life satisfaction were different among low level public hospital, high level public hospital, and private hospital. The promotion of patient's overall satisfaction with medical service delivery, the improvement of doctor-patient communication, the reduction of medical cost, the improvement of medical treatment process, the promotion of medical facility and hospital environment, the reduction of waiting time for medical service, the promotion of patient's trust in prescription, the promotion of patient's trust in doctor, and the promotion of patient's trust in recommended medical examination could all help promote patient's life satisfaction. But their promotion effects were different among low level public hospital, high level public hospital, and private hospital.

Comparative safety of the transport of high-level radioactive materials on dedicated, key, and regular trains: technical study

DOT National Transportation Integrated Search

2006-03-01

This study compares the risks in transporting spent nuclear fuel and high-level radioactive waste under three rail shipment alternatives: 1) regular train service, operating without restrictions with the exception of current hazardous materials regul...

Profiles of family needs of children and youth with cerebral palsy.

PubMed

Almasri, N; Palisano, R J; Dunst, C; Chiarello, L A; O'Neil, M E; Polansky, M

2012-11-01

To identify profiles of family needs of families of children and youth with cerebral palsy (CP), and determine whether profile membership is related to child, family and service characteristics. Participants were mostly mothers (80%) of 579 children and youth with CP. A family member completed modified version of the Family Needs Survey and questionnaires about their child, family and services. Research assistants determined the Gross Motor Function Classification System levels. K-means cluster analysis identified profiles of needs. Cluster membership was analysed to examine differences in clusters based on selected characteristics. Four profiles of needs were identified: Low needs, Needs related to community and financial resources, Needs related to child health condition and High needs. Profile membership was differentiated based on child/youth gross motor function, adaptive behaviour, family relationships, family income, access and effort to co-ordinate services. Despite heterogeneity among individuals with CP and their families, four profiles of family needs were identified. In total, 51% of families had low needs suggesting that they are effectively managing their children's health conditions while 11% of families had high needs that may require high levels of services and supports. Service providers are encouraged to partner with families, provide anticipatory guidance and co-ordinate services. © 2011 Blackwell Publishing Ltd.

General service and child immunization-specific readiness assessment of healthcare facilities in two selected divisions in Bangladesh.

PubMed

Shawon, Md Shajedur Rahman; Adhikary, Gourab; Ali, Md Wazed; Shamsuzzaman, Md; Ahmed, Shahabuddin; Alam, Nurul; Shackelford, Katya A; Woldeab, Alexander; Lim, Stephen S; Levine, Aubrey; Gakidou, Emmanuela; Uddin, Md Jasim

2018-01-25

Service readiness of health facilities is an integral part of providing comprehensive quality healthcare to the community. Comprehensive assessment of general and service-specific (i.e. child immunization) readiness will help to identify the bottlenecks in healthcare service delivery and gaps in equitable service provision. Assessing healthcare facilities readiness also helps in optimal policymaking and resource allocation. A health facility survey was conducted between March 2015 and December 2015 in two purposively selected divisions in Bangladesh; i.e. Rajshahi division (high performing) and Sylhet division (low performing). A total of 123 health facilities were randomly selected from different levels of service, both public and private, with variation in sizes and patient loads from the list of facilities. Data on various aspects of healthcare facility were collected by interviewing key personnel. General service and child immunization specific service readiness were assessed using the Service Availability and Readiness Assessment (SARA) manual developed by World Health Organization (WHO). The analyses were stratified by division and level of healthcare facilities. The general service readiness index for pharmacies, community clinics, primary care facilities and higher care facilities were 40.6%, 60.5%, 59.8% and 69.5%, respectively in Rajshahi division and 44.3%, 57.8%, 57.5% and 73.4%, respectively in Sylhet division. Facilities at all levels had the highest scores for basic equipment (ranged between 51.7% and 93.7%) and the lowest scores for diagnostic capacity (ranged between 0.0% and 53.7%). Though facilities with vaccine storage capacity had very high levels of service readiness for child immunization, facilities without vaccine storage capacity lacked availability of many tracer items. Regarding readiness for newly introduced pneumococcal conjugate vaccine (PCV) and inactivated polio vaccine (IPV), most of the surveyed facilities reported lack of sufficient funding and resources (antigen) for training programs. Our study suggested that health facilities suffered from lack of readiness in various aspects, most notably in diagnostic capacity. Conversely, with very few challenges, nearly all the health facilities designated to provide immunization services were ready to deliver routine childhood immunization services as well as newly introduced PCV and IPV.

Growing inequities in maternal health in South Africa: a comparison of serial national household surveys.

PubMed

Wabiri, Njeri; Chersich, Matthew; Shisana, Olive; Blaauw, Duane; Rees, Helen; Dwane, Ntabozuko

2016-09-01

Rates of maternal mortality and morbidity vary markedly, both between and within countries. Documenting these variations, in a very unequal society like South Africa, provides useful information to direct initiatives to improve services. The study describes inequalities over time in access to maternal health services in South Africa, and identifies differences in maternal health outcomes between population groups and across geographical areas. Data were analysed from serial population-level household surveys that applied multistage-stratified sampling. Access to maternal health services and health outcomes in 2008 (n = 1121) were compared with those in 2012 (n = 1648). Differences between socio-economic quartiles were quantified using the relative (RII) and slope (SII) index of inequality, based on survey weights. High levels of inequalities were noted in most measures of service access in both 2008 and 2012. Inequalities between socio-economic quartiles worsened over time in antenatal clinic attendance, with overall coverage falling from 97.0 to 90.2 %. Nationally, skilled birth attendance remained about 95 %, with persistent high inequalities (SII = 0.11, RII = 1.12 in 2012). In 2012, having a doctor present at childbirth was higher than in 2008 (34.4 % versus 27.8 %), but inequalities worsened. Countrywide, levels of planned pregnancy declined from 44.6 % in 2008 to 34.7 % in 2012. The RII and SII rose over this period and in 2012, only 22.4 % of the poorest quartile had a planned pregnancy. HIV testing increased substantially by 2012, though remains low in groups with a high HIV prevalence, such as women in rural formal areas, and from Gauteng and Mpumalanga provinces. Marked deficiencies in service access were noted in the Eastern Cape ad North West provinces. Though some population-level improvements occurred in access to services, inequalities generally worsened. Low levels of planned pregnancy, antenatal clinic access and having a doctor present at childbirth among poor women are of most concern. Policy makers should carefully balance efforts to increase service access nationally, against the need for programs targeting underserved populations.

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England

PubMed Central

Osaro, Erhabor; Chima, Njemanze

2014-01-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the “engine room” of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness. PMID:25182941

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England.

PubMed

Osaro, Erhabor; Chima, Njemanze

2014-06-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the "engine room" of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

Enhancing the Simulation Speed of Sensor Network Applications by Asynchronization of Interrupt Service Routines

PubMed Central

Joe, Hyunwoo; Woo, Duk-Kyun; Kim, Hyungshin

2013-01-01

Sensor network simulations require high fidelity and timing accuracy to be used as an implementation and evaluation tool. The cycle-accurate and instruction-level simulator is the known solution for these purposes. However, this type of simulation incurs a high computation cost since it has to model not only the instruction level behavior but also the synchronization between multiple sensors for their causality. This paper presents a novel technique that exploits asynchronous simulations of interrupt service routines (ISR). We can avoid the synchronization overheads when the interrupt service routines are simulated without preemption. If the causality errors occur, we devise a rollback procedure to restore the original synchronized simulation. This concept can be extended to any instruction-level sensor network simulator. Evaluation results show our method can enhance the simulation speed up to 52% in the case of our experiments. For applications with longer interrupt service routines and smaller number of preemptions, the speedup becomes greater. In addition, our simulator is 2 to 11 times faster than the well-known sensor network simulator. PMID:23966200

Socioecological Influences on Community Involvement in HIV Vaccine Research

PubMed Central

Frew, Paula M.; Archibald, Matthew; Hixson, Brooke; del Rio, Carlos

2011-01-01

Objective This study investigated socioecological factors influencing HIV vaccine research participation among communities living in geographic areas with high HIV prevalence and high poverty rates. Methods We surveyed a sample of 453 adults ≥ 18 years from areas of high poverty and high HIV prevalence in metro Atlanta and differentiated the effects of individual-, social/organizational-, and community-level characteristics on participation in HIV vaccine research via multilevel modeling techniques that incorporated questionnaire, program, and census data. Results Models that adjusted for both individual-level covariates (such as race, gender, attitudes, and beliefs concerning HIV research), social/organizational- and community-level factors such as local HIV prevalence rates, revealed that the extent of HIV prevention-related programs and services in census tracts contributed to individuals’ likelihood of participation in an HIV vaccine study. Additionally, neighborhood-based organizations offering HIV medical and treatment programs, support groups, and services (e.g., food, shelter, and clothing) encourage greater HIV vaccine research participation. Conclusions The findings support the hypothesis that community-level factors facilitate participation in HIV vaccine research independent of both individual- and social/organizational-level factors. PMID:21722689

Information specialist for a coming age (1)

NASA Astrophysics Data System (ADS)

Fujii, Kunihiko

It is said that a drastic progress is being made in information service today. Author guesses what talent and quality will be needed for future information specialist, on the assumption of image of the future information service. In the highly computerized society, information specialist will be required to make a quick delivery of high quality information. To meet such a high level request from researchers, information specialist will have to acquire much more information technology than ever. In the coming age of SIS, information specialist should have a qualification for librarian and researcher, and try to offer the active service with the enhanced technology.

Measuring effective coverage of curative child health services in rural Burkina Faso: a cross-sectional study

PubMed Central

Koulidiati, Jean-Louis; Nesbitt, Robin C; Ouedraogo, Nobila; Hien, Hervé; Robyn, Paul Jacob; Compaoré, Philippe; Souares, Aurélia; Brenner, Stephan

2018-01-01

Objective To estimate both crude and effective curative health services coverage provided by rural health facilities to under 5-year-old (U5YO) children in Burkina Faso. Methods We surveyed 1298 child health providers and 1681 clinical cases across 494 primary-level health facilities, as well as 12 497 U5YO children across 7347households in the facilities’ catchment areas. Facilities were scored based on a set of indicators along three quality-of-care dimensions: management of common childhood diseases, management of severe childhood diseases and general service readiness. Linking service quality to service utilisation, we estimated both crude and effective coverage of U5YO children by these selected curative services. Results Measured performance quality among facilities was generally low with only 12.7% of facilities surveyed reaching our definition of high and 57.1% our definition of intermediate quality of care. The crude coverage was 69.5% while the effective coverages indicated that 5.3% and 44.6% of children reporting an illness episode received services of only high or high and intermediate quality, respectively. Conclusion Our study showed that the quality of U5YO child health services provided by primary-level health facilities in Burkina Faso was low, resulting in relatively ineffective population coverage. Poor adherence to clinical treatment guidelines combined with the lack of equipment and qualified clinical staff that performed U5YO consultations seemed to be contributors to the gap between crude and effective coverage. PMID:29858415

Racial/Ethnic Disparities in the Use of Mental Health Services in Poverty Areas

PubMed Central

Chow, Julian Chun-Chung; Jaffee, Kim; Snowden, Lonnie

2003-01-01

Objectives. This study examined racial/ethnic disparities in mental health service access and use at different poverty levels. Methods. We compared demographic and clinical characteristics and service use patterns of Whites, Blacks, Hispanics, and Asians living in low-poverty and high-poverty areas. Logistic regression models were used to assess service use patterns of minority racial/ethnic groups compared with Whites in different poverty areas. Results. Residence in a poverty neighborhood moderates the relationship between race/ethnicity and mental health service access and use. Disparities in using emergency and inpatient services and having coercive referrals were more evident in low-poverty than in high-poverty areas. Conclusions. Neighborhood poverty is a key to understanding racial/ethnic disparities in the use of mental health services. PMID:12721146

Radiation Hardened, Modulator ASIC for High Data Rate Communications

NASA Technical Reports Server (NTRS)

McCallister, Ron; Putnam, Robert; Andro, Monty; Fujikawa, Gene

2000-01-01

Satellite-based telecommunication services are challenged by the need to generate down-link power levels adequate to support high quality (BER approx. equals 10(exp 12)) links required for modem broadband data services. Bandwidth-efficient Nyquist signaling, using low values of excess bandwidth (alpha), can exhibit large peak-to-average-power ratio (PAPR) values. High PAPR values necessitate high-power amplifier (HPA) backoff greater than the PAPR, resulting in unacceptably low HPA efficiency. Given the high cost of on-board prime power, this inefficiency represents both an economical burden, and a constraint on the rates and quality of data services supportable from satellite platforms. Constant-envelope signals offer improved power-efficiency, but only by imposing a severe bandwidth-efficiency penalty. This paper describes a radiation- hardened modulator which can improve satellite-based broadband data services by combining the bandwidth-efficiency of low-alpha Nyquist signals with high power-efficiency (negligible HPA backoff).

Modeling work of the dispatching service of high-rise building as queuing system

NASA Astrophysics Data System (ADS)

Dement'eva, Marina; Dement'eva, Anastasiya

2018-03-01

The article presents the results of calculating the performance indicators of the dispatcher service of a high-rise building as a queuing system with an unlimited queue. The calculation was carried out for three models: with a single control room and brigade of service, with a single control room and a specialized service, with several dispatch centers and specialized services. The aim of the work was to investigate the influence of the structural scheme of the organization of the dispatcher service of a high-rise building on the amount of operating costs and the time of processing and fulfilling applications. The problems of high-rise construction and their impact on the complication of exploitation are analyzed. The composition of exploitation activities of high-rise buildings is analyzed. The relevance of the study is justified by the need to review the role of dispatch services in the structure of management of the quality of buildings. Dispatching service from the lower level of management of individual engineering systems becomes the main link in the centralized automated management of the exploitation of high-rise buildings. With the transition to market relations, the criterion of profitability at the organization of the dispatching service becomes one of the main parameters of the effectiveness of its work. A mathematical model for assessing the efficiency of the dispatching service on a set of quality of service indicators is proposed. The structure of operating costs is presented. The algorithm of decision-making is given when choosing the optimal structural scheme of the dispatching service of a high-rise building.

A Pre-Emptive Horizontal Channel Borrowing and Vertical Traffic Overflowing Channel Allocation Scheme for Overlay Networks

NASA Astrophysics Data System (ADS)

Zhao, Fang-Ming; Jiang, Ling-Ge; He, Chen

In this paper, a channel allocation scheme is studied for overlay wireless networks to optimize connection-level QoS. The contributions of our work are threefold. First, a channel allocation strategy using both horizontal channel borrowing and vertical traffic overflowing (HCBVTO) is presented and analyzed. When all the channels in a given macrocell are used, high-mobility real-time handoff requests can borrow channels from adjacent homogeneous cells. In case that the borrowing requests fail, handoff requests may also be overflowed to heterogeneous cells, if possible. Second, high-mobility real-time service is prioritized by allowing it to preempt channels currently used by other services. And third, to meet the high QoS requirements of some services and increase the utilization of radio resources, certain services can be transformed between real-time services and non-real-time services as necessary. Simulation results demonstrate that the proposed schemes can improve system performance.

Helping Students toward Independence: The STEPS Program at USDB

ERIC Educational Resources Information Center

Smale, Kimberley P.

2010-01-01

Utah Schools for the Deaf and the Blind (USDB) serves students with varying abilities and needs. At the high school level, a range of transition services is required to help this diverse group of students prepare for life after high school. USDB established the STEPS program as part of this range of services. STEPS is a training and transition…

Family Characteristics and Children's Receipt of Autism Services in Low-Resourced Families.

PubMed

Karp, Elizabeth A; Dudovitz, Rebecca; Nelson, Bergen B; Shih, Wendy; Gulsrud, Amanda; Orlich, Felice; Colombi, Costanza; Kuo, Alice A

2018-04-01

Parents of children with autism spectrum disorder (ASD) face competing demands when caring for their child and fulfilling family commitments. It remains unknown whether family obligations and parental stress might decrease the use of intervention services for young children with ASD. The current study is a secondary analysis of baseline date from a published randomized control trial with 147 low-resourced caregiver-child dyads. Demographic information, data on service use, maternal employment, parent's perception of their child's development, and parental stress were collected for primary caregivers of 2- to 5-year-old children with ASD from 5 sites. Multiple logistic regressions of accessing any intervention services or more than 1 services on familial characteristics were performed, controlling for demographic and contextual variables. Twenty-five percent of children were receiving no intervention service; 26% were receiving 1 service; and 49% were receiving 2 or more services. Perceived developmental delay and not having a sibling in the home were associated with higher odds of receiving intervention services. Children were more likely to receive more than 1 service if their parents had at least a college education and low levels of stress. Factors including perceived developmental level, parental stress, and caring for siblings may play a role in accessing services for children with ASD. Results reveal that competing family needs may be barriers to service use. Mothers of children with ASD with multiple children in the home, low levels of education, and high levels of stress may need additional supports or alternative service delivery models. Copyright © 2018 by the American Academy of Pediatrics.

Semantic Repositories for eGovernment Initiatives: Integrating Knowledge and Services

NASA Astrophysics Data System (ADS)

Palmonari, Matteo; Viscusi, Gianluigi

In recent years, public sector investments in eGovernment initiatives have depended on making more reliable existing governmental ICT systems and infrastructures. Furthermore, we assist at a change in the focus of public sector management, from the disaggregation, competition and performance measurements typical of the New Public Management (NPM), to new models of governance, aiming for the reintegration of services under a new perspective in bureaucracy, namely a holistic approach to policy making which exploits the extensive digitalization of administrative operations. In this scenario, major challenges are related to support effective access to information both at the front-end level, by means of highly modular and customizable content provision, and at the back-end level, by means of information integration initiatives. Repositories of information about data and services that exploit semantic models and technologies can support these goals by bridging the gap between the data-level representations and the human-level knowledge involved in accessing information and in searching for services. Moreover, semantic repository technologies can reach a new level of automation for different tasks involved in interoperability programs, both related to data integration techniques and service-oriented computing approaches. In this chapter, we discuss the above topics by referring to techniques and experiences where repositories based on conceptual models and ontologies are used at different levels in eGovernment initiatives: at the back-end level to produce a comprehensive view of the information managed in the public administrations' (PA) information systems, and at the front-end level to support effective service delivery.

Communication, Community, and Disconnection: Pre-Service Teachers in Virtual School Field Experiences

ERIC Educational Resources Information Center

Wilkens, Christian; Eckdahl, Kelli; Morone, Mike; Cook, Vicki; Giblin, Thomas; Coon, Joshua

2014-01-01

This study examined the experiences of 11 graduate-level pre-service teachers completing Virtual School Field Experiences (VSFEs) with cooperating teachers in fully online, asynchronous high school courses in New York State. The VSFEs included a 7-week online teacher training course, and a 7-week online field experience. Pre-service teachers…

Student Learning Motivation as a Mediator of the Relationship between Service Quality and Student Performance

ERIC Educational Resources Information Center

Ibrahim, Hamdi H. M.

2016-01-01

Students look for evidence of service quality when selecting a university to attend. Student dissatisfaction with the quality of service may reduce student motivation in online higher-education settings, and low levels of motivation may lead to inferior student performance and a persistently high dropout rate. The purpose of this quantitative,…

Making It in Marketing Services. Exploration of Marketing Services Careers.

ERIC Educational Resources Information Center

Wilkie, Barbara J., Ed.

This curriculum guide is designed to be used with a distributive education course offering. It provides students, at the middle or junior high school level, an opportunity to explore marketing services careers. The guide is divided into two sections: The Teacher's Guide and Student Materials. The Teacher's Guide is composed of eleven units: (1)…

Behavioral management for children and adolescents: assessing the evidence.

PubMed

Johnson, Melissa H; George, Preethy; Armstrong, Mary I; Lyman, D Russell; Dougherty, Richard H; Daniels, Allen S; Ghose, Sushmita Shoma; Delphin-Rittmon, Miriam E

2014-05-01

Behavioral management services for children and adolescents are important components of the mental health service system. Behavioral management is a direct service designed to help develop or maintain prosocial behaviors in the home, school, or community. This review examined evidence for the effectiveness of family-centered, school-based, and integrated interventions. Literature reviews and individual studies published from 1995 through 2012 were identified by searching PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, Published International Literature on Traumatic Stress, the Educational Resources Information Center, and the Cumulative Index to Nursing and Allied Health Literature. Authors chose from three levels of evidence (high, moderate, and low) based on benchmarks for the number of studies and quality of their methodology. They also described the evidence of service effectiveness. The level of evidence for behavioral management was rated as high because of the number of well-designed randomized controlled trials across settings, particularly for family-centered and integrated family- and school-based interventions. Results for the effectiveness of behavioral management interventions were strong, depending on the type of intervention and mode of implementation. Evidence for school-based interventions as an isolated service was mixed, partly because complexities of evaluating group interventions in schools resulted in somewhat less rigor. Behavioral management services should be considered for inclusion in covered plans. Further research addressing the mechanisms of effect and specific populations, particularly at the school level, will assist in bolstering the evidence base for this important category of clinical intervention.

Assuring Software Reliability

DTIC Science & Technology

2014-08-01

technologies and processes to achieve a required level of confidence that software systems and services function in the intended manner. 1.3 Security Example...that took three high-voltage lines out of service and a software fail- ure (a race condition3) that disabled the computing service that notified the... service had failed. Instead of analyzing the details of the alarm server failure, the reviewers asked why the following software assurance claim had

Effect of Disease Improvement with Self-Measurement Compliance (Measurement Frequency Level) in SmartCare Hypertension Management Service.

PubMed

Lee, Chang-Hee; Chang, Byeong-Yun

2016-03-01

This study's purpose was to analyze the effect of the SmartCare pilot project, which was conducted in 2011 in South Korea. Recent studies of telehealth mostly compare the intervention group and the control group. Therefore, it is necessary to analyze the disease improvement effect depending on the self-measurement compliance (measurement frequency level) of patients who are receiving the hypertension management services. In the SmartCare center, health managers (nurses, nutritionists, and exercise prescribers) monitored the measurement data transmitted by participants through the SmartCare system. The health managers provided the prevention, consultation, and education services remotely to patients. Of the 231 participants who were enrolled in the study, the final analysis involved 213 individuals who completed their blood pressure measurements and SmartCare services until the end of a 6-month service period. The evaluated measurement group was classified into three groups (Low, Middle, and High) by evenly dividing the monthly average frequency of measurement for 6 months. The evaluation indices were systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, and body mass index (BMI); this information was transmitted through the SmartCare system. For changes in the evaluation indices after 6 months compared with the initial baseline, in the Low Group, SBP and DBP slightly decreased, and weight and BMI slightly increased (difference not statistically significant). In the Middle Group, SBP and DBP decreased slightly (difference not statistically significant); however, both weight and BMI decreased (difference statistically significant). In the High Group, SBP, DBP, weight, and BMI decreased (difference statistically significant). Patients who received the SmartCare services with higher measurement frequency levels at home showed greater effectiveness regarding the provided services compared with those patients with lower levels of BP, weight, and BMI control.

Factors affecting satisfaction on antenatal care services in Sarawak, Malaysia: evidence from a cross sectional study.

PubMed

Rahman, Md Mizanur; Ngadan, Deburra Peak; Arif, Mohammad Taha

2016-01-01

High levels of satisfaction among women with the antenatal care services will increase the compliance of antenatal visits during pregnancy. Thus, this study was done to assess the level of satisfaction among women on the quality of antenatal care received and the factors influencing thereof. This was a cross-sectional study conducted in the three zones of Sarawak. Women aged 18 years and above, irrespective of ethnic groups, having children aged 3 years and below were included in the study. Data was collected by face-to-face interview using interview schedule. A validated Patient Satisfaction Questionnaire (PSQ-18) was used to assess the satisfaction with antenatal care. A total of 1236 data was analysed using IBM SPSS version 22.0. A p value <0.05 was considered as statistically significant. A multinomial logistic regression analysis revealed that Bidayuh 17.4 % was less likely to be highly satisfied with antenatal care. Similarly, respondents with secondary level of education 29.9 % were less likely to be highly satisfied, whereas, respondents having primary level of education, 1.6 % were less likely to be highly satisfied. However, those who did not spend any money as out of pocket expenses were 1.935 times more likely to be highly satisfied with antenatal care. Overall the studied women were satisfied with the antenatal care services. Ethnicity, level of education and out of pocket expenses appeared to be important predictors of satisfaction with antenatal care. The finding recommends the community-based and language-specific interventions should be implemented to sustain the satisfaction of maternal care.

The costs of scaling up HIV prevention for high risk groups: lessons learned from the Avahan Programme in India.

PubMed

Chandrashekar, Sudhashree; Guinness, Lorna; Pickles, Michael; Shetty, Govindraj Y; Alary, Michel; Vickerman, Peter; Vassall, Anna

2014-01-01

The study objective is to measure, analyse costs of scaling up HIV prevention for high-risk groups in India, in order to assist the design of future HIV prevention programmes in South Asia and beyond. Prospective costing study. This study is one of the most comprehensive studies of the costs of HIV prevention for high-risk groups to date in both its scope and size. HIV prevention included outreach, sexually transmitted infections (STI) services, condom provision, expertise enhancement, community mobilisation and enabling environment activities. Economic costs were collected from 138 non-government organisations (NGOs) in 64 districts, four state level lead implementing partners (SLPs), and the national programme level (Bill and Melinda Gates Foundation (BMGF)) office over four years using a top down costing approach, presented in US$ 2011. Mean total unit costs (2004-08) per person reached at least once a year and per monthly contact were US$ 235(56-1864) and US$ 82(12-969) respectively. 35% of the cost was incurred by NGOs, 30% at the state level SLP and 35% at the national programme level. The proportion of total costs by activity were 34% for expertise enhancement, 37% for programme management (including support and supervision), 22% for core HIV prevention activities (outreach and STI services) and 7% for community mobilisation and enabling environment activities. Total unit cost per person reached fell sharply as the programme expanded due to declining unit costs above the service level (from US$ 477 per person reached in 2004 to US$ 145 per person reached in 2008). At the service level also unit costs decreased slightly over time from US$ 68 to US$ 64 per person reached. Scaling up HIV prevention for high risk groups requires significant investment in expertise enhancement and programme administration. However, unit costs decreased with programme expansion in spite of an increase in the scope of activities.

The Costs of Scaling Up HIV Prevention for High Risk Groups: Lessons Learned from the Avahan Programme in India

PubMed Central

Chandrashekar, Sudhashree; Guinness, Lorna; Pickles, Michael; Shetty, Govindraj Y.; Alary, Michel; Vickerman, Peter; Vassall, Anna

2014-01-01

Objective The study objective is to measure, analyse costs of scaling up HIV prevention for high-risk groups in India, in order to assist the design of future HIV prevention programmes in South Asia and beyond. Design Prospective costing study. Methods This study is one of the most comprehensive studies of the costs of HIV prevention for high-risk groups to date in both its scope and size. HIV prevention included outreach, sexually transmitted infections (STI) services, condom provision, expertise enhancement, community mobilisation and enabling environment activities. Economic costs were collected from 138 non-government organisations (NGOs) in 64 districts, four state level lead implementing partners (SLPs), and the national programme level (Bill and Melinda Gates Foundation (BMGF)) office over four years using a top down costing approach, presented in US$ 2011. Results Mean total unit costs (2004–08) per person reached at least once a year and per monthly contact were US$ 235(56–1864) and US$ 82(12–969) respectively. 35% of the cost was incurred by NGOs, 30% at the state level SLP and 35% at the national programme level. The proportion of total costs by activity were 34% for expertise enhancement, 37% for programme management (including support and supervision), 22% for core HIV prevention activities (outreach and STI services) and 7% for community mobilisation and enabling environment activities. Total unit cost per person reached fell sharply as the programme expanded due to declining unit costs above the service level (from US$ 477 per person reached in 2004 to US$ 145 per person reached in 2008). At the service level also unit costs decreased slightly over time from US$ 68 to US$ 64 per person reached. Conclusions Scaling up HIV prevention for high risk groups requires significant investment in expertise enhancement and programme administration. However, unit costs decreased with programme expansion in spite of an increase in the scope of activities. PMID:25203052

Markov Task Network: A Framework for Service Composition under Uncertainty in Cyber-Physical Systems.

PubMed

Mohammed, Abdul-Wahid; Xu, Yang; Hu, Haixiao; Agyemang, Brighter

2016-09-21

In novel collaborative systems, cooperative entities collaborate services to achieve local and global objectives. With the growing pervasiveness of cyber-physical systems, however, such collaboration is hampered by differences in the operations of the cyber and physical objects, and the need for the dynamic formation of collaborative functionality given high-level system goals has become practical. In this paper, we propose a cross-layer automation and management model for cyber-physical systems. This models the dynamic formation of collaborative services pursuing laid-down system goals as an ontology-oriented hierarchical task network. Ontological intelligence provides the semantic technology of this model, and through semantic reasoning, primitive tasks can be dynamically composed from high-level system goals. In dealing with uncertainty, we further propose a novel bridge between hierarchical task networks and Markov logic networks, called the Markov task network. This leverages the efficient inference algorithms of Markov logic networks to reduce both computational and inferential loads in task decomposition. From the results of our experiments, high-precision service composition under uncertainty can be achieved using this approach.

77 FR 26948 - Airworthiness Directives; Fokker Services B.V. Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-08

... sliding member cracks is high compressive stress during braking at higher deceleration levels outside the regular fatigue load spectrum. Starting at deceleration stress levels somewhat below limit load, the high compressive stress locally exceeds the elasticity limit of the material, leaving a residual tensile stress at...

Profile of women who carried out smoking cessation treatment: a systematic review

PubMed Central

Pereira, Caroline Figueira; de Vargas, Divane

2015-01-01

OBJECTIVE Analyze the profile of women, in health services, who carry out treatment for smoking cessation. METHODS Systematic review that used the following sources of information: Cummulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Biblioteca Virtual em Saúde (BVS), Scopus and Web of Science. We included quantitative studies that addressed the characterization of women, in health services, who carried out treatment for smoking cessation, resulting in 12 articles for analysis. The assessment of the methodological quality of the studies was performed using the instrument MAStARI from Joanna Briggs Institute. RESULTS The predominant profile of women who carried out treatment for smoking cessation in health services was composed of white, married, employed, and highly level educated women. Women who carried out the treatment for smoking cessation in specialized services had a more advanced age, were white, were married and had a diagnosis of depression. The quality level of most studies was moderate. CONCLUSIONS The profile of women who carry out treatment for smoking cessation, either in general or specialized health services, is composed of white, married, and highly level educated women. Publications about smoking women are scarce and the lack of Brazilian studies characterizing the profile of women who start treatment for smoking cessation shows the need for studies that explore this subject. PMID:26247386

Communities and community genetics in Ethiopia.

PubMed

Tadesse, Luche; Tafesse, Fikru; Hamamy, Hanan

2014-01-01

The rates of congenital and genetic disorders in low and middle income countries are similar or might be higher than in high income countries due to a multitude of risk factors and the dearth of community genetic services. To direct effective preventive, diagnostic and counseling services, collecting data on the incidence and prevalence of various congenital and genetic disorders and their risk factors is a pre-requisite for establishing genetic services at the community level and mainly at the primary health care setting. This brief review is meant to assess the available epidemiological data in Ethiopia pertaining to congenital and genetic disorders on which the future community genetic services could be built. Existing epidemiological data on congenital and genetic disorders in Ethiopia is limited, and the few studies conducted revealed that folate and iodine deficiencies are prevalent among women in the reproductive age. Pregnant women's infection with syphilis and rubella is prevailing. Based on available data, cleft lip and palate, congenital heart diseases, club-foot, and gastro-intestinal malformations are the most common birth defects in Ethiopia. Community based studies to accurately demonstrate the incidence and prevalence levels of these disorders are almost unavailable. To plan for organization and implementation of community genetic services at the primary health care level in Ethiopia, conducting standardized epidemiological studies is currently highly recommended.

Profile of women who carried out smoking cessation treatment: a systematic review.

PubMed

Pereira, Caroline Figueira; de Vargas, Divane

2015-01-01

OBJECTIVE Analyze the profile of women, in health services, who carry out treatment for smoking cessation. METHODS Systematic review that used the following sources of information: Cummulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Biblioteca Virtual em Saúde (BVS), Scopus and Web of Science. We included quantitative studies that addressed the characterization of women, in health services, who carried out treatment for smoking cessation, resulting in 12 articles for analysis. The assessment of the methodological quality of the studies was performed using the instrument MAStARI from Joanna Briggs Institute. RESULTS The predominant profile of women who carried out treatment for smoking cessation in health services was composed of white, married, employed, and highly level educated women. Women who carried out the treatment for smoking cessation in specialized services had a more advanced age, were white, were married and had a diagnosis of depression. The quality level of most studies was moderate. CONCLUSIONS The profile of women who carry out treatment for smoking cessation, either in general or specialized health services, is composed of white, married, and highly level educated women. Publications about smoking women are scarce and the lack of Brazilian studies characterizing the profile of women who start treatment for smoking cessation shows the need for studies that explore this subject.

Communities and community genetics in Ethiopia

PubMed Central

Tadesse, Luche; Tafesse, Fikru; Hamamy, Hanan

2014-01-01

The rates of congenital and genetic disorders in low and middle income countries are similar or might be higher than in high income countries due to a multitude of risk factors and the dearth of community genetic services. To direct effective preventive, diagnostic and counseling services, collecting data on the incidence and prevalence of various congenital and genetic disorders and their risk factors is a pre-requisite for establishing genetic services at the community level and mainly at the primary health care setting. This brief review is meant to assess the available epidemiological data in Ethiopia pertaining to congenital and genetic disorders on which the future community genetic services could be built. Existing epidemiological data on congenital and genetic disorders in Ethiopia is limited, and the few studies conducted revealed that folate and iodine deficiencies are prevalent among women in the reproductive age. Pregnant women's infection with syphilis and rubella is prevailing. Based on available data, cleft lip and palate, congenital heart diseases, club-foot, and gastro-intestinalmalformations are the most common birth defects in Ethiopia. Community based studies to accurately demonstrate the incidence and prevalence levels of these disorders are almost unavailable. To plan for organization and implementation of community genetic services at the primary health care level in Ethiopia, conducting standardized epidemiological studies is currently highly recommended. PMID:25404975

Characteristics of Human Brain Activity during the Evaluation of Service-to-Service Brand Extension

PubMed Central

Yang, Taeyang; Lee, Seungji; Seomoon, Eunbi; Kim, Sung-Phil

2018-01-01

Brand extension is a marketing strategy to apply the previously established brand name into new goods or service. A number of studies have reported the characteristics of human event-related potentials (ERPs) in response to the evaluation of goods-to-goods brand extension. In contrast, human brain responses to the evaluation of service extension are relatively unexplored. The aim of this study was investigating cognitive processes underlying the evaluation of service-to-service brand extension with electroencephalography (EEG). A total of 56 text stimuli composed of service brand name (S1) followed by extended service name (S2) were presented to participants. The EEG of participants was recorded while participants were asked to evaluate whether a given brand extension was acceptable or not. The behavioral results revealed that participants could evaluate brand extension though they had little knowledge about the extended services, indicating the role of brand in the evaluation of the services. Additionally, we developed a method of grouping brand extension stimuli according to the fit levels obtained from behavioral responses, instead of grouping of stimuli a priori. The ERP analysis identified three components during the evaluation of brand extension: N2, P300, and N400. No difference in the N2 amplitude was found among the different levels of a fit between S1 and S2. The P300 amplitude for the low level of fit was greater than those for higher levels (p < 0.05). The N400 amplitude was more negative for the mid- and high-level fits than the low level. The ERP results of P300 and N400 indicate that the early stage of brain extension evaluation might first detect low-fit brand extension as an improbable target followed by the late stage of the integration of S2 into S1. Along with previous findings, our results demonstrate different cognitive evaluation of service-to-service brand extension from goods-to-goods. PMID:29479313

Characteristics of Human Brain Activity during the Evaluation of Service-to-Service Brand Extension.

PubMed

Yang, Taeyang; Lee, Seungji; Seomoon, Eunbi; Kim, Sung-Phil

2018-01-01

Brand extension is a marketing strategy to apply the previously established brand name into new goods or service. A number of studies have reported the characteristics of human event-related potentials (ERPs) in response to the evaluation of goods-to-goods brand extension. In contrast, human brain responses to the evaluation of service extension are relatively unexplored. The aim of this study was investigating cognitive processes underlying the evaluation of service-to-service brand extension with electroencephalography (EEG). A total of 56 text stimuli composed of service brand name (S1) followed by extended service name (S2) were presented to participants. The EEG of participants was recorded while participants were asked to evaluate whether a given brand extension was acceptable or not. The behavioral results revealed that participants could evaluate brand extension though they had little knowledge about the extended services, indicating the role of brand in the evaluation of the services. Additionally, we developed a method of grouping brand extension stimuli according to the fit levels obtained from behavioral responses, instead of grouping of stimuli a priori . The ERP analysis identified three components during the evaluation of brand extension: N2, P300, and N400. No difference in the N2 amplitude was found among the different levels of a fit between S1 and S2. The P300 amplitude for the low level of fit was greater than those for higher levels ( p < 0.05). The N400 amplitude was more negative for the mid- and high-level fits than the low level. The ERP results of P300 and N400 indicate that the early stage of brain extension evaluation might first detect low-fit brand extension as an improbable target followed by the late stage of the integration of S2 into S1. Along with previous findings, our results demonstrate different cognitive evaluation of service-to-service brand extension from goods-to-goods.

Organizational Stress Moderates the Relationship between Mental Health Provider Adaptability and Organizational Commitment

PubMed Central

Green, Amy E.; Dishop, Christopher; Aarons, Gregory A

2016-01-01

Objective Community mental health providers often operate within stressful work environments and are at high risk for emotional exhaustion, which can negatively affect job performance and client satisfaction with services. This cross-sectional study examines the relationships between organizational stress, provider adaptability, and organizational commitment. Methods Variables were analyzed using moderated multi-level regression in a sample of 311 mental health providers from 49 community mental health programs. Results Stressful organizational climate, characterized by high levels of emotional exhaustion, role conflict, and role overload, was negatively related to organizational commitment. Organizational stress moderated the relationship between provider adaptability and organizational commitment, such that those who were more adaptable had greater levels of organizational commitment when organizational stress was low, but were less committed than those who were less adaptable when organizational stress was high. Conclusions In the current study, providers higher in adaptability may perceive their organization as a greater fit when characterized by lower levels of stressfulness; however, highly adaptable providers may also exercise choice that manifests in lower commitment to staying in an overly stressful work environment. Service systems and organizational contexts are becoming increasingly demanding and stressful for direct mental health service providers. Therefore, community mental health organizations should assess and understand their organizational climate and intervene with empirically based organizational strategies when necessary to reduce stressful climates and maintain desirable employees. PMID:27301760

Helping Teachers Teach Plasma Physics

NASA Astrophysics Data System (ADS)

Correll, Donald

2008-11-01

Lawrence Livermore National Laboratory's E/O program in Fusion Science and Plasma Physics now includes both `pre-service' as well as `in-service' high school science teacher professional development activities. Teachers are instructed and mentored by `master teachers' and LLNL plasma researchers working in concert. The Fusion/Plasma E/O program exploits a unique science education partnership that exists between LLNL's Science Education Program and the UC Davis Edward Teller Education Center. For `in-service' teachers, the Fusion & Astrophysics Teacher Research Academy (TRA) has four levels of workshops that are designed to give in-service high school science teachers experience in promoting and conducting research, most notably in the filed of plasma spectroscopy. Participating teachers in all four TRA levels may earn up to ten units of graduate credit from Cal-State University East Bay, and may apply these units toward a Masters of Science in Education. For `pre-service' teachers, the Science Teacher and Researcher (STAR) program, as a partnership with the California State University System, includes attracting undergraduate science majors to teaching careers by allowing them to pursue professional identities as both a research scientist as well as a science teacher. Participating `pre-service' STAR students are provided research internships at LLNL and work closely with the `in-service' TRA teachers. Results from the continuum `pre-service' to `in-service' science teacher professional development programs will be presented.

Work-related threats and violence in human service sectors: The importance of the psycho-social work environment examined in a multilevel prospective study.

PubMed

Andersen, Lars Peter; Hogh, Annie; Biering, Karin; Gadegaard, Charlotte Ann

2018-01-01

Threats and violence at work are major concerns for employees in many human service sectors. The prevention of work-related violence is a major challenge for employees and management. The purpose of this study was to identify prospective associations between psycho-social work environment and work-related threats and violence in four high risk human service sectors. Questionnaire data was collected from 3011 employees working at psychiatric wards, in the elder sector, in the Prison and Probation Service and at Special Schools. Associations between psycho-social work environment and work-related violence and threats were then studied using a one-year follow-up design and multilevel logistic regression analyses. The analyses showed that quantitative demands, high emotional demands, low level of influence over own work-situation, low predictability, low rewards at work, low role clarity, many role conflicts, many work-family conflicts and low organizational justice had statistically significant associations with high levels of work-related threats. Furthermore, high emotional demands, low predictability, low role clarity, many role conflicts, many work-family conflicts, low supervisor quality and low support from nearest supervisor had statistically significant associations with high levels of work-related violence. Finally, across the four sectors both similar and different associations between psycho-social work environment and work-related violence and threats were found. The results of the study underline the importance of including the psycho-social work environment as a supplement to existing violence prevention methods and interventions aimed at reducing work-related violence and threats.

Design guidelines for raised and traversable medians in urban areas.

DOT National Transportation Integrated Search

1983-01-01

Major urban and suburban streets must provide a high level of service for through traffic as well as access to abutting properties. To an extent, the provisions of traffic service and the accommodation of access needs are conflicting functions that a...

Service quality in health care.

PubMed

Kenagy, J W; Berwick, D M; Shore, M F

1999-02-17

Although US health care is described as "the world's largest service industry," the quality of service--that is, the characteristics that shape the experience of care beyond technical competence--is rarely discussed in the medical literature. This article illustrates service quality principles by analyzing a routine encounter in health care from a service quality point of view. This illustration and a review of related literature from both inside and outside health care has led to the following 2 premises: First, if high-quality service had a greater presence in our practices and institutions, it would improve clinical outcomes and patient and physician satisfaction while reducing cost, and it would create competitive advantage for those who are expert in its application. Second, many other industries in the service sector have taken service quality to a high level, their techniques are readily transferable to health care, and physicians caring for patients can learn from them.

FOS: A Factored Operating Systems for High Assurance and Scalability on Multicores

DTIC Science & Technology

2012-08-01

computing. It builds on previous work in distributed and microkernel OSes by factoring services out of the kernel, and then further distributing each...2 3.0 Methods, Assumptions, and Procedures (System Design) .................................................. 4 3.1 Microkernel ...cooperating servers. We term such a service a fleet. Figure 2 shows the high-level architecture of fos. A small microkernel runs on every core

Variability in Anxiety for Teaching Mathematics among Pre-service Elementary School Teachers Enrolled in a Mathematics Course.

ERIC Educational Resources Information Center

Levine, Gavrielle

This investigation traced changes in anxiety for teaching mathematics (ATM) among pre-service elementary school teachers (n=36) enrolled in a mathematics methods course by analyzing their weekly journal entries. Journal entries were coded for high level of ATM (ATM-high) or absence of ATM (ATM-absent) during the first class session, as well as…

Service Family Support -- A Small-Scale Project of Educational Psychologists Working with Parents

ERIC Educational Resources Information Center

Hogg, Jane; Hart, Anne; Collins, Zoe V.

2014-01-01

Being in a Service family can be a difficult position for children and parents alike due to high levels of mobility, parental separation, and the remaining parent's stress and emotional well-being. A Service family is defined as a family with one or both parents employed by the Ministry of Defence (MOD). The current project looked at the…

A comparison of offenders with intellectual disability across three levels of security.

PubMed

Hogue, Todd; Steptoe, Lesley; Taylor, John L; Lindsay, William R; Mooney, Paul; Pinkney, Lisa; Johnston, Susan; Smith, Anne H W; O'Brien, Gregory

2006-01-01

A number of authors have described, with disparate results, the prevalence of people with intellectual disability and their characteristics, in a range of offender cohorts defined by service use. These have included high security, a range of criminal justice services and community services. There is a need for research comparing cohorts of offenders with intellectual disabilities across different settings. AIM AND HYPOTHESIS: To conduct such a comparison and test the hypothesis that severity of characteristics measured will be highest in highest levels of residential security. A clinical-record-based comparison a offenders with intellectual disability in high security (n = 73), medium/low security (n = 70), and a community service (n = 69). Groups were similar in age and tested IQ levels. Early psychiatric service contact had been more likely in the lower security groups. In line with the hypothesis, more complex presentations, in particular comorbid personality disorder, was more likely in the highest security group. Both fatal and non-fatal interpersonal violence convictions were significantly related to group, with more in the high security group sustaining a conviction both at the index offence and prior to that. Over 50% of all groups had at least one conviction for a sexual offence. A regression model accounting for 78% of the variance was made up largely of disposal variables (Mental Health Act status and probation) and indications of antisocial traits (criminal damage, lifetime conviction for murder and ICD-10 personality disorder classification). The authors show that context of sampling affects most relationships between intellectual disability (ID) and offending when the methods for measuring ID are held constant. The results also present several questions on the relationship between risk, services available in an area and referral to higher security.

Clients’ perception and satisfaction toward service provided by pharmacy professionals at a teaching hospital in Ethiopia

PubMed Central

Teshome Kefale, Adane; Hagos Atsebah, Gebru; Ayele Mega, Teshale

2016-01-01

Background Evaluation of client’s perception and satisfaction with pharmacy services is important to identify specific areas of the service that need improvement in achieving high-quality pharmacy services. It also helps to detect the gaps in the current pharmaceutical services provision. Objective To assess clients’ perception and satisfaction toward service provided by pharmacy professionals at Mizan-Tepi University Teaching Hospital. Methods A cross-sectional study design was employed from March 8 to 24, 2016. A semistructured questionnaire was used to assess clients’ perception and satisfaction toward service provided by pharmacy professionals. The data collected were entered into Epi data 3.1, cleaned, and transported into and analyzed using SPSS version 20. Logistic regression was employed to determine associated factors, and statistical significance was considered at p-value <0.05. Results Among 384 respondents, 53.1% were male. Of the total participants, 63.8% had good perception and 36.2% had poor perception toward pharmacy services. With regard to satisfaction, 52.6% of the respondents were satisfied and 47.4% were unsatisfied by the pharmaceutical services. Sociodemographic variables such as educational level (p=0.000), occupation (p=0.031), payment for service (p=0.002), and reasons the respondents seek service (p=0.001) showed statistically significant association with the level of perception. Clients’ satisfaction was found to be significantly associated with educational level (p=0.002) and reason for seeking service (p=0.016). Conclusion and recommendation This study showed that the overall mean perception and satisfaction of clients in Mizan-Tepi University Teaching Hospital was low, even though it was above the mean level of perception and satisfaction. Action has to be taken to improve the perception and satisfaction of clients with the services provided in the pharmacy section. PMID:29354544

Clients' perception and satisfaction toward service provided by pharmacy professionals at a teaching hospital in Ethiopia.

PubMed

Teshome Kefale, Adane; Hagos Atsebah, Gebru; Ayele Mega, Teshale

2016-01-01

Evaluation of client's perception and satisfaction with pharmacy services is important to identify specific areas of the service that need improvement in achieving high-quality pharmacy services. It also helps to detect the gaps in the current pharmaceutical services provision. To assess clients' perception and satisfaction toward service provided by pharmacy professionals at Mizan-Tepi University Teaching Hospital. A cross-sectional study design was employed from March 8 to 24, 2016. A semistructured questionnaire was used to assess clients' perception and satisfaction toward service provided by pharmacy professionals. The data collected were entered into Epi data 3.1, cleaned, and transported into and analyzed using SPSS version 20. Logistic regression was employed to determine associated factors, and statistical significance was considered at p -value <0.05. Among 384 respondents, 53.1% were male. Of the total participants, 63.8% had good perception and 36.2% had poor perception toward pharmacy services. With regard to satisfaction, 52.6% of the respondents were satisfied and 47.4% were unsatisfied by the pharmaceutical services. Sociodemographic variables such as educational level ( p =0.000), occupation ( p =0.031), payment for service ( p =0.002), and reasons the respondents seek service ( p =0.001) showed statistically significant association with the level of perception. Clients' satisfaction was found to be significantly associated with educational level ( p =0.002) and reason for seeking service ( p =0.016). This study showed that the overall mean perception and satisfaction of clients in Mizan-Tepi University Teaching Hospital was low, even though it was above the mean level of perception and satisfaction. Action has to be taken to improve the perception and satisfaction of clients with the services provided in the pharmacy section.

Uncertainty in elevation data and sensitivity to a sea-level rise estuary habitat model: Costs and benefits of high precision

EPA Science Inventory

Understanding the threats of sea-level rise (SLR) to ecosystem services in key estuarine habitats is a high priority for Pacific Northwest coastal biologists, fish and wildlife managers, and shellfish growers. The utility of decision support systems for understanding potential e...

Can use of healthcare services among 15-16-year-olds predict an increased level of high school dropout? A longitudinal community study.

PubMed

Homlong, Lisbeth; Rosvold, Elin O; Haavet, Ole R

2013-09-19

To study associations between healthcare seeking in 15-16-year-olds and high school dropout 5 years later. Longitudinal community study. Data from a comprehensive youth health survey conducted in 2000-2004, linked to data from national registries up to 2010. 13 964 10th grade secondary school students in six Norwegian counties. Logistic regression was used to compute ORs for high school dropout. The total proportion of students not completing high school 5 years after registering was 29% (girls 24%, boys 34%). Frequent attenders to school health services and youth health clinics at age 15-16 years had a higher dropout rate (37/48% and 45/71%), compared with those with no or moderate use. Adolescents referred to mental health services were also more likely to drop out (47/62%). Boys with moderate use of a general practitioner (GP) had a lower dropout rate (30%). A multiple logistic regression analysis, in which we adjusted for selected health indicators and sociodemographic background variables, revealed that seeking help from the youth health clinic and consulting mental health services, were associated with increased level of high school dropout 5 years later. Frequent attenders (≥4 contacts) had the highest odds of dropping out. Yet, boys who saw a GP and girls attending the school health services regularly over the previous year were less likely than their peers to drop out from high school. Adolescents who seek help at certain healthcare services can be at risk of dropping out of high school later. Health workers should pay particular attention to frequent attenders and offer follow-up when needed. However, boys who attended a GP regularly were more likely to continue to high school graduation, which may indicate a protective effect of having a regular and stable relationship with a GP.

Process improvement by cycle time reduction through Lean Methodology

NASA Astrophysics Data System (ADS)

Siva, R.; patan, Mahamed naveed khan; lakshmi pavan kumar, Mane; Purusothaman, M.; pitchai, S. Antony; Jegathish, Y.

2017-05-01

In present world, every customer needs their products to get on time with good quality. Presently every industry is striving to satisfy their customer requirements. An aviation concern trying to accomplish continuous improvement in all its projects. In this project the maintenance service for the customer is analyzed. The maintenance part service is split up into four levels. Out of it, three levels are done in service shops and the fourth level falls under customer’s privilege to change the parts in their aircraft engines at their location. An enhancement for electronics initial provisioning (eIP) is done for fourth level. Customers request service shops to get their requirements through Recommended Spare Parts List (RSPL) by eIP. To complete this RSPL for one customer, it takes 61.5 hours as a cycle time which is very high. By mapping current state VSM and takt time, future state improvement can be done in order to reduce cycle time using Lean tools such as Poke-Yoke, Jidoka, 5S, Muda etc.,

Mental Health Treatment Involvement and Religious Coping among African American, Hispanic, and White Veterans of the Wars of Iraq and Afghanistan

PubMed Central

Greenawalt, David S.; Tsan, Jack Y.; Kimbrel, Nathan A.; Meyer, Eric C.; Kruse, Marc I.; Tharp, David F.; Gulliver, Suzy Bird; Morissette, Sandra B.

2011-01-01

Although racial/ethnic differences have been found in the use of mental health services for depression in the general population, research among Veterans has produced mixed results. This study examined racial/ethnic differences in the use of mental health services among 148 Operation Enduring/Iraqi Freedom (OEF/OIF) Veterans with high levels of depression and posttraumatic stress disorder (PTSD) symptoms and evaluated whether religious coping affected service use. No differences between African American, Hispanic, and Non-Hispanic white Veterans were found in use of secular mental health services or religious counseling. Women Veterans were more likely than men to seek secular treatment. After controlling for PTSD symptoms, depression symptom level was a significant predictor of psychotherapy attendance but not medication treatment. African American Veterans reported higher levels of religious coping than whites. Religious coping was associated with participation in religious counseling, but not secular mental health services. PMID:21785719

Client expectations and satisfaction of quality in home care services. A consumer perspective.

PubMed

Samuelsson, G; Wister, A

2000-12-01

This study examines clients' expectations of quality in home care services and their perceived satisfaction with services among a random sample of 76 home care recipients in Vancouver, Canada. The researchers conducted face-to-face interviews that applied Multiattribute Utility Technology, a procedure that organizes several quality attributes of "ideal" home care into a tree structure to compare their relative importance and ranking from the clients' perspective. Participants also were asked to state their satisfaction or dissatisfaction with the services received in these domains. Among the five main quality attributes identified, the subjects ranked suitability of the home helper and its subset, personal competence, as the most important indicators of quality, followed by continuity in service. In addition, clients tended to have a high level of satisfaction with regard to the attributes of overall home care services. The highest level of satisfaction was reported for elements of personal dispositions of home care staff. The lowest level of satisfaction involved the time/availability components of the service. Finally, comparisons between client expectations and satisfaction of received home care services showed the highest discrepancy for the attributes of influence and time/availability and the greatest congruence for personal attributes of the staff. The results are discussed in terms of their implications for the delivery of home care services.

Lean and the Learning Organization in Higher Education

ERIC Educational Resources Information Center

Francis, David E.

2014-01-01

Canadian post-secondary institutions are seeking enhanced efficiencies due to ongoing funding shortfalls and expanding teaching, research, and service mandates. These institutions have considered or enacted Lean methodology based on results reported by public service and healthcare organizations worldwide. Lean requires a high level of…

The Impact of Local Environmental Health Capacity on Foodborne Illness Morbidity in Maryland

PubMed Central

Resnick, Beth A.; Fox, Mary A.; McGready, John; Yager, James P.; Burke, Thomas A.

2011-01-01

Objectives. We evaluated the relationship between local food protection capacity and service provision in Maryland's 24 local food protection programs (FPPs) and incidence of foodborne illness at the county level. Methods. We conducted regression analyses to determine the relationship between foodborne illness and local FPP characteristics. We used the Centers for Disease Control and Prevention's FoodNet and Maryland Department of Health and Mental Hygiene outbreak data set, along with data on Maryland's local FPP capacity (workforce size and experience levels, budget) and service provision (food service facility inspections, public notification programs). Results. Counties with higher capacity, such as larger workforce, higher budget, and greater employee experience, had fewer foodborne illnesses. Counties with better performance and county-level regulations, such as high food service facility inspection rates and requiring certified food manager programs, respectively, had lower rates of illness. Conclusions. Counties with strong local food protection capacity and services can protect the public from foodborne illness. Research on public health services can enhance our understanding of the food protection infrastructure, and the effectiveness of food protection programs in preventing foodborne illness. PMID:21750282

Variation in teenage mothers' experiences of child care and other components of welfare reform: selection processes and developmental consequences.

PubMed

Yoshikawa, H; Rosman, E A; Hsueh, J

2001-01-01

Developmental evaluations of the current wave of welfare reform programs present challenges with regard to (1) assessing child outcomes; (2) accounting for heterogeneity among low-income families in both baseline characteristics and involvement in self-sufficiency activities and supports, and (3) development of alternatives to experimental approaches to causal inference. This study (N = 1,079) addresses these challenges by examining effects on 4- to 6-year-old children of different patterns of child care, self-sufficiency activities, and other service utilization indicators among experimental-group mothers in a 16-site welfare reform program. Outcomes in areas of cognitive ability and behavior problems were investigated. The study identified seven subgroups of participants engaging in different patterns of service utilization and activity involvement. A two-stage simultaneous equation methodology was used to account for selection, and effects on child cognitive ability of participation in specific patterns of services and activities were found. For example, children of mothers characterized by high levels of involvement in center-based child care, education, and job training showed higher levels of cognitive ability than children of mothers in groups characterized by high involvement in center-based care and education, or center-based care and job training. In addition, children of mothers in groups with high levels of involvement in any of these activities showed higher levels of cognitive ability than those with low levels of involvement. The bulk of selection effects occurred through site-level differences, rather than family-level socio-economic status or maternal depression indicators. Implications for welfare reform program and policy concerns are discussed.

Mental health services in South Africa: taking stock.

PubMed

Lund, C; Petersen, I; Kleintjes, S; Bhana, A

2012-11-01

There is new policy commitment to mental health in South Africa, demonstrated in the national mental health summit of April 2012. This provides an opportunity to take stock of our mental health services. At primary care level key challenges include- training and supervision of staff in the detection and management of common mental disorders, and the development of community-based psychosocial rehabilitation programmes for people with severe mental illness (in collaboration with existing non-governmental organizations). At secondary level, resources need to be invested in 72-hour observation facilities at designated district and regional hospitals, in keeping with the Mental Health Care Act. At tertiary level, greater continuity of care with primary and secondary levels is required to prevent "revolving door" patterns of care. There are major challenges and also opportunities related to the high level of comorbidity between mental illness and a range of other public health priorities, notably HIV/AIDS, cardiovascular disease and diabetes. The agenda for mental health services research needs to shift to a focus on evaluating interventions. With current policy commitment, the time to act and invest in evidence-based mental health services is now.

The influences of patient's satisfaction with medical service delivery, assessment of medical service, and trust in health delivery system on patient's life satisfaction in China

PubMed Central

2012-01-01

Background Patient’s satisfaction with medical service delivery/assessment of medical service/trust in health delivery system may have significant influence on patient’s life satisfaction in China’s health delivery system/in various kinds of hospitals. The aim of this study was to test whether and to what extent patient’s satisfaction with medical service delivery/patient’s assessments of various major aspects of medical service/various major aspects of patient’s trust in health delivery system influenced patient’s life satisfaction in China’s health delivery system/in various kinds of hospitals. Methods This study collaborated with National Bureau of Statistics of China to carry out a 2008 national urban resident household survey in 17 provinces, autonomous regions, and municipalities directly under the central government (N = 3,386), and specified ordered probit models were established to analyze dataset from this household survey. Results The key considerations in generating patient’s life satisfaction involved patient’s overall satisfaction with medical service delivery, assessment of doctor-patient communication, assessment of medical cost, assessment of medical treatment process, assessment of medical facility and hospital environment, assessment of waiting time for medical service, trust in prescription, trust in doctor, and trust in recommended medical examination. But the major considerations in generating patient’s life satisfaction were different among low level public hospital, high level public hospital, and private hospital. Conclusion The promotion of patient’s overall satisfaction with medical service delivery, the improvement of doctor-patient communication, the reduction of medical cost, the improvement of medical treatment process, the promotion of medical facility and hospital environment, the reduction of waiting time for medical service, the promotion of patient’s trust in prescription, the promotion of patient’s trust in doctor, and the promotion of patient’s trust in recommended medical examination could all help promote patient’s life satisfaction. But their promotion effects were different among low level public hospital, high level public hospital, and private hospital. PMID:22978432

Variation of ecosystem services and human activities: A case study in the Yanhe Watershed of China

NASA Astrophysics Data System (ADS)

Su, Chang-hong; Fu, Bo-Jie; He, Chan-Sheng; Lü, Yi-He

2012-10-01

The concept of 'ecosystem service' provides cohesive views on mechanisms by which nature contributes to human well-being. Fast social and economic development calls for research on interactions between human and natural systems. We took the Yanhe Watershed as our study area, and valued the variation of ecosystem services and human activities of 2000 and 2008. Five ecosystem services were selected i.e. net primary production (NPP), carbon sequestration and oxygen production (CSOP), water conservation, soil conservation, and grain production. Human activity was represented by a composite human activity index (HAI) that integrates human population density, farmland ratio, influence of residential sites and road network. Analysis results of the five ecosystem services and human activity (HAI) are as follows: (i) NPP, CSOP, water conservation, and soil conservation increased from 2000 to 2008, while grain production declined. HAI decreased from 2000 to 2008. Spatially, NPP, CSOP, and water conservation in 2000 and 2008 roughly demonstrated a pattern of decline from south to north, while grain production shows an endocentric increasing spatial pattern. Soil conservation showed a spatial pattern of high in the south and low in the north in 2000 and a different pattern of high in the west and low in the east in 2008 respectively. HAI is proportional to the administrative level and economic development. Variation of NPP/CSOP between 2000 and 2008 show an increasing spatial pattern from northwest to southeast. In contrast, the variation of soil conservation shows an increasing pattern from southeast to northwest. Variation of water conservation shows a fanning out decreasing pattern. Variation of grain production doesn't show conspicuous spatial pattern. (ii) Variation of water conservation and of soil conservation is significantly positively correlated at 0.01 level. Both variations of water conservation and soil conservation are negatively correlated with variation of HAI at 0.01 level. Variations of NPP/CSOP are negatively correlated with variations of soil conservation and grain production at 0.05 level. (iii) Strong tradeoffs exist between regulation services and provision service, while synergies exist within regulation services. Driving effect of human activities on ecosystem services and tradeoffs and synergies among ecosystem service are also discussed.

Linkages between organization climate and work outcomes: perceptual differences among health service professionals as a function of customer contact intensity.

PubMed

Scotti, Dennis J; Harmon, Joel

2014-01-01

The delivery of high-quality service, rendered by health service professionals who interact with customers (patients), increases the likelihood that customers will form positive evaluations of the quality of their service encounters as well as high levels of customer satisfaction. Using linkage theory to develop our conceptual framework, we identify four clusters of variables which contribute to a chain of sequential events that connect organization climate to personal and operational work outcomes. We then examine the perceptual differences of service professionals, grouped by intensity of customer contact, with respect to these variables. National data for this project were obtained from multiple sources made available by the Veterans Healthcare Administration (VHA). Cross-group differences were tested using a series of variance analyses. The results indicate that level of customer-contact intensity plays a significant role in explaining variation in perceptions of support staff, clinical practitioners, and nurses at the multivariate and univariate levels of analysis. Contact intensity appears to be a core determinant of the nature of work performed by health service professionals as well as their psychological responses to organizational and customer-related dynamics. Health service professionals are important resources because of their specialized knowledge, labor expense, and scarcity. Based on findings from our research, managers are advised to survey employees' perceptions of their organizational environment and design practices that respond to the unique viewpoints of each of the professional groups identified in this study. Such tailoring should help executives maximize the value of investments in human resources by underwriting patient satisfaction and financial sustainability.

Multimedia Messaging Service teleradiology in the provision of emergency neurosurgery services.

PubMed

Ng, Wai Hoe; Wang, Ernest; Ng, Ivan

2007-04-01

Neurosurgical emergencies constitute a significant proportion of workload of a tertiary neurosurgical service. Prompt diagnosis and emergent institution of definitive treatment are critical to reduce neurological mortality and morbidity. Diagnosis is highly dependent on accurate interpretation of scans by experienced clinicians. This expertise may not be readily available especially after office hours because many neurosurgical units are manned by middle-level neurosurgical staff with varying levels of experience in scan interpretation. Multimedia Messaging Service mobile phone technology offers a simple, cheap, quick, and effective solution to the problem of scan interpretation. An MMS takes only a few minutes to send and receive and allows senior doctors to view important images and make important clinical decisions to enhance patient management in an emergency situation. A mobile phone (with VGA camera and MMS capabilities) was provided to the neurosurgery registrar on call. The on-call mobile phone is passed on to the corresponding registrar on-call the next day. All consultants had personal mobile phones that are MMS-enabled. Relevant representative CT/MRI images can be taken directly from the mobile phone from the PACS off the computer screen. When only hard copies are available, the images can be taken off the light box. After a 12-month trial period, a questionnaire was given to all staff involved in the project to ascertain the usefulness of the MMS teleradiology service. The survey on the use of the MMS service in a tertiary neurosurgical service demonstrated that the technology significantly improved the level of confidence of the senior-level staff in emergent clinical decision making. Significantly, the MMS images were of sufficient quality and resolution to obviate the need to view the actual scans. The impact of MMS is less pronounced in the middle-level staff, but there was a trend that most of the junior staff found the service more useful. The MMS technology is demonstrated to be a useful media for the transmission of high-quality images to assist in the diagnostic process and implementation of emergent clinical therapy. It is already in widespread use and can be seamlessly and rapidly implemented in the clinical arena to improve the quality of patient care.

Attending surgeon burnout and satisfaction with the establishment of a regional acute care surgical service

PubMed Central

Helewa, Ramzi M.; Kholdebarin, Ramin; Hochman, David J.

2012-01-01

Background Establishment of the Acute Care Surgical Service (ACSS) has dramatically changed the management of acute, nontrauma surgical patients in Winnipeg, Manitoba. Its formation was partially driven by increasing strain on surgeons and surgical services. We sought to determine surgeon level of burnout and satisfaction with the ACSS. Methods All Winnipeg ACSS surgeons were mailed surveys. Burnout was established using the Maslach Burnout Inventory Human Services Survey. Satisfaction was ascertained with a series of questions. Results We attained a response rate of 76%. Most surgeons were married men with children. A burnout level of 61% was determined. Although most surgeons felt the ACSS was a positive change in their careers, they felt that operating room accessibility and teaching opportunities were lacking. Conclusion Although a high level of burnout exists among ACSS surgeons, most are satisfied with its establishment. Factors such as operating room accessibility and teaching opportunities must be addressed. PMID:22854111

Validation of an instrument to measure inter-organisational linkages in general practice.

PubMed

Amoroso, Cheryl; Proudfoot, Judith; Bubner, Tanya; Jayasinghe, Upali W; Holton, Christine; Winstanley, Julie; Beilby, Justin; Harris, Mark F

2007-12-03

Linkages between general medical practices and external services are important for high quality chronic disease care. The purpose of this research is to describe the development, evaluation and use of a brief tool that measures the comprehensiveness and quality of a general practice's linkages with external providers for the management of patients with chronic disease. In this study, clinical linkages are defined as the communication, support, and referral arrangements between services for the care and assistance of patients with chronic disease. An interview to measure surgery-level (rather than individual clinician-level) clinical linkages was developed, piloted, reviewed, and evaluated with 97 Australian general practices. Two validated survey instruments were posted to patients, and a survey of locally available services was developed and posted to participating Divisions of General Practice (support organisations). Hypotheses regarding internal validity, association with local services, and patient satisfaction were tested using factor analysis, logistic regression and multilevel regression models. The resulting General Practice Clinical Linkages Interview (GP-CLI) is a nine-item tool with three underlying factors: referral and advice linkages, shared care and care planning linkages, and community access and awareness linkages. Local availability of chronic disease services has no affect on the comprehensiveness of services with which practices link, however, comprehensiveness of clinical linkages has an association with patient assessment of access, receptionist services, and of continuity of care in their general practice. The GP-CLI may be useful to researchers examining comparable health care systems for measuring the comprehensiveness and quality of linkages at a general practice-level with related services, possessing both internal and external validity. The tool can be used with large samples exploring the impact, outcomes, and facilitators of high quality clinical linkages in general practice.

An Exploration of Human Well-Being Bundles as Identifiers of Ecosystem Service Use Patterns

PubMed Central

Biggs, Reinette; Reyers, Belinda

2016-01-01

We take a social-ecological systems perspective to investigate the linkages between ecosystem services and human well-being in South Africa. A recent paper identified different types of social-ecological systems in the country, based on distinct bundles of ecosystem service use. These system types were found to represent increasingly weak direct feedbacks between nature and people, from rural “green-loop” communities to urban “red-loop” societies. Here we construct human well-being bundles and explore whether the well-being bundles can be used to identify the same social-ecological system types that were identified using bundles of ecosystem service use. Based on national census data, we found three distinct well-being bundle types that are mainly characterized by differences in income, unemployment and property ownership. The distribution of these well-being bundles approximates the distribution of ecosystem service use bundles to a substantial degree: High levels of income and education generally coincided with areas characterised by low levels of direct ecosystem service use (or red-loop systems), while the majority of low well-being areas coincided with medium and high levels of direct ecosystem service use (or transition and green-loop systems). However, our results indicate that transformations from green-loop to red-loop systems do not always entail an immediate improvement in well-being, which we suggest may be due to a time lag between changes in the different system components. Using human well-being bundles as an indicator of social-ecological dynamics may be useful in other contexts since it is based on socio-economic data commonly collected by governments, and provides important insights into the connections between ecosystem services and human well-being at policy-relevant sub-national scales. PMID:27695120

An Exploration of Human Well-Being Bundles as Identifiers of Ecosystem Service Use Patterns.

PubMed

Hamann, Maike; Biggs, Reinette; Reyers, Belinda

2016-01-01

We take a social-ecological systems perspective to investigate the linkages between ecosystem services and human well-being in South Africa. A recent paper identified different types of social-ecological systems in the country, based on distinct bundles of ecosystem service use. These system types were found to represent increasingly weak direct feedbacks between nature and people, from rural "green-loop" communities to urban "red-loop" societies. Here we construct human well-being bundles and explore whether the well-being bundles can be used to identify the same social-ecological system types that were identified using bundles of ecosystem service use. Based on national census data, we found three distinct well-being bundle types that are mainly characterized by differences in income, unemployment and property ownership. The distribution of these well-being bundles approximates the distribution of ecosystem service use bundles to a substantial degree: High levels of income and education generally coincided with areas characterised by low levels of direct ecosystem service use (or red-loop systems), while the majority of low well-being areas coincided with medium and high levels of direct ecosystem service use (or transition and green-loop systems). However, our results indicate that transformations from green-loop to red-loop systems do not always entail an immediate improvement in well-being, which we suggest may be due to a time lag between changes in the different system components. Using human well-being bundles as an indicator of social-ecological dynamics may be useful in other contexts since it is based on socio-economic data commonly collected by governments, and provides important insights into the connections between ecosystem services and human well-being at policy-relevant sub-national scales.

The matron's role in acute National Health Service trusts.

PubMed

Gould, Dinah

2008-10-01

The aim of this study was to describe how matrons in an acute National Health Service trust perceive and undertake their role since its reconfiguration in 2005 and to investigate their needs for continuing professional development. Matrons returned to acute National Health Service trusts in 2002 to provide a senior, authoritative nursing presence throughout clinical areas. Their function is to promote high standards of clinical care and leadership; ensure that administrative and support services are in place to deliver high standards of care; and provide a visible, accessible and authoritative presence in ward settings. Data were obtained by interview. A qualitative approach using a semi-structured interview schedule was used to obtain data from 22 matrons and the data were subjected to thematic analysis. There were differences in the way that matrons performed their role. They promoted clinical leadership effectively and maintained a high clinical profile. Attempts to promote high standards of cleanliness and infection control were less effective because of the shortcomings of the domestic service. Overall the matron role is proving effective. However, matrons' ability to promote adequate levels of environmental cleanliness and control infection is a cause for concern. IMPLICATIONS FOR NURSING MANAGERS: The study findings suggest that where an existing service is performing poorly, expecting another occupational group to oversee it will not contribute to improvement unless resources can be improved. WHAT THIS PAPER ADDS TO CURRENT KNOWLEDGE: This study has provided an in-depth evaluation of the matron role at a local level. It is to date the most comprehensive study of its kind.

'Forensic' labelling: an empirical assessment of its effects on self-stigma for people with severe mental illness.

PubMed

Livingston, James D; Rossiter, Katherine R; Verdun-Jones, Simon N

2011-06-30

Increasingly, specialized 'forensic' mental health services are being developed to address the criminogenic and clinical needs of people with mental illness who are involved in the criminal justice system. Theoretically, the construction of such specialized services can produce simultaneous positive benefits and negative consequences. This mixed methods study examined and compared the level of self-stigma that was experienced by people who receive compulsory community-based treatment services in the forensic (n=52) and civil (n=39) mental health systems of British Columbia, Canada. The quantitative findings indicate that 'forensic' labelling was not associated with elevated levels of self-stigma. Quantitative level of self-stigma was significantly associated with psychiatric symptom severity, history of incarceration, and history of homelessness. The qualitative findings suggest that access to high-quality, well-resourced forensic mental health services may, for some service users, come at the risk of increased exposure to social and structural stigma. Together, these findings reveal some of the strengths and weaknesses that are associated with organizing forensic mental health services using a specialized service delivery model. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Patients'/Clients' Expectation Toward and Satisfaction from Pharmacy Services

PubMed Central

Ayalew, Mohammed Biset; Taye, Kaleab; Asfaw, Daniel; Lemma, Bethlehem; Dadi, Filagot; Solomon, Habtamu; Tazeze, Haile; Tsega, Bayew

2017-01-01

Objective: Satisfaction is becoming a popular health-care quality indicator as it reflects the reality of service or care provided. The aim of this study was to assess the level of patients' expectation toward and satisfaction from pharmacy service provided and to identify associated factor that might affect their expectation and satisfaction. Methods: A cross-sectional study was conducted on 287 patients, who were served in five pharmacies of Gondar University Hospital in May 2015. Data regarding socio-demographic characteristics and parameters that measure patients' expectation and satisfaction were collected through interview using the Amharic version of the questionnaire. Data were entered into SPSS version 21, and descriptive statistics, cross-tabs, and binary logistic regressions were utilized. P < 0.05 was used to declare association. Findings: Among 287 respondents involved in the study, 149 (51.9%) claimed to be satisfied with the pharmacy service and setting. Two hundred and twenty-nine (79.4%) respondents have high expectation toward gaining good services. Even though significant association was observed between the pharmacy type and patients level of satisfaction, sociodemographic characteristics of a patient were not found to predict the level of satisfaction. There is a higher level of expectation among study participants who earn higher income per month (>(2000 Ethiopian birr [ETB]) than those who get less income (<1000 ETB). Conclusion: Although patients have a higher level of expectation toward pharmacy services, their satisfaction from the service was found to be low. PMID:28331862

About Banking.

ERIC Educational Resources Information Center

Pieslak, Raymond F.

The student manual for high school level special needs students was prepared to provide deaf students with the basic fundamentals of banking. Five units are presented covering the topics of banks and banking services, checking accounts, other services of banks, savings accounts, and other investments. Each lesson was carefully written for easy…

Auto Service Career Preparation Moves to the Fast Track.

ERIC Educational Resources Information Center

Gray, Don

2000-01-01

Automotive Youth Educational Systems (AYES) is a school-to-career partnership among automotive manufacturers and dealers and selected high schools. AYES is designed to encourage students to consider careers in retail automotive service and to prepare them for entry-level positions at dealerships or colleges. (JOW)

Identifying priority areas for ecosystem service management in South African grasslands.

PubMed

Egoh, Benis N; Reyers, Belinda; Rouget, Mathieu; Richardson, David M

2011-06-01

Grasslands provide many ecosystem services required to support human well-being and are home to a diverse fauna and flora. Degradation of grasslands due to agriculture and other forms of land use threaten biodiversity and ecosystem services. Various efforts are underway around the world to stem these declines. The Grassland Programme in South Africa is one such initiative and is aimed at safeguarding both biodiversity and ecosystem services. As part of this developing programme, we identified spatial priority areas for ecosystem services, tested the effect of different target levels of ecosystem services used to identify priority areas, and evaluated whether biodiversity priority areas can be aligned with those for ecosystem services. We mapped five ecosystem services (below ground carbon storage, surface water supply, water flow regulation, soil accumulation and soil retention) and identified priority areas for individual ecosystem services and for all five services at the scale of quaternary catchments. Planning for individual ecosystem services showed that, depending on the ecosystem service of interest, between 4% and 13% of the grassland biome was required to conserve at least 40% of the soil and water services. Thirty-four percent of the biome was needed to conserve 40% of the carbon service in the grassland. Priority areas identified for five ecosystem services under three target levels (20%, 40%, 60% of the total amount) showed that between 17% and 56% of the grassland biome was needed to conserve these ecosystem services. There was moderate to high overlap between priority areas selected for ecosystem services and already-identified terrestrial and freshwater biodiversity priority areas. This level of overlap coupled with low irreplaceability values obtained when planning for individual ecosystem services makes it possible to combine biodiversity and ecosystem services in one plan using systematic conservation planning. Copyright © 2011 Elsevier Ltd. All rights reserved.

Ecological concerns following Superstorm Sandy: stressor level and recreational activity levels affect perceptions of ecosystem

PubMed Central

2015-01-01

Coastal habitats are vulnerable to storms, and with increasing urbanization, sea level rise, and storm frequency, some urban populations are at risk. This study examined perceptions of respondents in coastal and central New Jersey to Superstorm Sandy, including: 1) concerns about ecological resources and effects (open-ended question), 2) information sources for ecology of the coast (open-ended), and 3) ratings of a list of ecological services as a function of demographics, location (coastal, central Jersey), stressor level (power outages, high winds, flooding) and recreational rates. “Wildlife” and “fish” were the ecological concerns mentioned most often, while beaches and dunes were most often mentioned for environmental concerns. Television, radio, and web/internet were sources trusted for ecological information. The data indicate 1) stressor level was a better predictor of ratings of ecological services than geographical location, but days engaged in recreation contributed the most to variations in ratings, 2) ecological services were rated the highest by respondents with the highest stressor levels, and by those from the coast, compared to others, 3) Caucasians rated ecological services higher than all others, and 4) recreational rates were highest for coastal respondents, and ratings for ecological services increased with recreational rates. Only 20 % of respondents listed specific ecological services as one of their three most important environmental concerns. These data will be useful for increasing preparedness, enhancing educational strategies for shore protection, and providing managers and public policy makers with data essential to developing resiliency strategies. PMID:27011729

Clients' satisfaction with HIV treatment services in Bamenda, Cameroon: a cross-sectional study.

PubMed

Wung, Buh Amos; Peter, Nde Fon; Atashili, Julius

2016-07-19

Clients have explicit desires or requests for services when visiting hospitals; inadequate discovery of their needs may result in dissatisfaction. Patient satisfaction influences retention in HIV care, adherence to HAART and serves as determinant to HIV suppression. This study's objectives were to quantify clients' satisfaction with HIV services in Bamenda and determine relationship between satisfaction and clients' socio-demographic/structural characteristics. A cross-sectional study was conducted on HIV-positive patients followed-up, on treatment and who consulted in the Bamenda Regional Hospital treatment centre between July and August 2014. Participants consent was sought and data collected on client's level of satisfaction to staff-patient-communication, staff attitudes, privacy and confidentiality and staffing and amenities situations in the hospital. Data was collected using a structured questionnaire interviewer-administered by investigator and trained health personnel. Collected data was analyzed using Epi Info version 3.5.4 and clients' satisfaction measured using frequencies and percentages. A total of 384 participants took part in this study and their median age was 37 years (IQR: 29-46). Two hundred and seventy-four (71.4 %) participants were females. Overall satisfaction with HIV services was 91.2 % and participants reported less satisfaction with overall staffing and amenities situation of the centre (3.6 %). In the multivariate analysis, only being female, employed and perceiving high number of nurses working at the treatment centre remained significant predictors of overall satisfaction with HIV services. A high proportion of participants expressed satisfaction with HIV services. However, some dissatisfaction is masked in this high satisfaction level. This dissatisfaction underscores need to improve staff attitudes, staff-patient-communication, employ more staff and build better patient facilities. Future studies need to focus on assessing long-term progression of satisfaction levels with services and determinants of satisfaction involving larger samples in many treatment centres.

Unmet need for healthcare services in adolescents and young adults with cancer and their parent carers.

PubMed

Sawyer, Susan M; McNeil, Robyn; McCarthy, Maria; Orme, Lisa; Thompson, Kate; Drew, Sarah; Dunt, David

2017-07-01

Cancer in adolescents in and young adults (AYA) has the potential to disrupt health, well-being and developmental trajectories. This study aimed to describe the healthcare support service needs of AYAs with cancer and parent carers and to explore the association of unmet need and emotional distress. As part of a national Australian survey of 15-25 year olds with cancer and a nominated parent carer, 196 AYAs reported total and unmet need for 10 clinical services and 204 parents reported on their child's and their own healthcare service needs. Proportions of total and unmet need for specific clinical services are reported. The association of unmet service needs and distress (measured using the Posttraumatic Stress Disorder Checklist) was also examined. AYAs and parent carers expressed high total need for clinical services during treatment. Leading AYA unmet needs were for an exercise therapist (37%), genetic counsellor (30%), dietitian (26%), peer support group (26%) and educational and vocational advisor (24%). After treatment, AYAs and parents had fewer total needs. However, 60% of AYA and 38% of parents had two or more unmet needs, similar to during treatment. Female gender and receiving treatment in an adult setting were significantly associated with unmet need for clinical services. After treatment, higher distress levels in AYAs and parents were associated with two or more unmet service needs. AYAs and parents had high levels of total and unmet service need, which were associated with greater emotional distress. These results highlight opportunities to re-orientate services to better meet AYA and parent needs.

Linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services: a systematic review.

PubMed

Ferguson, Laura; Grant, Alison D; Watson-Jones, Deborah; Kahawita, Tanya; Ong'ech, John O; Ross, David A

2012-05-01

To quantify attrition between women testing HIV-positive in pregnancy-related services and accessing long-term HIV care and treatment services in low- or middle-income countries and to explore the reasons underlying client drop-out by synthesising current literature on this topic. A systematic search in Medline, EMBASE, Global Health and the International Bibliography of the Social Sciences of literature published 2000-2010. Only studies meeting pre-defined quality criteria were included. Of 2543 articles retrieved, 20 met the inclusion criteria. Sixteen (80%) drew on data from sub-Saharan Africa. The pathway between testing HIV-positive in pregnancy-related services and accessing long-term HIV-related services is complex, and attrition was usually high. There was a failure to initiate highly active antiretroviral therapy (HAART) among 38-88% of known-eligible women. Providing 'family-focused care', and integrating CD4 testing and HAART provision into prevention of mother-to-child HIV transmission services appear promising for increasing women's uptake of HIV-related services. Individual-level factors that need to be addressed include financial constraints and fear of stigma. Too few women negotiate the many steps between testing HIV-positive in pregnancy-related services and accessing HIV-related services for themselves. Recent efforts to stem patient drop-out, such as the MTCT-Plus Initiative, hold promise. Addressing barriers and enabling factors both within health facilities and at the levels of the individual woman, her family and society will be essential to improve the uptake of services. © 2012 Blackwell Publishing Ltd.

Modeling Adaptable Business Service for Enterprise Collaboration

NASA Astrophysics Data System (ADS)

Boukadi, Khouloud; Vincent, Lucien; Burlat, Patrick

Nowadays, a Service Oriented Architecture (SOA) seems to be one of the most promising paradigms for leveraging enterprise information systems. SOA creates opportunities for enterprises to provide value added service tailored for on demand enterprise collaboration. With the emergence and rapid development of Web services technologies, SOA is being paid increasing attention and has become widespread. In spite of the popularity of SOA, a standardized framework for modeling and implementing business services are still in progress. For the purpose of supporting these service-oriented solutions, we adopt a model driven development approach. This paper outlines the Contextual Service Oriented Modeling and Analysis (CSOMA) methodology and presents UML profiles for the PIM level service-oriented architectural modeling, as well as its corresponding meta-models. The proposed PIM (Platform Independent Model) describes the business SOA at a high level of abstraction regardless of techniques involved in the application employment. In addition, all essential service-specific concerns required for delivering quality and context-aware service are covered. Some of the advantages of this approach are that it is generic and thus not closely allied with Web service technology as well as specifically treating the service adaptability during the design stage.

The forgotten smoker: a qualitative study of attitudes towards smoking, quitting, and tobacco control policies among continuing smokers.

PubMed

Uppal, Navneet; Shahab, Lion; Britton, John; Ratschen, Elena

2013-05-03

Although research suggests that the majority of smokers want to quit smoking, the uptake of Stop Smoking Services, designed to assist smokers with quitting, remains low. Little is known about continuing smokers who do not access these services, and opportunities to influence their motivation and encourage quit attempts through the uptake of services. Using PRIME theory, this study explored differences between continuing smokers who had varying levels of motivation to quit, in terms of their plans to quit, evaluative beliefs about smoking, cigarette dependence, and attitudes towards tobacco control policies and services. Twenty-two current smokers, recruited from the community, were classified by motivation level to quit using a self-report questionnaire (two groups: high/low). Four focus groups (n=13) and individual interviews (n=9) were conducted with both groups using an interview guide incorporating aspects of PRIME theory. Discussion areas included motives for smoking, attitudes towards smoking and quitting, perceptions of dependence, motives for quitting, barriers to quitting, and attitudes towards existing and impending tobacco control policies and services. Verbatim transcripts were analysed using thematic framework analysis. All participants expressed low motivation to quit during discussions, despite some initially self-classifying as having high explicit levels of motivation to quit. Both groups reported similar attitudes towards smoking and quitting, including a perceived psychological addiction to smoking, positive evaluations about smoking which inhibited plans to quit, and similar suggested methods to increase motivation (simply wanting to, save money, improve health). Most felt that they 'ought' to quit as opposed to 'wanted' to. Little influence was ascribed towards tobacco control policies such as plain packaging and hidden sales displays, and participants felt that price increases of tobacco products needed to be considerable in order to influence motivation. Highly motivated smokers expressed more willingness to visit Stop Smoking Services, although none had done so. Continuing smokers' attitudes towards smoking and quitting suggests that research and policy need to focus on increasing smokers' implicit motivation to quit smoking, even for those who classified themselves as having high motivation to quit. Targeted information and further education about Stop Smoking Services is required to increase uptake.

Coordinating Resource Usage through Adaptive Service Provisioning in Wireless Sensor Networks

NASA Astrophysics Data System (ADS)

Fok, Chien-Liang; Roman, Gruia-Catalin; Lu, Chenyang

Wireless sensor networks (WSNs) exhibit high levels of network dynamics and consist of devices with limited energy. This results in the need to coordinate applications not only at the functional level, as is traditionally done, but also in terms of resource utilization. In this paper, we present a middleware that does this using adaptive service provisioning. Novel service binding strategies automatically adapt application behavior when opportunities for energy savings surface, and switch providers when the network topology changes. The former is accomplished by providing limited information about the energy consumption associated with using various services, systematically exploiting opportunities for sharing service invocations, and exploiting the broadcast nature of wireless communication in WSNs. The middleware has been implemented and evaluated on two disparate WSN platforms, the TelosB and Imote2. Empirical results show that adaptive service provisioning can enable energy-aware service binding decisions that result in increased energy efficiency and significantly increase service availability, while imposing minimal additional burden on the application, service, and device developers. Two applications, medical patient monitoring and structural health monitoring, demonstrate the middleware's efficacy.

Cloud-based hospital information system as a service for grassroots healthcare institutions.

PubMed

Yao, Qin; Han, Xiong; Ma, Xi-Kun; Xue, Yi-Feng; Chen, Yi-Jun; Li, Jing-Song

2014-09-01

Grassroots healthcare institutions (GHIs) are the smallest administrative levels of medical institutions, where most patients access health services. The latest report from the National Bureau of Statistics of China showed that 96.04 % of 950,297 medical institutions in China were at the grassroots level in 2012, including county-level hospitals, township central hospitals, community health service centers, and rural clinics. In developing countries, these institutions are facing challenges involving a shortage of funds and talent, inconsistent medical standards, inefficient information sharing, and difficulties in management during the adoption of health information technologies (HIT). Because of the necessity and gravity for GHIs, our aim is to provide hospital information services for GHIs using Cloud computing technologies and service modes. In this medical scenario, the computing resources are pooled by means of a Cloud-based Virtual Desktop Infrastructure (VDI) to serve multiple GHIs, with different hospital information systems dynamically assigned and reassigned according to demand. This paper is concerned with establishing a Cloud-based Hospital Information Service Center to provide hospital information software as a service (HI-SaaS) with the aim of providing GHIs with an attractive and high-performance medical information service. Compared with individually establishing all hospital information systems, this approach is more cost-effective and affordable for GHIs and does not compromise HIT performance.

Argobots: A Lightweight Low-Level Threading and Tasking Framework

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

Seo, Sangmin; Amer, Abdelhalim; Balaji, Pavan

In the past few decades, a number of user-level threading and tasking models have been proposed in the literature to address the shortcomings of OS-level threads, primarily with respect to cost and flexibility. Current state-of-the-art user-level threading and tasking models, however, are either too specific to applications or architectures or are not as powerful or flexible. In this paper, we present Argobots, a lightweight, low-level threading and tasking framework that is designed as a portable and performant substrate for high-level programming models or runtime systems. Argobots offers a carefully designed execution model that balances generality of functionality with providing amore » rich set of controls to allow specialization by the user or high-level programming model. We describe the design, implementation, and optimization of Argobots and present integrations with three example high-level models: OpenMP, MPI, and co-located I/O service. Evaluations show that (1) Argobots outperforms existing generic threading runtimes; (2) our OpenMP runtime offers more efficient interoperability capabilities than production OpenMP runtimes do; (3) when MPI interoperates with Argobots instead of Pthreads, it enjoys reduced synchronization costs and better latency hiding capabilities; and (4) I/O service with Argobots reduces interference with co-located applications, achieving performance competitive with that of the Pthreads version.« less

Differences in Use of Government Subsidised Mental Health Services by Men and Women with Psychological Distress: A Study of 229,628 Australians Aged 45 Years and Over.

PubMed

Dolja-Gore, Xenia; Loxton, Deborah; D'Este, Catherine; Blyth, Fiona; Byles, Julie

2018-04-17

This study examined factors associated with use of government subsidised mental health services by 229,628 men and women from the Sax Institute's 45 and Up Study. Logistical regression models assessed use of mental health services by gender and according to level of psychological distress. Approximately equal proportion of men and women had high psychological distress scores (approximately 7%) but only 7% of these men and 11% of these women used services. Use was associated with predisposing (younger age and higher education), enabling (private health insurance) and need factors (higher psychological distress scores). Associations were similar for men and women except urban area of residence, separated/divorced marital status, and smoking were associated with service use for women but not men. Results suggest some inequity in the use of services by those with higher levels of need and further efforts may be required to reach people with higher need but lower service use.

A Satellite-Based Infrastructure Providing Broadband IP Services on Board High Speed Trains

NASA Astrophysics Data System (ADS)

Feltrin, Eros; Weller, Elisabeth

After the earlier technologies that offered satellite mobile services for civil and military applications, today’s specific antenna design, modulation techniques and most powerful new generation satellites also allow a good level of performance to be achieved on-board high speed modes of transport such as aircraft and trains. This paper reports the Eutelsat’s experience in the developing and deploying architecture based on a spread spectrum system in order to provide broadband connectivity on board of high speed trains. After introducing the adopted technologies, the architecture and the constraints, some results obtained from analysis, testing and measuring of the availability of the service are reported and commented upon.

Exploring Multilevel Factors for Family Engagement in Home Visiting Across Two National Models.

PubMed

Latimore, Amanda D; Burrell, Lori; Crowne, Sarah; Ojo, Kristen; Cluxton-Keller, Fallon; Gustin, Sunday; Kruse, Lakota; Hellman, Daniela; Scott, Lenore; Riordan, Annette; Duggan, Anne

2017-07-01

The associations of family, home visitor and site characteristics with family engagement within the first 6 months were examined. The variation in family engagement was also explored. Home visiting program participants were drawn from 21 Healthy Families America sites (1707 families) and 9 Nurse-Family Partnership sites (650 families) in New Jersey. Three-level nested generalized linear mixed models assessed the associations of family, home visitor and site characteristics with family receipt of a high dose of services in the first 6 months of enrollment. A family was considered to have received a high dose of service in the first 6 months of enrollment if they were active at 6 months and had received at least 50% of their expected visits in the first 6 months. In general, both home visiting programs engaged, at a relatively high level (Healthy Families America (HFA) 59%, Nurse-Family Partnership (NFP) 64%), with families demonstrating high-risk characteristics such as lower maternal education, maternal smoking, and maternal mental health need. Home visitor characteristics explained more of the variation (87%) in the receipt of services for HFA, while family characteristics explained more of the variation (75%) in the receipt of services for NFP. At the family level, NFP may improve the consistency with which they engage families by increasing retention efforts among mothers with lower education and smoking mothers. HFA sites seeking to improve engagement consistency should consider increasing the flexible in home visitor job responsibilities and examining the current expected-visit policies followed by home visitors on difficult-to-engage families.

New Directions in Space Operations Services in Support of Interplanetary Exploration

NASA Technical Reports Server (NTRS)

Bradford, Robert N.

2005-01-01

To gain access to the necessary operational processes and data in support of NASA's Lunar/Mars Exploration Initiative, new services, adequate levels of computing cycles and access to myriad forms of data must be provided to onboard spacecraft and ground based personnel/systems (earth, lunar and Martian) to enable interplanetary exploration by humans. These systems, cycles and access to vast amounts of development, test and operational data will be required to provide a new level of services not currently available to existing spacecraft, on board crews and other operational personnel. Although current voice, video and data systems in support of current space based operations has been adequate, new highly reliable and autonomous processes and services will be necessary for future space exploration activities. These services will range from the more mundane voice in LEO to voice in interplanetary travel which because of the high latencies will require new voice processes and standards. New services, like component failure predictions based on data mining of significant quantities of data, located at disparate locations, will be required. 3D or holographic representation of onboard components, systems or family members will greatly improve maintenance, operations and service restoration not to mention crew morale. Current operational systems and standards, like the Internet Protocol, will not able to provide the level of service required end to end from an end point on the Martian surface like a scientific instrument to a researcher at a university. Ground operations whether earth, lunar or Martian and in flight operations to the moon and especially to Mars will require significant autonomy that will require access to highly reliable processing capabilities, data storage based on network storage technologies. Significant processing cycles will be needed onboard but could be borrowed from other locations either ground based or onboard other spacecraft. Reliability will be a key factor with onboard and distributed backup processing an absolutely necessary requirement. Current cluster processing/Grid technologies may provide the basis for providing these services. An overview of existing services, future services that will be required and the technologies and standards required to be developed will be presented. The purpose of this paper will be to initiate a technological roadmap, albeit at a high level, of current voice, video, data and network technologies and standards (which show promise for adaptation or evolution) to what technologies and standards need to be redefined, adjusted or areas where new ones require development. The roadmap should begin the differentiation between non manned and manned processes/services where applicable. The paper will be based in part on the activities of the CCSDS Monitor and Control working group which is beginning the process of standardization of the these processes. Another element of the paper will be based on an analysis of current technologies supporting space flight processes and services at JSC, MSFC, GSFC and to a lesser extent at KSC. Work being accomplished in areas such as Grid computing, data mining and network storage at ARC, IBM and the University of Alabama at Huntsville will be researched and analyzed.

Quality of antenatal care services and completion of four or more antenatal care visits in Ethiopia: a finding based on a demographic and health survey.

PubMed

Muchie, Kindie Fentahun

2017-09-11

Antenatal care (ANC) is one of the core interventions for improving maternal outcomes. The average annual decline of maternal mortality rate from 1990 to 2013 was 5% in Ethiopia. This figure was below the least expected 5.5% to achieve the targeted 75% by 1990-2015. Moreover, completion of the recommended four or more ANC visits was only 32%. This study was aimed to examine individual, household and community level potential determinants of completing the recommended visits in the country. The 2014 Ethiopian Mini Demographic and Health Survey data were used. Among women aged 15-49 years 3694 who had given birth in the 5 years preceding the survey were included in the analysis. The robust standard error method of generalized estimation equations were used for binary outcome variable from the clustered data. Only 33.0% (95% CI 31. 5% 34.5%) of women completed the recommended visits. Out of the total women, 56.5% had at least one ANC visit. Out of those who had at least one ANC visit, 37.4% visited in their first trimester. Completing the recommended visits was negatively associated with women in the lower educational level, lower economic conditions, higher birth order, and rural residence. But, it was positively associated with the community level high quality ANC services received. Difference in age and region also affected the completion of the recommended visits. The finding revealed the need for improving the uptake of ANC services, early arrival in the first trimester for services, and motivating mothers that begin ANC to confirm continuity. Strategies to foster completing the recommended visits should focus on upgrading quality of care services at the community level. Women in low economic level, high birth order, rural residence, and low educational status should be given special attention. Early and late age groups should be given special attention regarding the services.

Small City Transit : Chapel Hill, North Carolina : Public Transit Serving a University and Town

DOT National Transportation Integrated Search

1976-03-01

Chapel Hill, North Carolina, is an illustration of a public transit service providing a high level of service for a town its size and a good example of a cooperative arrangement between a town and a resident university. This case study is one of thir...

7 CFR 170.12 - What are the selection criteria for participation in the USDA Farmers Market?

Code of Federal Regulations, 2010 CFR

2010-01-01

... referred to the Internal Revenue Service or a tax advisor. Receipts for donated foods may be obtained from... Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices... Farmers Market? The selection criteria are designed to ensure a consistently high level of quality and...

78 FR 34385 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-07

... elementary, middle, and high school levels: health education, physical education, health services, mental... Physical Education 685 1 40/60 and Activity. District Health Services... 685 1 40/60 District Nutrition... School Recruitment Script.. 821 1 60/60 School Health Education.... 640 1 20/60 School Physical Education...

Managing Tensions in a Service-Learning Programme: Some Reflections

ERIC Educational Resources Information Center

Maistry, S. M.; Ramdhani, J.

2010-01-01

Service learning as a strategy for raising awareness amongst university students of their responsibilities to the community is rapidly gaining currency in higher education institutions in South Africa. High levels of unemployment and striking economic inequality have been an unfortunate feature of South African society for several decades. Since…

Being a Food Service Worker; Student Manual.

ERIC Educational Resources Information Center

Hospital Research and Educational Trust, Chicago, IL.

Instructional materials for student use in training or retraining for the occupation of food service worker at the vocational high school or community college level were developed by professional consultants. They were tested in a nationwide on-the-job training program and revised according to instructor evaluation and consultant suggestions. A…

Training the Food Service Worker; Instructor's Guide.

ERIC Educational Resources Information Center

Hospital Research and Educational Trust, Chicago, IL.

Curriculum materials for instructor use in planning lessons to train or retrain food service workers at the vocational high school or community college level were developed by professional consultants. They were tested in a nation-wide on-the-job training program and revised according to instructor evaluation and consultant suggestions. A minimum…

Competency Based Curriculum for Clothing Services and Production Sewing.

ERIC Educational Resources Information Center

Blake, Charlotte

Designed to meet individual needs and learning levels of high school and postsecondary students enrolled in vocational training for occupations in clothing services and production sewing, this competency-based curriculum teaches skills in alterations, dressmaking, and power sewing machine operations. Skills are organized into 13 units: Awareness…

Growing Up Responsible.

ERIC Educational Resources Information Center

Woehrle, Thomas

1993-01-01

From making holiday decorations for a local nursing home to serving food at a homeless shelter, students at Friends Academy in upstate New York participate in service activities designed to match their level of social awareness. Maurice Howard's sidebar shows how Maryland high schoolers participate in a state-mandated service-learning program that…

76 FR 51350 - Aerospace Executive Service Trade Mission (AESTM) to Seoul, Korea

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-18

... Korean governments and private aerospace and defense companies, the AESTM service at this major aerospace..., government officials, senior company managers, and high-level executives involved in the aerospace and... display company literature and conduct meetings with visitors to the air show. Company information and...

Analysis of Base Services Structure and Development of Cost-Saving Strategies to Counterattack Decreasing Funding Levels

DTIC Science & Technology

2005-12-01

7 habits of highly effective people ” puts it this way: “People and their managers are...corporations and 86 Covey, Stephen R., 7 Habits of Highly Effective People : Powerful Lessons in Personal Change, Simon Schuster, 1989, p. 52. 68...levels from January to July, 2006. Covey, Stephen R., 7 Habits of Highly Effective People : Powerful Lessons in Personal Change,

Toward Middle-Level Manpower Education for Colombia. A Report to USAID Colombia.

ERIC Educational Resources Information Center

Johnson, B. Lamar

Education for middle-level manpower, a high-priority need in Colombia, is discussed. The current programs of five educational agencies--universities, university institutes, SENA (National Apprentice Service), industrial schools, and agricultural schools--that are providing some preparation for middle-level manpower positions are described. A…

Why caregivers of people with dementia and memory loss don't use services.

PubMed

Brodaty, Henry; Thomson, Cathy; Thompson, Claire; Fine, Michael

2005-06-01

To develop a typography of the characteristics of caregivers of community dwelling people with dementia or memory loss who do not use services and empirically investigate the reasons for service non-use. The findings of a literature review were used to develop a typography of caregivers' non-use of services. This typography was applied to a sample of community-based caregivers. One in three caregivers were using no services and one in four only one service. Despite considerable proportions reporting low levels of life satisfaction and high levels of overload and resentment the main reasons caregivers gave for not using services were that they did not consider they needed the services. Other reasons for service non-use included care recipient reluctance to use services, lack of knowledge of services or being in the process of applying for services. Service availability or affordability were not identified as major impediments to service use. Presence of a physical disability and contact with a social worker were associated with service use. Caregivers of people with dementia incur significant strain and have substantial need for a variety of services. Nevertheless many caregivers were not using support services, mainly because of perceived lack of need or lack of awareness. Better public promotion of services, destigmatising dementia and encouraging referrals from health professionals could help overcome the barriers to service use. Copyright (c) 2005 John Wiley & Sons, Ltd

Scaling up ATLAS Event Service to production levels on opportunistic computing platforms

NASA Astrophysics Data System (ADS)

Benjamin, D.; Caballero, J.; Ernst, M.; Guan, W.; Hover, J.; Lesny, D.; Maeno, T.; Nilsson, P.; Tsulaia, V.; van Gemmeren, P.; Vaniachine, A.; Wang, F.; Wenaus, T.; ATLAS Collaboration

2016-10-01

Continued growth in public cloud and HPC resources is on track to exceed the dedicated resources available for ATLAS on the WLCG. Examples of such platforms are Amazon AWS EC2 Spot Instances, Edison Cray XC30 supercomputer, backfill at Tier 2 and Tier 3 sites, opportunistic resources at the Open Science Grid (OSG), and ATLAS High Level Trigger farm between the data taking periods. Because of specific aspects of opportunistic resources such as preemptive job scheduling and data I/O, their efficient usage requires workflow innovations provided by the ATLAS Event Service. Thanks to the finer granularity of the Event Service data processing workflow, the opportunistic resources are used more efficiently. We report on our progress in scaling opportunistic resource usage to double-digit levels in ATLAS production.

The demand for ambulatory mental health services from specialty providers.

PubMed Central

Horgan, C M

1986-01-01

A two-part model is used to examine the demand for ambulatory mental health services in the specialty sector. In the first equation, the probability of having a mental health visit is estimated. In the second part of the model, variations in levels of use expressed in terms of visits and expenditures are examined in turn, with each of these equations conditional on positive utilization of mental health services. In the second part of the model, users are additionally grouped into those with and without out-of-pocket payment for services. This specification accounts for special characteristics regarding the utilization of ambulatory mental health services: (1) a large part of the population does not use these services; (2) of those who use services, the distribution of use is highly skewed; and (3) a large number of users have zero out-of-pocket expenditures. Cost-sharing does indeed matter in the demand for ambulatory mental health services from specialty providers; however, the decision to use mental health services is affected by the level of cost-sharing to a lesser degree than is the decision regarding the level of use of services. The results also show that price is only one of several important factors in determining the demand for services. The lack of significance of family income and of being female is notable. Evidence is presented for the existence of bandwagon effects. The importance of Medicaid in the probability of use equations is noted. PMID:3721874

Relay Forward-Link File Management Services (MaROS Phase 2)

NASA Technical Reports Server (NTRS)

Allard, Daniel A.; Wallick, Michael N.; Hy, Franklin H.; Gladden, Roy E.

2013-01-01

This software provides the service-level functionality to manage the delivery of files from a lander mission repository to an orbiter mission repository for eventual spacelink relay by the orbiter asset on a specific communications pass. It provides further functions to deliver and track a set of mission-defined messages detailing lander authorization instructions and orbiter data delivery state. All of the information concerning these transactions is persisted in a database providing a high level of accountability of the forward-link relay process.

Improving access to oral health care services among underserved populations in the U.S.: is there a role for mid-level dental providers?

PubMed

Shaefer, H Luke; Miller, Matthew

2011-08-01

Nearly one-third of U.S. citizens lack access to basic preventive and primary oral health care services, which is primarily the result of the high costs of care and the uneven geographic distribution of dental providers. This article examines the case for and against one possible solution to address these barriers to oral health care: the introduction of a mid-level dental provider (MDP) position within the dental field.

The impact of ongoing national terror on the community of hospital nurses in Israel.

PubMed

Ron, Pnina; Shamai, Michal

2014-04-01

The main goal of this study was to explore the connections between the exposure of nurses in Israel to national terror and the levels of distress experienced due to ongoing terror attacks. The data were collected from 214 nurses from various parts of Israel who work in three types of heath services (mainly hospital departments) and provide help to victims of terror. The nurses reported very high levels of burnout, high levels of stress and medium-to high levels of intrusive memories. Levels of exposure were associated with burnout, intrusive memories and level of stress. More professional attention should be given to hospital nurses who provide care for trauma patients.

Spatial interactions among ecosystem services in an urbanizing agricultural watershed

PubMed Central

Qiu, Jiangxiao; Turner, Monica G.

2013-01-01

Understanding spatial distributions, synergies, and tradeoffs of multiple ecosystem services (benefits people derive from ecosystems) remains challenging. We analyzed the supply of 10 ecosystem services for 2006 across a large urbanizing agricultural watershed in the Upper Midwest of the United States, and asked the following: (i) Where are areas of high and low supply of individual ecosystem services, and are these areas spatially concordant across services? (ii) Where on the landscape are the strongest tradeoffs and synergies among ecosystem services located? (iii) For ecosystem service pairs that experience tradeoffs, what distinguishes locations that are “win–win” exceptions from other locations? Spatial patterns of high supply for multiple ecosystem services often were not coincident; locations where six or more services were produced at high levels (upper 20th percentile) occupied only 3.3% of the landscape. Most relationships among ecosystem services were synergies, but tradeoffs occurred between crop production and water quality. Ecosystem services related to water quality and quantity separated into three different groups, indicating that management to sustain freshwater services along with other ecosystem services will not be simple. Despite overall tradeoffs between crop production and water quality, some locations were positive for both, suggesting that tradeoffs are not inevitable everywhere and might be ameliorated in some locations. Overall, we found that different areas of the landscape supplied different suites of ecosystem services, and their lack of spatial concordance suggests the importance of managing over large areas to sustain multiple ecosystem services. PMID:23818612

Spatial interactions among ecosystem services in an urbanizing agricultural watershed.

PubMed

Qiu, Jiangxiao; Turner, Monica G

2013-07-16

Understanding spatial distributions, synergies, and tradeoffs of multiple ecosystem services (benefits people derive from ecosystems) remains challenging. We analyzed the supply of 10 ecosystem services for 2006 across a large urbanizing agricultural watershed in the Upper Midwest of the United States, and asked the following: (i) Where are areas of high and low supply of individual ecosystem services, and are these areas spatially concordant across services? (ii) Where on the landscape are the strongest tradeoffs and synergies among ecosystem services located? (iii) For ecosystem service pairs that experience tradeoffs, what distinguishes locations that are "win-win" exceptions from other locations? Spatial patterns of high supply for multiple ecosystem services often were not coincident; locations where six or more services were produced at high levels (upper 20th percentile) occupied only 3.3% of the landscape. Most relationships among ecosystem services were synergies, but tradeoffs occurred between crop production and water quality. Ecosystem services related to water quality and quantity separated into three different groups, indicating that management to sustain freshwater services along with other ecosystem services will not be simple. Despite overall tradeoffs between crop production and water quality, some locations were positive for both, suggesting that tradeoffs are not inevitable everywhere and might be ameliorated in some locations. Overall, we found that different areas of the landscape supplied different suites of ecosystem services, and their lack of spatial concordance suggests the importance of managing over large areas to sustain multiple ecosystem services.

Service quality in community pharmacy: an exploration of determinants.

PubMed

White, Lesley; Klinner, Christiane

2012-01-01

Although various instruments have been developed to measure customer satisfaction with community pharmacy services, there is limited research regarding pharmacy staffs' understanding of service quality and its determinants. This study aimed to explore the perceptions of pharmacy staff regarding the factors that constitute a high level of service quality using the service quality determinants proposed by the Conceptual Model of Service Quality. Structured interviews were conducted with 27 pharmacy assistants and 6 pharmacists in 3 community pharmacies in Sydney. The interview questions focused on the participants' perceptions of consumer expectations, the translation of these perceptions into service quality specifications, the actual service delivery, and the communication to customers. From the pharmacy staff perspective, service quality is significantly limited by insufficient internal communication and control processes that impede role clarity and the resolution of conflicting role expectations among customer service personnel. Participants indicated that these problems could be alleviated through the implementation of more transparent, realistic, measurable, and accepted quality specifications by pharmacy management. The study indicates that the extent to which pharmacy management sets, maintains, and communicates service quality specifications to staff directly affects role clarity, role conflict, and organizational commitment among customer service staff, which in turn directly influence the level of service quality provided to the customers. Copyright © 2012 Elsevier Inc. All rights reserved.

Evaluation of a primary care adult mental health service: Year 2

PubMed Central

2013-01-01

Aims This study aimed to examine the effectiveness of a primary care adult mental health service operating within a stepped care model of service delivery. Methods Supervised by a principal psychologist manager, psychology graduate practitioners provided one-to-one brief cognitive behavioural therapy (CBT) to service users. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) was used to assess service user treatment outcomes. Satisfaction questionnaires were administered to service users and referring general practitioners (GPs). Results A total of 43 individuals attended for an initial appointment, of whom 19 (44.2%) completed brief CBT treatment. Of the 13 service users who were in the clinical range pre-treatment, 11 (84.6%) achieved clinical and reliably significant improvement. Of the six service users who were in the non-clinical range pre-treatment, three (50%) achieved reliably significant improvement. Both service users and GPs indicated high levels of satisfaction with the service, although service accessibility was highlighted as needing improvement. Conclusion The service was effective in treating mild to moderate mental health problems in primary care. Stricter adherence to a stepped care model through the provision of low-intensity, high-throughput interventions would be desirable for future service provision. PMID:24381655

[Research survey on the information gathering methods, attitudes, and requests from care managers about the pharmaceutical service by pharmacists in home care].

PubMed

Nanaumi, Yoko; Onda, Mitsuko; Sakurai, Hidehiko; Tanaka, Rie; Tsubota, Kenichi; Matoba, Shunya; Mukai, Yusuke; Arakawa, Yukio; Hayase, Yukitoshi

2011-01-01

Care Managers (CMs) were surveyed to clarify the issues involving the promotion of cooperation between care managers and pharmacists in long-term-care and explore solutions. The length of work experience, occupational background, experience of pharmaceutical service; pharmacist visit patients' home for providing medicine and pharmaceutical care into a care plan, degree of understanding on pharmaceutical service, and awareness of work involved in pharmaceutical service were studied to see whether there made differences in the requests from CMs for information on pharmacists and for information gathering methods. The χ(2) test was used to this end. The opinions and requests described by the CMs were validated through text mining. More CMs tended to obtain information and knowledge through training sessions and professional magazines than those who did so through cooperation with pharmacists on a practical level. However, the survey strongly indicated that CMs with high level of understanding and awareness of pharmaceutical service wished to obtain information on pharmacists through cooperation with them on a practical level, and CMs with low level of understanding and awareness of pharmaceutical service wished to obtain such information through training sessions and professional magazines. Results of text mining showed that CMs wished pharmacists to strengthen the cooperation with physicians and provide information on pharmaceutical service. These findings have led to the conclusion that the issues surrounding the promotion of cooperation between CMs and pharmacists centered around "work cooperation on a practical level" and "provision of information to CMs about the roles of pharmacies and pharmacists and their work."

An examination of the role of perceived support and employee commitment in employee-customer encounters.

PubMed

Vandenberghe, Christian; Bentein, Kathleen; Michon, Richard; Chebat, Jean-Charles; Tremblay, Michel; Fils, Jean-François

2007-07-01

The authors examined the relationships between perceived organizational support, organizational commitment, commitment to customers, and service quality in a fast-food firm. The research design matched customer responses with individual employees' attitudes, making this study a true test of the service provider-customer encounter. On the basis of a sample of matched employee-customer data (N = 133), hierarchical linear modeling analyses revealed that perceived organizational support had both a unit-level and an employee-level effect on 1 dimension of service quality: helping behavior. Contrary to affective organizational commitment, affective commitment to customers enhanced service quality. The 2 sub-dimensions of continuance commitment to the organization--perceived high sacrifice and perceived lack of alternatives--exerted effects opposite in sign: The former fostered service quality, whereas the latter reduced it. The implications of these findings are discussed within the context of research on employee-customer encounters.

Factors associated with use of maternal health services in Haiti: a multilevel analysis.

PubMed

Babalola, Stella O

2014-07-01

To assess factors associated with utilization of maternal health services (MHS) among women giving birth in Haiti from 2007 - 2012. Observational data derived from the 2012 Haiti Mortality, Morbidity and Service Use Survey are analyzed. Multilevel analytic methods are used to assess factors associated with use of antenatal services and skilled birth attendance (SBA). The strongest adjusted predictors include child's birth rank, household poverty, and community media saturation. The odds of obtaining four antenatal care visits decrease by 53% (odds ratio (OR) = 0.47; 95% confidence interval (CI): 0.37-0.57) with high birth rank and by 37% (OR = 0.63; 95% CI: 0.51-0.78) with household poverty, and increase by 38% (OR = 1.38; 95% CI: 1.01-1.88) with high community media saturation. The odds of using SBA at delivery decrease by 72% (OR = 0.28; 95% CI: 0.22-0.34) with high birth rank and by 42% (OR = 0.58; 95% CI: 0.46-0.73) with household poverty, and increase by 92% (OR = 1.92; 95% CI: 1.41-2.61) with high community media saturation. Use of antenatal services is strongly associated with SBA (OR = 2.20; 95% CI: 1.85-2.61). Significant clustering of use of MHS exists at the community level. Factors associated with use of MHS operate at multiple levels. Efforts to promote such services should identify and pay special attention to the needs of multiparous and uneducated women, address the distance-decay phenomenon, and improve access for the poor. Community mobilization efforts designed to change norms hindering the use of MHS are also relevant.

Prevalence of suicide risk factors in people at ultra-high risk of developing psychosis: a service audit.

PubMed

Hutton, Paul; Bowe, Samantha; Parker, Sophie; Ford, Sarah

2011-11-01

Little data is available on the prevalence of suicide risk factors in people at ultra-high risk (UHR) of developing psychosis. The aim of this study was to provide an estimate of the cross-sectional prevalence of possible suicide risk factors in those attending a routine clinical service for people at UHR of developing psychosis. For all patients in treatment (n=34) over a 4-week period, levels of suicidal ideation and depression upon entry to the service were assessed by auditing intake scores on the Beck Depression Inventory, second edition. Level of engagement with services, social isolation, substance and alcohol misuse, ready access to means, current suicidal ideation, previous suicide attempts, current or previous self-harm, expressions of concern from others, depression, agitation, hopelessness, worthlessness, suspiciousness and fears of mental disintegration were all assessed by case note review and interview with the treating clinician. There was a high prevalence of at least mild suicidal ideation (58.8%, n=20) and severe depressed mood (47%, n=16) in this client group at point of entry to the service. Seven people (20.6%) had engaged in serious self-harm (including attempted suicide) during the time they were in contact with the service. Forty-seven per cent (n=16) reported at least 27 suicide attempts between them; the mean number of attempts being 1.69 (standard deviation=1.08). Suicide risk was high in this small sample of people at UHR of developing psychosis. Controlled research with larger samples and better methodology is urgently required to inform legal, ethical and scientific debates surrounding this group. © 2011 Blackwell Publishing Asia Pty Ltd.

Trajectories of psychological distress after prison release: implications for mental health service need in ex-prisoners.

PubMed

Thomas, E G; Spittal, M J; Heffernan, E B; Taxman, F S; Alati, R; Kinner, S A

2016-02-01

Understanding individual-level changes in mental health status after prison release is crucial to providing targeted and effective mental health care to ex-prisoners. We aimed to describe trajectories of psychological distress following prison discharge and compare these trajectories with mental health service use in the community. The Kessler Psychological Distress Scale (K10) was administered to 1216 sentenced adult prisoners in Queensland, Australia, before prison release and approximately 1, 3 and 6 months after release. We used group-based trajectory modeling to identify K10 trajectories after release. Contact with community mental health services in the year following release was assessed via data linkage. We identified five trajectory groups, representing consistently low (51.1% of the cohort), consistently moderate (29.8%), high increasing (11.6%), high declining (5.5%) and consistently very high (1.9%) psychological distress. Mood disorder, anxiety disorder, history of self-harm and risky drug use were risk factors for the high increasing, very high and high declining trajectory groups. Women were over-represented in the high increasing and high declining groups, but men were at higher risk of very high psychological distress. Within the high increasing and very high groups, 25% of participants accessed community mental health services in the first year post-release, for a median of 4.4 contact hours. For the majority of prisoners with high to very high psychological distress, distress persists after release. However, contact with mental health services in the community appears low. Further research is required to understand barriers to mental health service access among ex-prisoners.

[Design and Application of High-risk Pregnancy Monitoring & Warning Internet Platform Based on Internet of Things].

PubMed

Lu, Heqing; Zhang, Xiaofeng; Li, Bin

2017-09-30

Through illustrating the designing of high-risk pregnancy maternal-fetal monitoring system based on the internet of things, this paper introduced the specific application of using wearable medical devices to provide maternal-fetal mobile medical services. With the help of big data and cloud obstetrics platform, the monitoring and warning network was further improved, the level-to-level administration of high-risk pregnancy was realized, the level of perinatal health care was enhanced and the risk of critical emergency of pregnancy decreased.

Accessing disability services by people from culturally and linguistically diverse backgrounds in Australia.

PubMed

Zhou, Qingsheng

2016-01-01

To examine whether differences in access to specialist disability services by people from culturally and linguistically diverse (CALD) backgrounds when compared with those born in Australia represent a service gap or the healthy migrant effect. To use the latest disability statistics to measure the different rates of people with disability, and the rates of people with profound and severe disability, of people born in Australia and those born abroad; to compare the difference between those who mainly speak English with those who primarily speak a language other than English at home (LOTE); and examine the age-specific and standardised disability rates of these subgroups. The rate of access of specialist disability services by people with disability who were from CALD backgrounds is highly disproportionate to their presence in the community. As a whole, people from CALD backgrounds have a similar level of disability as Australia-born people. They have a greater rate of profound and severe disability and a higher level of need for assistance in undertaking core activities. For younger age cohorts targeted by specialist disability services, there is little difference in the level of need for assistance between people from CALD backgrounds and the rest of community. Those people who mainly speak LOTE at home have a relatively higher level of need for assistance than those who speak mainly English at home. The paper reveals a substantial gap in specialist disability services between people from CALD and the broader community. This cannot be explained by the difference in the level of need for assistance between Australia-born and overseas-born populations, therefore raises some policy questions as to the barriers to the use of such services and how to effectively narrow the service access gap and improve utilisation rates. The paper reveals a substantial accessibility gap in specialist disability services between people from culturally and linguistically diverse (CALD) backgrounds and the broader community in Australia. Rehabilitation is a large component of disability services. Therefore, understanding the gap, promoting the awareness of the services, developing appropriate and effective services to respond the need of people with disability from CALD backgrounds, are critically important to rehabilitation services and related research.

Exploration of Public Service Occupations. Curriculum Guide.

ERIC Educational Resources Information Center

California State Dept. of Education, Sacramento. Div. of Vocational Education.

The guide contains the basic concepts and instructional materials recommended for the exploration of public service occupations at the junior high school level (grades 7-9). The materials can be used as a separate course or can be integrated into the subject areas suggested. The 17 units deal with the functioning of Federal, State, and local…

Youth Risk Assessment in Complex Agency Practice

ERIC Educational Resources Information Center

Groner, Mark R.; Solomon, Jean

2007-01-01

Advancements in the delivery of community-based services and tight utilization management of high-cost treatment options result in youths with serious behavior problems receiving intervention in lower levels of care than was true ten or fifteen years ago. This shift in where services tend to be delivered necessitates enhancement of risk assessment…

Participation of Minority Youth in Urban Horticulture: A New York City High School Project.

ERIC Educational Resources Information Center

Gordon, Howard R. D.

1987-01-01

The author describes the experience-based urban Vocational Horticulture Project sponsored by the Central Diesel School of Brooklyn, New York, and involving the National Park Service and the Cornell Cooperative Extension Service. The program prepares minority youth for entry-level employment in ornamental horticulture or in forestry and wildlife…

DOE High Performance Computing Operational Review (HPCOR): Enabling Data-Driven Scientific Discovery at HPC Facilities

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

Gerber, Richard; Allcock, William; Beggio, Chris

2014-10-17

U.S. Department of Energy (DOE) High Performance Computing (HPC) facilities are on the verge of a paradigm shift in the way they deliver systems and services to science and engineering teams. Research projects are producing a wide variety of data at unprecedented scale and level of complexity, with community-specific services that are part of the data collection and analysis workflow. On June 18-19, 2014 representatives from six DOE HPC centers met in Oakland, CA at the DOE High Performance Operational Review (HPCOR) to discuss how they can best provide facilities and services to enable large-scale data-driven scientific discovery at themore » DOE national laboratories. The report contains findings from that review.« less

Practice-driven evaluation of a multi-layered psychosocial care package for children in areas of armed conflict.

PubMed

Jordans, M J D; Komproe, I H; Tol, W A; Susanty, D; Vallipuram, A; Ntamatumba, P; Lasuba, A C; De Jong, J T V M

2011-06-01

Psychosocial and mental health service delivery frameworks for children in low-income countries are scarce. This paper presents a practice-driven evaluation of a multi-layered community-based care package in Burundi, Indonesia, Sri Lanka and Sudan, through a set of indicators; (a) perceived treatment gains; (b) treatment satisfaction; (c) therapist burden; (d) access to care; (e) care package costs. Across four settings (n = 29,292 children), beneficiaries reported high levels of client satisfaction and moderate post-treatment problem reductions. Service providers reported significant levels of distress related to service delivery. Cost analyses demonstrated mean cost per service user to vary from 3.46 to 17.32 depending on country and specification of costs. The results suggest a multi-layered psychosocial care package appears feasible and satisfactory in reaching out to substantial populations of distressed children through different levels of care. Future replication should address therapist burden, cost reductions to increase sustainability and increase evidence for treatment efficacy.

Degree of Anger During Anger-Generating Situations Among Psychiatric Staff Nurses: Association Between Nurses' Attitudes Toward Service Users' Aggression and Confidence in Intervening in Aggressive Situations.

PubMed

Shimosato, Seiji; Kinoshita, Aimi

2018-04-17

Some situations require psychiatric staff nurses to respond to service users' negativity or aggression. As a result, psychiatric staff nurses may experience anger. The current study examined how anger levels of psychiatric staff nurses triggered by anger-generating situations by service users affected nurses' confidence and attitudes. A questionnaire survey was administered among 386 psychiatric staff nurses. The questionnaire surveyed anger levels in anger-generating situations, aggressiveness, nurses' attitudes toward aggression, and self-efficacy of intervening in aggressive situations. Path analysis revealed differences between male and female nurses. Male nurses' anger in response to physical aggression was mild when they were confident in handling aggression. Furthermore, female nurses who had high confidence in intervening in an aggressive situation had low anger levels. Confidence in intervening in aggressive situations appeared to dissipate anger and ease nurses during aggressive interactions. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.]. Copyright 2018, SLACK Incorporated.

Expansion of Safe Abortion Services in Nepal Through Auxiliary Nurse‐Midwife Provision of Medical Abortion, 2011‐2013

PubMed Central

Basnett, Indira; Shrestha, Dirgha Raj; Shrestha, Meena Kumari; Shah, Mukta; Aryal, Shilu

2016-01-01

Introduction The termination of unwanted pregnancies up to 12 weeks’ gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse‐midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal. Methods This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS‐11). Results By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary‐level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion. Discussion The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary‐level health facilities. Post‐training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion. PMID:26860072

Degradation of soil fertility can cancel pollination benefits in sunflower.

PubMed

Tamburini, Giovanni; Berti, Antonio; Morari, Francesco; Marini, Lorenzo

2016-02-01

Pollination and soil fertility are important ecosystem services to agriculture but their relative roles and potential interactions are poorly understood. We explored the combined effects of pollination and soil fertility in sunflower using soils from a trial characterized by different long-term input management in order to recreate plausible levels of soil fertility. Pollinator exclusion was used as a proxy for a highly eroded pollination service. Pollination benefits to yield depended on soil fertility, i.e., insect pollination enhanced seed set and yield only under higher soil fertility indicating that limited nutrient availability may constrain pollination benefits. Our study provides evidence for interactions between above- and belowground ecosystem services, highlighting the crucial role of soil fertility in supporting agricultural production not only directly, but also indirectly through pollination. Management strategies aimed at enhancing pollination services might fail in increasing yield in landscapes characterized by high soil service degradation. Comprehensive knowledge about service interactions is therefore essential for the correct management of ecosystem services in agricultural landscapes.

Provision of Prosthetic Services Following Lower Limb Amputation in Malaysia

PubMed Central

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

2017-01-01

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

Provision of Prosthetic Services Following Lower Limb Amputation in Malaysia.

PubMed

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

2017-10-01

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

The use and costs of health and social services in patients with longstanding substance abuse.

PubMed

Vossius, Corinna; Testad, Ingelin; Skjæveland, Rune; Nesvåg, Sverre

2013-05-22

Persons with longstanding substance abuse might become increasingly dependent on help by the public, eventually requiring permanent care. In 2006 the municipality of Stavanger established a so-called addiction ward for these clients, comprising 17 beds at the largest municipal nursing home. We assumed that the residents of this ward were high consumers of health care and social services during the last months preceding their admission. The aim of the study was to register the type and extent of services that were claimed by this client group during the last six months prior to admission, and to calculate the costs that were caused. Further, we estimated the incremental costs for nursing home placement. In 15 residents from the addiction ward the use of all welfare services during the six months prior to admission were registered. Costs were calculated by unit costs from a municipal, national and societal perspective. Mean total costs during this period were €32 474. Approximately half of these costs were borne by state-funded institutions, and half were borne by the municipality. The clients used a great variety of services aimed at subsistence, health care and support in independent living, while services aimed at drug withdrawal were not claimed. There was no correlation between costs and the level of functioning. The incremental costs for nursing home admission were borne by the municipalities. Persons with longstanding substance abuse represent a group with a high use of welfare resources and hence cause high costs. However, our findings do not indicate any correlation between the amount of services rendered and the level of functioning. Further research should focus on the identification of the clients' need for support in order to facilitate targeted interventions that might prevent further deterioration and, finally, the need for permanent care.

City Level of Income and Urbanization and Availability of Food Stores and Food Service Places in China.

PubMed

Liao, Chunxiao; Tan, Yayun; Wu, Chaoqun; Wang, Shengfeng; Yu, Canqing; Cao, Weihua; Gao, Wenjing; Lv, Jun; Li, Liming

2016-01-01

The contribution of unhealthy dietary patterns to the epidemic of obesity has been well recognized. Differences in availability of foods may have an important influence on individual eating behaviors and health disparities. This study examined the availability of food stores and food service places by city characteristics on city level of income and urbanization. The cross-sectional survey was comprised of two parts: (1) an on-site observation to measure availability of food stores and food service places in 12 cities of China; (2) an in-store survey to determine the presence of fresh/frozen vegetables or fruits in all food stores. Trained investigators walked all the streets/roads within study tracts to identify all the food outlets. An observational survey questionnaire was used in all food stores to determine the presence of fresh/frozen vegetables or fruits. Urbanization index was determined for each city using a principal components factor analysis. City level of income and urbanization and numbers of each type of food stores and food service places were examined using negative binomial regression models. Large-sized supermarkets and specialty retailers had higher number of fresh/frozen vegetables or fruits sold compared to small/medium-sized markets. High-income versus low-income, high urbanized versus low urbanized areas had significantly more large-sized supermarkets and fewer small/medium-sized markets. In terms of restaurants, high urbanized cities had more western fast food restaurants and no statistically significant difference in the relative availability of any type of restaurants was found between high- and low-income areas. The findings suggested food environment disparities did exist in different cities of China.

City Level of Income and Urbanization and Availability of Food Stores and Food Service Places in China

PubMed Central

Liao, Chunxiao; Tan, Yayun; Wu, Chaoqun; Wang, Shengfeng; Yu, Canqing; Cao, Weihua; Gao, Wenjing; Lv, Jun; Li, Liming

2016-01-01

Objective The contribution of unhealthy dietary patterns to the epidemic of obesity has been well recognized. Differences in availability of foods may have an important influence on individual eating behaviors and health disparities. This study examined the availability of food stores and food service places by city characteristics on city level of income and urbanization. Methods The cross-sectional survey was comprised of two parts: (1) an on-site observation to measure availability of food stores and food service places in 12 cities of China; (2) an in-store survey to determine the presence of fresh/frozen vegetables or fruits in all food stores. Trained investigators walked all the streets/roads within study tracts to identify all the food outlets. An observational survey questionnaire was used in all food stores to determine the presence of fresh/frozen vegetables or fruits. Urbanization index was determined for each city using a principal components factor analysis. City level of income and urbanization and numbers of each type of food stores and food service places were examined using negative binomial regression models. Results Large-sized supermarkets and specialty retailers had higher number of fresh/frozen vegetables or fruits sold compared to small/medium-sized markets. High-income versus low-income, high urbanized versus low urbanized areas had significantly more large-sized supermarkets and fewer small/medium-sized markets. In terms of restaurants, high urbanized cities had more western fast food restaurants and no statistically significant difference in the relative availability of any type of restaurants was found between high- and low-income areas. Conclusions The findings suggested food environment disparities did exist in different cities of China. PMID:26938866

47 CFR 73.1570 - Modulation levels: AM, FM, TV and Class A TV aural.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 4 2012-10-01 2012-10-01 false Modulation levels: AM, FM, TV and Class A TV... levels: AM, FM, TV and Class A TV aural. (a) The percentage of modulation is to be maintained at as high a level as is consistent with good quality of transmission and good broadcast service, with maximum...

47 CFR 73.1570 - Modulation levels: AM, FM, TV and Class A TV aural.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 4 2013-10-01 2013-10-01 false Modulation levels: AM, FM, TV and Class A TV... levels: AM, FM, TV and Class A TV aural. (a) The percentage of modulation is to be maintained at as high a level as is consistent with good quality of transmission and good broadcast service, with maximum...

47 CFR 73.1570 - Modulation levels: AM, FM, TV and Class A TV aural.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 4 2014-10-01 2014-10-01 false Modulation levels: AM, FM, TV and Class A TV... levels: AM, FM, TV and Class A TV aural. (a) The percentage of modulation is to be maintained at as high a level as is consistent with good quality of transmission and good broadcast service, with maximum...

Argobots: A Lightweight Low-Level Threading and Tasking Framework

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

Seo, Sangmin; Amer, Abdelhalim; Balaji, Pavan

In the past few decades, a number of user-level threading and tasking models have been proposed in the literature to address the shortcomings of OS-level threads, primarily with respect to cost and flexibility. Current state-of-the-art user-level threading and tasking models, however, either are too specific to applications or architectures or are not as powerful or flexible. In this paper, we present Argobots, a lightweight, low-level threading and tasking framework that is designed as a portable and performant substrate for high-level programming models or runtime systems. Argobots offers a carefully designed execution model that balances generality of functionality with providing amore » rich set of controls to allow specialization by end users or high-level programming models. We describe the design, implementation, and performance characterization of Argobots and present integrations with three high-level models: OpenMP, MPI, and colocated I/O services. Evaluations show that (1) Argobots, while providing richer capabilities, is competitive with existing simpler generic threading runtimes; (2) our OpenMP runtime offers more efficient interoperability capabilities than production OpenMP runtimes do; (3) when MPI interoperates with Argobots instead of Pthreads, it enjoys reduced synchronization costs and better latency-hiding capabilities; and (4) I/O services with Argobots reduce interference with colocated applications while achieving performance competitive with that of a Pthreads approach.« less

Argobots: A Lightweight Low-Level Threading and Tasking Framework

DOE PAGES

Seo, Sangmin; Amer, Abdelhalim; Balaji, Pavan; ...

2017-10-24

In the past few decades, a number of user-level threading and tasking models have been proposed in the literature to address the shortcomings of OS-level threads, primarily with respect to cost and flexibility. Current state-of-the-art user-level threading and tasking models, however, are either too specific to applications or architectures or are not as powerful or flexible. In this article, we present Argobots, a lightweight, low-level threading and tasking framework that is designed as a portable and performant substrate for high-level programming models or runtime systems. Argobots offers a carefully designed execution model that balances generality of functionality with providing amore » rich set of controls to allow specialization by the user or high-level programming model. Here, we describe the design, implementation, and optimization of Argobots and present integrations with three example high-level models: OpenMP, MPI, and co-located I/O service. Evaluations show that (1) Argobots outperforms existing generic threading runtimes; (2) our OpenMP runtime offers more efficient interoperability capabilities than production OpenMP runtimes do; (3) when MPI interoperates with Argobots instead of Pthreads, it enjoys reduced synchronization costs and better latency hiding capabilities; and (4) I/O service with Argobots reduces interference with co-located applications, achieving performance competitive with that of the Pthreads version.« less

Argobots: A Lightweight Low-Level Threading and Tasking Framework

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

Seo, Sangmin; Amer, Abdelhalim; Balaji, Pavan

In the past few decades, a number of user-level threading and tasking models have been proposed in the literature to address the shortcomings of OS-level threads, primarily with respect to cost and flexibility. Current state-of-the-art user-level threading and tasking models, however, are either too specific to applications or architectures or are not as powerful or flexible. In this article, we present Argobots, a lightweight, low-level threading and tasking framework that is designed as a portable and performant substrate for high-level programming models or runtime systems. Argobots offers a carefully designed execution model that balances generality of functionality with providing amore » rich set of controls to allow specialization by the user or high-level programming model. Here, we describe the design, implementation, and optimization of Argobots and present integrations with three example high-level models: OpenMP, MPI, and co-located I/O service. Evaluations show that (1) Argobots outperforms existing generic threading runtimes; (2) our OpenMP runtime offers more efficient interoperability capabilities than production OpenMP runtimes do; (3) when MPI interoperates with Argobots instead of Pthreads, it enjoys reduced synchronization costs and better latency hiding capabilities; and (4) I/O service with Argobots reduces interference with co-located applications, achieving performance competitive with that of the Pthreads version.« less

Out-of-pocket expenditure by private households for dental services - empirical evidence from Austria.

PubMed

Sanwald, Alice; Theurl, Engelbert

2016-12-01

Dental services differ from other health services in several dimensions. One important difference is that a substantial share of costs of dental services-especially costs beyond routine dental treatment-is paid directly by the patient out-of-pocket. This study analyses the socio-economic determinants of out-of-pocket expenditure for dental services (OOPE) in Austria at the household level. Cross-sectional information on OOPE and household characteristics provided by the Austrian household budget survey 2009/10 was analysed. A two-part model (Logit/GLM) and one-part GLM was applied. The probability of OOPE is strongly affected by the life cycle (structure) of the household. It is higher for higher age classes, higher income, and partially higher levels of education. The type of public insurance has an influence on expenditure probability while the existence of private health insurance has no significant effect. In contrast to the highly statistically significant coefficients in the first stage, the covariates of the second stage remain predominantly insignificant. According to the results, the level of expenditure is driven mainly by the level of education and income. The results of the one-part GLM confirm the results of the two-part model. The results allow new insights into the determinants of OOPE for dental care. The household level turns out to be an adequate basis to study the determinants of OOPE, although caution should be applied before jumping to conclusions for the individual level.

1994 Entry-Level Athletic Training Salaries

PubMed Central

Moss, Crayton L.

1996-01-01

In this study, I examined salaries for entry-level positions in athletic training during the year 1994. An entry-level position was defined as a position to be filled with an athletic trainer certified by the NATA, with no full-time paid employment experience. According to the “Placement Vacancy Notice” (NATA, Dallas, TX) and “BYLINE” (Athletic Trainer Services, Inc, Mt Pleasant, MI), there were 432 entry-level vacancies in hospital/clinics, college/universities, and high school settings. A total of 271 surveys (63%) were returned. Overall, beginning salaries for entry-level athletic training positions were $23,228 (±$3,177) for a bachelor's degree and $25,362 (±$3,883) for a master's degree. A stipend ($4,216 ± $2,039) was included in 86% of the high school positions. The term of contract for high school was usually a 10-month position (10.0 ± .9 months), hospital/clinic, 12-months (11.7 ± .7 months), while the college/university varied from 9 to 12 months (10.5 ± 1.2 months). Also included in the study was fringe benefit information: pension (other than Social Security), life, medical, dental, and vision insurance. Continued studies are recommended to establish salary norms and trends for entry-level positions so that athletic trainers will understand what monetary compensation to expect for their services. PMID:16558367

"There's a Real Mix...It's Not All Doom and Gloom around Here!": Parents' Views on Raising Children in a Community Experiencing High Levels of Disadvantage

ERIC Educational Resources Information Center

Peppard, Judith

2009-01-01

In 2006 three primary schools and a community youth service "crossed borders" by forming a network to improve student educational achievement in a community experiencing high levels of disadvantage. Recognising that they lacked the capacity and resources required to counteract the numerous barriers to learning experienced by many of…

Assessment of the Policy Guidelines for the Teaching and Learning of Geography at the Senior High School Level in Ghana

ERIC Educational Resources Information Center

Ababio, Bethel T.; Dumba, Hillary

2014-01-01

This article empirically assessed the extent to which geography teachers adhered to the Ghana Education Service policy guidelines on the teaching of geography at the Senior High School Level in Ghana. Census survey was used to collect data from seven geography teachers because of the researchers' objective of gaining a quick insight into the…

Working conditions and psychosocial risk factors of employees in French electricity and gas company customer support departments.

PubMed

Chevalier, Anne; Dessery, Michel; Boursier, Marie-Françoise; Grizon, Marie Catherine; Jayet, Christian; Reymond, Catherine; Thiebot, Michelle; Zeme-Ramirez, Monique; Calvez, Thierry

2011-01-01

Little is known about the real impact of working conditions on the health of call center employees. The aim of this article is to describe the working conditions of French electricity and gas company customer service teams, especially those spending more than 75% of their working time handling calls in order to determine their subjective experience of their work and identify situations at risk of psychosocial constraints. A cross-sectional study using a self-completion questionnaire was conducted on a representative sample of 2,000 employees working in customer service centers. The questions focused on the variety of tasks performed, the organization of working time, the physical environment of the workstation, violent situations and psychosocial factors (Job Content Questionnaire). Multivariate statistical analyses were performed to identify factors associated with the wish to leave the sector and with a high level of psychosocial constraints. Women made up 66% of the sample. Despite a high educational level, the average socio-professional level of the employees was relatively low. Although the vast majority of employees had chosen this career (74%), just over half would like to leave. The main factors associated with iso-strain were inadequate breaks (odds ratio (OR) = 2.0), low perceived quality of work (OR = 2.4), high proportion of working time spent handling calls (≥75% of working time: OR = 5.9, between 50 and <75%: OR = 5.2), exposure to violence either internally (often or very often: OR = 3.1) or from customers (often or very often: OR = 1.8) and an unsatisfactory workplace (OR = 2.0). Employees who spend more than 75% of their working time on the phone cumulate every factor linked with a high level of constraints, but all employees of the EDF and Gaz de France customer service centers are concerned. These workers share many characteristics with other call centers: predominantly female workforce; high educational level; wish to leave this sector despite the initial choice; high level of psychosocial risk factors.

Maternal willingness to pay for infant and young child nutrition counseling services in Vietnam.

PubMed

Nguyen, Phuong H; Hoang, Minh V; Hajeebhoy, Nemat; Tran, Lan M; Le, Chung H; Menon, Purnima; Rawat, Rahul

2015-01-01

Alive & Thrive Vietnam, a 6-year initiative (2009-2014), has developed and incorporated elements of social franchising into government health services to provide high-quality nutrition counseling services to improve infant and young child feeding practices. One element of franchising that has not yet been implemented is fee for service, which is a potential financing mechanism for sustaining services in the long run. This research aims to estimate maternal willingness to pay (WTP) for nutrition counseling services and to examine potential factors associated with their WTP. Data were drawn from an impact evaluation survey of 2,511 women with a child <2 years old from four provinces in Vietnam. An iterative bidding technique was employed to explore individual WTP. The first bid was defined as VND 20,000 (~US$ 1), which was approximately the level of the actual service cost. Depending on the participant response, the bid increased or decreased. Finally, the respondents were asked about the highest price they would be willing to pay for the service. Overall, 92.6% of clients reported a need for nutrition counseling services for children <2 years. The WTP rates at bid levels of VND 5,000, 10,000, 20,000, 40,000, and 100,000 were 95.2, 94.4, 90.7, 68.9, and 33.4%, respectively. The mean and median of the maximum WTP were VND 58,500 and 50,000, respectively. In multiple regression models, WTP rates were higher among younger women, the Kinh majority group, and better educated and wealthier women. A high demand for nutrition counseling coupled with a WTP by almost all segments of society would potentially cover costs of delivery for nutrition counseling services in Vietnam.

Maternal willingness to pay for infant and young child nutrition counseling services in Vietnam

PubMed Central

Nguyen, Phuong H.; Hoang, Minh V.; Hajeebhoy, Nemat; Tran, Lan M.; Le, Chung H.; Menon, Purnima; Rawat, Rahul

2015-01-01

Background Alive & Thrive Vietnam, a 6-year initiative (2009–2014), has developed and incorporated elements of social franchising into government health services to provide high-quality nutrition counseling services to improve infant and young child feeding practices. One element of franchising that has not yet been implemented is fee for service, which is a potential financing mechanism for sustaining services in the long run. Objective This research aims to estimate maternal willingness to pay (WTP) for nutrition counseling services and to examine potential factors associated with their WTP. Design and methods Data were drawn from an impact evaluation survey of 2,511 women with a child <2 years old from four provinces in Vietnam. An iterative bidding technique was employed to explore individual WTP. The first bid was defined as VND 20,000 (~US$ 1), which was approximately the level of the actual service cost. Depending on the participant response, the bid increased or decreased. Finally, the respondents were asked about the highest price they would be willing to pay for the service. Results Overall, 92.6% of clients reported a need for nutrition counseling services for children <2 years. The WTP rates at bid levels of VND 5,000, 10,000, 20,000, 40,000, and 100,000 were 95.2, 94.4, 90.7, 68.9, and 33.4%, respectively. The mean and median of the maximum WTP were VND 58,500 and 50,000, respectively. In multiple regression models, WTP rates were higher among younger women, the Kinh majority group, and better educated and wealthier women. Conclusion A high demand for nutrition counseling coupled with a WTP by almost all segments of society would potentially cover costs of delivery for nutrition counseling services in Vietnam. PMID:26328947

Strengthening health-related rehabilitation services at national levels.

PubMed

Gutenbrunner, Christoph; Bickenbach, Jerome; Melvin, John; Lains, Jorge; Nugraha, Boya

2018-04-18

One of the aims of the World Health Organization's Global Disability Action Plan is to strengthen rehabilitation services. Some countries have requested support to develop (scale-up) rehabilitation services. This paper describes the measures required and how (advisory) missions can support this purpose, with the aim of developing National Disability, Health and Rehabilitation Plans. It is important to clarify the involvement of governments in the mission, to define clear terms of reference, and to use a systematic pathway for situation assessment. Information must be collected regarding policies, health, disability, rehabilitation, social security systems, the need for rehabilitation, and the existing rehabilitation services and workforce. Site visits and stakeholder dialogues must be done. In order to develop a Rehabilitation Service Implementation Framework, existing rehabilitation services, workforce, and models for service implementation and development of rehabilitation professions are described. Governance, political will and a common understanding of disability and rehabilitation are crucial for implementation of the process. The recommendations of the World Report on Disability are used for reporting purposes. This concept is feasible, and leads to concrete recommendations and proposals for projects and a high level of consensus stakeholders.

School bus’s level of service in Malang City

NASA Astrophysics Data System (ADS)

Hariyani, S.

2017-06-01

School Bus began operated on the 12th of January 2015. Provision of school buses is expected to reduce not only the use of vehicles by students, but it is also to reduce the number of traffic jams. Malang school bus facilities provided by the Department of Transport in cooperation with the Department of Education to serve students in elementary school, junior and senior high schools. After the service running two years, based on the preliminary observation not all students are interested in using the school bus. The research objective was to measure the school bus’s level service. The method to measure school bus’s level of service was used Importance Performance analysis (IPA). The results showed that through IPA, it can be concluded that school bus’s level of service in Malang City have been able to serve students/customers with the mean of degree suitability (Tki) is 111. Meanwhile it must be observed and get more attention to improve by government, attributes which is lies in the first quadrant or concentrate here (attribute Adequate space, Seating capacity, Availability trash can, Passenger facility down in points, The availability of information boards in each bus stop, Availability public telephone in each bus stop, and Availability CCTV in each bus), in order to increase its performance.

Adolescent school absenteeism and service use in a population-based study.

PubMed

Askeland, Kristin Gärtner; Haugland, Siren; Stormark, Kjell Morten; Bøe, Tormod; Hysing, Mari

2015-07-09

School absenteeism is linked to a range of health concerns, health risk behaviors and school dropout. It is therefore important to evaluate the extent to which adolescents with absenteeism are in contact with health care and other services. The aim of the current study was to investigate service use of Norwegian adolescents with moderate and high absenteeism in comparison to students with lower rates of absence. The study employs data from a population-based study from 2012 targeting all pupils in upper secondary education in Hordaland County, Norway (the youth@hordaland-survey). A total of 8988 adolescents between the ages of 16 and 18 were included in the present study. Information on service use was based on adolescent self-report data collected in the youth@hordaland-survey. Absence data was collected using administrative data provided by the Hordaland County Council. High absence (defined as being absent 15% or more the past semester) was found among 10.1% of the adolescents. Compared to their peers with low absence (less than 3% absence the past semester), adolescents with high absence were more likely to be in contact with all the services studied, including mental health services (odds ratio (OR) 3.96), adolescent health clinics (OR 2.11) and their general practitioner (GP) (OR 1.94). Frequency of contact was higher among adolescents with moderate and high absence and there seems to be a gradient of service use corresponding to the level of absence. Still, 40% of the adolescents with high absence had not been in contact with any services. Adolescents with high absence had increased use of services, although a group of youth at risk seems to be without such contact. This finding suggests a potential to address school absenteeism through systematic collaboration between schools and health personnel.

Low Levels of Evidence on the Plastic Surgery In-Service Training Exam.

PubMed

Silvestre, Jason; Bilici, Nadir; Serletti, Joseph M; Chang, Benjamin

2016-06-01

The Plastic Surgery In-Service Training Exam is written by the American Society of Plastic Surgeons. Examinees reasonably infer that tested material reflects the Society's vision for the core curriculum in plastic surgery. The purpose of this study was to determine the levels of evidence on which credited answers to the examination questions are based. Two recent Plastic Surgery In-Service Training Exams (2014 and 2015) were analyzed. Questions were categorized using a taxonomy model. Recommended journal article references for Level III (decision-making) questions were assigned a level of evidence. Exam sections were analyzed for differences in question taxonomy distribution and level of evidence. To look for studies with higher levels of evidence, a PubMed search was conducted for a random sample of 10 questions from each section. One hundred three Level I (25.8 percent), 138 Level II (34.5 percent), and 159 Level III (39.8 percent) questions were analyzed (p < 0.001). The hand and lower extremity section had the highest percentage of Level III questions (50.0 percent; p = 0.005). Journal articles had a mean level of evidence of 3.9 ± 0.7. The number of articles with a low level of evidence (IV and V) (p = 0.624) and the percentage of questions supported by articles with a high level of evidence (I and II) (p = 0.406) did not vary by section. The PubMed search revealed no instances of a higher level of evidence than the recommended reading list. A significant percentage of Plastic Surgery In-Service Training Exam questions test clinical management, but most are supported with a low level of evidence. Although that is consistent with low level of evidence of plastic surgery literature, educators should recognize the potential for biases of question writers.

Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey

PubMed Central

Pachankis, John E.; Hatzenbuehler, Mark L.; Hickson, Ford; Weatherburn, Peter; Berg, Rigmor C.; Marcus, Ulrich; Schmidt, Axel J.

2016-01-01

Objective Substantial country-level variation exists in prejudiced attitudes towards male homosexuality and in the extent to which countries promote the unequal treatment of MSM through discriminatory laws. The impact and underlying mechanisms of country-level stigma on odds of diagnosed HIV, sexual opportunities, and experience of HIV-prevention services, needs and behaviours have rarely been examined, however. Design Data come from the European MSM Internet Survey (EMIS), which was administered between June and August 2010 across 38 European countries (N =174 209). Methods Country-level stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of attitudes held by the citizens of each country. We also assessed concealment, HIV status, number of past 12-month male sex partners, and eight HIV-preventive services, knowledge, and behavioural outcomes. Results MSM living in countries with higher levels of stigma had reduced odds of diagnosed HIV and fewer partners but higher odds of sexual risk behaviour, unmet prevention needs, not using testing services, and not discussing their sexuality in testing services. Sexual orientation concealment mediated associations between country-level stigma and these outcomes. Conclusion Country-level stigma may have historically limited HIV transmission opportunities among MSM, but by restricting MSM’s public visibility, it also reduces MSM’s ability to access HIV-preventive services, knowledge and precautionary behaviours. These findings suggest that MSM in European countries with high levels of stigma are vulnerable to HIV infection. Although they have less opportunity to identify and contact other MSM, this might change with emerging technologies. PMID:26035323

The risks of injury in public ice skating.

PubMed Central

Radford, P J; Williamson, D M; Lowdon, I M

1988-01-01

A prospective survey has been made of the injuries to members of the public attending a well established ice rink in a major city. Comparison is made with series in the literature reporting high levels of injuries, with corresponding demands on local hospital services, from newly established ice rinks. The main conclusion is that demands on hospital services have been markedly reduced for the well established rink, with corresponding savings in health service resources. PMID:3167509

Improving cancer control through a community-based cancer awareness initiative.

PubMed

Smith, Samuel G; Rendell, Helen; George, Helen; Power, Emily

2014-03-01

To assess the impact of the Cancer Research UK Cancer Awareness Roadshow on intentions to change health behaviours and use local health services related to cancer. Feedback forms from visitors to three Roadshows collected data on anticipated lifestyle changes and health service use following their visit to the Roadshow. Demographic predictors of intentions were investigated. A total of 6009 individuals completed a feedback form. On average, respondents intended to make between two and three (2.55; SD=1.77) lifestyle changes, and use between none and one (0.59; SD=0.77) local health services following their visit. Multivariable analysis showed that age (p=0.001), ethnicity (p=0.006), and occupation (p=0.043) were significant predictors of anticipated lifestyle changes. Anticipated health service use was higher among men (p=0.001), younger groups (p<0.001), and smokers (p<0.001). Overall effects of ethnicity (p=0.001) and occupation (p<0.001) on anticipated health service use were also observed. Post-hoc analyses indicated stronger effects of the Roadshow among disadvantaged groups. High levels of anticipated health behaviour change and health service use were observed among Roadshow visitors. Disadvantaged groups such as lower socioeconomic groups, ethnic minorities, and smokers showed particularly high levels of intention. A more in-depth evaluation of the Roadshow is warranted. Copyright © 2014 Elsevier Inc. All rights reserved.

A New NOAA Research Initiative on the Seasonal Prediction of U.S. Coastal High Water Levels

NASA Astrophysics Data System (ADS)

Mariotti, A.; Archambault, H. M.; Barrie, D.; Huang, J.

2017-12-01

A crucial part of NOAA's service mission is to make U.S. communities more resilient to rises in coastal sea level, which on a seasonal timescale may increase the threat for nuisance ("sunny day") flooding, as well as enhance the severity of storm surge events. Over a season, variability in climate or ocean dynamics, in combination with longer-term trends, can influence coastal sea level in a way that is potentially predictable. To leverage these emerging scientific findings, the Climate Program Office's Modeling, Analysis, Predictions, and Projections Program, in partnership with the National Marine Fisheries Service, has funded a set of three-year projects starting in FY 2017 to help develop NOAA's capability to produce skillful seasonal (i.e, 2-9 month) predictions of coastal high water levels as well as changing living marine resources. This presentation will describe the goals, scope and intended activities of this research initiative and its coordination via a new MAPP Ocean Prediction Task Force.

The Institutionalization of Service-Learning at the Independent Colleges and Universities of the Gulf Coast Region

ERIC Educational Resources Information Center

Lewing, Morgan; Shehane, Melissa

2017-01-01

Service-learning is a high-impact educational practice that benefits the community, the university, and students (Jacoby, 2015). It also represents an educational practice that specifically supports the integration of Christian thought and action within Christian institutions (Schaffer, 2004). The purpose of the study was to determine the level of…

Barriers to Implementation of Workplace Wellness Programs in Career Fire Service Organizations: An Exploratory Qualitative Study

ERIC Educational Resources Information Center

Harrington, Jillian

2017-01-01

Firefighter wellness has become a concern across the country, in large part because a combination of poor fitness levels, excess weight, and a high-intensity work environment contributes to chronic illness as well as line-of-duty deaths. Workplace wellness programs are effective in career fire service organizations, but nationwide implementation…

The Psychological Impact of Violence on Staff Working with Adults with Intellectual Disabilities

ERIC Educational Resources Information Center

Howard, Ruth; Rose, John; Levenson, Victor

2009-01-01

Background: Staff in intellectual disability services can experience high levels of violence, which may lead to burnout. Staff burnout may result in poorer quality services. Previous research has suggested that factors such as fear of violence, self-efficacy and staff support moderate the impact of violence on burnout. Aims: The research explores…

Workforce Planning for the Community Services and Health Industry. Occasional Paper

ERIC Educational Resources Information Center

Karmel, Tom; Blomberg, Davinia

2009-01-01

This paper aims to provide a picture of the occupations in the community services and health industry, and how the workforce obtains the required skills. The authors argue that planning for the industry should concentrate on occupations specific to the industry and those which require high skill levels. Findings suggest that the qualification…

A View through the Long Lens: Pre-Service Teachers' Perceptions of Multi-Campus Course Delivery

ERIC Educational Resources Information Center

Walker-Gibbs, Bernadette; Paatsch, Louise; Moles, Janet; Yim, Bonnie; Redpath, Terri

2016-01-01

This paper explores the results of a survey that was conducted with 277 pre-service teachers studying at two regional university campuses in Victoria, Australia in 2014. Data showed that participants expressed high level of satisfaction with the quality of their undergraduate courses in education including the flexible teaching and learning…

The forgotten smoker: a qualitative study of attitudes towards smoking, quitting, and tobacco control policies among continuing smokers

PubMed Central

2013-01-01

Background Although research suggests that the majority of smokers want to quit smoking, the uptake of Stop Smoking Services, designed to assist smokers with quitting, remains low. Little is known about continuing smokers who do not access these services, and opportunities to influence their motivation and encourage quit attempts through the uptake of services. Using PRIME theory, this study explored differences between continuing smokers who had varying levels of motivation to quit, in terms of their plans to quit, evaluative beliefs about smoking, cigarette dependence, and attitudes towards tobacco control policies and services. Methods Twenty-two current smokers, recruited from the community, were classified by motivation level to quit using a self-report questionnaire (two groups: high/low). Four focus groups (n=13) and individual interviews (n=9) were conducted with both groups using an interview guide incorporating aspects of PRIME theory. Discussion areas included motives for smoking, attitudes towards smoking and quitting, perceptions of dependence, motives for quitting, barriers to quitting, and attitudes towards existing and impending tobacco control policies and services. Verbatim transcripts were analysed using thematic framework analysis. Results All participants expressed low motivation to quit during discussions, despite some initially self-classifying as having high explicit levels of motivation to quit. Both groups reported similar attitudes towards smoking and quitting, including a perceived psychological addiction to smoking, positive evaluations about smoking which inhibited plans to quit, and similar suggested methods to increase motivation (simply wanting to, save money, improve health). Most felt that they ‘ought’ to quit as opposed to ‘wanted’ to. Little influence was ascribed towards tobacco control policies such as plain packaging and hidden sales displays, and participants felt that price increases of tobacco products needed to be considerable in order to influence motivation. Highly motivated smokers expressed more willingness to visit Stop Smoking Services, although none had done so. Conclusion Continuing smokers’ attitudes towards smoking and quitting suggests that research and policy need to focus on increasing smokers’ implicit motivation to quit smoking, even for those who classified themselves as having high motivation to quit. Targeted information and further education about Stop Smoking Services is required to increase uptake. PMID:23641875

Do targeted child health promotion services meet the needs of the most disadvantaged? A qualitative study of the views of health visitors working in inner-city and urban areas in England.

PubMed

Condon, Louise

2011-10-01

The aim of this study was to explore health visitors' views on the effects of policy change on the services they offer to preschool children in areas of high health inequalities in England. Child health promotion services are offered throughout the world to maintain and improve children's health. It is not known how the policy shift to a more overtly targeted service, which has occurred in some countries, has affected child health promotion practice in areas of deprivation. An in-depth telephone interview study was conducted between October 2006 and January 2007. All participants (n = 25) were registered health visitors who had taken part in a 2005 National Survey of Child Health Promotion Practice in England and were delivering health promotion services to preschool children in inner-city and urban areas. Despite high levels of need, some children who would have benefited from an enhanced health visiting service were offered only the core programme. Local interpretation of national policy is a key factor in determining the level of service offered, and the extent of targeting. This study illustrates the importance, in any country, of exploring the effects of national policy change from the perspective of practitioners, to identify unintended outcomes. Reductions in the core child health promotion programme can lead to difficulties in monitoring and improving children's health outcomes in areas of deprivation. © 2011 Blackwell Publishing Ltd.

Women's autonomy and maternal healthcare service utilization in Ethiopia.

PubMed

Tiruneh, Fentanesh Nibret; Chuang, Kun-Yang; Chuang, Ying-Chih

2017-11-13

Most previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women's autonomy. We assessed whether women's autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia. We analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively) for measuring women's decision-making power and permissive gender norms associated with wife beating. We used Spearman's correlation and the chi-squared test for bivariate analyses and constructed generalized estimating equation logistic regression models to analyze the associations between women's autonomy indicators and maternal healthcare service utilization with control for other socioeconomic characteristics. Our multivariate analysis showed that women living in communities with a higher percentage of opposing attitudes toward wife beating were more likely to use all three types of maternal healthcare services in 2011 (adjusted odds ratios = 1.21, 1.23, and 1.18 for four or more antenatal care visits, health facility delivery, and postnatal care visits, respectively). In 2005, the adjusted odds ratios were 1.16 and 1.17 for four or more antenatal care visits and health facility delivery, respectively. In 2011, the percentage of women in the community with high decision-making power was positively associated with the likelihood of four or more antenatal care visits (adjusted odds ratio = 1.14). The association of individual-level autonomy on maternal healthcare service utilization was less profound after we controlled for other individual-level and community-level characteristics. Our study shows that women's autonomy was positively associated with maternal healthcare service utilization in Ethiopia. We suggest addressing woman empowerment in national policies and programs would be the optimal solution.

Exploiting Aura OMI Level 2 Data with High Resolution Visualization

NASA Astrophysics Data System (ADS)

Wei, J. C.; Yang, W.; Johnson, J. E.; Zhao, P.; Gerasimov, I. V.; Pham, L.; Vicente, G. A.; Shen, S.

2014-12-01

Satellite data products are important for a wide variety of applications that can bring far-reaching benefits to the science community and the broader society. These benefits can best be achieved if the satellite data are well utilized and interpreted, such as model inputs from satellite, or extreme event (such as volcano eruption, dust storm, …etc) interpretation from satellite. Unfortunately, this is not always the case, despite the abundance and relative maturity of numerous satellite data products provided by NASA and other organizations. One way to help users better understand the satellite data is to provide data along with 'Images', including accurate pixel-level (Level 2) information, pixel coverage area delineation, and science team recommended quality screening for individual geophysical parameters. Goddard Earth Sciences Data and Information Services Center (GES DISC) always strives to best support (i.e., Software-as-a-service, SaaS) the user-community for NASA Earth Science Data. In this case, we will present a new visualization tool that helps users exploiting Aura Ozone Monitoring Instrument (OMI) Level 2 data. This new visualization service utilizes Open Geospatial Consortium (OGC) standard-compliant Web Mapping Service (WMS) and Web Coverage Service (WCS) calls in the backend infrastructure. The functionality of the service allows users to select data sources (e.g., multiple parameters under the same measurement, like NO2 and SO2 from OMI Level 2 or same parameter with different methods of aggregation, like NO2 in OMNO2G and OMNO2D products), defining area-of-interest and temporal extents, zooming, panning, overlaying, sliding, and data subsetting and reformatting. The interface will also be able to connect to other OGC WMS and WCS servers, which will greatly enhance its expandability to integrate additional outside data/map sources (such as Global Imagery Browse Services (GIBS)).

Impact of service delivery model on health care access among HIV-positive women in New York City.

PubMed

Pillai, Nandini V; Kupprat, Sandra A; Halkitis, Perry N

2009-01-01

As the New York City HIV=AIDS epidemic began generalizing beyond traditionally high-risk groups in the early 1990s, AIDS Service Organizations (ASO) sought to increase access to medical care and broaden service offerings to incorporate the needs of low-income women and their families. Strategies to achieve entry into and retention in medical care included the development of integrated care facilities, case management, and a myriad of supportive service offerings. This study examines a nonrandom sample of 60 HIV-positive women receiving case management and supportive services at New York City ASOs. Over 55% of the women interviewed reported high access to care, 43% reported the ability to access urgent care all of the time and 94% reported high satisfaction with obstetrics=gynecology (OB=GYN) care. This held true across race=ethnicity, income level, medical coverage, and service delivery model.Women who accessed services at integrated care facilities offering onsite medical care and case management=supportive services perceived lower access to medical specialists as compared to those who received services at nonintegrated sites. Data from this analysis indicate that supportive services increase access to and satisfaction with both HIV and non-HIV-related health care. Additionally, women who received services at a medical model agency were more likely to report accessing non-HIV care at a clinic compared to those receiving services at a nonmedical model agencies, these women were more likely to report receiving non-HIV care at a hospital.

Targeting smoking cessation to high prevalence communities: outcomes from a pilot intervention for gay men.

PubMed

Harding, Richard; Bensley, James; Corrigan, Nick

2004-09-30

Cigarette smoking prevalence among gay men is twice that of population levels. A pilot community-level intervention was developed and evaluated aiming to meet UK Government cessation and cancer prevention targets. Four 7-week withdrawal-oriented treatment groups combined nicotine replacement therapy with peer support. Self-report and carbon monoxide register data were collected at baseline and 7 weeks. N = 98 gay men were recruited through community newspapers and organisations in London UK. At 7 weeks, n = 44 (76%) were confirmed as quit using standard UK Government National Health Service monitoring forms. In multivariate analysis the single significant baseline variable associated with cessation was previous number of attempts at quitting (OR 1.48, p = 0.04). This tailored community-level intervention successfully recruited a high-prevalence group, and the outcome data compares very favourably to national monitoring data (which reports an average of 53% success). Implications for national targeted services are considered.

Investigating socio-economic inequity in access to and expenditures on routine immunization services in Anambra state.

PubMed

Sibeudu, Florence T; Uzochukwu, Benjamin S C; Onwujekwe, Obinna E

2017-02-01

Addressing existing inequities in the utilization of priority health services such as routine immunization is a current public health priority. Increasing access to routine immunization from the current low levels amongst all socio-economic status groups in Nigeria is challenging. However, little is known on the level of SES inequity in utilization of routine immunization services and such information which will inform the development of strategies for ensuring equitable provision of routine immunization services in the country. The study was a cross sectional household survey, which was undertaken in two randomly selected communities in Anambra State, southeast Nigeria. A pre-tested interviewer administered questionnaire was used to collect data on levels of access to RI by children under-2 years from randomly selected households. In each household, data was collected from the primary care givers or their representative (in their absence). The relationship between access to routine immunization and socio-economic status of households and other key variables was explored in data analysis. Households from high socio-economic status (well-off) groups utilized routine immunization services more than those that belong to low socio-economic status (poor) groups (X 2  = 9.97, p < 0.002). It was found that higher percentage of low socio-economic status households compared to the high socio-economic status households received routine immunization services at public health facilities. Households that belong to low socio-economic status groups had to travel longer distance to get to health facilities consequently incurring some transportation cost. The mean expenditures on service charge for routine immunization services (mostly informal payments) and transportation were US$1.84 and US$1.27 respectively. Logistic regression showed that access to routine immunization was positively related to socio-economic status and negatively related to distant of a household to a health facility. Ability to pay affects access to services, even when such services are free at point of consumption with lower socio-economic status groups having less access to services and also having other constraints such as transportation. Hence, innovative provision methods that will bring routine immunization services closer to the people and eliminate all formal and informal user fees for routine immunization will help to increase and improve equitable coverage with routine immunization services.

Spaceflight Operations Services Grid (SOSG) Prototype Implementation and Feasibility Study

NASA Technical Reports Server (NTRS)

Bradford, Robert N.; Thigpen, William W.; Lisotta, Anthony J.; Redman, Sandra

2004-01-01

Science Operations Services Grid is focusing on building a prototype grid-based environment that incorporates existing and new spaceflight services to enable current and future NASA programs with cost savings and new and evolvable methods to conduct science in a distributed environment. The Science Operations Services Grid (SOSG) will provide a distributed environment for widely disparate organizations to conduct their systems and processes in a more efficient and cost effective manner. These organizations include those that: 1) engage in space-based science and operations, 2) develop space-based systems and processes, and 3) conduct scientific research, bringing together disparate scientific disciplines like geology and oceanography to create new information. In addition educational outreach will be significantly enhanced by providing to schools the same tools used by NASA with the ability of the schools to actively participate on many levels in the science generated by NASA from space and on the ground. The services range from voice, video and telemetry processing and display to data mining, high level processing and visualization tools all accessible from a single portal. In this environment, users would not require high end systems or processes at their home locations to use these services. Also, the user would need to know minimal details about the applications in order to utilize the services. In addition, security at all levels is an underlying goal of the project. The Science Operations Services Grid will focus on four tools that are currently used by the ISS Payload community along with nine more that are new to the community. Under the prototype four Grid virtual organizations PO) will be developed to represent four types of users. They are a Payload (experimenters) VO, a Flight Controllers VO, an Engineering and Science Collaborators VO and an Education and Public Outreach VO. The User-based services will be implemented to replicate the operational voice, video, telemetry and commanding systems. Once the User-based services are in place, they will be analyzed to establish feasibility for Grid enabling. If feasible then each User-based service will be Grid enabled. The remaining non-Grid services if not already Web enabled will be so enabled. In the end, four portals will be developed one for each VO. Each portal will contain the appropriate User-based services required for that VO to operate.

Serving the Community. Lawyers Helping Young People Become Good Citizens. I'm the People--It's about Citizenship and You.

ERIC Educational Resources Information Center

American Bar Association, Chicago, IL. Special Committee on Youth Education for Citizenship.

Organized around the theme of community service, this booklet provides teachers and lawyers with classroom materials for elementary grades K-3 (Level A), intermediate grades 4-6 (Level B), middle school grades 6-8 (Level C), and high school grades 9-12 (Level D). In addition, each level contains pages for the lawyer (marked by the scales of…

Disparity in maternal, newborn and child health services in high focus states in India: a district-level cross-sectional analysis.

PubMed

Awasthi, Ashish; Pandey, C M; Chauhan, Rajesh K; Singh, Uttam

2016-08-05

To examine the level and trend in the coverage gap of a set of interventions of maternal and child health services using a summary index and to assess the disparity in usage of maternal and child health services in the districts of high focus states of India. Data for the present study are taken from the Annual Health Survey (AHS), 2010-2013 and Census of India, 2011. This study used secondary data from states having higher mortality and fertility rates, termed as high focus states in India. District-level information regarding children aged 12-23 months and ever married women aged 15-49 years has been extracted from the AHS (2010-2013), and household amenities, female literacy and main workforce information has been obtained from the Census of India 2011. 2 summary indexes were calculated first for maternal and child health services and another for socioeconomic and development status, using data from AHS and Census. Cronbach's α was used to assess the internal consistency of the items used in the index. The result shows that the coverage gap is highest in Uttar Pradesh (37%) and lowest in Madhya Pradesh (21%). Converge gap and socioeconomic development are negatively correlated (r=-0.49, p=0.01). The average coverage gap was highest in the lowest quintile of socioeconomic development. There was an absolute change of 1.5% per year in coverage gap during 2009-2013. In regression analysis, the coefficient of determination was 0.24, β=-30.05, p=0.01 for a negative relationship between socioeconomic development and coverage gap. There is a significant disparity in the usage of maternal and child healthcare services in the districts of India. Resource-rich people (urban residents and richest quintile) are way ahead of marginalised people (rural residents and poorest quintile) in the usage of healthcare services. 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/

Watson Jones Lecture. The organisation of trauma services in the UK.

PubMed Central

Templeton, J.

2000-01-01

To provide a high level of orthopaedic trauma care, education and research, across the country, trauma services in the UK require modification. Good information is necessary prior to formulating ideas and proposals. Trauma care provision must be considered comprehensively at both the national and local levels. As a first step, it is important to know just how many acute hospitals there are in the country. It is also important to know about the distribution of surgical specialities and the number of consultant orthopaedic surgeons staffing those hospitals. Images Figure 1 PMID:10700769

Association between perceived stress, multimorbidity and primary care health services: a Danish population-based cohort study

PubMed Central

Vestergaard, Mogens; Larsen, Karen Kjær; Fenger-Grøn, Morten

2018-01-01

Objectives Mental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental–physical multimorbidity. Design Population-based cohort study. Setting Primary healthcare in Denmark. Participants 118 410 participants from the Danish National Health Survey 2010 followed for 1 year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers. Outcome measures General daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers. Results Perceived stress levels were associated with primary care activity in a dose–response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95% CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95% CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95% CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95% CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95% CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services. Conclusion Persons with high stress levels generally had higher use of primary healthcare, 4–6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services. PMID:29478014

[Implementation and evaluation of case management in Catalonia: the ISP-SMD program].

PubMed

Balsera Gómez, J; Rodríguez Medina, C; Caba Calvet, R; Vega Prada, R; Ruiz Ureña, H; Berruezo Ortiz, L; Clusa Gironella, D; Rodríguez Montes, M J; Haro Abad, J M

2002-01-01

The pilot study of the Individualized Service Program for people with Severe Mental Disorders (ISP-SMD) consists of the implementation of case management services in Catalonia. The ISP-SMD has been implemented in two health care sectors and will be expanded to the rest of Catalonia in the next years. The program serves people with persistent mental disorders who have serious social or family problems and/or who have inadequate mental health service use (high use of inpatient services, no use of community services). The ISP-SMD is a community intervention program that focuses its activities on direct care and coordination between services. Thirty patients have been included in the evaluation. The results of the pilot study have shown that, compared to the year before entering the program, the patients show better clinical status, they decrease their unmet need level, they have more appropriate use of health services and have lower treatment costs. Satisfaction of the patients, family members and professionals with the program is very high. It is possible to adapt and implement case management services in Catalonia. When implemented, they improve patient quality of life.

Conflict, displacement and sexual and reproductive health services in Mali: analysis of 2013 health resources availability mapping system (HeRAMS) survey.

PubMed

Tunçalp, Özge; Fall, Ibrahima Socé; Phillips, Sharon J; Williams, Inga; Sacko, Massambou; Touré, Ousmane Boubacar; Thomas, Lisa J; Say, Lale

2015-01-01

Little is known specifically about the effects of conflict and displacement on provision of sexual and reproductive health (SRH) services. We aimed to understand the association between levels of conflict and displacement and the availability of SRH services in post-conflict Mali. A national assessment was conducted between April and May 2013 employing Health Systems Availability Mapping System (HeRAMS). Data from 1581 primary care facilities were analysed, focusing on SRH services. Descriptive analyses and multivariable logistic regression models were used to examine the availability of SRH services by different levels of conflict and displacement. Of 1581 facilities, 1551 had data available to identify the details of service provision. The majority of the facilities were part of the public sector (79.1 %), identified as basic community primary care facilities (71.9 %). Overall 15.7 % of the facilities were in the zones under occupation, 40.3 % in the areas with high concentration of displaced population and 44 % in areas with low concentration of displaced populations. Between zones of low concentration of displaced populations and under occupation the likelihood of service availability varied between OR: 2.9 (95 % CI 2.0-4.4) for basic emergency obstetric care and OR: 41.7 (95 % CI 20.4-85.3) for family planning. All of the services within the three domains of SRH were more likely to be available in the low and high concentration displaced population areas compared to the facilities in the under occupation zones, after adjusting for other facility-related variables. Areas with high concentration of displaced population had less service availability, and areas formerly under occupation had the least service availability. This suggests that those living in conflict areas, and many of those who are internally displaced, have poor access to essential SRH interventions. The systematic measurement of the availability of health services, including SRH, is feasible and can contribute to recovery planning in post-conflict and humanitarian settings.

Newborn Survival Case Study in Rwanda - Bottleneck Analysis and Projections in Key Maternal and Child Mortality Rates Using Lives Saved Tool (LiST).

PubMed

Khurmi, Manpreet Singh; Sayinzoga, Felix; Berhe, Atakilt; Bucyana, Tatien; Mwali, Assumpta Kayinamura; Manzi, Emmanuel; Muthu, Maharajan

2017-01-01

The Newborn Survival Case study in Rwanda provides an analysis of the newborn health and survival situation in the country. It reviews evidence-based interventions and coverage levels already implemented in the country; identifies key issues and bottlenecks in service delivery and uptake of services by community/beneficiaries, and provides key recommendations aimed at faster reduction in newborn mortality rate. This study utilized mixed method research including qualitative and quantitative analyses of various maternal and newborn health programs implemented in the country. This included interviewing key stakeholders at each level, field visits and also interviewing beneficiaries for assessment of uptake of services. Monitoring systems such as Health Management Information Systems (HMIS), maternal and newborn death audits were reviewed and data analyzed to aid these analyses. Policies, protocols, various guidelines and tools for monitoring are already in place however, implementation of these remains a challenge e.g. infection control practices to reduce deaths due to sepsis. Although existing staff are quite knowledgeable and are highly motivated, however, shortage of health personnel especially doctors in an issue. New facilities are being operationalized e.g. at Gisenyi, however, the existing facilities needs expansion. It is essential to implement high impact evidence based interventions but coverage levels need to be significantly high in order to achieve higher reduction in newborn mortality rate. Equity approach should be considered in planning so that the services are better implemented and the poor and needy can get the benefits of public health programs.

Expanding Cervical Cancer Screening and Treatment in Tanzania: Stakeholders’ Perceptions of Structural Influences on Scale-Up

PubMed Central

Giattas, Mary Rose; Sahasrabuddhe, Vikrant V.; Jolly, Pauline E.; Martin, Michelle Y.; Usdan, Stuart Lawrence; Kohler, Connie; Lisovicz, Nedra

2015-01-01

Tanzania has the highest burden of cervical cancer in East Africa. This study aims to identify perceived barriers and facilitators that influence scale-up of regional and population-level cervical cancer screening and treatment programs in Tanzania. Convenience sampling was used to select participants for this qualitative study among 35 key informants. Twenty-eight stakeholders from public-sector health facilities, academia, government, and nongovernmental organizations completed in-depth interviews, and a seven-member municipal health management team participated in a focus group discussion. The investigation identified themes related to the infrastructure of health services for cervical cancer prevention, service delivery, political will, and sociocultural influences on screening and treatment. Decentralizing service delivery, improving access to screening and treatment, increasing the number of trained health workers, and garnering political will were perceived as key facilitators for enhancing and initiating screening and treatment services. In conclusion, participants perceived that system-level structural factors should be addressed to expand regional and population-level service delivery of screening and treatment. Implications for Practice: Tanzanian women have a high burden of cervical cancer. Understanding the perceived structural factors that may influence screening coverage for cervical cancer and availability of treatment may be beneficial for program scale-up. This study showed that multiple factors contribute to the challenge of cervical cancer screening and treatment in Tanzania. In addition, it highlighted systematic developments aimed at expanding services. This study is important because the themes that emerged from the results may help inform programs that plan to improve screening and treatment in Tanzania and potentially in other areas with high burdens of cervical cancer. PMID:25926351

Childhood ADHD Symptoms: Association with Parental Social Networks and Mental Health Service Use during Adolescence.

PubMed

Bussing, Regina; Meyer, Johanna; Zima, Bonnie T; Mason, Dana M; Gary, Faye A; Garvan, Cynthia Wilson

2015-09-22

This study examines the associations of childhood attention-deficit/hyperactivity disorder (ADHD) risk status with subsequent parental social network characteristics and caregiver strain in adolescence; and examines predictors of adolescent mental health service use. Baseline ADHD screening identified children at high risk (n = 207) and low risk (n = 167) for ADHD. At eight-year follow-up, parents reported their social network characteristics, caregiver strain, adolescents' psychopathology and mental health service utilization, whereas adolescents self-reported their emotional status and ADHD stigma perceptions. Analyses were conducted using ANOVAs and nested logistic regression modeling. Parents of youth with childhood ADHD reported support networks consisting of fewer spouses but more healthcare professionals, and lower levels of support than control parents. Caregiver strain increased with adolescent age and psychopathology. Increased parental network support, youth ADHD symptoms, and caregiver strain, but lower youth stigma perceptions were independently associated with increased service use. Raising children with ADHD appears to significantly impact parental social network experiences. Reduced spousal support and overall lower network support levels may contribute to high caregiver strain commonly reported among parents of ADHD youth. Parental social network experiences influence adolescent ADHD service use. With advances in social networking technology, further research is needed to elucidate ways to enhance caregiver support during ADHD care.

[What patients think of the services of the Instituto Nacional de la Nutrición "Salvador Zubirán"].

PubMed

Ruiz-González, C; Vargas-Vorácková, F; Castillo-Rentería, C; Pérez Pimentel, L; Martínez Mata, R A

1990-01-01

The quality of care has always been a subject of interest to the Instituto Nacional de la Nutrición "Salvador Zubirán", in order to improve its services. This interest led to the present survey which aims to evaluate the patient's global satisfaction and to identify specific problems susceptible of improvement. One hundred and seventy-one patients or relatives attending eight different services of the Institute were interviewed. Opinions about the following aspects were explored by means of service-specific questionnaires: sociodemographic characteristics, satisfaction with care, waiting periods, patient-personnel relationship, hospital environment, food quality, drug availability and costs. Results of the survey show a high level of satisfaction with the services provided, i.e. 33% of the patients considered it good, and 64% excellent. However, and in agreement with other reports, this high level of satisfaction does not necessarily reflect an absence of problems, i.e. long waiting periods, insufficient restrooms, failures in getting information about their health status, and occasional absence of drugs in the pharmacy were identified. Continuation of this kind of surveys in our setting leads not only to the identification of problems, but also to the evaluation of the impact that resulting measures may have on the patient's satisfaction.

Ecosystem Services and Biodiversity in a Rapidly Transforming Landscape in Northern Borneo.

PubMed

Labrière, Nicolas; Laumonier, Yves; Locatelli, Bruno; Vieilledent, Ghislain; Comptour, Marion

2015-01-01

Because industrial agriculture keeps expanding in Southeast Asia at the expense of natural forests and traditional swidden systems, comparing biodiversity and ecosystem services in the traditional forest-swidden agriculture system vs. monocultures is needed to guide decision making on land-use planning. Focusing on tree diversity, soil erosion control, and climate change mitigation through carbon storage, we surveyed vegetation and monitored soil loss in various land-use areas in a northern Bornean agricultural landscape shaped by swidden agriculture, rubber tapping, and logging, where various levels and types of disturbance have created a fine mosaic of vegetation from food crop fields to natural forest. Tree species diversity and ecosystem service production were highest in natural forests. Logged-over forests produced services similar to those of natural forests. Land uses related to the swidden agriculture system largely outperformed oil palm or rubber monocultures in terms of tree species diversity and service production. Natural and logged-over forests should be maintained or managed as integral parts of the swidden system, and landscape multifunctionality should be sustained. Because natural forests host a unique diversity of trees and produce high levels of ecosystem services, targeting carbon stock protection, e.g. through financial mechanisms such as Reducing Emissions from Deforestation and Forest Degradation (REDD+), will synergistically provide benefits for biodiversity and a wide range of other services. However, the way such mechanisms could benefit communities must be carefully evaluated to counter the high opportunity cost of conversion to monocultures that might generate greater income, but would be detrimental to the production of multiple ecosystem services.

Ecosystem Services and Biodiversity in a Rapidly Transforming Landscape in Northern Borneo

PubMed Central

Labrière, Nicolas; Laumonier, Yves; Locatelli, Bruno; Vieilledent, Ghislain; Comptour, Marion

2015-01-01

Because industrial agriculture keeps expanding in Southeast Asia at the expense of natural forests and traditional swidden systems, comparing biodiversity and ecosystem services in the traditional forest–swidden agriculture system vs. monocultures is needed to guide decision making on land-use planning. Focusing on tree diversity, soil erosion control, and climate change mitigation through carbon storage, we surveyed vegetation and monitored soil loss in various land-use areas in a northern Bornean agricultural landscape shaped by swidden agriculture, rubber tapping, and logging, where various levels and types of disturbance have created a fine mosaic of vegetation from food crop fields to natural forest. Tree species diversity and ecosystem service production were highest in natural forests. Logged-over forests produced services similar to those of natural forests. Land uses related to the swidden agriculture system largely outperformed oil palm or rubber monocultures in terms of tree species diversity and service production. Natural and logged-over forests should be maintained or managed as integral parts of the swidden system, and landscape multifunctionality should be sustained. Because natural forests host a unique diversity of trees and produce high levels of ecosystem services, targeting carbon stock protection, e.g. through financial mechanisms such as Reducing Emissions from Deforestation and Forest Degradation (REDD+), will synergistically provide benefits for biodiversity and a wide range of other services. However, the way such mechanisms could benefit communities must be carefully evaluated to counter the high opportunity cost of conversion to monocultures that might generate greater income, but would be detrimental to the production of multiple ecosystem services. PMID:26466120

Community pharmacy-based asthma services--what do patients prefer?

PubMed

Naik Panvelkar, Pradnya; Armour, Carol; Saini, Bandana

2010-12-01

Patient preferences can influence the outcomes of treatment and so understanding and organizing health-care services around these preferences is vital. To explore patient preferences for types of community pharmacy-based asthma services, to investigate the influence of "experience" in molding preferences for such services, and to identify aspects of the services that patients prefer over others. Semistructured face-to-face interviews were conducted with a convenience sample of two types of asthma patients: (1) those naïve to a specialized asthma service and (2) those who had experienced a specialized asthma service. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Eighteen interviews were conducted (8 experienced patients, 10 naïve patients). The majority of the patients wanted the pharmacist to play a greater role in their asthma management. Patients experiencing increased levels of service had increased levels of expectations as well as more specific preferences for various aspects of the service. The key aspects of an asthma service that all patients wanted their pharmacists to provide were the provision of information about asthma and its medications, lung function testing and monitoring of their asthma, and checking/correcting their inhaler technique. Patients also expressed a desire for skilled communication and behavioral aspects from the pharmacist such as friendliness, empathy, attentiveness, and dedicated time. Patients highlighted the importance of privacy in the pharmacy. There was a high level of satisfaction toward the currently delivered asthma service among both naïve and experienced patients. The provision of the specialized service was associated with increased patient loyalty to the particular pharmacy. All patients indicated a willingness to participate in future pharmacy-delivered specialized asthma services. Elements of the specialized pharmacy-based asthma services important from a patient's perspective were identified. It would be important to identify the strength and magnitude of patient's preferences for different elements of such services. Future pharmacy-based services should incorporate patient preferences and tailor services to patient's needs to ensure their long-term viability.

Epidemiology of Pediatric Critical Care Transport in Northern Alberta and the Western Arctic.

PubMed

Kawaguchi, Atsushi; Nielsen, Charlene C; G Guerra, Gonzalo; Saunders, L Duncan; Yasui, Yutaka; DeCaen, Allan

2018-06-01

Specialized pediatric critical care transport teams are essential to pediatric retrieval systems. This study aims to describe the contemporary transports performed by a Canadian pediatric critical care transport team and to compare the treatment and outcomes of children referred from high-level care (hospitals offering pediatric services where an adult ICU exists) and nonhigh-level care (all other hospitals) hospitals. A descriptive cohort study. The Stollery Children's Hospital in Edmonton, Alberta, Western Canada. Children younger than 17 years old transported by the transport team from referral hospitals within the Stollery Children's Hospital catchment area to Stollery Children's Hospital between 1998 and 2015. None. Characteristics of transports, patient demographics presenting vital signs, and outcomes were described overall and compared by transport-related time and referral hospital types (high-level care and nonhigh-level care). In total, 3,352 transports met the inclusion criteria; 1,049 were retrieved from eight high-level care hospitals and 2,303 from 53 nonhigh-level care hospitals; the median one-way transport distance was 383 kilometers, and 70% of the transports were air transports. The annual number of transports has increased during the study period. The PICU admission rate was between 40% and 55%. Transports from high-level care hospitals had significantly higher odds of being admitted to the PICU (odds ratio, 1.96; 95% CI, 1.31-2.93). The odds of intubation at the referral hospital were higher in the high-level care group, but the odds of intubation upon PICU admission was similar between the two groups. Mortality during or after transport was not significantly different between high-level care and nonhigh-level care hospitals. The current transport system has multiple priorities with regard to efficiency and quality. The medical services at referral hospitals may affect the likelihood of PICU admission and subsequent PICU length of stay; however, no negative impact was observed in other outcomes including mortality.

The case for implementing activity based costing.

PubMed

Monge, Paul H; Bolinger-Perez, Nicole; Boysen, Kent

2012-01-01

ABC identifies profitable volumes to give managers information to better manage volumes. Managers must balance the demand for service while maintaining a reasonable profit margin. Disparate systems work extremely well for their intended purposes, but they do not communicate with one another. The strength of the data they hold individually may be leveraged when implementing ABC methodology. Mayo Clinic in Rochester, Minnesota implemented a pilot of ABC to evaluate CT services where there is a high volume, multiple service location for cost comparison, variety of patient acuity and service mix, and large capital investments.The goal was to reveal the actual cost of CT services at the procedural level.

Contracting for intensive care services.

PubMed

Dorman, S

1996-01-01

Purchasers will increasingly expect clinical services in the NHS internal market to provide objective measures of their benefits and cost effectiveness in order to maintain or develop current funding levels. There is limited scientific evidence to demonstrate the clinical effectiveness of intensive care services in terms of mortality/morbidity. Intensive care is a high-cost service and studies of cost-effectiveness need to take account of case-mix variations, differences in admission and discharge policies, and other differences between units. Decisions over development or rationalisation of intensive care services should be based on proper outcome studies of well defined patient groups. The purchasing function itself requires development in order to support effective contracting.

Laboratory testing of candidate robotic applications for space

NASA Technical Reports Server (NTRS)

Purves, R. B.

1987-01-01

Robots have potential for increasing the value of man's presence in space. Some categories with potential benefit are: (1) performing extravehicular tasks like satellite and station servicing, (2) supporting the science mission of the station by manipulating experiment tasks, and (3) performing intravehicular activities which would be boring, tedious, exacting, or otherwise unpleasant for astronauts. An important issue in space robotics is selection of an appropriate level of autonomy. In broad terms three levels of autonomy can be defined: (1) teleoperated - an operator explicitly controls robot movement; (2) telerobotic - an operator controls the robot directly, but by high-level commands, without, for example, detailed control of trajectories; and (3) autonomous - an operator supplies a single high-level command, the robot does all necessary task sequencing and planning to satisfy the command. Researchers chose three projects for their exploration of technology and implementation issues in space robots, one each of the three application areas, each with a different level of autonomy. The projects were: (1) satellite servicing - teleoperated; (2) laboratory assistant - telerobotic; and (3) on-orbit inventory manager - autonomous. These projects are described and some results of testing are summarized.

Future-proofing the pharmacy profession in a hypercompetitive market.

PubMed

Singleton, Judith A; Nissen, Lisa M

2014-01-01

This paper highlights the hypercompetitive nature of the current pharmacy landscape in Australia and to suggest either a superior level of differentiation strategy or a focused differentiation strategy targeting a niche market as two viable, alternative business models to cost leadership for small, independent community pharmacies. A description of the Australian health care system is provided as well as background information on the current community pharmacy environment in Australia. The authors propose a differentiation or focused differentiation strategy based on cognitive professional services (CPS) which must be executed well and of a superior quality to competitors' services. Market research to determine the services valued by target customers and that they are willing to pay for is vital. To achieve the superior level of quality that will engender high patient satisfaction levels and loyalty, pharmacy owners and managers need to develop, maintain and clearly communicate service quality specifications to the staff delivering these services. Otherwise, there will be a proliferation of pharmacies offering the same professional services with no evident service differential. However, to sustain competitive advantage over the long-term, these smaller, independent community pharmacies will need to exploit a broad core competency base in order to be able to continuously introduce new sources of competitive advantage. With the right expertise, the authors argue that smaller, independent community pharmacies can successfully deliver CPS and sustain profitability in a hypercompetitive market. Copyright © 2014 Elsevier Inc. All rights reserved.

The Italian National Health Service expenditure on workplace prevention and safety (2006-2013): a national-level analysis.

PubMed

Signorelli, C; Riccò, M; Odone, A

2016-01-01

The World Health Organization (WHO) stated that countries' health policies should give high priority to primary prevention of occupational health hazards. Scant data are available on health expenditure on workplace prevention and safety services and on its impact on occupational health outcomes in Italy and in other European countries. objective of the present study was to systematically retrieve, analyse and critically appraise the available national-level data on public health expenditure on workplace prevention and safety services as well as to correlate them with occupational health outcomes. National-level data on total public health expenditure on prevention services, its share spent on workplace prevention and safety services as well as on number of workers receiving appropriate health surveillance were derived from the national public health expenditure monitoring system over a 8-year study period (2006-2013). An analytic approach was adopted to explore the association between health expenditure and occupational health services supply. The Italian National Health Service spends almost € 5 billion per year on preventive care, of which 13.3% are spent on workplace prevention and safety programmes (€ 645 million, € 10.6 per capita). There is wide heterogeneity between Italian regions. Our findings are useful for health systems and policies analysis, national and international comparisons as well as for health policy makers to plan, implement and monitor occupational health prevention programmes.

North Atlantic Coast Comprehensive Study Phase I: Statistical Analysis of Historical Extreme Water Levels with Sea Level Change

DTIC Science & Technology

2014-09-01

14-7 ii Abstract The U.S. North Atlantic coast is subject to coastal flooding as a result of both severe extratropical storms (e.g., Nor’easters...Products and Services, excluding any kind of high-resolution hydrodynamic modeling. Tropical and extratropical storms were treated as a single...joint probability analysis and high-fidelity modeling of tropical and extratropical storms

The clinical profile of employees with mental health problems working in social firms in the UK.

PubMed

Milton, Alyssa; Parsons, Nicholas; Morant, Nicola; Gilbert, Eleanor; Johnson, Sonia; Fisher, Adrian; Singh, Swaran; Cunliffe, Di; Marwaha, Steven

2015-08-01

UK social firms are under-researched but are a potentially important vocational option for people with mental health problems. To describe the clinical profile, satisfaction levels and experiences of social firms employees with mental health problems. Clinical, work and service use characteristics were collected from social firms' employees with mental health problems in England and Wales. Workplace experience and satisfaction were explored qualitatively. Predominantly, social firms' employees (N = 80) report that they have a diagnosis of depression (56%) and anxiety (41%). People with schizophrenia (20%) or bipolar disorder (5%) were a minority. Respondents had low symptom and disability levels, high quality of life and job satisfaction and experienced reductions in secondary mental health service use over time. High-workplace satisfaction was related to flexibility, manager and colleague support and workplace accommodations. The clinical profile, quality of life and job satisfaction level of employees with mental health problems suggest social firms could be a useful addition to UK vocational services for some people. Current employees mainly have common mental disorders, and social firms will need to shift their focus if they are to form a substantial pathway for the vocational recovery of people currently using community mental health teams.

Legal issues in clouds: towards a risk inventory.

PubMed

Djemame, Karim; Barnitzke, Benno; Corrales, Marcelo; Kiran, Mariam; Jiang, Ming; Armstrong, Django; Forgó, Nikolaus; Nwankwo, Iheanyi

2013-01-28

Cloud computing technologies have reached a high level of development, yet a number of obstacles still exist that must be overcome before widespread commercial adoption can become a reality. In a cloud environment, end users requesting services and cloud providers negotiate service-level agreements (SLAs) that provide explicit statements of all expectations and obligations of the participants. If cloud computing is to experience widespread commercial adoption, then incorporating risk assessment techniques is essential during SLA negotiation and service operation. This article focuses on the legal issues surrounding risk assessment in cloud computing. Specifically, it analyses risk regarding data protection and security, and presents the requirements of an inherent risk inventory. The usefulness of such a risk inventory is described in the context of the OPTIMIS project.

The high societal costs of childhood conduct problems: evidence from administrative records up to age 38 in a longitudinal birth cohort.

PubMed

Rivenbark, Joshua G; Odgers, Candice L; Caspi, Avshalom; Harrington, HonaLee; Hogan, Sean; Houts, Renate M; Poulton, Richie; Moffitt, Terrie E

2018-06-01

Children with conduct problems that persist into adulthood are at increased risk for future behavioral, health, and social problems. However, the longer term public service usage among these children has not been fully documented. To aid public health and intervention planning, adult service usage across criminal justice, health care, and social welfare domains is compared among all individuals from a representative cohort who followed different conduct problem trajectories from childhood into adulthood. Participants are from the Dunedin Multidisciplinary Health and Development Study, a prospective, representative cohort of consecutive births (N = 1,037) from April 1972 to March 1973 in Dunedin, New Zealand. Regression analyses were used to compare levels of public service usage up to age 38, gathered via administrative and electronic medical records, between participants who displayed distinct subtypes of childhood conduct problems (low, childhood-limited, adolescent-onset, and life-course persistent). Children exhibiting life-course persistent conduct problems used significantly more services as adults than those with low levels of childhood conduct problems. Although this group comprised only 9.0% of the population, they accounted for 53.3% of all convictions, 15.7% of emergency department visits, 20.5% of prescription fills, 13.1% of injury claims, and 24.7% of welfare benefit months. Half of this group (50.0%) also accrued high service use across all three domains of criminal justice, health, and social welfare services, as compared to only 11.3% of those with low conduct problems (OR = 7.27, 95% CI = 4.42-12.0). Conduct problems in childhood signal high future costs in terms of service utilization across multiple sectors. Future evaluations of interventions aimed at conduct problems should also track potential reductions in health burden and service usage that stretch into midlife. © 2017 Association for Child and Adolescent Mental Health.

Homebound Learning Opportunities: reaching out to older shut-ins and their caregivers.

PubMed

Penning, M; Wasyliw, D

1992-10-01

Homebound Learning Opportunities (HLO) represents an innovative health promotion and educational outreach service for homebound older adults and their caregivers. It provides over 125 topics for individualized learning programs delivered to participants in their own places of residence, an audiovisual lending library, educational television programming, and a peer counseling service. Shut-ins are recruited as instructors and as participants in service projects that benefit the greater community. Preliminary assessments reveal high levels of participation and satisfaction with the program.

Taverna: a tool for building and running workflows of services

PubMed Central

Hull, Duncan; Wolstencroft, Katy; Stevens, Robert; Goble, Carole; Pocock, Mathew R.; Li, Peter; Oinn, Tom

2006-01-01

Taverna is an application that eases the use and integration of the growing number of molecular biology tools and databases available on the web, especially web services. It allows bioinformaticians to construct workflows or pipelines of services to perform a range of different analyses, such as sequence analysis and genome annotation. These high-level workflows can integrate many different resources into a single analysis. Taverna is available freely under the terms of the GNU Lesser General Public License (LGPL) from . PMID:16845108

Trauma and PTSD rates in an irish psychiatric population

PubMed Central

Wilson, Fiona E; Hennessy, Eilis; Dooley, Barbara; Kelly, Brendan D; Ryan, Dermot A

2013-01-01

Although Western mental health services are increasingly finding themselves concerned with assisting traumatized individuals migrating from other countries, trauma and posttraumatic stress disorder (PTSD) are under-detected and undiagnosed in psychiatric populations. This study examined and compared rates of traumatic experiences, frequency of traumatic events, trauma symptomatology levels, rates of torture, rates of PTSD and chart documentation of trauma and PTSD between (a) Irish and migrant service-users and (b) forced migrant and voluntary migrant service-users in Dublin, Ireland. Data were gathered from 178 psychiatric outpatients attending using a sociodemographic questionnaire, the Harvard Trauma Questionnaire-Revised Cambodian Version and the SCID-I/P. A substantial number of service-users had experienced at least one lifetime trauma (71.3%), and a high percentage of both the Irish (47.4%) and migrant groups (70.3%) of service-users had experienced two or more events. Overall, analyses comparing rates between Irish, forced migrant and voluntary migrant service-users found that forced migrants displayed more traumatic life events, posttraumatic symptoms, and higher levels of PTSD than their voluntary migrant and Irish counterparts, with over 50% experiencing torture prior to arrival in Ireland. The lifetime rate of PTSD in the overall sample was 15.7% but only 53.57% of cases were documented in patient charts. The results of this study are informative about the nature and extent of the problem of trauma and PTSD among migrant mental health service users as well as highlighting the under-detected levels of trauma among native-born service users. PMID:28228990

VR Employment Outcomes of Individuals with Autism Spectrum Disorders: A Decade in the Making.

PubMed

Alverson, Charlotte Y; Yamamoto, Scott H

2018-01-01

This study utilized hierarchical linear modeling analysis of a 10-year extant dataset from Rehabilitation Services Administration to investigate significant predictors of employment outcomes for vocational rehabilitation (VR) clients with autism. Predictor variables were gender, ethnicity, attained education level, IEP status in high school, secondary disability status, and total number of VR services. Competitive employment was the criterion variable. Only one predictor variable, Total Number of VR Services, was significant across all 10 years. IEP status in high school was not significant in any year. The remaining predictors were significant in one or more years. Further research and implications for researchers and practitioners are included.

On Designing Lightweight Threads for Substrate Software

NASA Technical Reports Server (NTRS)

Haines, Matthew

1997-01-01

Existing user-level thread packages employ a 'black box' design approach, where the implementation of the threads is hidden from the user. While this approach is often sufficient for application-level programmers, it hides critical design decisions that system-level programmers must be able to change in order to provide efficient service for high-level systems. By applying the principles of Open Implementation Analysis and Design, we construct a new user-level threads package that supports common thread abstractions and a well-defined meta-interface for altering the behavior of these abstractions. As a result, system-level programmers will have the advantages of using high-level thread abstractions without having to sacrifice performance, flexibility or portability.

Crisis resolution: consumer, family and referrer perspectives on care.

PubMed

Carter, Frances A; Taylor, M Joan; Weston, Madeline J; Quigley, Teresa A; Beveridge, John H; Green, Robert Aj; Duffy, Steve

2018-06-08

To systematically assess the service satisfaction of consumers, their families and referrers with crisis resolution (CR). Consecutive consumers discharged after receiving CR over a five-week period were potentially eligible for participation, together with their family and referrer (broadly defined). Structured telephone interviews were conducted and involved forced-choice questions assessing global satisfaction and satisfaction with specific aspects of care, plus two open-ended questions. Participants were 75 consumers, 22 family and 16 referrers. High levels of satisfaction were seen for all participants for both global (86-96%) and most specific aspects of care (>75%). If consumers were dissatisfied with their overall care, they were significantly more likely to be aged 25-34 years of age. High levels of agreement among raters were found for global satisfaction (>85%) and most specific aspects of care (>70%), which provides some level of reassurance for staff. Open-ended questions showed that having effective treatment of sufficient duration and staff manner were most important to participants. High levels of satisfaction and agreement were found among consumers, family and referrers with CR. Open-ended questions identified which issues matter the most to key stakeholders, which may have implications for service evaluation tools.

Social networks, mental health problems, and mental health service utilization in OEF/OIF National Guard veterans.

PubMed

Sripada, Rebecca K; Bohnert, Amy S B; Teo, Alan R; Levine, Debra S; Pfeiffer, Paul N; Bowersox, Nicholas W; Mizruchi, Mark S; Chermack, Stephen T; Ganoczy, Dara; Walters, Heather; Valenstein, Marcia

2015-09-01

Low social support and small social network size have been associated with a variety of negative mental health outcomes, while their impact on mental health services use is less clear. To date, few studies have examined these associations in National Guard service members, where frequency of mental health problems is high, social support may come from military as well as other sources, and services use may be suboptimal. Surveys were administered to 1448 recently returned National Guard members. Multivariable regression models assessed the associations between social support characteristics, probable mental health conditions, and service utilization. In bivariate analyses, large social network size, high social network diversity, high perceived social support, and high military unit support were each associated with lower likelihood of having a probable mental health condition (p < .001). In adjusted analyses, high perceived social support (OR .90, CI .88-.92) and high unit support (OR .96, CI .94-.97) continued to be significantly associated with lower likelihood of mental health conditions. Two social support measures were associated with lower likelihood of receiving mental health services in bivariate analyses, but were not significant in adjusted models. General social support and military-specific support were robustly associated with reduced mental health symptoms in National Guard members. Policy makers, military leaders, and clinicians should attend to service members' level of support from both the community and their units and continue efforts to bolster these supports. Other strategies, such as focused outreach, may be needed to bring National Guard members with need into mental health care.

Knowledge of free delivery policy among women who delivered at health facilities in Oudomxay Province, Lao PDR.

PubMed

Chankham, Tengbriacheu; Yamamoto, Eiko; Reyer, Joshua A; Arafat, Rahman; Khonemany, Innoukham; Panome, Sayamoungkhoun; Hongkham, Dalavong; Bounfeng, Phommalaysith; Anonh, Xeuthvongsa; Hamajima, Nobuyuki

2017-02-01

To promote the utilization of maternal health services and reduce financial barriers, the Laos government introduced its "Free Maternal Health Services Policy" in 2012. This policy provides free maternal health services for pregnant women, which includes costs related to treatment, transportation, food fees, referral and an incentive for four antenatal care appointments. This study aims to ascertain the knowledge level regarding this policy among Lao women and determine their level of satisfaction with the maternal service provision. This is a cross-sectional study conducted in Xay district, La district, and Namore district of Oudomxay province, in August 2015. Three hundred and sixty women who delivered their children at the health facilities from July 2014 to June 2015 were randomly selected from the list of mothers who lived in each area. The majority of women had heard about the free delivery policy and knew that the main health services related to delivery and pregnancy were free of charge. Logistic regression analysis showed that education level (P=0.026), length of stay (P<0.0001) and receiving transportation support (P=0.005) had significant associations with the knowledge level. The women were highly satisfied with the quality of the services, health care providers, and health facilities. However, most mothers were not satisfied with accessibility to health facilities. To increase utilization of health facilities and reduce the maternal mortality ratio in rural areas, the government needs to improve people's education status and health care accessibility.

Exploring NASA Satellite Data with High Resolution Visualization

NASA Astrophysics Data System (ADS)

Wei, J. C.; Yang, W.; Johnson, J. E.; Shen, S.; Zhao, P.; Gerasimov, I. V.; Vollmer, B.; Vicente, G. A.; Pham, L.

2013-12-01

Satellite data products are important for a wide variety of applications that can bring far-reaching benefits to the science community and the broader society. These benefits can best be achieved if the satellite data are well utilized and interpreted, such as model inputs from satellite, or extreme event (such as volcano eruption, dust storm, ...etc) interpretation from satellite. Unfortunately, this is not always the case, despite the abundance and relative maturity of numerous satellite data products provided by NASA and other organizations. Such obstacles may be avoided by providing satellite data as ';Images' with accurate pixel-level (Level 2) information, including pixel coverage area delineation and science team recommended quality screening for individual geophysical parameters. We will present a prototype service from the Goddard Earth Sciences Data and Information Services Center (GES DISC) supporting various visualization and data accessing capabilities from satellite Level 2 data (non-aggregated and un-gridded) at high spatial resolution. Functionality will include selecting data sources (e.g., multiple parameters under the same measurement, like NO2 and SO2 from Ozone Monitoring Instrument (OMI), or same parameter with different methods of aggregation, like NO2 in OMNO2G and OMNO2D products), defining area-of-interest and temporal extents, zooming, panning, overlaying, sliding, and data subsetting and reformatting. The portal interface will connect to the backend services with OGC standard-compliant Web Mapping Service (WMS) and Web Coverage Service (WCS) calls. The interface will also be able to connect to other OGC WMS and WCS servers, which will greatly enhance its expandability to integrate additional outside data/map sources.

Consumption of and satisfaction with health care among opioid users with chronic non-malignant pain.

PubMed

Hansen, A B; Skurtveit, S; Borchgrevink, P C; Dale, O; Romundstad, P R; Mahic, M; Fredheim, O M

2015-11-01

Although persons with chronic pain are frequent users of the health care system, they report poor satisfaction with health care services. Participants with persistent opioid use in Nord-Trøndelag Health Study (HUNT)3 report severe pain in spite of treatment. The aim of the study was to test the hypothesis that subjects with persistent opioid use have both a higher consumption of health care services and a poorer satisfaction than the remaining subjects reporting chronic pain. This cross-sectional study was based on linkage of self-reported data from the substudy (10,238 were invited, 6927 met the inclusion criteria) of health care use in HUNT3; a population-based health survey during the years 2006-2008 and the complete national registers of the Norwegian Prescription Database and the Cancer Registry of Norway. Patients with chronic pain are stratified according to the level of opioid use as persistent users of opioids, intermittent users, and persons not using opioids. Persons with chronic non-malignant pain reported a higher consumption of all health care services compared to the control group. Consumption of health care services increased with increasing level of opioid use. Persons with persistent opioid use were highly satisfied with all health care services, although less satisfied than persons without chronic pain. Combined with previous findings of high levels of pain in spite of opioid treatment, the present findings indicate that symptomatic relief is not a prerequisite for patient satisfaction. The study shows higher patient satisfaction compared to previous studies. © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Levels of satisfaction of 'low-risk' mothers with their current health visiting service.

PubMed

Bowns, I R; Crofts, D J; Williams, T S; Rigby, A S; Hall, D M; Haining, R P

2000-04-01

To assess the expressed levels of satisfaction of 'low-risk' mothers with the current health visiting service. Setting Sheffield, England, Autumn 1997. Self-completion, postal questionnaire (initial postcard reminder followed by a second letter and questionnaire) to a sample of 403 mothers assessed as 'low priority' by their health visitor. Questions largely related to maternal opinion of the adequacy of the health visiting service delivered during the first 9-12 months. The local research ethics committee approved the study. A corrected response rate of 75% with little evidence of significant bias. A high proportion (86%) of women stated that they were either 'fairly' or 'very' satisfied with the service they had received from their health visitor with regard to their baby. A lower proportion (72%) was equally satisfied with the service they had received in respect of their own health. Despite an average number of approximately 10 contacts in relation to infant health with the health visitor during the first year of life, some 6% of women wanted more frequent contacts, particularly in the first few weeks. Study limitations The questionnaire was designed specifically for the study and validation was limited. The study population comprised a selected, 'low-risk' group. The number of reported contacts with the health visitor seemed to greatly exceed those indicated by a basic child health surveillance programme. The overall level of maternal satisfaction is high, though a minority of women would like more support. Dissatisfaction was expressed with the lack of an appointment system for clinics, poor punctuality in home visits, and inappropriate or inadequate advice.

Assessment of an Innovative Voluntary Substance Abuse Treatment Program Designed to Replace Compulsory Drug Detention Centers in Malaysia.

PubMed

Khan, Farrah; Krishnan, Archana; Ghani, Mansur A; Wickersham, Jeffrey A; Fu, Jeannia J; Lim, Sin How; Dhaliwal, Sangeeth Kaur; Kamarulzaman, Adeeba; Altice, Frederick L

2018-01-28

As part of an ongoing initiative by the Malaysian government to implement alternative approaches to involuntary detention of people who use drugs, the National Anti-Drug Agency has created new voluntary drug treatment programs known as Cure and Care (C&C) Centers that provide free access to addiction treatment services, including methadone maintenance therapy, integrated with social and health services.   We evaluated early treatment outcomes and client satisfaction among patients accessing C&C treatment and ancillary services at Malaysia's second C&C Center located in Kota Bharu, Kelantan. In June-July 2012, a cross-sectional convenience survey of 96 C&C inpatients and outpatients who entered treatment >30 days previously was conducted to assess drug use, criminal justice experience, medical co-morbidities, motivation for seeking treatment, and attitudes towards the C&C. Drug use was compared for the 30-day-period before C&C entry and the 30-day-period before the interview. Self-reported drug use levels decreased significantly among both inpatient and outpatient clients after enrolling in C&C treatment. Higher levels of past drug use, lower levels of social support, and more severe mental health issues were reported by participants who were previously imprisoned. Self-reported satisfaction with C&C treatment services was high. Conclusions/Importance: Preliminary evidence of reduced drug use and high levels of client satisfaction among C&C clients provide support for Malaysia's ongoing transition from compulsory drug detention centers (CDDCs) to these voluntary drug treatment centers. If C&C centers are successful, Malaysia plans to gradually transition away from CDDCs entirely.

The personal assistance workforce: trends in supply and demand.

PubMed

Kaye, H Stephen; Chapman, Susan; Newcomer, Robert J; Harrington, Charlene

2006-01-01

The workforce providing noninstitutional personal assistance and home health services tripled between 1989 and 2004, according to U.S. survey data, growing at a much faster rate than the population needing such services. During the same period, Medicaid spending for such services increased dramatically, while both workforce size and spending for similar services in institutional settings remained relatively stable. Low wage levels for personal assistance workers, which have fallen behind those of comparable occupations; scarce health benefits; and high job turnover rates highlight the need for greater attention to ensuring a stable and well-trained workforce to meet growing demand.

Emergency Medical Service (EMS): Rotorcraft Technology Workshop

NASA Technical Reports Server (NTRS)

Bauchspies, J. S.; Adams, R. J.

1981-01-01

A lead organization on the national level should be designated to establish concepts, locations, and the number of shock trauma air medical services. Medical specialists desire a vehicle which incorporates advances in medical technology trends in health care. Key technology needs for the emergency medical services helicopter of the future include the riding quality of fixed wing aircraft (reduced noise and vibration), no tail rotor, small rotor, small rotor diameter, improved visibility, crashworthy vehicle, IFR capability, more affordability high reliability, fuel efficient, and specialized cabins to hold medical/diagnostic and communications equipment. Approaches to a national emergency medical service are discussed.

When high pressure, system constraints, and a social justice mission collide: A socio-structural analysis of emergency department social work services.

PubMed

Moore, Megan; Cristofalo, Margaret; Dotolo, Danae; Torres, Nicole; Lahdya, Alexandra; Ho, Leyna; Vogel, Mia; Forrester, Mollie; Conley, Bonnie; Fouts, Susan

2017-04-01

The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N = 1509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N = 10). Eight major social work roles were identified: investigator, gatekeeper, resource broker, care coordinator, problem solver, crisis manager, advocate, discharge planner. Analyses revealed a complex interplay between ED social work services and multi-layered contexts. Using a social-ecological framework, we identified the interactions between micro or individual level factors, mezzo or local system level factors and macro environmental and systemic factors that play a role in ED interactions and patient services. Macro-level contextual influences were socio-structural forces including socioeconomic barriers to health, social hierarchies that reflected power differentials between providers and patients, and distrust or bias. Mezzo-level forces were limited resources, lack of healthcare system coordination, a challenging hierarchy within the medical model and the pressure to discharge patients quickly. Micro-level factors included characteristics of patients and social workers, complexity of patient stressors, empathic strain, lack of closure and compassion. All of these forces were at play in patient-social worker interactions and impacted service provision. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. A conceptual model of ED social work and the influences on the patient-social worker interactions was developed to assist in guiding innovative research and practice models to improve services and outcomes in the complex, fast-paced ED. Copyright © 2017 Elsevier Ltd. All rights reserved.

When high pressure, system constraints, and a social justice mission collide: a socio-structural analysis of emergency department social work services

PubMed Central

Cristofalo, Margaret; Dotolo, Danae; Torres, Nicole; Lahdya, Alexandra; Ho, Leyna; Vogel, Mia; Forrester, Mollie; Conley, Bonnie; Fouts, Susan

2017-01-01

The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N=1,509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N=10). Eight major social work roles were identified: investigator, gatekeeper, resource broker, care coordinator, problem solver, crisis manager, advocate, discharge planner. Analyses revealed a complex interplay between ED social work services and multi-layered contexts. Using a social-ecological framework, we identified the interactions between micro or individual level factors, mezzo or local system level factors and macro environmental and systemic factors that play a role in ED interactions and patient services. Macro-level contextual influences were socio-structural forces including socioeconomic barriers to health, social hierarchies that reflected power differentials between providers and patients, and distrust or bias. Mezzo-level forces were limited resources, lack of healthcare system coordination, a challenging hierarchy within the medical model and the pressure to discharge patients quickly. Micro-level factors included characteristics of patients and social workers, complexity of patient stressors, empathic strain, lack of closure and compassion. All of these forces were at play in patient-social worker interactions and impacted service provision. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. A conceptual model of ED social work and the influences on the patient-social worker interactions was developed to assist in guiding innovative research and practice models to improve services and outcomes in the complex, fast-paced ED. PMID:28214722

76 FR 10368 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-24

... programs at the elementary, middle, and high school levels: health education, physical education, health... Health Education 51 1 30/60 26 State Physical Education 51 1 30/60 26 State Health Services 51 1 30/60 26... Health Education 685 1 30/60 343 District Physical Education 685 1 40/60 457 District Health Services 685...

Reconciling Discourse about Geography and Teaching Geography: The Case of Singapore Pre-Service Teachers

ERIC Educational Resources Information Center

Seow, Tricia

2016-01-01

This study draws upon a Foucauldian notion of discourse to explore how four pre-service geography teachers in Singapore made decisions about what geography is and how to enact their understandings of geography in their classrooms. This analysis of discursive power is particularly relevant to Singapore because of the high level of state control…

High Levels Of Capitation Payments Needed To Shift Primary Care Toward Proactive Team And Nonvisit Care.

PubMed

Basu, Sanjay; Phillips, Russell S; Song, Zirui; Bitton, Asaf; Landon, Bruce E

2017-09-01

Capitated payments in the form of fixed monthly payments to cover all of the costs associated with delivering primary care could encourage primary care practices to transform the way they deliver care. Using a microsimulation model incorporating data from 969 US practices, we sought to understand whether shifting to team- and non-visit-based care is financially sustainable for practices under traditional fee-for-service, capitated payment, or a mix of the two. Practice revenues and costs were computed for fee-for-service payments and a range of capitated payments, before and after the substitution of team- and non-visit-based services for low-complexity in-person physician visits. The substitution produced financial losses for simulated practices under fee-for-service payment of $42,398 per full-time-equivalent physician per year; however, substitution produced financial gains under capitated payment in 95 percent of cases, if more than 63 percent of annual payments were capitated. Shifting to capitated payment might create an incentive for practices to increase their delivery of team- and non-visit-based primary care, if capitated payment levels were sufficiently high. Project HOPE—The People-to-People Health Foundation, Inc.

Children of mothers diagnosed with serious mental illness: patterns and predictors of service use.

PubMed

Mowbray, Carol T; Lewandowski, Lisa; Bybee, Deborah; Oyserman, Daphna

2004-09-01

Children who have a parent diagnosed with a mental illness are at risk of psychiatric and behavioral problems; yet, these children do not necessarily receive needed services. Research has investigated correlates of child mental health service use, but not for these high-risk children. This study is part of an NIMH-funded, longitudinal investigation and describes child problems, service use, and predictors of service use for 506 children of 252 mothers diagnosed with serious mental illness. Mothers are primarily poor, minority women from urban areas. A multilevel-model approach is used to examine service use for multiple siblings in a family. More than one third of children had received services (from school or mental health agencies) in their lifetimes. Service use was predicted by child demographic characteristics (being male, non-African American, and older), social context variables (more negative life events, less financial satisfaction, and more parenting dissatisfaction), and maternal psychiatric variables (positively by high levels of case management receipt and affective diagnoses, negatively by maternal substance abuse history). In a subsample of "target children," mothers' rating of child behavior problems additionally predicted service use. Implications of results for research and intervention are discussed.

Restructuring Nigerian Tertiary (University) Education for Better Performance

ERIC Educational Resources Information Center

Oyebade, Stephen Adebanjo; Dike, Chika

2013-01-01

This study assesses the goals of university level of education, namely, development of high level manpower, scholarship and community service, and found that universities have not been able to achieve close to average. Problems range from social, political, financial as well as personnel issues. Specifically, they include problems of…

A Public Health Grid (PHGrid): Architecture and value proposition for 21st century public health.

PubMed

Savel, T; Hall, K; Lee, B; McMullin, V; Miles, M; Stinn, J; White, P; Washington, D; Boyd, T; Lenert, L

2010-07-01

This manuscript describes the value of and proposal for a high-level architectural framework for a Public Health Grid (PHGrid), which the authors feel has the capability to afford the public health community a robust technology infrastructure for secure and timely data, information, and knowledge exchange, not only within the public health domain, but between public health and the overall health care system. The CDC facilitated multiple Proof-of-Concept (PoC) projects, leveraging an open-source-based software development methodology, to test four hypotheses with regard to this high-level framework. The outcomes of the four PoCs in combination with the use of the Federal Enterprise Architecture Framework (FEAF) and the newly emerging Federal Segment Architecture Methodology (FSAM) was used to develop and refine a high-level architectural framework for a Public Health Grid infrastructure. The authors were successful in documenting a robust high-level architectural framework for a PHGrid. The documentation generated provided a level of granularity needed to validate the proposal, and included examples of both information standards and services to be implemented. Both the results of the PoCs as well as feedback from selected public health partners were used to develop the granular documentation. A robust high-level cohesive architectural framework for a Public Health Grid (PHGrid) has been successfully articulated, with its feasibility demonstrated via multiple PoCs. In order to successfully implement this framework for a Public Health Grid, the authors recommend moving forward with a three-pronged approach focusing on interoperability and standards, streamlining the PHGrid infrastructure, and developing robust and high-impact public health services. Published by Elsevier Ireland Ltd.

The quality of service in passenger transport terminals

NASA Astrophysics Data System (ADS)

Oprea, C.; Roşca, E.; Popa, M.; Ilie, A.; Dinu, O.; Roşca, M.

2016-11-01

The quality of service in transport terminals is differently perceived by engineers, economists, transport operators and sociologists. The traveler's perception is nevertheless decisive. The quality of service is well connected with the inside design of terminals, with the facilities in terminals and with the provided service standards. In order to provide a high level of service, the activities taking place in the public transport terminal and the maximum travelers flow size must be carefully analyzed and dimensioned. The purpose of modelling is to find the best route for each traveler from origin (entrance) to destination (exit) through all the intermediate service points, taking into consideration the instant network conditions. In developing the model we consider the walking, the waiting and the serving time. Using a simulation program written in ARENA we determine the waiting time. For validation, the model is used to evaluate the performance level in Bucharest Basarab station. By comparing the total walking distance for the possible routes and the utility function that describes the utility of all activities from entrance to exit we can find the optimal route.

Determinants of farmers' choice for veterinary service providers in Nepal Mountains.

PubMed

Lamichhane, Dirga Kumar; Shrestha, Sabina

2012-08-01

This study was aimed to analyze factors that affect farmers' choice for major actors of veterinary service providers in village areas of Kaski district of Nepal, with the objective of identifying choice-specific attributes which could be addressed for improving the penetration of professional veterinary services in village areas. The information was obtained from 125 farmers using a structured questionnaire. A proportional hazard model was used for data analysis because of its ability to accommodate the attributes of both the chooser and the choice simultaneously. The results showed that village animal health workers (VAHWs) were the most preferred service providers followed by veterinarians and mid-level technicians. The farmers' age and education level had a significant but inverse relationship with the probability of choosing any of the three service providers. From our study, we found that the main choice-specific attributes with a significant impact on the choice probability was the distance to the preferred service provider. Since there was a high preference for VAHW, this suggests the possibility of poorly trained service providers dominating veterinary service market in village areas of Kaski district. Hence, the efforts put forward in the legalization of VAHW system in Nepal should first address the constraints that obstruct the accessibility of professional veterinary service providers in village areas.

Pakistani women's use of mental health services and the role of social networks: a systematic review of quantitative and qualitative research.

PubMed

Kapadia, Dharmi; Brooks, Helen Louise; Nazroo, James; Tranmer, Mark

2017-07-01

Pakistani women in the UK are an at-risk group with high levels of mental health problems, but low levels of mental health service use. However, the rates of service use for Pakistani women are unclear, partly because research with South Asian women has been incorrectly generalised to Pakistani women. Further, this research has been largely undertaken within an individualistic paradigm, with little consideration of patients' social networks, and how these may drive decisions to seek help. This systematic review aimed to clarify usage rates, and describe the nature of Pakistani women's social networks and how they may influence mental health service use. Ten journal databases (ASSIA, CINAHL Plus, EMBASE, HMIC, IBSS, MEDLINE, PsycINFO, Social Sciences Abstracts, Social Science Citation Index and Sociological Abstracts) and six sources of grey literature were searched for studies published between 1960 and the end of March 2014. Twenty-one studies met inclusion criteria. Ten studies (quantitative) reported on inpatient or outpatient service use between ethnic groups. Seven studies (four quantitative, three qualitative) investigated the nature of social networks, and four studies (qualitative) commented on how social networks were involved in accessing mental health services. Pakistani women were less likely than white (British) women to use most specialist mental health services. No difference was found between Pakistani and white women for the consultation of general practitioners for mental health problems. Pakistani women's networks displayed high levels of stigmatising attitudes towards mental health problems and mental health services, which acted as a deterrent to seeking help. No studies were found which compared stigma in networks between Pakistani women and women of other ethnic groups. Pakistani women are at a considerable disadvantage in gaining access to and using statutory mental health services, compared with white women; this, in part, is due to negative attitudes to mental health problems evident in social support networks. © 2015 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

The Black Sea Monitoring and Forecasting Center (BS-MFC) in the framework of the Copernicus Marine Service

NASA Astrophysics Data System (ADS)

Palazov, Atanas; Coppini, Giovanni; Ciliberti, Stefania Angela; Gregoire, Marilaure; Staneva, Joanna; Peneva, Elisaveta; Özsoy, Emin; Vandenbulcke, Luc; Storto, Andrea; Lemieux-Dudon, Benedicte; Lovato, Tomas; Masina, Simona; Pinardi, Nadia; Palermo, Francesco; Creti, Sergio; Macchia, Francesca; Lecci, Rita; Behrens, Arno; Marinova, Veselka; Slabakova, Violeta

2017-04-01

The BS-MFC entered the Copernicus Marine Environment Monitoring Service (CMEMS, http://marine.copernicus.eu/) in October 2016, providing regular and systematic information about the ocean state in the Black Sea in operational mode. An expert team constitutes the BS-MFC Consortium: the Institute of Oceanology, Bulgarian Academy of Sciences (IO-BAS, Bulgaria) coordinates the service and the management in collaboration with Fondazione Centro Euro-Mediterraneo sui Cambiamenti Climatici (CMCC, Italy), Helmholtz-Zentrum Geesthacht - Institute of Coastal Research (HZG, Germany), the University of Liege (ULG, Belgium), the Sofia University "St. Kliment Ohridski (USOF, Bulgaria) and the Eurasia Earth Sciences Institute - Istanbul Technical University (ITU, Turkey). The system provides a complete data catalogue for the Black Sea ocean variables such as temperature, salinity, sea level, currents, biogeochemistry and waves through a technologically advanced and resilient service, which is fully interconnected with the other Centers in the Copernicus network. The high level BS-MFC architecture is based on 3 Production Units, for Physics, Biogeochemistry and Waves products respectively, a Dissemination/Archiving Unit for the delivery of the products and their archiving/accessibility, a Local Service Desk connected to the CMEMS Service Desk devoted to support all the operational activities, and backup units for all the main service components. Products consist of analysis/hindcast, 10-days forecast and reanalysis, describing the physical (currents, temperature, salinity, sea level, mixed layer depth and bottom temperature), the biogeochemical state and waves. To implement and improve the service, the BS-MFC has detailed an evolution plan, actually under implementation, devoted to establish, assess and improve the systems and their operational functionalities, providing some improvements from the scientific point of view concerning the modeling components (e.g., the fully aligned Physics, Biogeochemistry and Waves systems, the open boundary conditions at the Bosporus, the state-of-the-art core models and increased spatial resolution among the major actions) and high quality products, towards an optimal interface between the Mediterranean and the Black Seas. The contribution will present the main operational and research & development activities at the basis of the systems, given an overview on the future plans for improving the service for the delivery of new products.

What words and where? Applying usability testing techniques to name a new live reference service.

PubMed

Duncan, Vicky; Fichter, Darlene M

2004-04-01

A user-focused design approach was taken to develop a new "live reference" service at the Health Sciences Library, University of Saskatchewan. The name of the service, the placement of the links, and the design of a graphical button were seen as key elements in creating service awareness and its subsequent use. To ensure library users recognized and understood the label for the new service, selected library users were given an opportunity to choose a phrase that would best describe the service. The top two preferred phrases were then placed on the library Web pages as text and graphic images for further testing. Some pages had links in multiple locations to determine which placement worked best. Task-based usability testing was carried out with participants who were unaware of the new service. Participants were observed as they completed seven Website tasks arranged in increasing levels of difficulty to see whether they would notice the live reference service and seek assistance. The high level of recognition and use of the service indicate that the label name and link placement were effective with library Website users. Using user-centered design methodology helped ensure that the new live reference service was visible and used and demonstrated the effectiveness of the user-centered design approach for adding new services to an existing Website.

Organizational Stress as Moderator of Relationship Between Mental Health Provider Adaptability and Organizational Commitment.

PubMed

Green, Amy E; Dishop, Christopher R; Aarons, Gregory A

2016-10-01

Community mental health providers often operate within stressful work environments and are at high risk of emotional exhaustion, which can negatively affect job performance and client satisfaction with services. This cross-sectional study examined the relationships between organizational stress, provider adaptability, and organizational commitment. Variables were analyzed with moderated multilevel regression in a sample of 311 mental health providers from 49 community mental health programs. Stressful organizational climate, characterized by high levels of emotional exhaustion, role conflict, and role overload, was negatively related to organizational commitment. Organizational stress moderated the relationship between provider adaptability and organizational commitment, such that those who were more adaptable had greater levels of organizational commitment when organizational stress was low but were less committed than those who were less adaptable when organizational stress was high. Providers higher in adaptability may perceive their organization as a greater fit when the work environment is less stressful; however, highly adaptable providers may also exercise choice that manifests in lower commitment to staying in an overly stressful work environment. Service systems and organizational contexts are becoming increasingly demanding and stressful for direct mental health service providers. Therefore, community mental health organizations should assess and understand their organizational climate and intervene with empirically based organizational strategies when necessary to reduce stressful climates and maintain adaptable employees.

Implementing ecosystem management in public agencies: lessons from the U.S. Bureau of Land Management and the Forest Service.

PubMed

Koontz, Tomas M; Bodine, Jennifer

2008-02-01

Ecosystem management was formally adopted over a decade ago by many U.S. natural resource agencies, including the Forest Service and the Bureau of Land Management. This approach calls for management based on stakeholder collaboration; interagency cooperation; integration of scientific, social, and economic information; preservation of ecological processes; and adaptive management. Results of previous studies indicate differences in the extent to which particular components of ecosystem management would be implemented within the U.S. Forest Service and the Bureau of Land Management and suggest a number of barriers thought to impede implementation. Drawing on survey and interview data from agency personnel and stakeholders, we compared levels of ecosystem-management implementation in the Forest Service and Bureau of Land Management and identified the most important barriers to implementation. Agency personnel perceived similarly high levels of implementation on many ecosystem-management components, whereas stakeholders perceived lower levels. Agencies were most challenged by implementation of preservation of ecological processes, adaptive management, and integration of social and economic information, whereas the most significant barriers to implementation were political, cultural, and legal.

Empowerment of Metacognitive Skills through Development of Instructional Materials on the Topic of Hydrolysis and Buffer Solutions

NASA Astrophysics Data System (ADS)

Azizah, U.; Nasrudin, H.

2018-01-01

Metacognitive skills are one of the high-level thinking skills that pre-service teachers need in chemistry problem-solving. Metacognitive skills that empowered in learning focuses on how pre-service teachers participate in designing what was to be learned, monitor the progress of learning outcomes, and assess what has been learned in solving problems. The purpose of this research was (1) describe how pre-service teachers empowering metacognitive skills using developed instructional materials, and (2) describe the pre-service teacher’s response to the learning process. The research involved 22 pre-service teachers in Chemistry Education Program Universitas Negeri Surabaya, Indonesia. The design of this research was a pre-experimental research with One Group Pretest-Posttest Design. The data of the research was analyzed by quantitative descriptive. The result of the research that: (1) performance of metacognitive skills pre-service teachers have high and very high criteria in learning chemistry on each indicator includes goal setting, identify the known knowledge, determining the learning strategies, monitoring the relevance of knowledge which has been owned with learning strategies are used, monitoring the achievement of the goal in the making conclusions, and evaluating the process and outcomes of thinking, and (2) most of the pre-service teachers are willing to join to this teaching-learning activity.

Are consumer-directed home care beneficiaries satisfied? Evidence from Washington state.

PubMed

Wiener, Joshua M; Anderson, Wayne L; Khatutsky, Galina

2007-12-01

This study analyzed the effect of consumer-directed versus agency-directed home care on satisfaction with paid personal assistance services among Medicaid beneficiaries in Washington State. The study analyzed a survey of 513 Medicaid beneficiaries receiving home- and community-based services. As part of a larger study, we developed an 8-item Satisfaction With Paid Personal Assistance Scale as the measure of satisfaction. In predicting satisfaction with personal assistance services, we estimated an ordinary least squares regression model that was right-censored to account for the large percentage of respondents who were highly satisfied with their care. Among the older population, but not younger people with disabilities, beneficiaries receiving consumer-directed services were more satisfied than individuals receiving agency-directed care. There was no evidence that quality of care was less with consumer-directed services. In addition, overall satisfaction levels with paid home care were very high. This study supports the premise that consumer satisfaction, an important measure of quality, in consumer-directed home care is not inferior to that in agency-directed care. The positive effect of consumer direction for older people underlines the fact that this service option is relevant for this population. In addition, this research provides evidence that home- and community-based services are of high quality, at least on one dimension.

Loyalty and positive word-of-mouth: patients and hospital personnel as advocates of a customer-centric health care organization.

PubMed

Ferguson, Ronald J; Paulin, Michele; Leiriao, Elizabeth

2006-01-01

The ability to attract and retain loyal customers depends on the successful implementation of a customer-centric strategy. Customer loyalty is an attitude about an organization and its' services that is manifested by intentions and behaviors of re-patronization and recommendation. In the context of many medical services, loyalty through repeat patronization is not pertinent, whereas loyalty through positive word-of mouth (WOM) recommendation can be a powerful marketing tool. The Shouldice Hospital, a well-known institution for the surgical correction of hernias, instituted a marketing plan to develop a stable base of patients by creating positive WOM advocacy. This study focused on the consequences of both hernia patient overall satisfaction (and overall service quality) and hospital personnel satisfaction on the level of positive WOM advocacy. Using a commitment ladder of positive WOM advocacy, respondents were divided into three categories described as passive supporters, active advocates and ambassador advocates. Patient assessments of overall satisfaction and service quality were significantly related to these progressive levels of WOM for recommending the hospital to potential patients. Similarly, the satisfaction of the hospital employees was also significantly related to these progressive levels of positive WOM about recommending the hospital to potential patients and to potential employees. High levels of satisfaction are required to create true ambassadors of a service organization.

Text and Mobile Media Smoking Cessation Service for Young Adults in South Texas: Operation and Cost-Effectiveness Estimation.

PubMed

Ramirez, Amelie G; Chalela, Patricia; Akopian, David; Munoz, Edgar; Gallion, Kipling J; Despres, Cliff; Morales, Jafet; Escobar, Rodrigo; McAlister, Alfred L

2017-07-01

To realize the promising potential of services delivered via smart phones to help young adults quit smoking at a high level of cost-efficiency, we constructed a texting and mobile media system that was promoted in South Texas via social media advertising and other recruitment channels. During the 6-month service period described here, enrollments were achieved for 798 participants with a mean age of 29.3 years. Seven-month texted follow-up found that 21% (171) of the enrollees reported abstinence at that point. This is consistent with high rates of success found in studies of telephone counseling for young adults and confirms that text and mobile media service specifically designed for young adults provide a feasible and potentially cost-effective approach to promoting cessation.

Environmental and occupational exposure to benzene in Thailand.

PubMed

Navasumrit, Panida; Chanvaivit, Sirirat; Intarasunanont, Pornpat; Arayasiri, Manaswee; Lauhareungpanya, Narumon; Parnlob, Varaporn; Settachan, Daam; Ruchirawat, Mathuros

2005-05-30

Exposure to benzene in air is a concern in Thailand, particularly since it was observed that the incidence of blood-related cancers, such as leukemia and lymphoma, has increased in the past few decades. In Bangkok, the mean atmospheric levels of benzene on main roads and in schools were 33.71 and 8.25 ppb, respectively, while in gasoline service stations and petrochemical factories the mean ambient levels were 64.78 and 66.24 ppb, respectively. Cloth vendors (22.61 ppb) and grilled-meat vendors (28.19 ppb) working on the roadsides were exposed to significantly higher levels of benzene than the control group (12.95 ppb; p<0.05). Bangkok school children (5.50 ppb) were exposed to significantly higher levels of benzene than provincial school children (2.54 ppb; p<0.01). Factory workers (73.55 ppb) and gasoline service attendants (121.67 ppb) were exposed to significantly higher levels of benzene than control workers (4.77 ppb; p<0.001). In accordance with the increased benzene exposures, levels of urinary trans,trans-muconic acid (MA) were significantly increased in all benzene-exposed groups. In school children, the levels of MA were relatively high, taking into account the much lower level of exposure. Blood benzene levels were also significantly increased in Bangkok school children (77.97 ppt; p<0.01), gasoline service attendants (641.84 ppt; p<0.05) and factory workers (572.61 ppt; p<0.001), when compared with the respective controls. DNA damage, determined as DNA strand breaks, was found to be elevated in gasoline service attendants, petrochemical factory workers, and Bangkok school children (p<0.001). The cytogenetic challenge assay, which measures DNA repair capacity, showed varying levels of significant increases in the numbers of dicentrics and deletions in gasoline service attendants, petrochemical factory workers and Bangkok school children, indicating a decrease in DNA repair capacity in these subjects.

How Environmental Uncertainty Moderates the Effect of Relative Advantage and Perceived Credibility on the Adoption of Mobile Health Services by Chinese Organizations in the Big Data Era.

PubMed

Chen, Xing; Zhang, Xing

2016-01-01

Despite the importance of adoption of mobile health services by an organization on the diffusion of mobile technology in the big data era, it has received minimal attention in literature. This study investigates how relative advantage and perceived credibility affect an organization's adoption of mobile health services, as well as how environmental uncertainty changes the relationship of relative advantage and perceived credibility with adoption. A research model that integrates relative advantage, perceived credibility, environmental uncertainty, and an organization's intention to use mobile health service is developed. Quantitative data are collected from senior managers and information systems managers in 320 Chinese healthcare organizations. The empirical findings show that while relative advantage and perceived credibility both have positive effects on an organization's intention to use mobile health services, relative advantage plays a more important role than perceived credibility. Moreover, environmental uncertainty positively moderates the effect of relative advantage on an organization's adoption of mobile health services. Thus, mobile health services in environments characterized with high levels of uncertainty are more likely to be adopted because of relative advantage than in environments with low levels of uncertainty.

Industry structures in private dental markets in Finland.

PubMed

Widström, E; Mikkola, H

2012-12-01

To use industrial organisation and organisational ecology research methods to survey industry structures and performance in the markets for private dental services and the effect of competition. Data on practice characteristics, performance, and perceived competition were collected from full-time private dentists (n = 1,121) using a questionnaire. The response rate was 59.6%. Cluster analysis was used to identify practice type based on service differentiation and process integration variables formulated from the questionnaire. Four strategic groups were identified in the Finnish markets: Solo practices formed one distinct group and group practices were classified into three clusters Integrated practices, Small practices, and Loosely integrated practices. Statistically significant differences were found in performance and perceived competitiveness between the groups. Integrated practices with the highest level of process integration and service differentiation performed better than solo and small practices. Moreover, loosely integrated and small practices outperformed solo practises. Competitive intensity was highest among small practices which had a low level of service differentiation and was above average among solo practises. Private dental care providers that had differentiated their services from public services and that had a high number of integrated service production processes enjoyed higher performance and less competitive pressures than those who had not.

Responding to the Needs of Children and Families After a Disaster: Linkages Between Unmet Needs and Caregiver Functioning

PubMed Central

Kilmer, Ryan P.; Gil-Rivas, Virginia

2010-01-01

Disasters may negatively influence caregivers’ ability to respond to the needs of their families. In this context, service organizations’ response to families’ needs may affect caregivers’ symptoms and parenting. Interviews were conducted with caregivers affected by Hurricane Katrina approximately 12-months (T1; N = 68) and 2 years post-hurricane (T2; N = 52). Caregivers reported high levels of service needs and unmet needs for themselves and their child(ren) and family at both time points. Regression analyses indicated that after accounting for hurricane exposure: (a) child unmet service needs significantly contributed to T1 caregiver distress; (b) caregiver service needs and child unmet needs were associated with higher levels of posttraumatic stress symptoms (PTSS); and (c) caregiver unmet needs related to greater strain at T1. At T2, after accounting for T1 scores, service need variables did not contribute to distress or PTSS. Caregiver strain at T1 and T1 child service needs were associated with greater T2 strain. These findings highlight the importance of extending the availability of services beyond the initial post-disaster recovery period to better meet the needs of caregivers and families. PMID:20397998

Responding to the needs of children and families after a disaster: linkages between unmet needs and caregiver functioning.

PubMed

Kilmer, Ryan P; Gil-Rivas, Virginia

2010-01-01

Disasters may negatively influence caregivers' ability to respond to the needs of their families. In this context, service organizations' response to families' needs may affect caregivers' symptoms and parenting. Interviews were conducted with caregivers affected by Hurricane Katrina approximately 1 year (T(1); N = 68) and 2 years posthurricane (T(2); N = 52). Caregivers reported high levels of service needs and unmet needs for themselves and their child(ren) and family at both time points. Regression analyses indicated that after accounting for hurricane exposure: (a) child unmet service needs significantly contributed to T(1) caregiver distress, (b) caregiver service needs and child unmet needs were associated with higher levels of posttraumatic stress symptoms, and (c) caregiver unmet needs related to greater strain at T(1). At T(2), after accounting for T(1) scores, service need variables did not contribute to distress or posttraumatic stress symptoms. Caregiver strain at T(1) and T(1) child service needs were associated with greater T(2) strain. These findings highlight the importance of extending the availability of services beyond the initial postdisaster recovery period to better meet the needs of caregivers and families.

Socio-economic inequalities in health services utilization: a cross-sectional study.

PubMed

Ranjbar Ezzatabadi, Mohammad; Khosravi, Ameneh; Bahrami, Mohammad Amin; Rafiei, Sima

2018-02-12

Purpose Developing country workers mainly face important challenges when examining equality in health services utilization among the population and identifying influential factors. The purpose of this paper us to: understand health service use among households with different socio-economic status in Isfahan province; and to investigate probable inequality determinants in service utilization. Design/methodology/approach Almost 1,040 households living in Isfahan province participated in this cross-sectional study in 2013. Data were collected by a questionnaire with three sections: demographic characteristics; socio-economic status; and health services utilization. The concentration index was applied to measure inequality. Analysts used STATA 11. Findings Economic status, educational level, insurance coverage and household gender were the most influential factors on health services utilization. Those with a high socio-economic level were more likely to demand and use such services; although self-medication patterns showed an opposite trend. Practical implications Female-headed families face with more difficulties in access to basic human needs including health. Supportive policies are needed to meet their demands. Originality/value The authors used principle component analysis to assess households' economic situation, which reduced the variables into a single index.

How Environmental Uncertainty Moderates the Effect of Relative Advantage and Perceived Credibility on the Adoption of Mobile Health Services by Chinese Organizations in the Big Data Era

PubMed Central

2016-01-01

Despite the importance of adoption of mobile health services by an organization on the diffusion of mobile technology in the big data era, it has received minimal attention in literature. This study investigates how relative advantage and perceived credibility affect an organization's adoption of mobile health services, as well as how environmental uncertainty changes the relationship of relative advantage and perceived credibility with adoption. A research model that integrates relative advantage, perceived credibility, environmental uncertainty, and an organization's intention to use mobile health service is developed. Quantitative data are collected from senior managers and information systems managers in 320 Chinese healthcare organizations. The empirical findings show that while relative advantage and perceived credibility both have positive effects on an organization's intention to use mobile health services, relative advantage plays a more important role than perceived credibility. Moreover, environmental uncertainty positively moderates the effect of relative advantage on an organization's adoption of mobile health services. Thus, mobile health services in environments characterized with high levels of uncertainty are more likely to be adopted because of relative advantage than in environments with low levels of uncertainty. PMID:28115932

Early Performance Results from the GOES-R Product Generation System

NASA Astrophysics Data System (ADS)

Marley, S.; Weiner, A.; Kalluri, S. N.; Hansen, D.; Dittberner, G.

2013-12-01

Enhancements to remote sensing capabilities for the next generation of Geostationary Operational Environmental Satellite (GOES R-series) scheduled to be launched in 2015 require high performance computing capabilities to output meteorological observations and products at low latency compared to the legacy processing systems. GOES R-series (GOES-R, -S, -T, and -U) represents a generational change in both spacecraft and instrument capability, and the GOES Re-Broadcast (GRB) data which contains calibrated and navigated radiances from all the instruments will be at a data rate of 31 Mb/sec compared to the current 2.11 Mb/sec from existing GOES satellites. To keep up with the data processing rates, the Product Generation (PG) system in the ground segment is designed on a Service Based Architecture (SBA). Each algorithm is executed as a service and subscribes to the data it needs to create higher level products via an enterprise service bus. Various levels of product data are published and retrieved from a data fabric. Together, the SBA and the data fabric provide a flexible, scalable, high performance architecture that meets the needs of product processing now and can grow to accommodate new algorithms in the future. The algorithms are linked together in a precedence chain starting from Level 0 to Level 1b and higher order Level 2 products that are distributed to data distribution nodes for external users. Qualification testing for more than half the product algorithms has so far been completed the PG system.

A quantitative analysis of factors influencing the professional longevity of high school science teachers in Florida

NASA Astrophysics Data System (ADS)

Ridgley, James Alexander, Jr.

This dissertation is an exploratory quantitative analysis of various independent variables to determine their effect on the professional longevity (years of service) of high school science teachers in the state of Florida for the academic years 2011-2012 to 2013-2014. Data are collected from the Florida Department of Education, National Center for Education Statistics, and the National Assessment of Educational Progress databases. The following research hypotheses are examined: H1 - There are statistically significant differences in Level 1 (teacher variables) that influence the professional longevity of a high school science teacher in Florida. H2 - There are statistically significant differences in Level 2 (school variables) that influence the professional longevity of a high school science teacher in Florida. H3 - There are statistically significant differences in Level 3 (district variables) that influence the professional longevity of a high school science teacher in Florida. H4 - When tested in a hierarchical multiple regression, there are statistically significant differences in Level 1, Level 2, or Level 3 that influence the professional longevity of a high school science teacher in Florida. The professional longevity of a Floridian high school science teacher is the dependent variable. The independent variables are: (Level 1) a teacher's sex, age, ethnicity, earned degree, salary, number of schools taught in, migration count, and various years of service in different areas of education; (Level 2) a school's geographic location, residential population density, average class size, charter status, and SES; and (Level 3) a school district's average SES and average spending per pupil. Statistical analyses of exploratory MLRs and a HMR are used to support the research hypotheses. The final results of the HMR analysis show a teacher's age, salary, earned degree (unknown, associate, and doctorate), and ethnicity (Hispanic and Native Hawaiian/Pacific Islander); a school's charter status; and a school district's average SES are all significant predictors of a Florida high school science teacher's professional longevity. Although statistically significant in the initial exploratory MLR analyses, a teacher's ethnicity (Asian and Black), a school's geographic location (city and rural), and a school's SES are not statistically significant in the final HMR model.

Improving cancer control through a community-based cancer awareness initiative☆

PubMed Central

Smith, Samuel G.; Rendell, Helen; George, Helen; Power, Emily

2014-01-01

Objective To assess the impact of the Cancer Research UK Cancer Awareness Roadshow on intentions to change health behaviours and use local health services related to cancer. Method Feedback forms from visitors to three Roadshows collected data on anticipated lifestyle changes and health service use following their visit to the Roadshow. Demographic predictors of intentions were investigated. Results A total of 6009 individuals completed a feedback form. On average, respondents intended to make between two and three (2.55; SD = 1.77) lifestyle changes, and use between none and one (0.59; SD = 0.77) local health services following their visit. Multivariable analysis showed that age (p = 0.001), ethnicity (p = 0.006), and occupation (p = 0.043) were significant predictors of anticipated lifestyle changes. Anticipated health service use was higher among men (p = 0.001), younger groups (p < 0.001), and smokers (p < 0.001). Overall effects of ethnicity (p = 0.001) and occupation (p < 0.001) on anticipated health service use were also observed. Post-hoc analyses indicated stronger effects of the Roadshow among disadvantaged groups. Conclusion High levels of anticipated health behaviour change and health service use were observed among Roadshow visitors. Disadvantaged groups such as lower socioeconomic groups, ethnic minorities, and smokers showed particularly high levels of intention. A more in-depth evaluation of the Roadshow is warranted. PMID:24239683

Monitoring techniques and alarm procedures for CMS services and sites in WLCG

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

Molina-Perez, J.; Bonacorsi, D.; Gutsche, O.

2012-01-01

The CMS offline computing system is composed of roughly 80 sites (including most experienced T3s) and a number of central services to distribute, process and analyze data worldwide. A high level of stability and reliability is required from the underlying infrastructure and services, partially covered by local or automated monitoring and alarming systems such as Lemon and SLS, the former collects metrics from sensors installed on computing nodes and triggers alarms when values are out of range, the latter measures the quality of service and warns managers when service is affected. CMS has established computing shift procedures with personnel operatingmore » worldwide from remote Computing Centers, under the supervision of the Computing Run Coordinator at CERN. This dedicated 24/7 computing shift personnel is contributing to detect and react timely on any unexpected error and hence ensure that CMS workflows are carried out efficiently and in a sustained manner. Synergy among all the involved actors is exploited to ensure the 24/7 monitoring, alarming and troubleshooting of the CMS computing sites and services. We review the deployment of the monitoring and alarming procedures, and report on the experience gained throughout the first two years of LHC operation. We describe the efficiency of the communication tools employed, the coherent monitoring framework, the proactive alarming systems and the proficient troubleshooting procedures that helped the CMS Computing facilities and infrastructure to operate at high reliability levels.« less

Interoperability Across the Stewardship Spectrum in the DataONE Repository Federation

NASA Astrophysics Data System (ADS)

Jones, M. B.; Vieglais, D.; Wilson, B. E.

2016-12-01

Thousands of earth and environmental science repositories serve many researchers and communities, each with their own community and legal mandates, sustainability models, and historical infrastructure. These repositories span the stewardship spectrum from highly curated collections that employ large numbers of staff members to review and improve data, to small, minimal budget repositories that accept data caveat emptor and where all responsibility for quality lies with the submitter. Each repository fills a niche, providing services that meet the stewardship tradeoffs of one or more communities. We have reviewed these stewardship tradeoffs for several DataONE member repositories ranging from minimally (KNB) to highly curated (Arctic Data Center), as well as general purpose (Dryad) to highly discipline or project specific (NEON). The rationale behind different levels of stewardship reflect resolution of these tradeoffs. Some repositories aim to encourage extensive uptake by keeping processes simple and minimizing the amount of information collected, but this limits the long-term utility of the data and the search, discovery, and integration systems that are possible. Other repositories require extensive metadata input, review, and assessment, allowing for excellent preservation, discovery, and integration but at the cost of significant time for submitters and expense for curatorial staff. DataONE recognizes these different levels of curation, and attempts to embrace them to create a federation that is useful across the stewardship spectrum. DataONE provides a tiered model for repositories with growing utility of DataONE services at higher tiers of curation. The lowest tier supports read-only access to data and requires little more than title and contact metadata. Repositories can gradually phase in support for higher levels of metadata and services as needed. These tiered capabilities are possible through flexible support for multiple metadata standards and services, where repositories can incrementally increase their requirements as they want to satisfy more use cases. Within DataONE, metadata search services support minimal metadata models, but significantly expanded precision and recall become possible when repositories provide more extensively curated metadata.

An experiment with community health funds in Afghanistan.

PubMed

Rao, Krishna D; Waters, Hugh; Steinhardt, Laura; Alam, Sahibullah; Hansen, Peter; Naeem, Ahmad Jan

2009-07-01

As Afghanistan rebuilds its health system, it faces key challenges in financing health services. To reduce dependence on donor funds, it is important to develop sustainable local financing mechanisms. A second challenge is to reduce high levels of out-of-pocket payments. Community-based health insurance (CBHI) schemes offer the possibility of raising revenues from communities and at the same time providing financial protection. This paper describes the performance of one type of CBHI scheme, the Community Health Fund (CHF), which was piloted for the first time in five provinces of Afghanistan between June 2005 and October 2006. The performance of the CHF programme demonstrates that complex community-based health financing schemes can be implemented in post-conflict settings like Afghanistan, except in areas of high insecurity. The funds raised from the community, via premiums and user fees, enabled the pilot facilities to overcome temporary shortages of drugs and supplies, and to conduct outreach services via mobile clinics. However, enrolment and cost-recovery were modest. The median enrolment rate for premium-paying households was 6% of eligible households in the catchment areas of the clinics. Cost recovery rates ranged up to 16% of total operating costs and 32% of non-salary operating costs. No evidence of reduced out-of-pocket health expenditures was observed at the community level, though CHF members had markedly higher utilization of health services. The main reasons among non-members for not enrolling were being unaware of the programme; high premiums; and perceived low quality of services at the CHF clinics. The performance of Afghanistan's CHF was similar to other CHF-type programmes operating at the primary care level internationally. The solution to building local capacity to finance health services lies in a combination of financing sources rather than any single mechanism. In this context, it is critical that international assistance for Afghanistan's health sector continues.

A generic simulation model to assess the performance of sterilization services in health establishments.

PubMed

Di Mascolo, Maria; Gouin, Alexia

2013-03-01

The work presented here is with a view to improving performance of sterilization services in hospitals. We carried out a survey in a large number of health establishments in the Rhône-Alpes region in France. Based on the results of this survey and a detailed study of a specific service, we have built a generic model. The generic nature of the model relies on a common structure with a high level of detail. This model can be used to improve the performance of a specific sterilization service and/or to dimension its resources. It can also serve for quantitative comparison of performance indicators of various sterilization services.

Factors that allow elderly individuals to stay at home with their families using the Japanese long-term care insurance system.

PubMed

Oyama, Yumiko; Tamiya, Nanako; Kashiwagi, Masayo; Sato, Mikiya; Ohwaki, Kazuhiro; Yano, Eiji

2013-07-01

This study examined the factors that allow elderly individuals to stay at home continuously by considering the roles of the family caregiver, the use of services and characteristics of the elderly individual. We analyzed 432 elderly individuals living at home with family. The outcome was that participants remained at home continuously over a 24-month period. The participants were stratified into two care-needs levels, and then multiple logistic regression analyses were carried out to examine relationships between staying at home and the Japanese version of the Zarit Burden Interview (J-ZBI), public Long-term Care Insurance (LTCI) service use, family caregivers' characteristics and elderly peoples' characteristics. Low scores on the J-ZBI were related to outcome in both care-needs subgroups (low care-needs subgroup: OR 2.11; 95% CI 1.31-3.43, high care-needs subgroup: OR 5.03; 95% CI 1.04-31.1). Regarding LTCI services, the use of home-visit nursing (HN) service was related to staying at home continuously in the high care-needs group (OR 37.39; 95% CI 3.31-879.1). Alleviation of caregiver' burden was essential for continuous stay at home of elderly people regardless of care-needs levels. Also, the HN service was founded as the relevant LTCI service factor for staying at home continuously. The HN service use might affect the outcome when we consider the causal relationship. Therefore, the policy for the promotion of HN service use will be important to achieve the ultimate goal of LTCI, which is to allow elderly people to live in their communities for as long as possible. © 2012 Japan Geriatrics Society.

Health Services for Gender-Based Violence: Médecins Sans Frontières Experience Caring for Survivors in Urban Papua New Guinea.

PubMed

Lokuge, Kamalini; Verputten, Meggy; Ajakali, Maryanne; Tolboom, Bianca; Joshy, Grace; Thurber, Katherine A; Plana, Daisy; Howes, Steven; Wakon, Anastasia; Banks, Emily

2016-01-01

Levels of gender-based violence in Papua New Guinea (PNG) are high; health services for survivors are limited. Evidence from the few existing health services for survivors can inform improvements in care in this and similar settings. Médecins Sans Frontières supported health services for survivors in Lae, PNG from 2008-2013. Routine monitoring data from August 2010-April 2013 were used to describe patient and service characteristics. 5,892 individuals received care over 6,860 presentations, the majority self-referred or referred by friends and family. Presentations were attributed to intimate partner violence(62%), non-partner sexual violence(15%), other forms of violence(3%), and past (but not current) violence(21%). 97% were female; an estimated 4.9% (95%CI:4.8-5.0%) of females resident in the catchment area presented to the programme during the 2.8years analysed. Of presentations for non-partner sexual violence, 79% knew their abuser and 50% were children <16 years. 92% of presentations reporting current violence received medical treatment for injuries. The majority of patients who received multiple counselling sessions reported improved functioning and decreased severity of psycho-social complaints. Community awareness of the availability of free, best-practice, accessible, confidential medical and counselling services for sexual and gender-based violence in Lae, PNG resulted in many survivors presenting for care. High levels of ongoing intimate partner violence and child sexual abuse by known abusers indicates that alongside comprehensive medical care, access to effective services in non-health sectors such as policing, protection and legal services are needed if survivors are to escape the cycle of violence.

National College Progression Rates: For High Schools Participating in the National Student Clearinghouse StudentTracker Service. High School Benchmarks

ERIC Educational Resources Information Center

National Student Clearinghouse, 2014

2014-01-01

This second annual report provides high school-to-college transition rates for graduates of public non-charter, public charter, and private high schools. For students of public non-charter high schools the rates are reported in 12 categories based on the school-level demographic and geographic characteristics. This timely and comprehensive data is…

Breast cancer patients' satisfaction with individual therapy goals and treatment in a standardized integrative medicine consultancy service.

PubMed

Hack, Carolin C; Antoniadis, Sophia; Hackl, Janina; Langemann, Hanna; Schwitulla, Judith; Fasching, Peter A; Beckmann, Matthias W; Theuser, Anna-Katharin

2018-07-01

Complementary medicine services are nowadays usually quite heterogeneous, and little information is available on standards for running an integrative medicine consultancy service. This study aimed to assess patients' satisfaction with a standardized treatment service on integrative medicine. Using a cross-sectional design, 75 breast cancer patients from the integrative medicine consultancy service at the University Breast Center for Franconia were evaluated between January 2016 and March 2017. At primary consultation, patients answered a standardized questionnaire on their medical history and treatment goals regarding integrative medicine. In a subsequent interview, patients evaluated their satisfaction with the treatment service and individual treatment goals. 72% of the patients (n = 54) reported high satisfaction with the overall approach of the treatment service. 76% of the patients (n = 57) were very satisfied or satisfied with their individual treatment plans. The most frequently reported goals were to slow tumor progression (n = 64, 85.3%), reducing the side effects of conventional cancer treatments (n = 60, 80%), and a desire to participate actively in the treatment of breast cancer (n = 64, 85.3%). Using a standardized procedure in integrative medicine allows a high quality level to be offered to patients. Overall, breast cancer patients report very high satisfaction with the integrative medicine consultancy service and state long-term treatment goals. Hence, long-term treatment with integrative medicine methods should be taken into consideration.

Geohazards and Poverty: An Ecosystem Services Approach in Bangladesh

NASA Astrophysics Data System (ADS)

Hutton, C.; Nicholls, R. J.; Lazar, A.

2014-12-01

The Ecosystem Services (ES) of river deltas often support high population densities, estimated at over 500 million people globally, with particular concentrations in South, South-East and East Asia and Africa. Further, a large proportion of delta populations experience extremes of poverty and are highly vulnerable to the environmental and ecological stress and degradation that is occurring. A systems dynamics approach is adopted to provide policy makers with the knowledge and tools to enable them to evaluate the effects of Geohazards and environmental stressors and associated policy decisions on people's livelihoods (Ecosystem Services for Poverty Alleviation - ESPA Deltas). This is done by a multidisciplinary and multi-national team of policy analysts, social and natural scientists and engineers. The work presents a participatory approach to formally evaluating ecosystem services and poverty in the context of the wide range of environmetnal stressors and hazards. These changes include subsidence and sea level rise, land degradation and population pressure in delta regions. The approach will be developed, tested and applied in coastal Bangladesh. Rural livelihoods are inextricably linked with the natural ecosystems and low income farmers are highly vulnerable to changes in ecosystem services as they are impacted by geohazards and environmental stressors. Their health, wellbeing and financial security are under threat from many directions such as unreliable supplies of clean water, increasing salinisation of soils and flood, while in the longer term they are threatened by subsidence and sea-level rise. This study will contribute to the understanding of this present vulnerability and help the people who develop the relevant policy to make more informed choices about how best to reduce this vulnerability.

The Willingness-to-Pay for General Practitioners in Contractual Service and Influencing Factors among Empty Nesters in Chongqing, China.

PubMed

Chen, Fei; Xu, Xiang-Long; Yang, Zhan; Tan, Hua-Wei; Zhang, Liang

2015-08-10

In 2012, a pilot health policy of contractual service relations between general practitioners and patients was implemented in China. Due to the decline in body and cognitive function, as well as the lack of family care and narrow social support networks, the demand of health services among the elderly is much higher than that among the general population. This study aims to probe into the empty nesters' willingness-to-pay for general practitioners using a contractual service policy, investigating empty nesters' payment levels for the service, and analyze the main factors affecting the willingness of empty-nesters' general practitioners using contractual service supply cost. This cross-sectional study adopted a multistage stratified sampling method to survey 865, city empty nesters (six communities in three districts of one city) aged 60-85 years. A condition value method was used to infer the distribution of the willingness-to-pay; Cox's proportional hazards regression model was used to analyze the influencing factors of willingness-to-pay. More than seventy percent (76.6%) of the empty nesters in this city were willing to pay general practitioners using contract service in Chongqing. The level of willingness-to-pay for the surveyed empty nesters was 34.1 yuan per year. The median value was 22.1 yuan per year, which was below the Chongqing urban and rural cooperative medical insurance individual funding level (60 yuan per year) in 2013. Cox's proportional hazards regression model analysis showed that the higher the education level was, the worse the self-reported health status would be, accompanied by higher family per capita income, higher satisfaction of community health service, and higher willingness-to-pay empty nesters using a contract service. Women had a higher willingness-to-pay than men. The willingness-to-pay for general practitioners by contractual service is high among city empty nesters in Chongqing, thus, individual financing is feasible. However, people are willing to pay less than half of the current personal financing of cooperative medical insurance of urban and rural residents. Education level, family per capita income, and self-reported health status are the main factors affecting the cost sharing intention for general practitioners using contract service supply. According to the existing situation of different empty nesters, it is important to perfect the design of general practitioners using a contractual service policy system, according to differentiated personal financing levels.

The Willingness-to-Pay for General Practitioners in Contractual Service and Influencing Factors among Empty Nesters in Chongqing, China

PubMed Central

Chen, Fei; Xu, Xiang-Long; Yang, Zhan; Tan, Hua-Wei; Zhang, Liang

2015-01-01

Background: In 2012, a pilot health policy of contractual service relations between general practitioners and patients was implemented in China. Due to the decline in body and cognitive function, as well as the lack of family care and narrow social support networks, the demand of health services among the elderly is much higher than that among the general population. This study aims to probe into the empty nesters’ willingness-to-pay for general practitioners using a contractual service policy, investigating empty nesters’ payment levels for the service, and analyze the main factors affecting the willingness of empty-nesters’ general practitioners using contractual service supply cost. Methods: This cross-sectional study adopted a multistage stratified sampling method to survey 865, city empty nesters (six communities in three districts of one city) aged 60–85 years. A condition value method was used to infer the distribution of the willingness-to-pay; Cox’s proportional hazards regression model was used to analyze the influencing factors of willingness-to-pay. Results: More than seventy percent (76.6%) of the empty nesters in this city were willing to pay general practitioners using contract service in Chongqing. The level of willingness-to-pay for the surveyed empty nesters was 34.1 yuan per year. The median value was 22.1 yuan per year, which was below the Chongqing urban and rural cooperative medical insurance individual funding level (60 yuan per year) in 2013. Cox’s proportional hazards regression model analysis showed that the higher the education level was, the worse the self-reported health status would be, accompanied by higher family per capita income, higher satisfaction of community health service, and higher willingness-to-pay empty nesters using a contract service. Women had a higher willingness-to-pay than men. Conclusions: The willingness-to-pay for general practitioners by contractual service is high among city empty nesters in Chongqing, thus, individual financing is feasible. However, people are willing to pay less than half of the current personal financing of cooperative medical insurance of urban and rural residents. Education level, family per capita income, and self-reported health status are the main factors affecting the cost sharing intention for general practitioners using contract service supply. According to the existing situation of different empty nesters, it is important to perfect the design of general practitioners using a contractual service policy system, according to differentiated personal financing levels. PMID:26266416

Why not? Understanding the spatial clustering of private facility-based delivery and financial reasons for homebirths in Nigeria.

PubMed

Wong, Kerry L M; Radovich, Emma; Owolabi, Onikepe O; Campbell, Oona M R; Brady, Oliver J; Lynch, Caroline A; Benova, Lenka

2018-06-01

In Nigeria, the provision of public and private healthcare vary geographically, contributing to variations in one's healthcare surroundings across space. Facility-based delivery (FBD) is also spatially heterogeneous. Levels of FBD and private FBD are significantly lower for women in certain south-eastern and northern regions. The potential influence of childbirth services frequented by the community on individual's barriers to healthcare utilization is under-studied, possibly due to the lack of suitable data. Using individual-level data, we present a novel analytical approach to examine the relationship between women's reasons for homebirth and community-level, health-seeking surroundings. We aim to assess the extent to which cost or finance acts as a barrier for FBD across geographic areas with varying levels of private FBD in Nigeria. The most recent live births of 20,467 women were georeferenced to 889 locations in the 2013 Nigeria Demographic and Health Survey. Using these locations as the analytical unit, spatial clusters of high/low private FBD were detected with Kulldorff statistics in the SatScan software package. We then obtained the predicted percentages of women who self-reported financial reasons for homebirth from an adjusted generalized linear model for these clusters. Overall private FBD was 13.6% (95%CI = 11.9,15.5). We found ten clusters of low private FBD (average level: 0.8, 95%CI = 0.8,0.8) and seven clusters of high private FBD (average level: 37.9, 95%CI = 37.6,38.2). Clusters of low private FBD were primarily located in the north, and the Bayelsa and Cross River States. Financial barrier was associated with high private FBD at the cluster level - 10% increase in private FBD was associated with + 1.94% (95%CI = 1.69,2.18) in nonusers citing cost as a reason for homebirth. In communities where private FBD is common, women who stay home for childbirth might have mild increased difficulties in gaining effective access to public care, or face an overriding preference to use private services, among other potential factors. The analytical approach presented in this study enables further research of the differentials in individuals' reasons for service non-uptake across varying contexts of healthcare surroundings. This will help better devise context-specific strategies to improve health service utilization in resource-scarce settings.

"You Never Know What Research Is Like Unless You've Done It!": Action Research to Promote Collaborative Student-Teacher Research

ERIC Educational Resources Information Center

Yan, Chunmei

2017-01-01

In contrast with its high level of popularity in both research and practice for in-service teacher development, teacher research has received much less attention in pre-service language teacher education as a reflective learning approach, particularly in China's context. Action research, as a major form of teacher research, has rarely been…

Advanced Pumped Storage Hydropower and Ancillary Services Provision

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

Muljadi, Eduard; Gevorgian, Vahan; Mohanpurkar, Manish

This paper presents a high-level overview of the capability of advanced pumped storage hydropower to provide ancillary services including frequency regulation and oscillation damping. Type 3 and Type 4 generators are discussed. The examples given are for a small power system that uses a diesel generator as the main generator and a very large system that uses a gas turbine as the main generator.

[Organizational climate in management teams and its relationship with health care outcomes].

PubMed

Peña-Viveros, Raúl; Hernández-Hernández, Dulce María; Vélez-Moreno, Ana María Luz; García-Sandoval, Martha Gabriela; Reyes-Tellez, María Araceli; Ureña-Bogarin, Enrique L

2015-01-01

To identify the relationship between organizational climate of management teams and the performance of health services. A transversal and analytical study was designed. The Organizational Climate Scale (OCS) was utilized and performance was assessed by the achievement indicators through correlation analysis and multiple regression. Thirty four medical benefits services headquarters (JSPM) were measured of the Mexican Social Security Institute. Of 862 participating, 238 (27.6%) evaluated the climate of their organizations with a high level; the maximal score was 56%. Average performance value was 0.79 ± 0.07 (minimal: 0.65; maximal: 0.92). A positive correlation was demonstrated between organizational climate level and performance (r=0.4; p=0.008). The organizational climate of the health services managers (JSPM) is directly related with performance in health care.

Are the poor differentially benefiting from provision of priority public health services? A benefit incidence analysis in Nigeria

PubMed Central

2012-01-01

Background The paper presents evidence about the distribution of the benefits of public expenditures on a subset of priority public health services that are supposed to be provided free of charge in the public sector, using the framework of benefit incidence analysis. Methods The study took place in 2 rural and 2 urban Local Government Areas from Enugu and Anambra states, southeast Nigeria. A questionnaire was used to collect data on use of the priority public health services by all individuals in the households (n=22,169). The level of use was disaggregated by socio-economic status (SES), rural-urban location and gender. Benefits were valued using the cost of providing the service. Net benefit incidence was calculated by subtracting payments made for services from the value of benefits. Results The results showed that 3,281 (14.8%) individuals consumed wholly free services. There was a greater consumption of most free services by rural dwellers, females and those from poorer SES quintiles (but not for insecticide-treated nets and ante-natal care services). High levels of payment were observed for immunisation services, insecticide-treated nets, anti-malarial medicines, antenatal care and childbirth services, all of which are supposed to be provided for free. The net benefits were significantly higher for the rural residents, males and the poor compared to the urban residents, females and better-off quintiles. Conclusion It is concluded that coverage of all of these priority public health services fell well below target levels, but the poorer quintiles and rural residents that are in greater need received more benefits, although not so for females. Payments for services that are supposed to be delivered free of charge suggests that there may have been illegal payments which probably hindered access to the public health services. PMID:23158434

Barriers to formal emergency obstetric care services' utilization.

PubMed

Essendi, Hildah; Mills, Samuel; Fotso, Jean-Christophe

2011-06-01

Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be put in place to enhance security in the slums at night.

High-Throughput and Low-Latency Network Communication with NetIO

NASA Astrophysics Data System (ADS)

Schumacher, Jörn; Plessl, Christian; Vandelli, Wainer

2017-10-01

HPC network technologies like Infiniband, TrueScale or OmniPath provide low- latency and high-throughput communication between hosts, which makes them attractive options for data-acquisition systems in large-scale high-energy physics experiments. Like HPC networks, DAQ networks are local and include a well specified number of systems. Unfortunately traditional network communication APIs for HPC clusters like MPI or PGAS exclusively target the HPC community and are not suited well for DAQ applications. It is possible to build distributed DAQ applications using low-level system APIs like Infiniband Verbs, but it requires a non-negligible effort and expert knowledge. At the same time, message services like ZeroMQ have gained popularity in the HEP community. They make it possible to build distributed applications with a high-level approach and provide good performance. Unfortunately, their usage usually limits developers to TCP/IP- based networks. While it is possible to operate a TCP/IP stack on top of Infiniband and OmniPath, this approach may not be very efficient compared to a direct use of native APIs. NetIO is a simple, novel asynchronous message service that can operate on Ethernet, Infiniband and similar network fabrics. In this paper the design and implementation of NetIO is presented and described, and its use is evaluated in comparison to other approaches. NetIO supports different high-level programming models and typical workloads of HEP applications. The ATLAS FELIX project [1] successfully uses NetIO as its central communication platform. The architecture of NetIO is described in this paper, including the user-level API and the internal data-flow design. The paper includes a performance evaluation of NetIO including throughput and latency measurements. The performance is compared against the state-of-the- art ZeroMQ message service. Performance measurements are performed in a lab environment with Ethernet and FDR Infiniband networks.

A Virtual Learning Application of the Schoolwide Enrichment Model and High-End Learning Theory

ERIC Educational Resources Information Center

Renzulli, Joseph S.; Reis, Sally M.

2012-01-01

Remarkable advances in instructional communication technology (ICT) have now made it possible to provide high levels of enrichment services to students online. This paper describes an Internet-based enrichment program based on a high-end learning theory that focuses on the development of creative productivity through the "application" of knowledge…

Qualitative assessment of the dental health services provided at a dental school in Kerman, Iran.

PubMed

Rad, Maryam; Haghani, Jahangir; Shahravan, Arash; Khosravifar, Ali

2009-01-01

Increasing the quality of the services provided in a Dental School can raise the satisfaction level of patients and consequently increase the level of their oral health. This study was conducted to evaluate the quality of dental care and services provided to patients referred to a Dental School in Kerman, Iran. In this qualitative study, face-to-face, in-depth interviews were conducted with 41 participants [25 patients (P), 5 nurses (N), 6 dental academic staff (AS), and 5 dental students (S)]. Then, the interviews were transcribed and analyzed, using content analysis of data. Data analysis in qualitative research involves breaking down the data and searching for codes and categories that are then reassembled to form themes. Both positive and negative themes emerged. Positive themes included: good infection control, service accessibility, patient appointments and visits were not assigned on merit, precise examinations, and comprehensive treatment plans. Negative themes included: long wait time, lack of options to pass waiting time, such as newspapers and television, an insufficient number of nurses, and not enough professors for supervision. In addition, the results of this study show that the patients and dental staff have high expectations in relation to dental services, and that implementation of these expectations would increase the overall satisfaction with and the quality of the level of services. Finally, some recommendations for improving services in the Kerman Dental School were given to the managing team of the Dental School.

Why carers use adult day respite: a mixed method case study

PubMed Central

2014-01-01

Background We need to improve our understanding of the complex interactions between family carers’ emotional relationships with care-recipients and carers use of support services. This study assessed carer’s expectations and perceptions of adult day respite services and their commitment to using services. Methods A mixed-method case study approach was used with psychological contract providing a conceptual framework. Data collection was situated within an organisational case study, and the total population of carers from the organisation’s day respite service were approached. Fifty respondents provided quantitative and qualitative data through an interview survey. The conceptual framework was expanded to include Maslow’s hierarchy of needs during analysis. Results Carers prioritised benefits for and experiences of care-recipients when making day respite decisions. Respondents had high levels of trust in the service and perceived that the major benefits for care-recipients were around social interaction and meaningful activity with resultant improved well-being. Carers wanted day respite experiences to include all levels of Maslow’s hierarchy of needs from the provision of physiological care and safety through to the higher levels of belongingness, love and esteem. Conclusion The study suggests carers need to trust that care-recipients will have quality experiences at day respite. This study was intended as a preliminary stage for further research and while not generalizable it does highlight key considerations in carers’ use of day respite services. PMID:24906239

Why carers use adult day respite: a mixed method case study.

PubMed

Stirling, Christine M; Dwan, Corinna A; McKenzie, Angela R

2014-06-06

We need to improve our understanding of the complex interactions between family carers' emotional relationships with care-recipients and carers use of support services. This study assessed carer's expectations and perceptions of adult day respite services and their commitment to using services. A mixed-method case study approach was used with psychological contract providing a conceptual framework. Data collection was situated within an organisational case study, and the total population of carers from the organisation's day respite service were approached. Fifty respondents provided quantitative and qualitative data through an interview survey. The conceptual framework was expanded to include Maslow's hierarchy of needs during analysis. Carers prioritised benefits for and experiences of care-recipients when making day respite decisions. Respondents had high levels of trust in the service and perceived that the major benefits for care-recipients were around social interaction and meaningful activity with resultant improved well-being. Carers wanted day respite experiences to include all levels of Maslow's hierarchy of needs from the provision of physiological care and safety through to the higher levels of belongingness, love and esteem. The study suggests carers need to trust that care-recipients will have quality experiences at day respite. This study was intended as a preliminary stage for further research and while not generalizable it does highlight key considerations in carers' use of day respite services.

Psychological distress in student nurses undertaking an educational programme with professional registration as a nurse: Their perceived barriers and facilitators in seeking psychological support.

PubMed

Mitchell, A E P

2018-05-01

WHAT IS KNOWN ON THE SUBJECT?: Psychological distress is a major health concern, and university student populations are at a risk due to high academic, economic and interpersonal demands at this time. While a number of studies have been conducted looking at distress and service uptake amongst university students, there is a lack of comparative information in the student nurse population. Therefore, this study focuses on level of psychological distress and service uptake in student nurses during their training. Student nurses in training are acknowledged as particularly vulnerable to anxiety and depression. Anxiety and depression can interfere with educational achievement and interfere with working relationships, which are an important aspect of clinical practice. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study investigates psychological distress and service uptake in student nurses, in a single study, by measuring the level of distress and comparing this with adult nonpatient norms. The key findings suggest high levels of anxiety and depression and poor uptake of support in student nurses. The main barrier to seeking support was the fear of disclosure about their anxiety and/or depression, and feared impact on their suitability to train as a nurse. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Due to the fear of disclosure and low levels of support seeking, mental health nurses and academics have a key role to play in mental health literacy. It seems reasonable, given the key findings, to suggest that interventions be directed at decreasing anxiety and depression such as mindfulness training and other evidence-based strategies. It is recommended that psychological distress needs due attention from higher education sector and those health professionals involved in mental health service provision to support evidence-based strategies that target these issues. Introduction This study adds to the existing international evidence on psychological distress in the student population by focusing on student nurses. It quantitatively assesses psychological distress with comparative norms and investigates service uptake in a single study. Aim The aim of this study was to investigate the level of psychological distress in students and compare this with population norms and highlight potential facilitators and barriers to help seeking. Methods This study recruited N = 121 student nurses from one university in a cross-sectional design. Data were analysed using descriptive statistics, independent t tests and one-way ANOVAs. Findings The key findings show high levels of psychological distress, which is above levels seen in the general population. The main barriers to seeking support were fear of disclosure and the perceived impact on their suitability as a student nurse. Discussion The study highlights that high levels of distress identified in the literature are seen in student nurses and that fear of disclosure may account for some not seeking support. Relevance The fear of disclosure and low levels of seeking support suggest there is a need for mental health nurses and academics to play a key role in mental health literacy and evidence-based interventions such as mindfulness to combat these issues. © 2018 John Wiley & Sons Ltd.

Home Economics/Health Grades 6-12. Program Evaluation.

ERIC Educational Resources Information Center

Des Moines Public Schools, IA. Teaching and Learning Div.

Home economics programs are offered to students in grades 6-12 in the Des Moines INdependent Community School District (Iowa). Programs at the middle school level are exploratory, leading to occupational training in family and consumer science, child care, food service, and textile and fashion arts at the high school level. Health education…

Knowledge and Beliefs of Early Childhood Education Students at Different Levels of Professional Preparation

ERIC Educational Resources Information Center

Goble, Carla B.; Horm, Diane M.; Atanasov, Amy M.; Williamson, Amy C.; Choi, Ji Young

2015-01-01

The expansion of early childhood education programming has heightened the focus on teachers' educational preparation and its role in providing high-quality services for young children. The interest in teachers' education is especially relevant in early childhood since differentiated levels of preparation are commonly used in quality rating and…

Teacher Preferences for Middle Grades: Insights into Attracting Teacher Candidates

ERIC Educational Resources Information Center

Radcliffe, Rich A.; Mandeville, Thomas F.

2007-01-01

Shortages of middle-level teacher candidates may cause teacher educators to recruit candidates by focusing on what attracts and discourages candidates about teaching at the middle level. The authors used a survey approach (n = 110) to investigate why preservice middle school and high school teachers and in-service middle school teachers chose the…

Multi-Tier Mental Health Program for Refugee Youth

ERIC Educational Resources Information Center

Ellis, B. Heidi; Miller, Alisa B.; Abdi, Saida; Barrett, Colleen; Blood, Emily A.; Betancourt, Theresa S.

2013-01-01

Objective: We sought to establish that refugee youths who receive a multi-tiered approach to services, Project SHIFA, would show high levels of engagement in treatment appropriate to their level of mental health distress, improvements in mental health symptoms, and a decrease in resource hardships. Method: Study participants were 30 Somali and…

21st Century Teachers: How Non-Traditional Pre-Service Teachers Navigate Their Initial Experiences of Contemporary Classrooms

ERIC Educational Resources Information Center

Crosswell, Leanne; Beutel, Denise

2017-01-01

In the twenty-first century, teachers' work has become more complex with high levels of accountability, increased bureaucratic responsibilities and unprecedented levels of public scrutiny. However, teaching fundamentally remains a caring profession, requiring well-developed social skills and emotional labour to successfully engage and motivate…

Reproductive justice & preventable deaths: state funding, family planning, abortion, and infant mortality, US 1980-2010.

PubMed

Krieger, Nancy; Gruskin, Sofia; Singh, Nakul; Kiang, Mathew V; Chen, Jarvis T; Waterman, Pamela D; Beckfield, Jason; Coull, Brent A

2016-12-01

Little current research examines associations between infant mortality and US states' funding for family planning services and for abortion, despite growing efforts to restrict reproductive rights and services and documented associations between unintended pregnancy and infant mortality. We obtained publicly available data on state-only public funding for family planning and abortion services (years available: 1980, 1987, 1994, 2001, 2006, and 2010) and corresponding annual data on US county infant death rates. We modeled the funding as both fraction of state expenditures and per capita spending (per woman, age 15-44). State-level covariates comprised: Title X and Medicaid per capita funding, fertility rate, and percent of counties with no abortion services; county-level covariates were: median family income, and percent: black infants, adults without a high school education, urban, and female labor force participation. We used Possion log-linear models for: (1) repeat cross-sectional analyses, with random state and county effects; and (2) panel analysis, with fixed state effects. Four findings were robust to analytic approach. First, since 2000, the rate ratio for infant death comparing states in the top funding quartile vs. no funding for abortion services ranged (in models including all covariates) between 0.94 to 0.98 (95% confidence intervals excluding 1, except for the 2001 cross-sectional analysis, whose upper bound equaled 1), yielding an average 15% reduction in risk (range: 8 to 22%). Second, a similar risk reduction for state per capita funding for family planning services occurred in 1994. Third, the excess risk associated with lower county income increased over time, and fourth, remained persistently high for counties with a high percent of black infants. Insofar as reducing infant mortality is a government priority, our data underscore the need, despite heightened contention, for adequate public funding for abortion services and for redressing health inequities.

The use and costs of health and social services in patients with longstanding substance abuse

PubMed Central

2013-01-01

Background Persons with longstanding substance abuse might become increasingly dependent on help by the public, eventually requiring permanent care. In 2006 the municipality of Stavanger established a so-called addiction ward for these clients, comprising 17 beds at the largest municipal nursing home. We assumed that the residents of this ward were high consumers of health care and social services during the last months preceding their admission. The aim of the study was to register the type and extent of services that were claimed by this client group during the last six months prior to admission, and to calculate the costs that were caused. Further, we estimated the incremental costs for nursing home placement. Methods In 15 residents from the addiction ward the use of all welfare services during the six months prior to admission were registered. Costs were calculated by unit costs from a municipal, national and societal perspective. Results Mean total costs during this period were €32 474. Approximately half of these costs were borne by state-funded institutions, and half were borne by the municipality. The clients used a great variety of services aimed at subsistence, health care and support in independent living, while services aimed at drug withdrawal were not claimed. There was no correlation between costs and the level of functioning. The incremental costs for nursing home admission were borne by the municipalities. Conclusion Persons with longstanding substance abuse represent a group with a high use of welfare resources and hence cause high costs. However, our findings do not indicate any correlation between the amount of services rendered and the level of functioning. Further research should focus on the identification of the clients’ need for support in order to facilitate targeted interventions that might prevent further deterioration and, finally, the need for permanent care. PMID:23692822

Modeling Cortisol Daily Rhythms of Family Caregivers of Individuals With Dementia: Daily Stressors and Adult Day Services Use.

PubMed

Liu, Yin; Almeida, David M; Rovine, Michael J; Zarit, Steven H

2018-03-02

The study examined the typical diurnal cortisol trajectory and its differential associations with an intervention, the adult day services (ADS) use, among a sample of family caregivers who experienced high levels of daily stress. On hundred and sixty-five caregivers of individuals with dementia completed an 8-day diary on daily stressors, positive events, sleep quality, and ADS use. The caregivers also provided five saliva samples on each diary day. Daily cortisol trajectories were modeled as a function of time elapsed since awakening, and three spline growth curve models were fit to the cortisol data. Based on the best-fitting linear spline model, the effect of daily ADS use was examined at both daily and person levels. Covariates included daily experiences and other caregiving characteristics. On ADS days, caregivers had a steeper cortisol awakening response (CAR) slope and a steeper morning decline. ADS use remained significant after controlling for covariates at both daily and person levels. The findings suggested potential biophysiological benefits of daily ADS use for a sample that was under chronic stress and high levels of daily stress.

[Silver Hills Junior High School Talent Pool].

ERIC Educational Resources Information Center

Wallace School District 393, ID.

The paper describes the Silver Hills (Idaho) Junior High School Talent Pool, a program designed to advance thinking skills through enrichment activities. The Talent Pool concept was established as an alternate means of identifying students eligible for gifted/talented services and programs. Students participate in three levels of enrichment…

Reviving a Community, Modernizing an Industry: Ireland's Furniture College.

ERIC Educational Resources Information Center

Regional Technology Strategies, Inc., Carrboro, NC.

Connemara, a rural region in Ireland, is characterized by high unemployment, high emigration, poor infrastructure, inadequate public services, and a low rate of transfer to third-level education. To address the situation, the Galway-Mayo Institute of Technology (GMIT), joined forces with Connemara West (a community-owned development organization…

Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan.

PubMed

Hoge, Charles W; Auchterlonie, Jennifer L; Milliken, Charles S

2006-03-01

The US military has conducted population-level screening for mental health problems among all service members returning from deployment to Afghanistan, Iraq, and other locations. To date, no systematic analysis of this program has been conducted, and studies have not assessed the impact of these deployments on mental health care utilization after deployment. To determine the relationship between combat deployment and mental health care use during the first year after return and to assess the lessons learned from the postdeployment mental health screening effort, particularly the correlation between the screening results, actual use of mental health services, and attrition from military service. Population-based descriptive study of all Army soldiers and Marines who completed the routine postdeployment health assessment between May 1, 2003, and April 30, 2004, on return from deployment to Operation Enduring Freedom in Afghanistan (n = 16,318), Operation Iraqi Freedom (n = 222,620), and other locations (n = 64,967). Health care utilization and occupational outcomes were measured for 1 year after deployment or until leaving the service if this occurred sooner. Screening positive for posttraumatic stress disorder, major depression, or other mental health problems; referral for a mental health reason; use of mental health care services after returning from deployment; and attrition from military service. The prevalence of reporting a mental health problem was 19.1% among service members returning from Iraq compared with 11.3% after returning from Afghanistan and 8.5% after returning from other locations (P<.001). Mental health problems reported on the postdeployment assessment were significantly associated with combat experiences, mental health care referral and utilization, and attrition from military service. Thirty-five percent of Iraq war veterans accessed mental health services in the year after returning home; 12% per year were diagnosed with a mental health problem. More than 50% of those referred for a mental health reason were documented to receive follow-up care although less than 10% of all service members who received mental health treatment were referred through the screening program. Combat duty in Iraq was associated with high utilization of mental health services and attrition from military service after deployment. The deployment mental health screening program provided another indicator of the mental health impact of deployment on a population level but had limited utility in predicting the level of mental health services that were needed after deployment. The high rate of using mental health services among Operation Iraqi Freedom veterans after deployment highlights challenges in ensuring that there are adequate resources to meet the mental health needs of returning veterans.

Predictors of Outreach Meetings Among Substance Using Homeless Youth.

PubMed

Carmona, Jasmin; Slesnick, Natasha; Guo, Xiamei; Murnan, Aaron; Brakenhoff, Brittany

2017-01-01

Homeless youth have high rates of substance use and often lack connection to social services. Outreach is critical for connecting youth to services, but factors influencing their outreach engagement are unknown. This study examined predictors of meetings with outreach workers among 79 non-service connected, substance using homeless youth between 14 and 24 years of age. Results provide direction to service providers in that older age, higher levels of depressive symptoms, fewer drug-related problems, and no use of hard drugs within the prior 30 days predicted higher meeting attendance. Future research is needed testing strategies that overcome barriers to outreach engagement.

Quality indicators for family support services and their relationship to organizational social context.

PubMed

Olin, S Serene; Williams, Nate; Pollock, Michele; Armusewicz, Kelsey; Kutash, Krista; Glisson, Charles; Hoagwood, Kimberly E

2014-01-01

Quality measurement is an important component of healthcare reform. The relationship of quality indicators (QIs) for parent-delivered family support services to organizational social contexts known to improve quality is unexamined. This study employs data collected from 21 child mental health programs that deliver team-based family support services. Performance on two levels of QIs-those targeting the program and staff-were significantly associated with organizational social context profiles and dimensions. High quality program policies are associated with positive organizational cultures and engaging climates. Inappropriate staff practices are associated with resistant cultures. Implications for organizational strategies to improve service quality are discussed.

Quality Indicators for Family Support Services and Their Relationship to Organizational Social Context

PubMed Central

Olin, S. Serene; Williams, Nate; Pollock, Michele; Armusewicz, Kelsey; Kutash, Krista; Glisson, Charles; Hoagwood, Kimberly E.

2013-01-01

Quality measurement is an important component of healthcare reform. The relationship of quality indicators (QIs) for parent-delivered family support services to organizational social contexts known to improve quality is unexamined. This study employs data collected from 21 child mental health programs that deliver team-based family support services. Performance on two levels of QIs —those targeting the program and staff -- were significantly associated with organizational social context profiles and dimensions. High quality program policies are associated with positive organizational cultures and engaging climates. Inappropriate staff practices are associated with resistant cultures. Implications for organizational strategies to improve service quality are discussed. PMID:23709286

From public to private and back again: sustaining a high service-delivery level during transition of management authority: a Cambodia case study.

PubMed

Jacobs, Bart; Thomé, Jean-Marc; Overtoom, Rob; Sam, Sam Oeun; Indermühle, Lorenz; Price, Neil

2010-05-01

Contracting non-governmental organizations (NGOs) has been shown to increase health service delivery output considerably over relatively short time frames in low-income countries, especially when applying performance-related pay as a stimulus. A key concern is how to manage the transition back to government-operated systems while maintaining health service delivery output levels. In this paper we describe and analyse the transition from NGO-managed to government-managed health services over a 3-year period in a health district in Cambodia with a focus on the level of health service delivery. Data are derived from four sources, including cross-sectional surveys and health management and financial information systems. The transition was achieved by focusing on all the building blocks of the health care system and ensuring an acceptable financial remuneration for the staff members of contracted health facilities. The latter was attained through performance subsidies derived from financial commitment by the central government, and revenue from user fees. Performance management had a crucial role in the gradual handover of responsibilities. Not all responsibilities were handed back to government over the case study period-notably the development of performance indicators and targets and the performance monitoring.

The three keys to quality customer service: opening the doors to exceptional performance.

PubMed

Myers, Pennie; Nance, Don W

2002-01-01

Excellence in customer service requires three things. The first is a commitment to a set of principles. These principles reflect beliefs and assumptions that people are valuable and deserve to be treated with dignity and respect. This commitment is expressed to customers by an adherence to six customer-friendly processes and by personnel who possess a high level of skill in the behaviors that make up customer service. When these three requirements are met, laboratorians not only maintain a competitive edge but also fulfill their mission as health-care professionals.

Information technology in the foxhole.

PubMed

Eyestone, S M

1995-08-01

The importance of digital data capture at the point of health care service within the military environment is highlighted. Current paper-based data capture does not allow for efficient data reuse throughout the medical support information domain. A simple, high-level process and data flow model is used to demonstrate the importance of data capture at point of service. The Department of Defense is developing a personal digital assistant, called MEDTAG, that accomplishes point of service data capture in the field using a prototype smart card as a data store in austere environments.

Association between perceived stress, multimorbidity and primary care health services: a Danish population-based cohort study.

PubMed

Prior, Anders; Vestergaard, Mogens; Larsen, Karen Kjær; Fenger-Grøn, Morten

2018-02-24

Mental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental-physical multimorbidity. Population-based cohort study. Primary healthcare in Denmark. 118 410 participants from the Danish National Health Survey 2010 followed for 1 year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers. General daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers. Perceived stress levels were associated with primary care activity in a dose-response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95% CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95% CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95% CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95% CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95% CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services. Persons with high stress levels generally had higher use of primary healthcare, 4-6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Level of quality management in the Municipal Sports Services, contrast trough EFQM Excellence Model.

PubMed

Martínez-Moreno, Alfonso; Díaz Suárez, Arturo

2016-01-01

The quality management in the Municipal Sports Services is embedded in the servuction provided to the citizens, which are their internal customers who determine the quality improvement ensuring competitiveness with excellence criteria. The Model of the European Foundation for Quality Management enables the evaluation of organization progress towards achieving quality goals, from a structured, measurable and comparable methodology. The aim is to carry out a diagnosis of the level of implementation of quality in the Municipal Sports Services of the Region of Murcia, Spain. The sample of 287 workers of 30 sports services gets a high level of reliability at all scales, with a coefficient of variation of .985 (range .810-.943). The score in the criteria of Policy and Strategy, People Management, Alliances and Resources, Processes and People Results were significantly higher (p < .05) in the Municipalities with more than 25,000 inhabitants when compared with those less than 10,000 and with those from 10,000 to 25,000 inhabitants obtaining global ratings of 571 points, those less than 10,000, 590 points those from 10,000 to 25,000 and those higher than 25,000 reach 636, having a good level of quality in relation to the scale that determines the model.

Social Capital, Acculturation, Mental Health, and Perceived Access to Services among Mexican American Women

PubMed Central

Valencia-Garcia, Dellanira; Simoni, Jane M.; Alegría, Margarita; Takeuchi, David T.

2012-01-01

Objective We examined whether individual-level social capital--the intangible resources in a community available through membership in social networks or other social structures and perceived trust in the community—was associated with acculturation; depression and anxiety symptoms; and perceived access to services among women of Mexican ancestry. Method Recruited through venue-based targeted sampling in King County, WA, 205 women of Mexican descent age 18 to 64 years who differed in socioeconomic status and nativity completed a cross-sectional survey. Half completed the survey in Spanish and half in English. Structural equation modeling was used for model testing. Results Social capital increased with level of acculturation and was negatively related to depression and anxiety; it had no direct association with perceived access to services. Social capital mediated the relation between acculturation and both depression and anxiety symptoms. Acculturation had no direct association with psychological distress but was directly associated with perceived access to services. This community sample of women reported high levels of psychological distress, with 20–26% of women meeting diagnostic criteria for depression or anxiety. Conclusions Social capital can be assessed at the individual level, increases with acculturation, and may be a potential target for interventions to improve mental health among Mexican American women residing in the U.S. PMID:22329824

Creep-Rupture Behavior and Recrystallization in HR6W and Haynes Alloy 230 Cold-Bent Boiler Tubing for Ultrasupercritical (USC) Steam Boiler Applications

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

Shingledecker, John P

2007-01-01

Creep-rupture experiments were conducted on HR6W and Haynes 230, candidate Ultrasupercritical (USC) alloys, tubes to evaluate the effects of cold-work and recrystallization during high-temperature service. These creep tests were performed by internally pressurizing cold-bent boiler tubes at 775 C for times up to 8000 hours. The bends were fabricated with cold-work levels beyond the current ASME Boiler and Pressure Vessel (ASME B&PV) Code Section I limits for austenitic stainless steels. Destructive metallographic evaluation of the crept tube bends was used to determine the effects of cold-work and the degree of recrystallization. The metallographic analysis combined with an evaluation of themore » creep and rupture data suggest that solid-solution strengthened nickel-based alloys can be fabricated for high-temperature service at USC conditions utilizing levels of cold-work higher than the current allowed levels for austenitic stainless steels.« less

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

Doczi, Julian, Dorr, Tobias; Mason, Nathaniel; Scott, Andrew

In this new working paper, the authors focus specifically on what would be necessary to achieve High Level Panel-style goals and targets for water, energy and transport, if these were to be eventually adopted by world leaders. In all three cases, much of the advocacy - and the proposed High Level Panel goals - have emphasized the need to strive for universal and sustainable access to at least basic levels of services from these sectors. Many of the proposals for post-2015 goals and targets appear ambitious, but what would it take to achieve them? This paper assesses what is neededmore » to achieve goals for universal and sustainable access to infrastructure, specifically water, energy and transport. Using illustrative goals and targets, the paper reviews the development challenges in each sector, and what will be necessary to overcome the barriers to universal and sustainable access to water, energy and transport infrastructure services, in the areas of governance, finance, capacity development and environmental protection. The paper ends with general conclusions about infrastructure in the post-2015 development agenda.« less

The Roles of Individual and Organizational Factors in Burnout among Community-Based Mental Health Service Providers

PubMed Central

Green, Amy E.; Albanese, Brian J.; Shapiro, Nicole M.; Aarons, Gregory A.

2014-01-01

Public sector mental health care providers are at high risk for burnout which negatively affects not only provider well-being but also the quality of services for clients and the functioning of organizations. This study examines the influence of demographics, work characteristic, and organizational variables on levels of burnout among child and adolescent mental health service providers operating within a public sector mental health service system. Additionally, given the dearth of research examining differences in burnout levels among mental health sub-disciplines (e.g., social work, psychology, marital and family therapy) and mental health programs (e.g., outpatient, day treatment, Wraparound, case management), analyses were conducted to compare levels of burnout among multiple mental health disciplines and program types. Surveys were completed by 285 providers across 49 mental health programs in a large urban public mental health system. Variables representing dimensions of organizational climate and transformational leadership accounted for the greatest amount of variance in provider reported burnout. Analyses demonstrated significantly lower levels of depersonalization among Wraparound providers compared to traditional case managers. Age was the only demographic variable related to burnout. Additionally, no significant effects were found for provider discipline or for agency tenure and caseload size. Results suggest the need to consider organizational development strategies aimed at creating more functional and less stressful climates and increasing levels of transformational leadership behaviors in order to reduce levels of burnout among clinicians working in public mental health settings for youth and families. PMID:24564442

Assessment of an Innovative Voluntary Substance Abuse Treatment Program Designed to Replace Compulsory Drug Detention Centers in Malaysia

PubMed Central

Khan, Farrah; Krishnan, Archana; Ghani, Mansur A.; Wickersham, Jeffrey A.; Fu, Jeannia J.; Lim, Sin How; Dhaliwal, Sangeeth Kaur; Kamarulzaman, Adeeba; Altice, Frederick L.

2017-01-01

Background As part of an ongoing initiative by the Malaysian government to implement alternative approaches to involuntary detention of people who use drugs, the National Anti-Drug Agency has created new voluntary drug treatment programs known as Cure and Care (C&C) Centers that provide free access to addiction treatment services, including methadone maintenance therapy, integrated with social and health services. Objectives We evaluated early treatment outcomes and client satisfaction among patients accessing C&C treatment and ancillary services at Malaysia’s second C&C Center located in Kota Bharu, Kelantan. Methods In June–July 2012, a cross-sectional convenience survey of 96 C&C inpatients and outpatients who entered treatment >30 days previously was conducted to assess drug use, criminal justice experience, medical co-morbidities, motivation for seeking treatment, and attitudes towards the C&C. Drug use was compared for the 30-day-period before C&C entry and the 30-day-period before the interview. Results Self-reported drug use levels decreased significantly among both inpatient and outpatient clients after enrolling in C&C treatment. Higher levels of past drug use, lower levels of social support, and more severe mental health issues were reported by participants who were previously imprisoned. Self-reported satisfaction with C&C treatment services was high. Conclusions/Importance Preliminary evidence of reduced drug use and high levels of client satisfaction among C&C clients provide support for Malaysia’s ongoing transition from compulsory drug detention centers (CDDCs) to these voluntary drug treatment centers. If C&C centers are successful, Malaysia plans to gradually transition away from CDDCs entirely. PMID:28635521

Evaluation of emergency department nursing services and patient satisfaction of services.

PubMed

Mollaoğlu, Mukadder; Çelik, Pelin

2016-10-01

To identify nursing services and assess patient satisfaction in patients who present to the emergency department. Emergency nursing care is a significant determinant of patient satisfaction. Patient satisfaction is often regarded as a reliable indicator of the quality of services provided in the emergency department. This is a descriptive study. Eighty-four patients who presented to the university emergency department were included in the study. The study data were collected by the Patient Information Form and the Satisfaction Level Form. Emergency nursing services, including history taking, assessing vital signs, preparing the patient for an emergency intervention, oxygen therapy, drug delivery and blood-serum infusion were shown to be more commonly provided compared with other services such as counselling the patients and the relatives about their care or delivering educational and psychosocial services. However, 78·6% of the patients were satisfied with their nursing services. The highest satisfaction rates were observed in the following sub-dimensions of the Satisfaction Level Form: availability of the nurse (82·1%), behaviour of the nurse towards the patient (78·6%) and the frequency of nursing rounds (77·4%). The most common practices performed by nurses in the emergency department were physical nursing services. Patient satisfaction was mostly associated with the availability of nurses when they were needed. Our results suggest that in addition to the physical care, patients should also receive education and psychosocial care in the emergency department. We believe that this study will contribute to the awareness and understanding of principles and concepts of emergency nursing, extend the limits of nursing knowledge and abilities, and improve and maintain the quality of clinical nursing education and practice to train specialist nurses with high levels of understanding in ethical, intellectual, administrative, investigative and professional issues. © 2016 John Wiley & Sons Ltd.

Sea Level Station Metadata for Tsunami Detection, Warning and Research

NASA Astrophysics Data System (ADS)

Stroker, K. J.; Marra, J.; Kari, U. S.; Weinstein, S. A.; Kong, L.

2007-12-01

The devastating earthquake and tsunami of December 26, 2004 has greatly increased recognition of the need for water level data both from the coasts and the deep-ocean. In 2006, the National Oceanic and Atmospheric Administration (NOAA) completed a Tsunami Data Management Report describing the management of data required to minimize the impact of tsunamis in the United States. One of the major gaps defined in this report is the access to global coastal water level data. NOAA's National Geophysical Data Center (NGDC) and National Climatic Data Center (NCDC) are working cooperatively to bridge this gap. NOAA relies on a network of global data, acquired and processed in real-time to support tsunami detection and warning, as well as high-quality global databases of archived data to support research and advanced scientific modeling. In 2005, parties interested in enhancing the access and use of sea level station data united under the NOAA NCDC's Integrated Data and Environmental Applications (IDEA) Center's Pacific Region Integrated Data Enterprise (PRIDE) program to develop a distributed metadata system describing sea level stations (Kari et. al., 2006; Marra et.al., in press). This effort started with pilot activities in a regional framework and is targeted at tsunami detection and warning systems being developed by various agencies. It includes development of the components of a prototype sea level station metadata web service and accompanying Google Earth-based client application, which use an XML-based schema to expose, at a minimum, information in the NOAA National Weather Service (NWS) Pacific Tsunami Warning Center (PTWC) station database needed to use the PTWC's Tide Tool application. As identified in the Tsunami Data Management Report, the need also exists for long-term retention of the sea level station data. NOAA envisions that the retrospective water level data and metadata will also be available through web services, using an XML-based schema. Five high-priority metadata requirements identified at a water level workshop held at the XXIV IUGG Meeting in Perugia will be addressed: consistent, validated, and well defined numbers (e.g. amplitude); exact location of sea level stations; a complete record of sea level data stored in the archive; identifying high-priority sea level stations; and consistent definitions. NOAA's National Geophysical Data Center (NGDC) and co-located World Data Center for Solid Earth Geophysics (including tsunamis) would hold the archive of the sea level station data and distribute the standard metadata. Currently, NGDC is also archiving and distributing the DART buoy deep-ocean water level data and metadata in standards based formats. Kari, Uday S., John J. Marra, Stuart A. Weinstein, 2006 A Tsunami Focused Data Sharing Framework For Integration of Databases that Describe Water Level Station Specifications. AGU Fall Meeting, 2006. San Francisco, California. Marra, John, J., Uday S. Kari, and Stuart A. Weinstein (in press). A Tsunami Detection and Warning-focused Sea Level Station Metadata Web Service. IUGG XXIV, July 2-13, 2007. Perugia, Italy.

[Models of care and classification of "Children with special health care needs-CSHCN": Recommendations from the CSHCN Committee, Chilean Paediatric Society].

PubMed

Flores Cano, Juan Carlos; Lizama Calvo, Macarena; Rodríguez Zamora, Natalie; Ávalos Anguita, María Eugenia; Galanti De La Paz, Mónica; Barja Yañez, Salesa; Becerra Flores, Carlos; Sanhueza Sepúlveda, Carolina; Cabezas Tamayo, Ana María; Orellana Welch, Jorge; Zillmann Geerdts, Gisela; Antilef, Rosa María; Cox Melane, Alfonso; Valle Maluenda, Marcelo; Vargas Catalán, Nelson

2016-01-01

"Children with special health care needs" (CSHCN) is an emerging and heterogeneous group of paediatric patients, with a wide variety of medical conditions and with different uses of health care services. There is consensus on how to classify and assess these patients according to their needs, but not for their specific diagnosis. Needs are classified into 6 areas: a) specialised medical care; b) use or need of prescription medication; c) special nutrition; d) dependence on technology; e) rehabilitation therapy for functional limitation; and f) special education services. From the evaluation of each area, a classification for CSHCN is proposed according to low, medium, or high complexity health needs, to guide and distribute their care at an appropriate level of the health care system. Low complexity CSHCN should be incorporated into Primary Care services, to improve benefits for patients and families at this level. It is critical to train health care professionals in taking care of CSHCN, promoting a coordinated, dynamic and communicated work between different levels of the health care system. Compliance with these guidelines will achieve a high quality and integrated care for this vulnerable group of children. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Phoenix: SOA based information management services

NASA Astrophysics Data System (ADS)

Grant, Rob; Combs, Vaughn; Hanna, Jim; Lipa, Brian; Reilly, Jim

2009-05-01

The Air Force Research Laboratory (AFRL) has developed a reference set of Information Management (IM) Services that will provide an essential piece of the envisioned final Net-Centric IM solution for the Department of Defense (DoD). These IM Services will provide mission critical functionality to enable seamless interoperability between existing and future DoD systems and services while maintaining a highly available IM capability across the wide spectrum of differing scalability and performance requirements. AFRL designed this set of IM Services for integration with other DoD and commercial SOA environments. The services developed will provide capabilities for information submission, information brokering and discovery, repository, query, type management, dissemination, session management, authorization, service brokering and event notification. In addition, the IM services support common information models that facilitate the management and dissemination of information consistent with client needs and established policy. The services support flexible and extensible definitions of session, service, and channel contexts that enable the application of Quality of Service (QoS) and security policies at many levels within the SOA.

Scalable service architecture for providing strong service guarantees

NASA Astrophysics Data System (ADS)

Christin, Nicolas; Liebeherr, Joerg

2002-07-01

For the past decade, a lot of Internet research has been devoted to providing different levels of service to applications. Initial proposals for service differentiation provided strong service guarantees, with strict bounds on delays, loss rates, and throughput, but required high overhead in terms of computational complexity and memory, both of which raise scalability concerns. Recently, the interest has shifted to service architectures with low overhead. However, these newer service architectures only provide weak service guarantees, which do not always address the needs of applications. In this paper, we describe a service architecture that supports strong service guarantees, can be implemented with low computational complexity, and only requires to maintain little state information. A key mechanism of the proposed service architecture is that it addresses scheduling and buffer management in a single algorithm. The presented architecture offers no solution for controlling the amount of traffic that enters the network. Instead, we plan on exploiting feedback mechanisms of TCP congestion control algorithms for the purpose of regulating the traffic entering the network.

Assessment of antiretroviral treatment (ART) care service provision in Tigray Region health centers, North Ethiopia.

PubMed

Tessema, Shewaye Belay; Adane, Mesafint Molla

2015-09-10

Client satisfaction is a vital component and main concern intertwined with strategic decisions in service provisions. To improve efficiency of services, eliciting the opinion of users about the available services and identifying factors associated with dissatisfaction is very critical. Thus, the main objective of this study was to assess the perceived levels of clients' satisfaction with health services at ART clinic level in health centres of Tigray Region in Ethiopia. Cross sectional study was conducted from May to June 2013 in Tigray Region ART clinics. A total of 714 ART care user were included in the study using both purposive and probability sampling technique. Data was collected by using structured questionnaire and the collected data was analysed using Statistical Package for the Social Sciences (SPSS) version 16.0. Crude and Adjusted logistic regression analyses were carried out to identify the associated factors underlying perceived levels of clients' overall satisfaction. Finally, the results were presented with table as well as odds ratio (OR) and 95% confidence interval (CI). A total of 714 study participants were enrolled in this study. An overall satisfaction level of 89.6% was reported by ART care service users. Higher scores of satisfaction of services provisions were reported for courtesy and respect (95.80%) followed by privacy (93.28%). On the other hand, respondents' dissatisfaction was rated 35.32% for toilet cleanliness followed by 26.19% for availability of additional drugs. As for overall satisfaction and associated factors, adjusted logistic regression analyses showed that marital status [AOR = 2.01 (95% CI: 1.11, 3.60)], educational status [AOR = 3.13 (95% CI: 1.15, 8.53)], travel distance to reach health centre [AOR = 3.59 (95% CI: 1.23, 10.50)], toilet cleanliness [AOR = 2.22 (95% CI :1.62, 6.32)], and ART drug availability [AOR = 2.60 (95% CI :1.18, 6.52)] were found to have influence on overall ART service satisfaction status. This study revealed high level of client satisfaction rate and were associated with preventable and modifiable factors such as marital status, educational status, travel distance to reach health centre, toilet cleanliness and ART drug availability. Therefore, countermeasures such as increasing access to ART service, availing clean toilet and ART drugs may further increase client satisfaction level in the region.

A partial test of a hospital behavioral model.

PubMed

Hornbrook, M C; Goldfarb, M G

1983-01-01

The influence of hospital and community characteristics on the behavior of five dimensions of hospital output is examined in this article. These dimensions are the level of emergency stand-by capacity, total admissions, the diagnosis-mix of admissions and the hospital's 'style of practice' with regard to ancillary services and length of stay. A simultaneous equations model is estimated with data from a sample of 63 New England short-term general hospitals for 1970. The findings suggest that various types of short-term general hospitals have distinctive preferences for emergency capacity, volume, case mix and style of practice, and that style of practice may be more appropriately viewed as a rate of resource use per day. Specific findings of interest include the positive interdependence between protection against running out of emergency beds and length of stay, and between length of stay and ancillary service use. Hospitals that admit greater numbers of patients tend to treat more severely ill patients, and sicker patients tend to go to larger hospitals. Hospitals that provide more ancillary services tend to attract the more acutely ill patients. Relationships among other elements of the hospital's utility function represent trade-offs, i.e. substitution, in a constrained world. Among the exogenous factors, patient preferences and ability to pay have strong associations with the types of care provided by hospitals. Highly educated, high income communities, for example, tend to prefer risk averse, service intensive hospital output. Teaching hospitals are shown to prefer higher protection levels, service-intensive patterns of care, and higher admissions levels. Self-paying patients tend to be admitted for more discretionary types of diagnoses and to receive longer diagnosis-specific lengths of stay. A relatively greater supply of physician specialists in the market area is associated with increased use of ancillary services in the hospital. If replicated, these results have significant policy implications for reimbursing teaching hospitals; for defining accessibility of hospital care for the uninsured; for identifying the practice of 'skimming' by proprietary hospitals; and for specifying the role of community preferences in determining hospital performance, especially with respect to quality of care and level of emergency stand-by capacity.

Prevalence of type I sensitization to alpha-gal in forest service employees and hunters.

PubMed

Fischer, J; Lupberger, E; Hebsaker, J; Blumenstock, G; Aichinger, E; Yazdi, A S; Reick, D; Oehme, R; Biedermann, T

2017-10-01

The production of IgE molecules specific to the carbohydrate galactose-α-1,3-galactose (alpha-gal) is known to induce delayed anaphylaxis against mammalian meat. Tick bites constitute the primary sensitization source, as ticks transfer alpha-gal in their saliva to a host during a bite. The reported prevalence of alpha-gal-specific IgE (alpha-gal-sIgE) positivity varies between different populations from diverse geographic regions. To investigate the prevalence of alpha-gal-sIgE positivity in a population of forest service employees who are highly exposed to ticks in comparison with a residential population and a historic sample. A cross-sectional study evaluating 300 forest service employees and hunters from southwest Germany was performed. Alpha-gal-sIgE levels were assessed by ImmunoCAP assay. The prevalence of alpha-gal-sIgE-positive individuals was compared with a matched cohort composed of a residential population and blood samples from forest service employees collected 15 years ago. In the study population, the prevalence of alpha-gal-sIgE-positive (≥0.10 kU A /L) individuals was 35.0%, whereas the prevalence of individuals with alpha-gal-sIgE levels ≥0.35 kU A /L was 19.3%. Alpha-gal-sIgE positivity was associated with total IgE levels and recent tick bites. Mammalian meat-induced delayed anaphylaxis was found in 8.6% of the participants with alpha-gal-sIgE levels ≥0.35 kU A /L. For forest service employees and hunters, the odds ratio for alpha-gal-sIgE positivity was 2.48 compared to the residential population. The prevalence of alpha-gal-sIgE positivity in the current and historic cohort was comparable. Forest service employees and hunters compose a population with a high prevalence of alpha-gal-sIgE positivity and carry a considerable risk of red meat allergy. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study

PubMed Central

2011-01-01

Background The assessment of those presenting to prison in-reach and court diversion services and those referred for admission to mental health services is a triage decision, allocating the patient to the appropriate level of therapeutic security. This is a critical clinical decision. We set out to improve on unstructured clinical judgement. We collated qualitative information and devised an 11 item structured professional judgment instrument for this purpose then tested for validity. Methods All those assessed following screening over a three month period at a busy remand committals prison (n = 246) were rated in a retrospective cohort design blind to outcome. Similarly, all those admitted to a mental health service from the same prison in-reach service over an overlapping two year period were rated blind to outcome (n = 100). Results The 11 item scale had good internal consistency (Cronbach's alpha = 0.95) and inter-rater reliability. The scale score did not correlate with the HCR-20 'historical' score. For the three month sample, the receiver operating characteristic area under the curve (AUC) for those admitted to hospital was 0.893 (95% confidence interval 0.843 to 0.943). For the two year sample, AUC distinguished at each level between those admitted to open wards, low secure units or a medium/high secure service. Open wards v low secure units AUC = 0.805 (95% CI 0.680 to 0.930); low secure v medium/high secure AUC = 0.866, (95% CI 0.784 to 0.949). Item to outcome correlations were significant for all 11 items. Conclusions The DUNDRUM-1 triage security scale and its items performed to criterion levels when tested against the real world outcome. This instrument can be used to ensure consistency in decision making when deciding who to admit to secure forensic hospitals. It can also be used to benchmark admission thresholds between services and jurisdictions. In this study we found some divergence between assessed need and actual placement. This provides fertile ground for future research as well as practical assistance in assessing unmet need, auditing case mix and planning care pathways. PMID:21410967

Quality of care in reproductive health programmes: education for quality improvement.

PubMed

Kwast, B E

1998-09-01

The provision of high quality maternity care will make the difference between life and death or lifelong maiming for millions of pregnant women. Barriers preventing access to affordable, appropriate, acceptable and effective services, and lack of facilities providing high quality obstetric care result in about 1600 maternal deaths every day. Education in its broadest sense is required at all levels and sectors of society to enhance policy formulation that will strengthen programme commitment, improve services with a culturally sensitive approach and ensure appropriate delegation of responsibility to health staff at peripheral levels. This paper is the second in series of three which addresses quality of care. The first (Kwast 1998) contains an overview of concepts, assessments, barriers and improvements of quality of care. The third article will describe selected aspects of monitoring and evaluation of quality of care.

Realising the Real Benefits of Outsourcing: Measurement Excellence and Its Importance in Achieving Long Term Value

NASA Astrophysics Data System (ADS)

Oshri, Ilan; Kotlarsky, Julia

These days firms are, more than ever, pressed to demonstrate returns on their investment in outsourcing. While the initial returns can always be associated with one-off cost cutting, outsourcing arrangements are complex, often involving inter-related high-value activities, which makes the realisation of long-term benefits from outsourcing ever more challenging. Executives in client firms are no longer satisfied with the same level of service delivery through the outsourcing lifecycle. They seek to achieve business transformation and innovation in their present and future services, beyond satisfying service level agreements (SLAs). Clearly the business world is facing a new challenge: an outsourcing delivery system of high-value activities that demonstrates value over time and across business functions. However, despite such expectations, many client firms are in the dark when trying to measure and quantify the return on outsourcing investments: results of this research show that less than half of all CIOs and CFOs (43%) have attempted to calculate the financial impact of outsourcing to their bottom line, indicating that the financial benefits are difficult to quantify (51%).

Digital Health Services and Digital Identity in Alberta.

PubMed

McEachern, Aiden; Cholewa, David

2017-01-01

The Government of Alberta continues to improve delivery of healthcare by allowing Albertans to access their health information online. Alberta is the only province in Canada with provincial electronic health records for all its citizens. These records are currently made available to medical practitioners, but Alberta Health believes that providing Albertans access to their health records will transform the delivery of healthcare in Alberta. It is important to have a high level of assurance that the health records are provided to the correct Albertan. Alberta Health requires a way for Albertans to obtain a digital identity with a high level of identity assurance prior to releasing health records via the Personal Health Portal. Service Alberta developed the MyAlberta Digital ID program to provide a digital identity verification service. The Ministry of Health is leveraging MyAlberta Digital ID to enable Albertans to access their personal health records through the Personal Health Portal. The Government of Alberta is advancing its vision of patient-centred healthcare by enabling Albertans to access a trusted source for health information and their electronic health records using a secure digital identity.

Reassurance as a key outcome valued by emergency ambulance service users: a qualitative interview study.

PubMed

Togher, Fiona J; O'Cathain, Alicia; Phung, Viet-Hai; Turner, Janette; Siriwardena, Aloysius Niroshan

2015-12-01

There is an increasing need to assess the performance of emergency ambulance services using measures other than the time taken for an ambulance to arrive on scene. In line with government policy, patients and carers can help to shape new measures of ambulance service performance. To investigate the aspects of emergency ambulance service care valued by users. Qualitative interview study. One of 11 ambulance services in England. Twenty-two users and eight of their spouses (n = 30). Users of the emergency ambulance service, experiencing different types of ambulance service response, valued similar aspects of their pre-hospital care. Users were often extremely anxious about their health, and the outcome they valued was reassurance provided by ambulance service staff that they were receiving appropriate advice, treatment and care. This sense of being reassured was enhanced by the professional behaviour of staff, which instilled confidence in their care; communication; a short wait for help; and continuity during transfers. A timely response was valued in terms of allaying anxiety quickly. The ability of the emergency ambulance service to allay the high levels of fear and anxiety felt by users is crucial to the delivery of a high quality service. Measures developed to assess and monitor the performance of emergency ambulance services should include the proportion of users reporting feeling reassured by the response they obtained. © 2014 John Wiley & Sons Ltd.

In-Service Teachers’ Understanding on the Concept of Limits and Derivatives and the Way They Deliver the Concepts to Their High School Students

NASA Astrophysics Data System (ADS)

Desfitri, Rita

2016-02-01

The aim of this study was to analyze the teachers’ understanding on the concept of limits and derivative and the way they deliver the subjects to their students. The study was divided into two main phases during two years of research. This research was conducted in 7 high schools vary from general, Islamic and occasional schools. The participants of the study were 20 in-service mathematics teachers from 7 high schools. Questioners were given to find out how teachers’ understanding on the concepts and how they organized their class. The teachers’ level of complexity on the subject was analyzed by Structure of the Observed Learning Outcome (SOLO) Taxonomy, and teachers’ class organizations was analyzed by assessing and classifying their responds written on the questioner sheets and discussion with the selected participants.. Based on the data, it can be figured out that the most teachers’ position were on third level out of five level of SOLO Taxonomy. Data also told us that half of the teachers experienced the difficulties in teaching the concept due to their limitations on mastering subject. Data also showed that there is a relevance between teachers’ level of understanding and teachers’ ability in delivering subject to their students.

A hybrid of monopoly and perfect competition model for hi-tech products

NASA Astrophysics Data System (ADS)

Yang, P. C.; Wee, H. M.; Pai, S.; Yang, H. J.; Wee, P. K. P.

2010-11-01

For Hi-tech products, the demand rate, the component cost as well as the selling price usually decline significantly with time. In the case of perfect competition, shortages usually result in lost sales; while in a monopoly, shortages will be completely backordered. However, neither perfect competition nor monopoly exists. Therefore, there is a need to develop a replenishment model considering a hybrid of perfect competition and monopoly when the cost, price and demand are decreasing simultaneously. A numerical example and sensitivity analysis are carried out to illustrate this model. The results show that a higher decline-rate in the component cost leads to a smaller service level and a larger replenishment interval. When the component cost decline rate increases and the selling price decline rate decreases simultaneously, the replenishment interval decreases. In perfect competition it is better to have a high service level, while for the case with monopoly, keeping a low service level is better due to complete backordering.

Institutionalizing and sustaining social change in health systems: the case of Uganda.

PubMed

Hage, Jerald; Valadez, Joseph J

2017-11-01

The key to high impact health services is institutionalizing and sustaining programme evaluation. Uganda represents a success story in the use of a specific programme evaluation method: Lot Quality Assurance Sampling (LQAS). Institutionalization is defined by two C's: competent programme evaluators and control mechanisms that effectively use evaluation data to improve health services. Sustainability means continued training and funding for the evaluation approach. Social science literature that researches institutionalization has emphasized 'stability', whereas in global health, the issue is determining how to improve the impact of services by 'changing' programmes. In Uganda, we measured the extent of the institutionalization and sustainability of evaluating programmes that produce change in nine districts sampled to represent three largely rural regions and varying levels of effective health programmes. We used the proportion of mothers with children aged 0-11 months who delivered in a health facility as the principal indicator to measure programme effectiveness. Interviews and focus groups were conducted among directors, evaluation supervisors, data collectors in the district health offices, and informant interviews conducted individually at the central government level. Seven of the nine districts demonstrated a high level of institutionalization of evaluation. The two others had only conducted one round of programme evaluation. When we control for the availability of health facilities, we find that the degree of institutionalization is moderately related to the prevalence of the delivery of a baby in a health facility. Evaluation was institutionalized at the central government level. Sustainability existed at both levels. Several measures indicate that lessons from the nine district case studies may be relevant to the 74 districts that had at least two rounds of programme evaluation. We note that there is an association between the evaluation data being used to change health services, and the four separate indicators being used to measure women's health and child survival services. We conclude that the two C's (competent evaluators and control mechanisms) have been critical for sustaining programme evaluation in Uganda. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Institutionalizing and sustaining social change in health systems: the case of Uganda

PubMed Central

Hage, Jerald; Valadez, Joseph J

2017-01-01

Abstract The key to high impact health services is institutionalizing and sustaining programme evaluation. Uganda represents a success story in the use of a specific programme evaluation method: Lot Quality Assurance Sampling (LQAS). Institutionalization is defined by two C’s: competent programme evaluators and control mechanisms that effectively use evaluation data to improve health services. Sustainability means continued training and funding for the evaluation approach. Social science literature that researches institutionalization has emphasized ‘stability’, whereas in global health, the issue is determining how to improve the impact of services by ‘changing’ programmes. In Uganda, we measured the extent of the institutionalization and sustainability of evaluating programmes that produce change in nine districts sampled to represent three largely rural regions and varying levels of effective health programmes. We used the proportion of mothers with children aged 0–11 months who delivered in a health facility as the principal indicator to measure programme effectiveness. Interviews and focus groups were conducted among directors, evaluation supervisors, data collectors in the district health offices, and informant interviews conducted individually at the central government level. Seven of the nine districts demonstrated a high level of institutionalization of evaluation. The two others had only conducted one round of programme evaluation. When we control for the availability of health facilities, we find that the degree of institutionalization is moderately related to the prevalence of the delivery of a baby in a health facility. Evaluation was institutionalized at the central government level. Sustainability existed at both levels. Several measures indicate that lessons from the nine district case studies may be relevant to the 74 districts that had at least two rounds of programme evaluation. We note that there is an association between the evaluation data being used to change health services, and the four separate indicators being used to measure women's health and child survival services. We conclude that the two C’s (competent evaluators and control mechanisms) have been critical for sustaining programme evaluation in Uganda. PMID:28981663

Do guidelines influence the implementation of health programs? — Uganda’s experience

PubMed Central

2012-01-01

Background A guideline contains processes and procedures intended to guide health service delivery. However, the presence of guidelines may not guarantee their implementation, which may be a result of weaknesses in the development process. This study was undertaken to describe the processes of developing health planning, services management, and clinical guidelines within the health sector in Uganda, with the goal of understanding how these processes facilitate or abate the utility of guidelines. Methods Qualitative and quantitative research methods were used to collect and analyze data. Data collection was undertaken at the levels of the central Ministry of Health, the district, and service delivery. Qualitative methods included review of documents, observations, and key informant interviews, as well as quantitative aspects included counting guidelines. Quantitative data were analyzed with Microsoft Excel, and qualitative data were analyzed using deductive content thematic analysis. Results There were 137 guidelines in the health sector, with programs related to Millennium Development Goals having the highest number (n = 83). The impetus for guideline development was stated in 78% of cases. Several guidelines duplicated content, and some conflicted with each other. The level of consultation varied, and some guidelines did not consider government-wide policies and circumstances at the service delivery level. Booklets were the main format of presentation, which was not tailored to the service delivery level. There was no framework for systematic dissemination, and target users were defined broadly in most cases. Over 60% of guidelines available at the central level were not available at the service delivery level, but there were good examples in isolated cases. There was no framework for systematic monitoring of use, evaluation, and review of guidelines. Suboptimal performance of the supervision framework that would encourage the use of guidelines, assess their utilization, and provide feedback was noted. Conclusions Guideline effectiveness is compromised by the development process. To ensure the production of high-quality guidelines, efforts must be employed at the country and regional levels. The regional level can facilitate pooling resources and expertise in knowledge generation, methodology development, guideline repositories, and capacity building. Countries should establish and enforce systems and guidance on guideline development. PMID:23068082

Measurement of patient satisfaction with community pharmacy services: a review.

PubMed

Naik Panvelkar, Pradnya; Saini, Bandana; Armour, Carol

2009-10-01

The aim of this review is to conduct an in-depth analysis of the available literature in order to identify and evaluate studies measuring patient satisfaction with pharmacy services delivered by pharmacists in a community setting. An extensive literature search was conducted in five databases (Medline, Scopus, Embase, Psychinfo, International Pharmaceutical Abstracts) using the search terms "patient/client/consumer satisfaction" AND "community pharmacy/pharmacies" AND "pharmacy service/pharmaceutical services/pharmacy program/intervention/intervention studies". Only those articles where the main focus was measuring patient satisfaction with services delivered in community pharmacies were included in the review. Patient satisfaction was explored with three different levels of pharmacy services -- general services, intervention services and cognitive services. Twenty-four articles measuring patient satisfaction with community pharmacy services were retrieved. Of these, eleven measured patient satisfaction with general services, six measured satisfaction with intervention services and seven measured satisfaction with cognitive services. The majority of studies reviewed had adopted and measured satisfaction as a multidimensional construct. None of the studies reviewed tested any theoretical models of satisfaction. Further a lack of consistent instruments measuring patient satisfaction was observed, with most of the reviewed studies using self developed, non-validated or ad hoc instruments with items from various previously published papers. The review also observed high levels of patient satisfaction with pharmacy services be they general, intervention or cognitive services. This review found that patient satisfaction has been measured within the community pharmacy context to a certain degree. Further research is needed to develop and test instruments based on theoretical frameworks, to test satisfaction pre and post hoc and in well designed randomized controlled trials and to measure changes in satisfaction over time. Novel approaches involving an understanding of expectations and preferences of patients and matching these to the services provided also need to be explored.

Context-Awareness Based Personalized Recommendation of Anti-Hypertension Drugs.

PubMed

Chen, Dexin; Jin, Dawei; Goh, Tiong-Thye; Li, Na; Wei, Leiru

2016-09-01

The World Health Organization estimates that almost one-third of the world's adult population are suffering from hypertension which has gradually become a "silent killer". Due to the varieties of anti-hypertensive drugs, patients are interested in how these drugs can be selected to match their respective conditions. This study provides a personalized recommendation service system of anti-hypertensive drugs based on context-awareness and designs a context ontology framework of the service. In addition, this paper introduces a Semantic Web Rule Language (SWRL)-based rule to provide high-level context reasoning and information recommendation and to overcome the limitation of ontology reasoning. To make the information recommendation of the drugs more personalized, this study also devises three categories of information recommendation rules that match different priority levels and uses a ranking algorithm to optimize the recommendation. The experiment conducted shows that combining the anti-hypertensive drugs personalized recommendation service context ontology (HyRCO) with the optimized rule reasoning can achieve a higher-quality personalized drug recommendation service. Accordingly this exploratory study of the personalized recommendation service for hypertensive drugs and its method can be easily adopted for other diseases.

Renewable Electricity Futures (Presentation)

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

Hand, M. M.

2012-08-01

This presentation library summarizes findings of NREL's Renewable Electricity Futures study, published in June 2012. RE Futures investigated the challenges and impacts of achieving very high renewable electricity generation levels in the contiguous United States by 2050. It was presented to the 2012 Western Conference of Public Service Commissioners, during their June, 2012, meeting. The Western Conference of Public Service Commissioners is a regional association within the National Association of Regulatory Utility Commissioners (NARUC).

CHIPS. Volume 29, Issue 1, January - March 2011

DTIC Science & Technology

2011-03-01

services, like electricity, heating or cable television. Bank/Finance Fraud: • They may create counterfeit checks using their victim’s name or...consolidating disparate, stove- piped networks into a single, modern, cost-effective enterprise network with a high level of service that meets...Holland, NGEN program manager. “If NMCI is not the most secure network in the world, it is certainly close. There is no shortfall flexibility

Investigating the Impact of Working in Multi-Agency Service Delivery Settings in the UK on Early Years Practitioners' Beliefs and Practices

ERIC Educational Resources Information Center

Anning, Angela

2005-01-01

In the UK Centres of Excellence were funded by the DfES to model high quality, multi-agency, early years services for young children and their families. They were precursors to Children's Centres to be established across the UK. Early Excellence Centres were evaluated at national and local levels. This article will draw on data from local…

Participation of patients and family members in healthcare services at the service and national levels: A lesson learned in Dublin, Ireland.

PubMed

Whiston, Lucy; Barry, Joe M; Darker, Catherine D

2017-03-01

Identify the current amount and intensity of patient and family participation at the patient, service and national levels from a diabetes and a psychiatric service perspective. Establish the current level of support for greater participation and related characteristics. Researcher-administered questionnaires were conducted with 738 patients and family members in an outpatient type 2 diabetes service and an outpatient psychiatric service, both in Dublin, Ireland. Patient and family participation at the service and national levels are restricted to the provision of information. Typically no involvement in discussions or the decision -making process is reported. The majority of participants favour greater patient participation at the service level (537/669; 80.3%) and the national level (561/651; 86.2%). Greater support for patient and family member participation is significantly associated with participant's age, service satisfaction and level of education. Patient and family participation is greatest at the patient level. The majority of patients and family members support greater participation at the service and national levels. The best way to implement participation needs to be identified. There needs to be a greater focus on participation at the service level. The role of family members also needs to be investigated further. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Population level of unmet need for mental healthcare in Europe.

PubMed

Alonso, Jordi; Codony, Miquel; Kovess, Viviane; Angermeyer, Matthias C; Katz, Steven J; Haro, Josep M; De Girolamo, Giovanni; De Graaf, Ron; Demyttenaere, Koen; Vilagut, Gemma; Almansa, Josué; Lépine, Jean Pierre; Brugha, Traolach S

2007-04-01

The high prevalence of mental disorders has fuelled controversy about the need for mental health services. To estimate unmet need for mental healthcare at the population level in Europe. As part of the European Study of Epidemiology of Mental Disorders (ESEMeD) project, a cross-sectional survey was conducted of representative samples of the adult general population of Belgium, France, Germany, Italy, The Netherlands and Spain (n=8796). Mental disorders were assessed with the Composite International Diagnostic Interview 3.0. Individuals with a 12-month mental disorder that was disabling or that had led to use of services in the previous 12 months were considered in need of care. About six per cent of the sample was defined as being in need of mental healthcare. Nearly half (48%) of these participants reported no formal healthcare use. In contrast, only 8% of the people with diabetes had reported no use of services for their physical condition. In total, 3.1% of the adult population had an unmet need for mental healthcare. About 13% of visits to formal health services were made by individuals without any mental morbidity. There is a high unmet need for mental care in Europe, which may not be eliminated simply by reallocating existing healthcare resources.

Architecture of a framework for providing information services for public transport.

PubMed

García, Carmelo R; Pérez, Ricardo; Lorenzo, Alvaro; Quesada-Arencibia, Alexis; Alayón, Francisco; Padrón, Gabino

2012-01-01

This paper presents OnRoute, a framework for developing and running ubiquitous software that provides information services to passengers of public transportation, including payment systems and on-route guidance services. To achieve a high level of interoperability, accessibility and context awareness, OnRoute uses the ubiquitous computing paradigm. To guarantee the quality of the software produced, the reliable software principles used in critical contexts, such as automotive systems, are also considered by the framework. The main components of its architecture (run-time, system services, software components and development discipline) and how they are deployed in the transportation network (stations and vehicles) are described in this paper. Finally, to illustrate the use of OnRoute, the development of a guidance service for travellers is explained.

Working with sports organizations and teams.

PubMed

McDuff, David R; Garvin, Michelle

2016-12-01

Athletes and coaches at all competitive levels will utilize sports performance and psychiatric services at very high rates if the services are offered on-site and free of charge and are broad in scope and culturally sensitive. Services should be available throughout the team year and cover areas such as team building, mental preparation, stress control, substance prevention, sleep and energy regulation, injury recovery, crisis intervention, and mental disorder treatment. The staff offering these services should be diverse by gender, profession, and culture, and the fees should be paid by the organization. When these services are endorsed by the team's leaders and integrated with the athletic training/medical/player development staff, their utilization will grow quickly and lead to positive outcomes individually and collectively.

Integrating HIV testing and care into tuberculosis services in Benin: programmatic aspects.

PubMed

Ferroussier, O; Dlodlo, R A; Capo-Chichi, D; Boillot, F; Gninafon, M; Trébucq, A; Fujiwara, P I

2013-11-01

Between 2005 and 2008, the diagnosis and care of human immunodeficiency virus (HIV) infection and tuberculosis (TB) services were integrated in Benin. The appointment of a TB-HIV Coordinator by the National Tuberculosis Control Programme and quarterly supervisory visits to TB clinics have bolstered the implementation of integrated HIV-TB activities. HIV testing and cotrimoxazole preventive therapy were integrated smoothly into the TB services. The strategy chosen to facilitate access of HIV-positive TB patients to antiretroviral treatment contributed to greater integration over time, but perpetuated, for some, the burden of attending two facilities. The integration and decentralisation of TB and HIV care services at national level in Benin resulted in a high uptake of HIV services among TB patients.

Callers’ Experiences of Contacting a National Suicide Prevention Helpline

PubMed Central

Coveney, Catherine M.; Pollock, Kristian; Armstrong, Sarah; Moore, John

2012-01-01

Background: Helplines are a significant phenomenon in the mixed economy of health and social care. Given the often anonymous and fleeting nature of caller contact, it is difficult to obtain data about their impact and how users perceive their value. This paper reports findings from an online survey of callers contacting Samaritans emotional support services. Aims: To explore the (self-reported) characteristics of callers using a national suicide prevention helpline and their reasons given for contacting the service, and to present the users’ evaluations of the service they received. Methods: Online survey of a self-selected sample of callers. Results: 1,309 responses were received between May 2008 and May 2009. There were high incidences of expressed suicidality and mental health issues. Regular and ongoing use of the service was common. Respondents used the service for complex and varied reasons and often as part of a network of support. Conclusions: Respondents reported high levels of satisfaction with the service and perceived contact to be helpful. Although Samaritans aims to provide a crisis service, many callers do not access this in isolation or as a last resort, instead contacting the organization selectively and often in tandem with other types of support. PMID:22759662

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

Surface elevation change and susceptibility of different mangrove zones to sea-level rise on Pacific high islands o Micronesia

Treesearch

K.W. Krauss; D.R. Cahoon; J.A. Allen; K.C. Ewel; J.C. Lynch; N. Cormier

2010-01-01

Mangroves on Pacific high islands offer a number of important ecosystem services to both natural ecological communities and human societies. High islands are subjected to constant erosion over geologic time, which establishes an important source of terrigeneous sediment for nearby marinecommunities. Many of these sediments are deposited in mangrove forests and offer...

Five Steps for Developing Effective Transition Plans for High School Students with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Szidon, Katherine; Ruppar, Andrea; Smith, Leann

2015-01-01

Lakeview High School is a medium sized high school in a rural farming community. The staff at Lakeview meets at the beginning of each school year to discuss building-level professional development plans. This year, Lakeview's special education team has requested to focus its professional development time on improving special education services for…

Descriptive study of stress and satisfaction at work in the Saragossa university services and administration staff

PubMed Central

2010-01-01

Background The notion of stress in connection with the work environment became an important topic during the 1970's, when the first studies on the subject were published and the term of work stress was first coined. In 1974, Freudenberger proposed the term burnout to refer to the condition of physical and emotional exhaustion, as well as the associated negative attitudes, resulting from the intense interaction in working with people. The aim of our study is to examine burnout and job satisfaction in Saragossa University Services and Administration Staff (SAS) and detect the main factors which could contribute to too much stress, because job stress has emerged as a major psychosocial influence on mental health, associated with burnout. Methods 24 people from the Services and Administration Staff in the University of Saragossa participated in the study. The research was carried out during the implementation of a module on Stress Management organised by the University of Saragossa and commissioned to the Unit for Research in Physical Therapy (University School of Health Sciences) from that University. This research is an exploratory research to improve the stress management program. A personal interview was carried out and additionally, participants were given the Maslach Burnout Inventory and the Scale of Satisfaction at Work of Warr, Cook & Wall. Results However using small sample this is worth to state that participants present most of them low burnout levels in the burnout scale. Only in one person high exhaustion level was reflected, even though other seven showed mean levels; in the professional self-esteem section, most of them showed high self-esteem, with two cases of low self-esteem and five with mean level. With regard to satisfaction people participating in the study show mean levels in intrinsic as much as in extrinsic factors and general satisfaction. Conclusions Services and Administration Staff from the University of Saragossa shows low burnout levels linked with high professional self-esteem and low emotional exhaustion and depersonalization. It has been found also medium levels in work satisfaction probably related with the continuous quality improvement efforts in the academics environment to create protective factors in decreasing levels of job stress. These results show that not only personality or temperament have an influence on burnout and stress, also the job conditions are related with these diseases. These aspects should be taken into account in the design of stress prevention programme at work. PMID:20409314

Biofuels on the landscape: Is "land sharing" preferable to "land sparing"?

NASA Astrophysics Data System (ADS)

DeLucia, E. H.; Anderson-Teixeira, K. J.; Duval, B. D.; Long, S. P.

2012-12-01

Widespread land use changes—and ensuing effects on biodiversity and ecosystem services—are expected as a result of expanding bioenergy production. Although almost all US production of ethanol today is from corn, it is envisaged that future ethanol production will also draw from cellulosic sources such as perennial grasses. In selecting optimal bioenergy crops, there is debate as to whether it is preferable from an environmental standpoint to cultivate bioenergy crops with high ecosystem services (a "land sharing" strategy) or to grow crops with lower ecosystem services but higher yield, thereby requiring less land to meet bioenergy demand (a "land sparing" strategy). Here, we develop a simple model to address this question. Assuming that bioenergy crops are competing with uncultivated land, our model calculates land requirements to meet a given bioenergy demand intensity based upon the yields of bioenergy crops and combines fractional land cover of each ecosystem type with its associated ecosystem services to determine whether land sharing or land sparing strategies maximize ecosystem services at the landscape level. We apply this model to a case in which climate protection through GHG regulation—an ecosystem's greenhouse gas value (GHGV)—is the ecosystem service of interest. We consider five bioenergy crops competing for land area with five unfarmed ecosystem types in the central and eastern US. Our results show that the relative advantages of land sparing and land sharing depend upon the type of ecosystem with which the bioenergy crop is competing for land; as the GHGV value of the unfarmed land increases, the preferable strategy shifts from land sharing to land sparing. This implies that, while it may be preferable to replace ecologically degraded land with high-GHGV, lower yielding bioenergy crops, average landscape GHGV will most often be maximized through high yielding bioenergy crops that leave more land for uncultivated, high-GHGV ecosystems. While our case study focuses on GHGV, the same principles will be generally applicable to any ecosystem service whose value does not depend upon the spatial configuration of the landscape. Whenever bioenergy crops have substantially lower ecosystem services than the ecosystems with which they are competing for land, the most effective strategy for meeting bioenergy demand while maximizing ecosystem services on a landscape level is one of land sparing—that is, focusing simultaneously on maximizing the yield of bioenergy crops while preserving or restoring natural ecosystems.

Satellite -Based Networks for U-Health & U-Learning

NASA Astrophysics Data System (ADS)

Graschew, G.; Roelofs, T. A.; Rakowsky, S.; Schlag, P. M.

2008-08-01

The use of modern Information and Communication Technologies (ICT) as enabling tools for healthcare services (eHealth) introduces new ways of creating ubiquitous access to high-level medical care for all, anytime and anywhere (uHealth). Satellite communication constitutes one of the most flexible methods of broadband communication offering high reliability and cost-effectiveness of connections meeting telemedicine communication requirements. Global networks and the use of computers for educational purposes stimulate and support the development of virtual universities for e-learning. Especially real-time interactive applications can play an important role in tailored and personalised services.

Restoring California black oak ecosystems to promote tribal values and wildlife

Treesearch

Jonathan W. Long; M. Kat Anderson; Lenya Quinn-Davidson; Ron W. Goode; Frank K. Lake; Carl N. Skinner

2016-01-01

This report synthesizes information to help promote the distinctive ecological and cultural benefits provided by California black oak. Production of abundant, high-quality acorns desired by Native Americans in California, as well as other valued services, requires the presence of mature, broad-crowned trees with low fuel levels and low pest levels. Although black oaks...

Enhancing recovery rates: lessons from year one of IAPT.

PubMed

Gyani, Alex; Shafran, Roz; Layard, Richard; Clark, David M

2013-09-01

The English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines. Data from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7). Data completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff. Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Two-dimensional priority-based dynamic resource allocation algorithm for QoS in WDM/TDM PON networks

NASA Astrophysics Data System (ADS)

Sun, Yixin; Liu, Bo; Zhang, Lijia; Xin, Xiangjun; Zhang, Qi; Rao, Lan

2018-01-01

Wavelength division multiplexing/time division multiplexing (WDM/TDM) passive optical networks (PON) is being viewed as a promising solution for delivering multiple services and applications. The hybrid WDM / TDM PON uses the wavelength and bandwidth allocation strategy to control the distribution of the wavelength channels in the uplink direction, so that it can ensure the high bandwidth requirements of multiple Optical Network Units (ONUs) while improving the wavelength resource utilization. Through the investigation of the presented dynamic bandwidth allocation algorithms, these algorithms can't satisfy the requirements of different levels of service very well while adapting to the structural characteristics of mixed WDM / TDM PON system. This paper introduces a novel wavelength and bandwidth allocation algorithm to efficiently utilize the bandwidth and support QoS (Quality of Service) guarantees in WDM/TDM PON. Two priority based polling subcycles are introduced in order to increase system efficiency and improve system performance. The fixed priority polling subcycle and dynamic priority polling subcycle follow different principles to implement wavelength and bandwidth allocation according to the priority of different levels of service. A simulation was conducted to study the performance of the priority based polling in dynamic resource allocation algorithm in WDM/TDM PON. The results show that the performance of delay-sensitive services is greatly improved without degrading QoS guarantees for other services. Compared with the traditional dynamic bandwidth allocation algorithms, this algorithm can meet bandwidth needs of different priority traffic class, achieve low loss rate performance, and ensure real-time of high priority traffic class in terms of overall traffic on the network.

Stress markers in relation to job strain in human service organizations.

PubMed

Ohlson, C G; Söderfeldt, M; Söderfeldt, B; Jones, I; Theorell, T

2001-01-01

Workers in human service organizations are often confronted with conflicting demands in providing care or education. The aim of this cross-sectional study was to relate levels of endocrine stress markers to perceived job strain in two human service organizations. Employees in two local units of the social insurance organization and two local units of the individual and family care sections of the social welfare in Sweden were selected and 103 employees participated (56% participation rate). The perceived job strain was assessed with a standardized questionnaire containing questions of the demand-control model. Questions specially designed to measure emotional demands were also included. The stress markers cortisol, prolactin, thyroid-stimulating hormone, testosterone and IgA and IgG were analysed in blood samples. The main finding was an association between high emotional strain and increased levels of prolactin. The levels of cortisol, but none of the other four stress markers, increased slightly with emotional strain. Emotional strain experienced in human service work may cause psychological stress. The increase in prolactin was modest but consistent with findings in other published studies on stress-related endocrine alterations. Copyright 2001 S. Karger AG, Basel.

Acoustic pollution in hospital environments

NASA Astrophysics Data System (ADS)

Olivera, J. M.; Rocha, L. A.; Rotger, V. I.; Herrera, M. C.

2011-12-01

There are many different services within a hospital. This means different types of noise which can be considered as acoustic pollution. Knowing that preterm infants exposed to high amounts of noise in the NICU are at a much higher risk because of their neurologic immaturity and physiologic instability, that excessive levels of noise also affect the persons and it can also impede some studies on patients, it was proposed to evaluate the Sound Pressure Level in some services of the Instituto de Maternidad, Tucumán, Argentina. There were evaluated the Level III NICU, the laundry service, a physical space destined for a service of evoked potential and a neonatal incubator under working conditions. The measurements were performed with a type II sonometer (CENTER 322) and it was also used an incubator analyzer (FLUKE INCU) for the incubator. The average values obtained were of 63.6 dBA for the NICU, 82.5dBA for the laundry room, 52.7 dBA for the evoked potential room and 62.8 dBA in the inside of the incubator under 64 dBA in the outside. The reports were documented in compliance with the appropriate standards.

Benchmarking surgeon satisfaction at academic health centers: a nationwide comparative survey.

PubMed

Drachman, D A

1996-01-01

Forty-six academic health centers (AHCs) belonging to the University HealthSystem consortium joined forces to compare the efficiency of their surgical services and to identify best practices. In addition to measures of operational performance, surgeon satisfaction with the surgical services provided was measured by using a standardized questionnaire. From hospital records, indicators of the efficiency of surgical services were collected in three main areas: scheduling, preoperative testing and assessment, and the intraoperative process. Responding to a mail questionnaire, a sample of surgeons rated their satisfaction with key aspects of surgical services including scheduling, operating room staff, and equipment/supplies. On the basis of a review of the operational measures and the survey results, high performers were identified. Site visits were made to several of these high performers to uncover the critical factors responsible for their success. The survey revealed distinct variations in surgeon satisfaction across the participating institutions. Numerical benchmarks were obtained for surgeon satisfaction with each key component of surgical services. Scheduling was the most important component of overall surgeon satisfaction, explaining 71% of the variance in the rating of overall satisfaction with surgical services. High operational efficiency and high surgeon satisfaction were not incompatible. Several of the participating institutions were able to achieve both. These results were disseminated to all of the participants at a national meeting as well as in written form. The surgeon satisfaction survey allowed the participants to establish benchmarks for surgeon satisfaction for each key component of the surgical services they receive. The site visits revealed several common characteristics of highly efficient surgical services. Taken by themselves, the participating institutions might have been reluctant to consider adopting these best practices for fear of alienating the surgical staff. The availability of data on surgeon satisfaction showed the participants that these best practices can coexist with high levels of surgeon satisfaction. This has helped to promote their adoption by the other participating institutions.

Does health facility service environment matter for the receipt of essential newborn care? Linking health facility and household survey data in Malawi.

PubMed

Carvajal-Aguirre, Liliana; Mehra, Vrinda; Amouzou, Agbessi; Khan, Shane M; Vaz, Lara; Guenther, Tanya; Kalino, Maggie; Zaka, Nabila

2017-12-01

Health facility service environment is an important factor for newborns survival and well-being in general and in particular in high mortality settings such as Malawi where despite high coverage of essential interventions, neonatal mortality remains high. The aim of this study is to assess whether the quality of the health service environment at birth is associated with quality of care received by the newborn. We used data from the Malawi Millennium Development Goals Endline household survey conducted as part of MICS survey program and Service Provision Assessment Survey carried out in 2014. The analysis is based on 6218 facility births that occurred during the past 2 years. Descriptive statistics, bivariate and multivariate random effect models are used to assess the association of health facility service readiness score for normal deliveries and newborn care with newborns receiving appropriate newborn care, defined for this analysis as receiving 5 out of 6 recommended interventions during the first 2 days after birth. Newborns in districts with top facility service readiness score have 1.5 higher odds of receiving appropriate newborn care (adjusted odds ratio (aOR) = 1.52, 95% confidence interval CI = 1.19-1.95, P  = 0.001), as compared to newborns in districts with a lower facility score after adjusting for potential confounders. Newborns in the Northern region were two times more likely to receive 5 newborn care interventions as compared to newborns in the Southern region (aOR = 2.06, 95% CI = 1.50-2.83, P  < 0.001). Living in urban or rural areas did not have an impact on receiving appropriate newborn care. There is need to increase the level of service readiness across all facilities, so that all newborns irrespective of the health facility, district or region of delivery are able to receive all recommended essential interventions. Investments in health systems in Malawi should concentrate on increasing training and availability of health staff in facilities that offer normal delivery and newborn care services at all levels in the country.

High-level neutron coincidence counter maintenance manual

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

Swansen, J.; Collinsworth, P.

1983-05-01

High-level neutron coincidence counter operational (field) calibration and usage is well known. This manual makes explicit basic (shop) check-out, calibration, and testing of new units and is a guide for repair of failed in-service units. Operational criteria for the major electronic functions are detailed, as are adjustments and calibration procedures, and recurrent mechanical/electromechanical problems are addressed. Some system tests are included for quality assurance. Data on nonstandard large-scale integrated (circuit) components and a schematic set are also included.

Simulation Data Management - Requirements and Design Specification

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

Clay, Robert L.; Friedman-Hill, Ernest J.; Gibson, Marcus J.

Simulation Data Management (SDM), the ability to securely organize, archive, and share analysis models and the artifacts used to create them, is a fundamental requirement for modern engineering analysis based on computational simulation. We have worked separately to provide secure, network SDM services to engineers and scientists at our respective laboratories for over a decade. We propose to leverage our experience and lessons learned to help develop and deploy a next-generation SDM service as part of a multi-laboratory team. This service will be portable across multiple sites and platforms, and will be accessible via a range of command-line tools andmore » well-documented APIs. In this document, we’ll review our high-level and low-level requirements for such a system, review one existing system, and briefly discuss our proposed implementation.« less

An exploratory survey of money boys and HIV transmission risk in Jilin Province, PR China.

PubMed

Meng, Xiangdong; Anderson, Allen F; Wang, Lu; Li, Zhihe; Guo, Wei; Lee, Zixuan; Jin, Huixin; Cai, Yong

2010-06-17

This report represents the first exploratory study of Chinese men who provide commercial sex services to other men ("money boys") in Jilin Province, People's Republic of China, through a convenience sample drawn from Changchun and Jilin City. A total of 86 active money boy participants (Changchun, n = 49; Jilin City, n = 37) were surveyed concerning background and demographics, basic HIV transmission knowledge, and sexual practices. The survey indicated that while Jilin Province money boy behavior matches other studies concerning propensity to high risk behavior and significant bridging potential, the Jilin money boys, unlike previous studies, exhibited a high level of basic HIV/AIDS transmission knowledge. In spite of this level of knowledge, none of the participants reported always using a condom in their sexual activities. They also exhibited a high level of awareness of voluntary counseling and testing available in the province, yet relatively few had availed themselves of these services. These preliminary findings will be used as a baseline and springboard for continuing study in the Jilin Province money boy community. Even now, however, it is becoming clear that the dynamics of male commercial sex work may vary greatly depending upon local influences, and will necessitate that future interventions are highly tailored to area-specific circumstances.

Listening to immigrant latino men in rural Oregon: exploring connections between culture and sexual and reproductive health services.

PubMed

Harvey, S Marie; Branch, Meredith R; Hudson, Deanne; Torres, Antonio

2013-03-01

This study explored factors that affect access to and use of sexual and reproductive health services including family planning among immigrant Latino men residing in rural Oregon communities that have experienced a high growth in their Latino population. In-depth interviews were conducted with 49 sexually active men aged 18 to 30 years who recently immigrated to the United States. Findings from content analysis identified multiple overlapping individual-level barriers, including lack of knowledge, perception of personal risk for unintended pregnancy and STIs, and fear of disease. On a service delivery level, structural factors and the importance of confianza when interacting with providers and clinic staff were dominant themes. The majority of these themes were grounded in a cultural context and linked to men's cultural background, beliefs, and experiences. Examining the needs of immigrant Latino men through this cultural lens may be critically important for improving access and use of sexual and reproductive health services.

National Service Framework for Older People: stroke coordinators.

PubMed

McDonald, Paul S; Mayer, Peter; Dunn, Linda

The National Service Framework (NSF) for Older People aims to develop integrated stroke services with specialized treatment, carer involvement, secondary prevention and rehabilitation. There is an emphasis upon the role of stroke coordinators. The aim of this study was to examine the relationships between stroke coordinators and other agencies involved in stroke care, and to describe stroke coordinators' current roles. Interviews with 11 stroke coordinators across the West Midlands region took place and were evaluated using a grounded theory approach. The roles of stroke coordinators and the perceived levels of integration among stroke services varied between localities. In a few areas, a number of 'adhesive' factors helped bond the coordinator role to successful integration, while in most areas the absence of all or some of these factors made the role less effective. To meet the demands of the NSF, a stroke coordinator's role needs to be a high profile, corporate function, requiring a higher level of autonomy, accountability and responsibility, and demanding creativity and innovation from post holders.

Mapping regional livelihood benefits from local ecosystem services assessments in rural Sahel

PubMed Central

Sinare, Hanna; Enfors Kautsky, Elin; Ouedraogo, Issa; Gordon, Line J.

2018-01-01

Most current approaches to landscape scale ecosystem service assessments rely on detailed secondary data. This type of data is seldom available in regions with high levels of poverty and strong local dependence on provisioning ecosystem services for livelihoods. We develop a method to extrapolate results from a previously published village scale ecosystem services assessment to a higher administrative level, relevant for land use decision making. The method combines remote sensing (using a hybrid classification method) and interviews with community members. The resulting landscape scale maps show the spatial distribution of five different livelihood benefits (nutritional diversity, income, insurance/saving, material assets and energy, and crops for consumption) that illustrate the strong multifunctionality of the Sahelian landscapes. The maps highlight the importance of a diverse set of sub-units of the landscape in supporting Sahelian livelihoods. We see a large potential in using the resulting type of livelihood benefit maps for guiding future land use decisions in the Sahel. PMID:29389965

Mapping regional livelihood benefits from local ecosystem services assessments in rural Sahel.

PubMed

Malmborg, Katja; Sinare, Hanna; Enfors Kautsky, Elin; Ouedraogo, Issa; Gordon, Line J

2018-01-01

Most current approaches to landscape scale ecosystem service assessments rely on detailed secondary data. This type of data is seldom available in regions with high levels of poverty and strong local dependence on provisioning ecosystem services for livelihoods. We develop a method to extrapolate results from a previously published village scale ecosystem services assessment to a higher administrative level, relevant for land use decision making. The method combines remote sensing (using a hybrid classification method) and interviews with community members. The resulting landscape scale maps show the spatial distribution of five different livelihood benefits (nutritional diversity, income, insurance/saving, material assets and energy, and crops for consumption) that illustrate the strong multifunctionality of the Sahelian landscapes. The maps highlight the importance of a diverse set of sub-units of the landscape in supporting Sahelian livelihoods. We see a large potential in using the resulting type of livelihood benefit maps for guiding future land use decisions in the Sahel.

Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe

PubMed Central

Jennings, Larissa; Bertrand, Jane; Rech, Dino; Harvey, Steven A.; Hatzold, Karin; Samkange, Christopher A.; Omondi Aduda, Dickens S.; Fimbo, Bennett; Cherutich, Peter; Perry, Linnea; Castor, Delivette; Njeuhmeli, Emmanuel

2014-01-01

Background The rapid expansion of voluntary medical male circumcision (VMMC) has raised concerns whether health systems can deliver and sustain VMMC according to minimum quality criteria. Methods and Findings A comparative process evaluation was used to examine data from SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-Up, among health facilities providing VMMC across two years of program scale-up. Site-level assessments examined the availability of guidelines, supplies and equipment, infection control, and continuity of care services. Direct observation of VMMC surgeries were used to assess care quality. Two sample tests of proportions and t-tests were used to examine differences in the percent of facilities meeting requisite preparedness standards and the mean number of directly-observed surgical tasks performed correctly. Results showed that safe, high quality VMMC can be implemented and sustained at-scale, although substantial variability was observed over time. In some settings, facility preparedness and VMMC service quality improved as the number of VMMC facilities increased. Yet, lapses in high performance and expansion of considerably deficient services were also observed. Surgical tasks had the highest quality scores, with lower performance levels in infection control, pre-operative examinations, and post-operative patient monitoring and counseling. The range of scale-up models used across countries additionally underscored the complexity of delivering high quality VMMC. Conclusions Greater efforts are needed to integrate VMMC scale-up and quality improvement processes in sub-Saharan African settings. Monitoring of service quality, not just adverse events reporting, will be essential in realizing the full health impact of VMMC for HIV prevention. PMID:24801073

Essential tips for measuring levels of consumer satisfaction with rural health service quality.

PubMed

Smith, Karly B; Humphreys, John S; Jones, Judith A

2006-01-01

Quality of health services is a matter of increasing importance to health authorities. Monitoring consumer satisfaction of health care is an important input to improving the quality of health services. This article highlights a number of important considerations learned from rural consumer studies relevant to ensuring the valid measurement of consumer satisfaction with rural health services, as a means of contributing to quality improvements. This article compares two methods of analysing rural consumers' satisfaction with healthcare services. In one study of three rural communities in western New South Wales (NSW) and eight communities in north-west Victoria, residents were asked to rate their satisfaction with five key aspects of local health services (availability, geographical accessibility, choice, continuity, economic accessibility as measured by affordability) using a 5 point Likert scale from: one = very satisfied to five = very dissatisfied. An alternative method of assessing levels of consumer satisfaction was undertaken in the survey of eight rural communities in north-west Victoria by investigating consumers' experiences with actual and potential complaints in relation to health services. Both the NSW and Victorian respondents reported generally high levels of satisfaction with the five indicators of quality of health care. At the same time, 11% of Victorian study respondents reported having made a complaint about a health service in the previous 12 months, and one-third of the Victorian respondents reported experiences with their health services about which they wanted to complain but did not, over the same period. Interpretation of apparent consumer satisfaction with their health services must take particular account of the measures and research methods used. In assessing consumer satisfaction with health services in rural areas, specific attention should be given to maximising the engagement of rural consumers in order to ensure representativeness of findings, and to minimise possible biases in satisfaction ratings associated with the use of particular tools.

Reproductive health service utilization and social determinants among married female rural-to-urban migrants in two metropolises, China.

PubMed

Liu, Zhi-Yong; Li, Jiang; Hong, Yang; Yao, Lan

2016-12-01

Reproductive health (RH) education and services of female migrants in China have become an important health issue. This research aimed to investigate the RH knowledge and utilization among married female migrants, and to explore the influencing factors from the perspectives of population and sociology. We conducted a cross-section survey in Shenzhen and Wuhan, China, using the purposive sampling method. A total of 1021 rural-to-urban married migrants were recruited, with 997 valid survey results obtained. A face-to-face structured questionnaire survey was used, with primary focus on knowledge of fertility, contraception, family planning policy and sexual transmitted diseases/acquired immunodeficiency syndrome (STD/AIDs), and RH service utilization. The results showed that the RH service utilization (38.0%) was at a low level in married migrants and the accessibility of RH service was poor. Females who migrated to (OR=0.32) Wuhan obtained fewer RH consultations than those in Shenzhen. The workers with high school education received additional RH consultations and checkup services than those with other background education, apart from the white collar workers who received extra RH consultations and checkup services than the blue collar workers (P<0.05). We can draw a conclusion that the utilization of RH services in married female migrants remains at a low level in China. RH service utilization can be improved via the relevant health departments by enhancing the responsibility of maternal and health care in the community health service center.

A randomized controlled trial to promote long-term contraceptive use among HIV-serodiscordant and concordant positive couples in Zambia.

PubMed

Stephenson, Rob; Vwalika, Bellington; Greenberg, Lauren; Ahmed, Yusuf; Vwalika, Cheswa; Chomba, Elwyn; Kilembe, William; Tichacek, Amanda; Allen, Susan

2011-04-01

Countries facing high HIV prevalence often also experience high levels of fertility and low contraceptive use, suggesting high levels of unmet need for contraceptive services. In particular, the unique needs of couples with one or both partners HIV positive are largely missing from many current family planning efforts, which focus on the prevention of pregnancies in the absence of reduction of the risk of HIV and other sexually transmitted infections (STIs). This article presents an examination of contraceptive method uptake among a cohort of HIV serodiscordant and concordant positive study participants in Zambia. Baseline contraceptive use was low; however, exposure to a video-based intervention that provided information on contraceptive methods and modeled desirable future planning behaviors dramatically increased the uptake of modern contraceptive methods. Including information on family planning in voluntary counseling and testing (VCT) services in addition to tailoring the delivery of family planning information to meet the needs and concerns of HIV-positive women or those with HIV-positive partners is an essential step in the delivery of services and prevention efforts to reduce the transmission of HIV. Family planning and HIV prevention programs should integrate counseling on dual method use, combining condoms for HIV/STI prevention with a long-acting contraceptive for added protection against unplanned pregnancy.

Climate Control. Secondary School Course Guide.

ERIC Educational Resources Information Center

DuPlantis, Ernest P.

This course guide is oriented toward developing skills in air conditioning and refrigeration installation and service. Although primarily designed as a 2-year program for high school students at the junior and senior levels, it is equally acceptable for the post high school student as an occupational training program, or as a refresher course for…

High Speed Computing, LANs, and WAMs

NASA Technical Reports Server (NTRS)

Bergman, Larry A.; Monacos, Steve

1994-01-01

Optical fiber networks may one day offer potential capacities exceeding 10 terabits/sec. This paper describes present gigabit network techniques for distributed computing as illustrated by the CASA gigabit testbed, and then explores future all-optic network architectures that offer increased capacity, more optimized level of service for a given application, high fault tolerance, and dynamic reconfigurability.

An Approach to Developing Local Climate Change Environmental Public Health Indicators in a Rural District.

PubMed

Houghton, Adele; Austin, Jessica; Beerman, Abby; Horton, Clayton

2017-01-01

Climate change represents a significant and growing threat to population health. Rural areas face unique challenges, such as high rates of vulnerable populations; economic uncertainty due to their reliance on industries that are vulnerable to climate change; less resilient infrastructure; and lower levels of access to community and emergency services than urban areas. This article fills a gap in public health practice by developing climate and health environmental public health indicators for a local public health department in a rural area. We adapted the National Environmental Public Health Tracking Network's framework for climate and health indicators to a seven-county health department in Western Kentucky. Using a three-step review process, we identified primary climate-related environmental public health hazards for the region (extreme heat, drought, and flooding) and a suite of related exposure, health outcome, population vulnerability, and environmental vulnerability indicators. Indicators that performed more poorly at the county level than at the state and national level were defined as "high vulnerability." Six to eight high vulnerability indicators were identified for each county. The local health department plans to use the results to enhance three key areas of existing services: epidemiology, public health preparedness, and community health assessment.

Patient satisfaction with clinical laboratory services at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

PubMed Central

Abera, Rodas Getachew; Abota, Boaz Arka; Legese, Melese Hailu; Negesso, Abebe Edao

2017-01-01

Background Monitoring patient satisfaction is an important and useful quality improvement tool for clinical laboratories in particular and health care organizations in general. Thus, this study aimed to assess patient satisfaction toward clinical laboratory services at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Methods A hospital-based cross-sectional study was conducted and a convenient sampling technique was applied to recruit study participants. A total of 210 patients who had received laboratory services were included. A self-administered predesigned, pretested, structured questionnaire was used, and data were collected through face-to-face interviews. A 5-point Likert scale with 1 and 5 indicating the lowest and highest levels of satisfaction, respectively, was used and their weighted average was used to categorize the satisfaction level of the patients. Chi square test was used (taking P≤0.05 as the statistically significant level) to find out if any association existed between the level of satisfaction and different attributes. Data were analyzed using SPSS version 20. Results The overall level of patient satisfaction toward clinical laboratory services in this study was 59.7% with a response rate of 210 (100%). The Likert scale results of patient satisfaction of the laboratory services revealed that the mean rating values ranged from 3.05 (±1.12) to 4.12 (±1.08) out of a possible 5. Among the different indicators, patients were highly satisfied with the cleanliness of facility (82%), maintenance of privacy and confidentiality (83.2%), and the cost of the laboratory service (86.5%), while they were dissatisfied with the location of the laboratory (56%), latrine accessibility and availability (58.4%), and latrine cleanness and comfort (63.8%). Conclusion The whole availability of requested tests, availability of place in blood drawing room to put personal things, and waiting time for specimen collection were found to have a statistically significant association with the overall satisfaction of patients toward clinical laboratory services. Therefore, these could be the possible determinants among others that account for the dissatisfaction of patients with clinical laboratory services. PMID:28761333

From the parents' perspective: a user-satisfaction survey of immunization services in Guatemala.

PubMed

Barrera, Lissette; Trumbo, Silas Pierson; Bravo-Alcántara, Pamela; Velandia-González, Martha; Danovaro-Holliday, M Carolina

2014-03-06

Immunization coverage levels in Guatemala have increased over the last two decades, but national targets of ≥95% have yet to be reached. To determine factors related to undervaccination, Guatemala's National Immunization Program conducted a user-satisfaction survey of parents and guardians of children aged 0-5 years. Variables evaluated included parental immunization attitudes, preferences, and practices; the impact of immunization campaigns and marketing strategies; and factors inhibiting immunization. Based on administrative coverage levels and socio-demographic indicators in Guatemala's 22 geographical departments, five were designated as low-coverage and five as high-coverage areas. Overall, 1194 parents and guardians of children aged 0-5 years were interviewed in these 10 departments. We compared indicators between low- and high-coverage areas and identified risk factors associated with undervaccination. Of the 1593 children studied, 29 (1.8%) were determined to be unvaccinated, 458 (28.8%) undervaccinated, and 1106 (69.4%) fully vaccinated. In low-coverage areas, children of less educated (no education: RR=1.49, p=0.01; primary or less: 1.39, p=0.009), older (aged>39 years: RR=1.31, p=0.05), and single (RR=1.32, p=0.03) parents were more likely to have incomplete vaccination schedules. Similarly, factors associated with undervaccination in high-coverage areas included the caregiver's lack of education (none: RR=1.72, p=0.0007; primary or less: RR=1.30, p=0.05) and single marital status (RR=1.36, p=0.03), as well as the child's birth order (second: RR=1.68, p=0.003). Although users generally approved of immunization services, problems in service quality were identified. According to participants, topics such as the risk of adverse events (47.4%) and next vaccination appointments (32.3%) were inconsistently communicated to parents. Additionally, 179 (15.0%) participants reported the inability to vaccinate their child on at least one occasion. Compared to high-coverage areas, participants in low-coverage areas reported poorer service, longer wait times, and greater distances to health centers. In high-coverage areas, participants reported less knowledge about the availability of services. Generally, immunization barriers in Guatemala are related to problems in accessing and attaining high-quality immunization services rather than to a population that does not adequately value vaccination. We provide recommendations to aid the country in maintaining its achievements and addressing new challenges.

Managing Minor Ailments; The Public's Preferences for Attributes of Community Pharmacies. A Discrete Choice Experiment.

PubMed

Porteous, Terry; Ryan, Mandy; Bond, Christine; Watson, Margaret; Watson, Verity

2016-01-01

Demand for health services continues to rise. Greater use of community pharmacy services instead of medical services for minor ailments could help relieve pressure on healthcare providers in high-cost settings. Community pharmacies are recognised sources of treatment and advice for people wishing to manage these ailments. However, increasing the public's use of pharmacy services may depend on attributes of pharmacies and their staff. This study aimed to determine the general public's relative preferences for community pharmacy attributes using a discrete choice experiment (DCE). A UK-wide DCE survey of the general public was conducted using face-to-face computer-assisted personal interviews. Attributes and levels for the DCE were informed by a literature review and a cohort study of community pharmacy customers. The context for the experiment was a minor ailment scenario describing flu-like symptoms. The DCE choice sets described two hypothetical community pharmacy services; respondents were asked to choose which (if either) of the two pharmacies they would prefer to help them manage symptoms. Data from 1,049 interviews were analysed using an error components logit model. Willingness to pay (WTP), a monetary measure of benefit, was estimated for the different attribute levels. When seeking help or treatment for flu-like symptoms, respondents most valued a pharmacy service that would improve their understanding and management of symptoms (WTP = £6.28), provided by staff who are trained (WTP (pharmacist) = £2.63: WTP(trained assistant) = £3.22), friendly and approachable (WTP = £3.38). Waiting time, pharmacy location and availability of parking also contributed to respondents' preferences. WTP for a service comprising the best possible combination of attributes and levels was calculated as £55.43. Attributes of a community pharmacy and its staff may influence people's decisions about which pharmacy they would visit to access treatment and advice for minor ailments. In line with the public's preferences, offering community pharmacy services that help people to better understand and manage symptoms, are provided promptly by trained staff who are friendly and approachable, and in a local setting with easy access to parking, has the potential to increase uptake amongst those seeking help to manage minor ailments. In this way it may be possible to shift demand away from high-cost health services and make more efficient use of scarce public resources.

The effects of simulated patients and simulated gynecologic models on student anxiety in providing IUD services.

PubMed

Khadivzadeh, Talat; Erfanian, Fatemeh

2012-10-01

Midwifery students experience high levels of stress during their initial clinical practices. Addressing the learner's source of anxiety and discomfort can ease the learning experience and lead to better outcomes. The aim of this study was to find out the effect of a simulation-based course, using simulated patients and simulated gynecologic models on student anxiety and comfort while practicing to provide intrauterine device (IUD) services. Fifty-six eligible midwifery students were randomly allocated into simulation-based and traditional training groups. They participated in a 12-hour workshop in providing IUD services. The simulation group was trained through an educational program including simulated gynecologic models and simulated patients. The students in both groups then practiced IUD consultation and insertion with real patients in the clinic. The students' anxiety in IUD insertion was assessed using the "Spielberger anxiety test" and the "comfort in providing IUD services" questionnaire. There were significant differences between students in 2 aspects of anxiety including state (P < 0.001) and trait (P = 0.024) and the level of comfort (P = 0.000) in providing IUD services in simulation and traditional groups. "Fear of uterine perforation during insertion" was the most important cause of students' anxiety in providing IUD services, which was reported by 74.34% of students. Simulated patients and simulated gynecologic models are effective in optimizing students' anxiety levels when practicing to deliver IUD services. Therefore, it is recommended that simulated patients and simulated gynecologic models be used before engaging students in real clinical practice.

Assessing the role of appropriate primary health care on the use of dental services by Brazilian low-income preschool children.

PubMed

Baldani, Márcia Helena; Rocha, Juliana Schaia; Fadel, Cristina Berger; Nascimento, Antonio Carlos; Antunes, José Leopoldo Ferreira; Moysés, Samuel Jorge

2017-11-21

This cross-sectional study aimed to assess the association between the quality of primary health care (PHC) and the use of dental services by preschoolers served by the Family Health Strategy (FHS), controlling for socio-demographic determinants and perceived need. The sample encompassed 438 children aged 3-5 years, enrolled in 19 FHS facilities in Ponta Grossa, Paraná State, Brazil. Individual level variables were collected by interviewing parents or caregivers at home. They answered a questionnaire on socioeconomic conditions, oral hygiene habits and use of dental services. Parental perception of child's oral health related quality of life, as perceived need, was assessed by the Brazilian version of Early Childhood Oral Health Impact Scale (ECOHIS). Normative need was assessed by oral examinations, according to guidelines standardized by the World Health Organization. The contextual level factor was defined as the extent of implementation of PHC in the facilities. Managers responded to PCATool-Brazil, a validated questionnaire which measures the extent of PHC. Dentists answered to a version of PCATool, which was adapted and pretested for dental services. Multilevel analysis, based on Andersen's behavioral model, fitted the adjustment of "having ever consulted a dentist" to contextual and individual covariates. We observed high prevalence of dental caries. Almost half of the sample had had dental appointments in life. Social gradients were observed for the use of dental services. Although it was not able to eliminate the impact of adverse social conditions, higher levels of PHC attributes in dental services favored the effective use of such services by low-income children.

Access to dental care among 15–64 year old people

PubMed Central

Eslamipour, Faezeh; Heydari, Kamal; Ghaiour, Marzieh; Salehi, Hoda

2018-01-01

INTRODUCTION: The current study aims to study people's access to oral and dental health-care services and their satisfaction with the services provided to them. MATERIALS AND METHODS: A descriptive study with multi-stage sampling was conducted on 1360 people aged 16–64 years residing in Isfahan city, Iran. The required data were collected by a questionnaire which comprised of three main parts: demographic characteristics, patients’ access to oral and dental health-care services and its barriers and participants’ satisfaction with access to services. Data were analyzed by SPSS statistical software. RESULTS: The results showed 40% of participants reported an average level for oral health, and 82% of them did not have any problems regarding access to dental care facilities. The main causes of their dissatisfaction were high cost of services (60%) and insufficient health insurance coverage (40%). About 73% reported that they had to spend 30 min or less to access to a dental health-care facility. In addition, 50% of participants were satisfied with the provided services. The main reported reasons for referring to dentists were oral and dental problems (69%) and regular check-ups (15%). There was no significant relationship between participants’ gender, education level, insurance coverage, and access to dental health-care centers (P > 0.05). CONCLUSION: Most participants were satisfied with access to dental healthcare, but they were dissatisfied with the costs and inadequate insurance coverage. About half of the participants were satisfied with the services provided to them, and the highest level of satisfaction was reported for easy access to health-care centers. PMID:29693027

Specialized stroke rehabilitation services in seven countries: Preliminary results from nine rehabilitation centers.

PubMed

Langhammer, Birgitta; Becker, Frank; Sunnerhagen, Katharina S; Zhang, Tong; Du, Xiaoxia; Bushnik, Tamara; Panchenko, Maria; Keren, Ofer; Banura, Samir; Elessi, Khamis; Luzon, Fuad; Lundgren-Nilsson, Åsa; Li, Xie; Sällström, Susanne; Stanghelle, Johan Kvalvik

2015-12-01

There is a lack of defined levels of rehabilitation, indicating possibly random content and access to specialized services. The aim of the study was to perform a multinational descriptive study of specialized rehabilitation in persons with stroke, to elucidate what the different centers define as prerequisites for specialized rehabilitation, and to analyze whether these descriptions map to currently applied standards or constructs of specialized rehabilitation. A secondary aim was to look for similarities and differences between therapies and services for persons with stroke in the sub-acute stage in the different institutions. Descriptive data of the collaborating centers regarding structure and processes of services were recorded and compared with the British Society of Rehabilitation Medicine and Specialized Services National Definitions sets. Comparisons of the definitions showed that all centers admitted severely disabled persons with stroke, in need of complex rehabilitation, and provided high levels of physical services, with specialized equipment and facilities. However, funding, size, university affiliation, quality accreditation, staffing levels, specialist training, cognitive and vocational services, coordination of the professional teams, admission procedures, time and type of therapies, estimated length of stay, and follow-up procedures differed between the centers. This multinational study of specialized stroke rehabilitation centers shows that a universal definition of specialized rehabilitation is possible, even in quite different countries and settings, in terms of general principles. There were however differences in structures and procedures, which may influence patients' outcomes, indicating a need for refinement of the definitions to be globally applicable. © 2015 World Stroke Organization.

Integration of High-Performance Computing into Cloud Computing Services

NASA Astrophysics Data System (ADS)

Vouk, Mladen A.; Sills, Eric; Dreher, Patrick

High-Performance Computing (HPC) projects span a spectrum of computer hardware implementations ranging from peta-flop supercomputers, high-end tera-flop facilities running a variety of operating systems and applications, to mid-range and smaller computational clusters used for HPC application development, pilot runs and prototype staging clusters. What they all have in common is that they operate as a stand-alone system rather than a scalable and shared user re-configurable resource. The advent of cloud computing has changed the traditional HPC implementation. In this article, we will discuss a very successful production-level architecture and policy framework for supporting HPC services within a more general cloud computing infrastructure. This integrated environment, called Virtual Computing Lab (VCL), has been operating at NC State since fall 2004. Nearly 8,500,000 HPC CPU-Hrs were delivered by this environment to NC State faculty and students during 2009. In addition, we present and discuss operational data that show that integration of HPC and non-HPC (or general VCL) services in a cloud can substantially reduce the cost of delivering cloud services (down to cents per CPU hour).

RGCA: A Reliable GPU Cluster Architecture for Large-Scale Internet of Things Computing Based on Effective Performance-Energy Optimization

PubMed Central

Chen, Qingkui; Zhao, Deyu; Wang, Jingjuan

2017-01-01

This paper aims to develop a low-cost, high-performance and high-reliability computing system to process large-scale data using common data mining algorithms in the Internet of Things (IoT) computing environment. Considering the characteristics of IoT data processing, similar to mainstream high performance computing, we use a GPU (Graphics Processing Unit) cluster to achieve better IoT services. Firstly, we present an energy consumption calculation method (ECCM) based on WSNs. Then, using the CUDA (Compute Unified Device Architecture) Programming model, we propose a Two-level Parallel Optimization Model (TLPOM) which exploits reasonable resource planning and common compiler optimization techniques to obtain the best blocks and threads configuration considering the resource constraints of each node. The key to this part is dynamic coupling Thread-Level Parallelism (TLP) and Instruction-Level Parallelism (ILP) to improve the performance of the algorithms without additional energy consumption. Finally, combining the ECCM and the TLPOM, we use the Reliable GPU Cluster Architecture (RGCA) to obtain a high-reliability computing system considering the nodes’ diversity, algorithm characteristics, etc. The results show that the performance of the algorithms significantly increased by 34.1%, 33.96% and 24.07% for Fermi, Kepler and Maxwell on average with TLPOM and the RGCA ensures that our IoT computing system provides low-cost and high-reliability services. PMID:28777325

RGCA: A Reliable GPU Cluster Architecture for Large-Scale Internet of Things Computing Based on Effective Performance-Energy Optimization.

PubMed

Fang, Yuling; Chen, Qingkui; Xiong, Neal N; Zhao, Deyu; Wang, Jingjuan

2017-08-04

This paper aims to develop a low-cost, high-performance and high-reliability computing system to process large-scale data using common data mining algorithms in the Internet of Things (IoT) computing environment. Considering the characteristics of IoT data processing, similar to mainstream high performance computing, we use a GPU (Graphics Processing Unit) cluster to achieve better IoT services. Firstly, we present an energy consumption calculation method (ECCM) based on WSNs. Then, using the CUDA (Compute Unified Device Architecture) Programming model, we propose a Two-level Parallel Optimization Model (TLPOM) which exploits reasonable resource planning and common compiler optimization techniques to obtain the best blocks and threads configuration considering the resource constraints of each node. The key to this part is dynamic coupling Thread-Level Parallelism (TLP) and Instruction-Level Parallelism (ILP) to improve the performance of the algorithms without additional energy consumption. Finally, combining the ECCM and the TLPOM, we use the Reliable GPU Cluster Architecture (RGCA) to obtain a high-reliability computing system considering the nodes' diversity, algorithm characteristics, etc. The results show that the performance of the algorithms significantly increased by 34.1%, 33.96% and 24.07% for Fermi, Kepler and Maxwell on average with TLPOM and the RGCA ensures that our IoT computing system provides low-cost and high-reliability services.

['NischE - Nicht von schlechten Eltern' - Evaluation of a Multidisciplinary Teamwork Approach to Support Children in Families with Mentally Ill Parents].

PubMed

Nienaber, A; Wieskus-Friedemann, E; Kliem, S; Hoppmann, J; Kemper, U; Löhr, M; Kronmüller, K-T; Wabnitz, P

2017-02-01

Objective: Evaluation of a project offering low-threshold anonymous counseling services jointly by mental health services and child and youth services to support children in families with mentally ill parents Methods: Evaluating performance data and completed questionnaires returned by parents included in the project. Results: Between 2011-2014, 150 families received up to 10 sessions of family-oriented counseling. The survey results indicate a high level of satisfaction with the services of the cooperation project. The vast majority of respondents said that they would recommend this service to others or would themselves take advantage of the services again. Conclusion: A collaboration of service providers from psychiatry and child and youth welfare department resulting in continuous availability of counseling with a common family medical perspective represents a forward-looking model for families with a mentally ill parent. © Georg Thieme Verlag KG Stuttgart · New York.

Resource Provisioning in SLA-Based Cluster Computing

NASA Astrophysics Data System (ADS)

Xiong, Kaiqi; Suh, Sang

Cluster computing is excellent for parallel computation. It has become increasingly popular. In cluster computing, a service level agreement (SLA) is a set of quality of services (QoS) and a fee agreed between a customer and an application service provider. It plays an important role in an e-business application. An application service provider uses a set of cluster computing resources to support e-business applications subject to an SLA. In this paper, the QoS includes percentile response time and cluster utilization. We present an approach for resource provisioning in such an environment that minimizes the total cost of cluster computing resources used by an application service provider for an e-business application that often requires parallel computation for high service performance, availability, and reliability while satisfying a QoS and a fee negotiated between a customer and the application service provider. Simulation experiments demonstrate the applicability of the approach.

Psychiatric treatment in prison: a missed opportunity?

PubMed

Smith, S S; Baxter, V J; Humphreys, M S

2003-04-01

National Health Service Executive guidelines require psychiatric services to maintain links with prisoners previously subject to the Care Programme Approach (CPA) and to participate in discharge planning. We are unaware of previous studies assessing the involvement of general psychiatric services with patients in prison or prisoners' perceptions of their needs. Consecutive referrals to a prison psychiatric liaison service over a three-month period were screened for previous psychiatric contact. Half of those interviewed reported previous psychiatric contact. Two-thirds were in contact with services at the time of detention. One-third believed services knew of their imprisonment. Ninety-three per cent believed they would require psychiatric support after release. Few patients received input from general psychiatric services during imprisonment despite a high level of perceived need. Improved liaison would help facilitate both care in prison and discharge planning in the spirit of CPA and the government directive.

How to achieve optimal organization of primary care service delivery at system level: lessons from Europe.

PubMed

Pelone, Ferruccio; Kringos, Dionne S; Spreeuwenberg, Peter; De Belvis, Antonio G; Groenewegen, Peter P

2013-09-01

To measure the relative efficiency of primary care (PC) in turning their structures into services delivery and turning their services delivery into quality outcomes. Cross-sectional study based on the dataset of the Primary Healthcare Activity Monitor for Europe project. Two Data Envelopment models were run to compare the relative technical efficiency. A sensitivity analysis of the resulting efficiency scores was performed. PC systems in 22 European countries in 2009/2010. Model 1 included data on PC governance, workforce development and economic conditions as inputs and access, coordination, continuity and comprehensiveness of care as outputs. Model 2 included the previous process dimensions as inputs and quality indicators as outputs. There is relatively reasonable efficiency in all countries at delivering as many as possible PC processes at a given level of PC structure. It is particularly important to invest in economic conditions to achieve an efficient structure-process balance. Only five countries have fully efficient PC systems in turning their services delivery into high quality outcomes, using a similar combination of access, continuity and comprehensiveness, although they differ on the adoption of coordination of services. There is a large variation in efficiency levels obtained by countries with inefficient PC in turning their services delivery into quality outcomes. Maximizing the individual functions of PC without taking into account the coherence within the health-care system is not sufficient from a policymaker's point of view when aiming to achieve efficiency.

HIV health center affiliation networks of black men who have sex with men: disentangling fragmented patterns of HIV prevention service utilization.

PubMed

Schneider, John A; Walsh, Tim; Cornwell, Benjamin; Ostrow, David; Michaels, Stuart; Laumann, Edward O

2012-08-01

In the United States, black men who have sex with men (BMSM) are at highest risk for HIV infection and are at high risk for limited health service utilization. We describe HIV health center (HHC) affiliation network patterns and their potential determinants among urban BMSM. The Men's Assessment of Social and Risk Network instrument was used to elicit HHC utilization, as reported by study respondents recruited through respondent-driven sampling. In 2010, 204 BMSM were systematically recruited from diverse venues in Chicago, IL. A 2-mode data set was constructed that included study participants and 9 diverse HHCs. Associations between individual-level characteristics and HHC utilization were analyzed using Multiple Regression Quadratic Assignment Procedure. Visualization analyses included computation of HHC centrality and faction membership. High utilization of HHCs (45.9%-70.3%) was evident among BMSM, 44.4% who were HIV infected. Multiple Regression Quadratic Assignment Procedure revealed that age, social network size, and HIV status were associated with HHC affiliation patterns (coeff., 0.13-0.27; all P < 0.05). With the exception of one HHC, HHCs offering HIV prevention services to HIV-infected participants occupied peripheral positions within the network of health centers. High-risk HIV-uninfected participants affiliated most with an HHC that offers only treatment services. Subcategories of BMSM in this sample affiliated with HHCs that may not provide appropriate HIV prevention services. Using 2-mode data, public health authorities may be better able to match prevention services to BMSM need; in particular, HIV prevention services for high-risk HIV-uninfected men and HIV "prevention for positives" services for HIV-infected men.

Service user satisfaction with cognitive behavioural therapy for psychosis: Associations with therapy outcomes and perceptions of the therapist.

PubMed

Lawlor, Caroline; Sharma, Bina; Khondoker, Mizanur; Peters, Emmanuelle; Kuipers, Elizabeth; Johns, Louise

2017-03-01

Few studies have investigated service user satisfaction with cognitive behavioural therapy for psychosis (CBTp). This study explored its associations with clinical presentation and outcomes, retrospective expectations of progress, perceptions of the therapist, and demographic variables. One hundred and sixty-five service users completed self-report questionnaires pre- and post-CBTp in relation to the constructs of interest. Regression analyses explored associations with (1) overall satisfaction with therapy and (2) perceived progress, skills, and knowledge gained. Ninety-six per cent of service users reported satisfaction with therapy. Higher levels of overall satisfaction with, and perceived benefit from, therapy were associated with positive therapy expectations, positive ratings of therapist's personal qualities, competence and trustworthiness, lower pre-therapy depression, and improvements in quality of life. Symptom improvements were not related to overall satisfaction with therapy; however, with the exception of voices, better clinical outcomes were associated with subjective ratings of having made more progress and gained more CBT skills and knowledge. Demographic factors were not associated with satisfaction or perceived progress. In multiple regression analyses, expectations of progress showed the strongest associations with both satisfaction and perceived benefits. Other remaining significant associations consisted of perceptions of the therapist for satisfaction, and both pre-therapy levels of, and changes in, depression for perceived benefits. Qualitative feedback emphasized the importance of the therapeutic relationship and developing new coping strategies. The findings provide preliminary evidence that high levels of satisfaction with therapy are not contingent on good clinical outcomes and are instead associated with positive therapy expectations and perceptions of the therapist. Therapy expectations represent a neglected area of research and may have implications for levels of satisfaction with therapy and perceived benefit. The findings reinforce the importance of cognitive behavioural therapy for psychosis (CBTp) therapists demonstrating that they are supportive, competent, and trustworthy. The findings suggest that positive experiences of therapy do not require changes in psychosis symptoms and are instead related to changes in quality of life. Depressive symptoms at the start of therapy may adversely influence the extent to which CBT skills and knowledge are gained and levels of perceived progress at the end of therapy. The present sample was restricted to service users who completed therapy. Satisfaction levels were high. Further research is needed to explore factors associated with dissatisfaction with therapy. © 2016 The British Psychological Society.

Use of general medical services among Medicaid patients with severe and persistent mental illness.

PubMed

Salsberry, Pamela J; Chipps, Esther; Kennedy, Carol

2005-04-01

The aim of this study was to examine patterns of use of general medical services among persons with a severe and persistent mental illness enrolled in Medicaid from 1996 to 1998. A total of 669 persons with a severe and persistent mental illness were identified by using statewide clinical criteria. A three-year database of Medicaid claims was developed to examine service use. The main outcome measures were use of outpatient services for a general medical problem, use of dental and vision services, and use of screening tests for women. Service use was examined by primary psychiatric diagnosis (schizophrenic, affective, paranoid, and anxiety disorders), and analyses controlled for the presence of a chronic medical condition, age, race, and sex. This study found high levels of service use for outpatient services but very low levels for primary and preventive services. Although 78 percent of persons with a schizophrenic disorder had an office-based visit during the three-year period, all persons with an anxiety disorder had such a visit. Sixty-nine percent of persons with a schizophrenic disorder had at least one emergency department visit, whereas 83 percent of those with an anxiety disorder had such a visit. Dental and vision visits and the use of mammograms and pap tests followed the same pattern; persons with a schizophrenic disorder had fewer visits and had less overall use than the other diagnostic groups. The use patterns across the four groups were significantly different in outpatient service use, dental and vision service use, and screening tests for women. Compared with persons with a schizophrenic disorder, those with an anxiety disorder were more likely to have had an office-based visit and to have received vision services, those with a paranoid disorder were more likely to have used dental services or received a mammogram, and those with an affective disorder were more likely to have had a pap test. Although this group of Medicaid patients with severe and persistent mental illness had access to providers, they received an unacceptably low level of preventive care. Use of health services for general medical problems differed somewhat by primary psychiatric illness.

The effectiveness of emergency nurse practitioner service in the management of patients presenting to rural hospitals with chest pain: a multisite prospective longitudinal nested cohort study.

PubMed

Roche, Tina E; Gardner, Glenn; Jack, Leanne

2017-06-27

Health reforms in service improvement have included the use of nurse practitioners. In rural emergency departments, nurse practitioners work to the full scope of their expanded role across all patient acuities including those presenting with undifferentiated chest pain. Currently, there is a paucity of evidence regarding the effectiveness of emergency nurse practitioner service in rural emergency departments. Inquiry into the safety and quality of the service, particularly regarding the management of complex conditions is a priority to ensure that this service improvement model meets health care needs of rural communities. This study used a prospective, longitudinal nested cohort study of rural emergency departments in Queensland, Australia. Sixty-one consecutive adult patients with chest pain who presented between November 2014 and February 2016 were recruited into the study cohort. A nested cohort of 41 participants with suspected or confirmed acute coronary syndrome were identified. The primary outcome was adherence to guidelines and diagnostic accuracy of electrocardiograph interpretation for the nested cohort. Secondary outcomes included service indicators of waiting times, diagnostic accuracy as measured by unplanned representation rates, satisfaction with care, quality-of-life, and functional status. Data were examined and compared for differences for participants managed by emergency nurse practitioners and those managed in the standard model of care. The median waiting time was 8.0 min (IQR 20) and length-of-stay was 100.0 min (IQR 64). Participants were 2.4 times more likely to have an unplanned representation if managed by the standard service model. The majority of participants (91.5%) were highly satisfied with the care that they received, which was maintained at 30-day follow-up measurement. In the evaluation of quality of life and functional status, summary scores for the SF-12 were comparable with previous studies. No differences were demonstrated between service models. There was a high level of adherence to clinical guidelines for the emergency nurse practitioner service model and a concomitant high level of diagnostic accuracy. Nurse practitioner service demonstrated comparable effectiveness to that of the standard care model in the evaluation of the service indicators and patient reported outcomes. These findings provide a foundation for the beginning evaluation of rural emergency nurse practitioner service in the delivery of safe and effective beyond the setting of minor injury and illness presentations. Australian New Zealand Clinical Trials Registry, ACTRN12616000823471 (Retrospectively registered).

Health care utilization, somatic and mental health distress, and well-being among widowed and non-widowed female survivors of war.

PubMed

Morina, Nexhmedin; Emmelkamp, Paul M G

2012-05-11

The aim of the study was to assess levels of somatic and mental health distress, well-being, AS WELL AS utilization of primary and specialist health care services among war-related widowed and non-widowed female civilian survivors of war. 100 war-related widowed lone mothers and 106 non-widowed mothers who had experienced the Kosovo war ten years previously participated in the study. Measures of somatic, depressive, post-traumatic stress, anxiety, and grief complaints, subjective well-being, and utilization of health care services during the previous three months were used. Compared to non-widowed mothers, widowed lone mothers reported significantly higher levels of somatic, depressive, post-traumatic stress, and anxiety complaints. Further, they reported significantly lower levels of subjective well-being as composed of positive and negative affect and satisfaction with life. More than half of both widowed and non-widowed mothers reported utilization of health care services during the last three months, without significant differences between the groups. However, only three percent of widowed lone mothers and four percent of non-bereaved mothers reported utilization of mental health services during the last three months, despite high levels of mental health distress especially among widowed lone mothers. Among widowed lone mothers, severity of prolonged grief symptoms significantly predicted number of contacts of specialist health care use over and above sociodemographic variables, number of war-related events, and other psychopathology. War-related widowed lone mothers suffer from elevated somatic and mental distress even a decade after the war. The tiny proportion of widowed lone mothers in use of mental health services can be seen as a reflection of lack of previous and current mental health services to meet mental health needs of this population.

Health care utilization, somatic and mental health distress, and well-being among widowed and non-widowed female survivors of war

PubMed Central

2012-01-01

Background The aim of the study was to assess levels of somatic and mental health distress, well-being, AS WELL AS utilization of primary and specialist health care services among war-related widowed and non-widowed female civilian survivors of war. Methods 100 war-related widowed lone mothers and 106 non-widowed mothers who had experienced the Kosovo war ten years previously participated in the study. Measures of somatic, depressive, post-traumatic stress, anxiety, and grief complaints, subjective well-being, and utilization of health care services during the previous three months were used. Results Compared to non-widowed mothers, widowed lone mothers reported significantly higher levels of somatic, depressive, post-traumatic stress, and anxiety complaints. Further, they reported significantly lower levels of subjective well-being as composed of positive and negative affect and satisfaction with life. More than half of both widowed and non-widowed mothers reported utilization of health care services during the last three months, without significant differences between the groups. However, only three percent of widowed lone mothers and four percent of non-bereaved mothers reported utilization of mental health services during the last three months, despite high levels of mental health distress especially among widowed lone mothers. Among widowed lone mothers, severity of prolonged grief symptoms significantly predicted number of contacts of specialist health care use over and above sociodemographic variables, number of war-related events, and other psychopathology. Conclusion War-related widowed lone mothers suffer from elevated somatic and mental distress even a decade after the war. The tiny proportion of widowed lone mothers in use of mental health services can be seen as a reflection of lack of previous and current mental health services to meet mental health needs of this population. PMID:22578096

Video Relay Service for Signing Deaf - Lessons Learnt from a Pilot Study

NASA Astrophysics Data System (ADS)

Ponsard, Christophe; Sutera, Joelle; Henin, Michael

The generalization of high speed Internet, efficient compression techniques and low cost hardware have resulted in low cost video communication since the year 2000. For the Deaf community, this enables native communication in sign language and a better communication with hearing people over the phone. This implies that Video Relay Service can take over the old Text Relay Service which is less natural and requires mastering written language. A number of such services have developed throughout the world. The objectives of this paper are to present the experience gained in the Walloon Region of Belgium, to share a number of lessons learnt, and to provide recommendations at the technical, user adoption and political levels. A survey of video relay services around the world is presented together with the feedback from users both before and after using the pilot service.

Air ambulance services--integrated emergency care.

PubMed

Ferdinand, M

1994-10-01

In the name of cost-conscious care, air ambulance program directors and service contractors are seeing the dawn of integrated networks as a boon to their business. As integrated networks form, facilities will become increasingly specialized in the types of services they provide. Patients will need to be moved around the system, resulting in more frequent patient transport and more points of transfer. Many programs are considering aircraft replacement and additions, rather than leasing. Financial benefits could come on depreciation and the high resale value of aircraft. Unless reimbursement levels increase, more program mergers and affiliations may take place to spread and reduce cost. Air ambulance services will increasingly become part of a facility's strategic plan.

Effectiveness of a liaison program in meeting information needs of college of pharmacy faculty.

PubMed

Kramer, Sandra S; Martin, Jennifer R; Schlimgen, Joan B; Slack, Marion K; Martin, Jim

2011-01-01

This article describes the creation and implementation of focus groups to evaluate the effectiveness of a health sciences library's liaison program of the College of Pharmacy faculty and to better understand the faculty's information needs in order to design new and improved library services. The liaison services support the teaching and research needs of faculty and students through literature research, classroom teaching, and an extensive library collection of pharmacy literature. Focus group results demonstrated a high level of satisfaction with library liaison services and collections. Opportunities exist for expanded interaction with graduate students and greater marketing of library services to increase faculty awareness of specific library programs.

Development of a High Level Waste Tank Inspection System

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

Appel, D.K.; Loibl, M.W.; Meese, D.C.

1995-03-21

The Westinghouse Savannah River Technology Center was requested by it`s sister site, West Valley Nuclear Service (WVNS), to develop a remote inspection system to gather wall thickness readings of their High Level Waste Tanks. WVNS management chose to take a proactive approach to gain current information on two tanks t hat had been in service since the early 70`s. The tanks contain high level waste, are buried underground, and have only two access ports to an annular space between the tank and the secondary concrete vault. A specialized remote system was proposed to provide both a visual surveillance and ultrasonicmore » thickness measurements of the tank walls. A magnetic wheeled crawler was the basis for the remote delivery system integrated with an off-the-shelf Ultrasonic Data Acquisition System. A development program was initiated for Savannah River Technology Center (SRTC) to design, fabricate, and test a remote system based on the Crawler. The system was completed and involved three crawlers to perform the needed tasks, an Ultrasonic Crawler, a Camera Crawler, and a Surface Prep Crawler. The crawlers were computer controlled so that their operation could be done remotely and their position on the wall could be tracked. The Ultrasonic Crawler controls were interfaced with ABB Amdata`s I-PC, Ultrasonic Data Acquisition System so that thickness mapping of the wall could be obtained. A second system was requested by Westinghouse Savannah River Company (WSRC), to perform just ultrasonic mapping on their similar Waste Storage Tanks; however, the system needed to be interfaced with the P-scan Ultrasonic Data Acquisition System. Both remote inspection systems were completed 9/94. Qualifications tests were conducted by WVNS prior to implementation on the actual tank and tank development was achieved 10/94. The second inspection system was deployed at WSRC 11/94 with success, and the system is now in continuous service inspecting the remaining high level waste tanks at WSRC.« less

Domestic violence and mental health: a cross-sectional survey of women seeking help from domestic violence support services.

PubMed

Ferrari, Giulia; Agnew-Davies, Roxane; Bailey, Jayne; Howard, Louise; Howarth, Emma; Peters, Tim J; Sardinha, Lynnmarie; Feder, Gene Solomon

2016-01-01

Domestic violence and abuse (DVA) are associated with increased risk of mental illness, but we know little about the mental health of female DVA survivors seeking support from domestic violence services. Our goal was to characterise the demography and mental health of women who access specialist DVA services in the United Kingdom and to investigate associations between severity of abuse and measures of mental health and health state utility, accounting for important confounders and moderators. Baseline data on 260 women enrolled in a randomized controlled trial of a psychological intervention for DVA survivors were analysed. We report the prevalence of and associations between mental health status and severity of abuse at the time of recruitment. We used logistic and normal regression models for binary and continuous outcomes, respectively. The following mental health measures were used: Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), Patient Health Questionnaire, Generalised Anxiety Disorder Assessment, and the Posttraumatic Diagnostic Scale to measure posttraumatic stress disorder (PTSD). The Composite Abuse Scale (CAS) measured abuse. Exposure to DVA was high, with a mean CAS score of 56 (SD 34). The mean CORE-OM score was 18 (SD 8) with 76% above the clinical threshold (95% confidence interval: 70-81%). Depression and anxiety levels were high, with means close to clinical thresholds, and more than three-quarters of respondents recorded PTSD scores above the clinical threshold. Symptoms of mental illness increased stepwise with increasing severity of DVA. Women DVA survivors who seek support from DVA services have recently experienced high levels of abuse, depression, anxiety, and especially PTSD. Clinicians need to be aware that patients presenting with mental health conditions or symptoms of depression or anxiety may be experiencing or have experienced DVA. The high psychological morbidity in this population means that trauma-informed psychological support is needed for survivors who seek support from DVA services.

Domestic violence and mental health: a cross-sectional survey of women seeking help from domestic violence support services

PubMed Central

Ferrari, Giulia; Agnew-Davies, Roxane; Bailey, Jayne; Howard, Louise; Howarth, Emma; Peters, Tim J.; Sardinha, Lynnmarie; Feder, Gene Solomon

2016-01-01

Background Domestic violence and abuse (DVA) are associated with increased risk of mental illness, but we know little about the mental health of female DVA survivors seeking support from domestic violence services. Objective Our goal was to characterise the demography and mental health of women who access specialist DVA services in the United Kingdom and to investigate associations between severity of abuse and measures of mental health and health state utility, accounting for important confounders and moderators. Design Baseline data on 260 women enrolled in a randomized controlled trial of a psychological intervention for DVA survivors were analysed. We report the prevalence of and associations between mental health status and severity of abuse at the time of recruitment. We used logistic and normal regression models for binary and continuous outcomes, respectively. The following mental health measures were used: Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), Patient Health Questionnaire, Generalised Anxiety Disorder Assessment, and the Posttraumatic Diagnostic Scale to measure posttraumatic stress disorder (PTSD). The Composite Abuse Scale (CAS) measured abuse. Results Exposure to DVA was high, with a mean CAS score of 56 (SD 34). The mean CORE-OM score was 18 (SD 8) with 76% above the clinical threshold (95% confidence interval: 70–81%). Depression and anxiety levels were high, with means close to clinical thresholds, and more than three-quarters of respondents recorded PTSD scores above the clinical threshold. Symptoms of mental illness increased stepwise with increasing severity of DVA. Conclusions Women DVA survivors who seek support from DVA services have recently experienced high levels of abuse, depression, anxiety, and especially PTSD. Clinicians need to be aware that patients presenting with mental health conditions or symptoms of depression or anxiety may be experiencing or have experienced DVA. The high psychological morbidity in this population means that trauma-informed psychological support is needed for survivors who seek support from DVA services. PMID:26860876

Domestic violence and mental health: a cross-sectional survey of women seeking help from domestic violence support services

PubMed Central

Ferrari, Giulia; Agnew-Davies, Roxane; Bailey, Jayne; Howard, Louise; Howarth, Emma; Peters, Tim J.; Sardinha, Lynnmarie; Feder, Gene

2014-01-01

Background Domestic violence and abuse (DVA) are associated with an increased risk of mental illness, but we know little about the mental health of female DVA survivors seeking support from domestic violence services. Objective To characterize the demography and mental health of women who access specialist DVA services in the United Kingdom and to investigate associations between severity of abuse and measures of mental health and health state utility, accounting for important confounders and moderators. Design Baseline data on 260 women enrolled in a randomized controlled trial of a psychological intervention for DVA survivors was analyzed. We report prevalence of and associations between mental health status and severity of abuse at the time of recruitment. We used logistic and normal regression models for binary and continuous outcomes, respectively. Mental health measures used were: Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM), Patient Health Questionnaire, Generalized Anxiety Disorder Assessment, and the Posttraumatic Diagnostic Scale (PDS) to measure posttraumatic stress disorder. The Composite Abuse Scale (CAS) measured abuse. Results Exposure to DVA was high, with a mean CAS score of 56 (SD 34). The mean CORE-OM score was 18 (SD 8) with 76% above the clinical threshold (95% confidence interval: 70–81%). Depression and anxiety levels were high, with means close to clinical thresholds, and all respondents recorded PTSD scores above the clinical threshold. Symptoms of mental illness increased stepwise with increasing severity of DVA. Conclusions Women DVA survivors who seek support from DVA services have recently experienced high levels of abuse, depression, anxiety, and especially PTSD. Clinicians need to be aware that patients presenting with mental health conditions or symptoms of depression or anxiety may be experiencing or may have experienced DVA. The high psychological morbidity in this population means that trauma-informed psychological support is needed for survivors who seek support from DVA services. PMID:25319597

Guaranteeing patient satisfaction.

PubMed

Levin, R P

1994-04-01

Dental practice is about people and service. As the competition for patients increases, the successful practices will be the ones that focus increasingly on communication, relationship building and customer service. Quality care will be demonstrated through focusing on the total clinical and psychological aspects of patient satisfaction--and not just on technical parameters. Any practice can convert to a high level patient relations office if the commitment is truly there. These will be the leading practices of tomorrow.

Other Defense Organizations and Defense Finance and Accounting Service Controls Over High-Risk Transactions Were Not Effective

DTIC Science & Technology

2016-03-28

Management (DHA- CRM ), agreed with Recommendations 1 and 2. The Chief stated that the service-level agreements should be updated to provide...descriptive language on the defined roles and responsibilities. In some instances, DHA- CRM personnel find it difficult to identify responsible parties at...that it maintains a universe of all accounting transactions processed daily to include disbursements. Additionally, DHA- CRM personnel perform a

Exploratory Factor Analyses of the CAHPS® Hospital Pilot Survey Responses across and within Medical, Surgical, and Obstetric Services

PubMed Central

O'Malley, A James; Zaslavsky, Alan M; Hays, Ron D; Hepner, Kimberly A; Keller, San; Cleary, Paul D

2005-01-01

Objectives To estimate the associations among hospital-level scores from the Consumer Assessments of Healthcare Providers and Systems (CAHPS®) Hospital pilot survey within and across different services (surgery, obstetrics, medical), and to evaluate differences between hospital- and patient-level analyses. Data Source CAHPS Hospital pilot survey data provided by the Centers for Medicare and Medicaid Services. Study Design Responses to 33 questionnaire items were analyzed using patient- and hospital-level exploratory factor analytic (EFA) methods to identify both a patient-level and hospital-level composite structures for the CAHPS Hospital survey. The latter EFA was corrected for patient-level sampling variability using a hierarchical model. We compared results of these analyses with each other and to separate EFAs conducted at the service level. To quantify the similarity of assessments across services, we compared correlations of different composites within the same service with those of the same composite across different services. Data Collection Cross-sectional data were collected during the summer of 2003 via mail and telephone from 19,720 patients discharged from November 2002 through January 2003 from 132 hospitals in three states. Principal Findings Six factors provided the best description of inter-item covariation at the patient level. Analyses that assessed variability across both services and hospitals suggested that three dimensions provide a parsimonious summary of inter-item covariation at the hospital level. Hospital-level factor structures also differed across services; as much variation in quality reports was explained by service as by composite. Conclusions Variability of CAHPS scores across hospitals can be reported parsimoniously using a limited number of composites. There is at least as much distinct information in composite scores from different services as in different composite scores within each service. Because items cluster slightly differently in the different services, service-specific composites may be more informative when comparing patients in a given service across hospitals. When studying individual-level variability, a more differentiated structure is probably more appropriate. PMID:16316439

Cross-Sector Service Use Among High Health Care Utilizers In Minnesota After Medicaid Expansion.

PubMed

Vickery, Katherine Diaz; Bodurtha, Peter; Winkelman, Tyler N A; Hougham, Courtney; Owen, Ross; Legler, Mark S; Erickson, Erik; Davis, Matthew M

2018-01-01

Childless adults in the Medicaid expansion population have complex social and behavioral needs. This study compared the cross-sector involvement of Medicaid expansion enrollees who were high health care utilizers to that of other expansion enrollees in Hennepin County, Minnesota. We examined forty-six months of annualized utilization and cost data for expansion-eligible residents with at least twelve months of enrollment (N = 70,134) across health care, housing, criminal justice, and human service sectors. High health care utilizers, approximately 7 percent of our sample, were disproportionately American Indian, younger, and significantly more likely than other expansion enrollees to have mental health (88.1 percent versus 48.0 percent) or substance use diagnoses (79.2 percent versus 29.6 percent). Total cross-sector public spending was nearly four times higher for high health care users ($25,337 versus $6,786), and their non-health care expenses were 2.4 times higher ($7,476 versus $3,108). High levels of cross-sector service use suggest that there are opportunities for collaboration that may result in cost savings across sectors.

Diversification of health care services: the effects of ownership, environment, and strategy.

PubMed

Shortell, S M; Morrison, E M; Hughes, S L; Friedman, B S; Vitek, J L

1987-01-01

The present findings suggest that the trend toward greater diversification of hospital services is likely to be most strongly influenced by state Medicaid policies and certain hospital characteristics. Increasing Medicaid eligibility and payment levels is likely to have a positive effect on services diversification. Growth in the number of inpatient services provided and a more severe case mix are also likely to be involved with greater service diversification. Affiliation with a not-for-profit hospital system is likely to be associated with more diversified hospital services but not affiliation with an investor-owned system. There is also some indication that the overall portfolio of services which a hospital offers in regard to market share and market growth characteristics influences diversification. Specifically, a low market share portfolio is likely to be associated with less diversification. Competition is likely to be associated with more diversification; particularly for hospitals belonging to systems. The effect of competition on hospital strategy and services diversification is a particularly important area for further investigation. Increasing Medicaid payment and eligibility levels are also likely to have a positive effect on the provision of services which are usually unprofitable. Raising such levels is likely to be particularly beneficial to inner-city hospitals who are already providing a greater number of such services. However, the present data suggest that investor-owned hospitals are least likely to provide such services. Increasing Medicaid eligibility levels is also likely to be associated with fewer services for which charity care has to be provided. State regulation in the form of rate review and certificate of need is likely to be associated with more services for which hospitals provide some charity care. But such policies alone do not deal with the larger issue of how to finance care for the medically indigent. Present data suggest the charity care issue may be particularly salient in markets characterized by a relatively high degree of competition. Finally, investor-owned hospitals provide as many services involving charity care as not-for-profit system hospitals, although investor-owned system hospitals provide fewer such services than not-for-profit freestanding hospitals. Throughout, the findings indicate the importance of distinguishing between ownership and system affiliation. Previous research has failed to make a distinction between ownership form and system affiliation, thus attributing to ownership form differences which, as present findings suggest, appear to be more associated with system affiliation.(ABSTRACT TRUNCATED AT 400 WORDS)

Use of AIRS, OMI, MLS, and TES Data in Assessing Forest Ecosystem Exposure to Ozone

NASA Technical Reports Server (NTRS)

Spruce, Joseph P.

2007-01-01

Ground-level ozone at high levels poses health threats to exposed flora and fauna, including negative impacts to human health. While concern is common regarding depletion of ozone in the stratosphere, portions of the urban and rural United States periodically have high ambient levels of tropospheric ozone on the ground. Ozone pollution can cause a variety of impacts to susceptible vegetation (e.g., Ponderosa and Jeffrey pine species in the southwestern United States), such as stunted growth, alteration of growth form, needle or leaf chlorosis, and impaired ability to withstand drought-induced water stress. In addition, Southern Californian forests with high ozone exposures have been recently subject to multiyear droughts that have led to extensive forest overstory mortality from insect outbreaks and increased incidence of wildfires. Residual forests in these impacted areas may be more vulnerable to high ozone exposures and to other forest threats than ever before. NASA sensors collect a wealth of atmospheric data that have been used recently for mapping and monitoring regional tropospheric ozone levels. AIRS (Atmospheric Infrared Sounder), OMI (Ozone Monitoring Instrument), MLS (Microwave Limb Sounder), and TES (Tropospheric Emission Spectrometer) data could be used to assess forest ecosystem exposure to ozone. Such NASA data hold promise for providing better or at least complementary synoptic information on ground-level ozone levels that Federal agency partners can use to assess forest health trends and to mitigate the threats as needed in compliance with Federal laws and mandates. NASA data products on ozone concentrations may be able to aid applications of DSTs (decision support tools) adopted by the USDA FS (U.S. Department of Agriculture Forest Service) and by the NPS (National Park Service), such as the Ozone Calculator, in which ground ozone estimates are employed to assess ozone impacts to forested vegetation.

Utilization of cervical cancer screening services and its associated factors among primary school teachers in Ilala Municipality, Dar es Salaam, Tanzania.

PubMed

Kileo, Neema Minja; Michael, Denna; Neke, Nyasule Majura; Moshiro, Candida

2015-12-15

Worldwide cervical cancer is one of the more common forms of carcinoma among women, causing high morbidity and high mortality. Despite being a major health problem in Tanzania, screening services for cervical cancer are very limited, and uptake of those services is low. We therefore conducted a study to investigate utilization of cancer screening services, and its associated factors among female primary school teachers in Ilala Municipality, Dar es Salaam. We conducted a cross-sectional study between May - August 2011 which involved 110 primary schools in Ilala Municipality in Dar es Salaam. Five hundred and twelve female primary school teachers were sampled using a two-stage cluster sampling procedure. Data on utilization of cervical cancer and risk factors were collected using a self-administered questionnaire. Proportional utilization of cervical cancer screening services was identified through a self report. Risk factors for services utilization were assessed using logistic regression analyses. Out of 512 female primary school teachers, only 108 (21 %) reported to ever been screened for cervical cancer. Utilization of cervical cancer screening services was 28 % among those aged 20-29, 22 % among married and 24 % among those with higher level of education. Women were more likely to utilize the cancer-screening service if they were multiparous (age-adjusted OR = 3.05, 95 % CI 1.15-8.06, P value 0.025), or reported more than one lifetime sexual partner (age-adjusted OR 2.17, 95 % CI 1.04-4.54, P value 0.038), or did not involve their spouse in making health decisions (adjusted OR 3.56, 95 % CI 2.05-6.18, P value <0.001). The study has demonstrated low level of utilization of cervical cancer screening service among female primary school teachers in Ilala munipality. Female primary school teachers with more than one previous pregnancy and those with more than one life-time sex partners were more likely to report utilization of the service. Spouse or partners support was an important factor in the utilization of cervical cancer screening service amongst the study population.

Different factors influence self-reports and third-party reports of anger by adults with intellectual disabilities.

PubMed

Rose, John; Willner, Paul; Shead, Jennifer; Jahoda, Andrew; Gillespie, David; Townson, Julia; Lammie, Claire; Woodgate, Christopher; Stenfert Kroese, Biza; Felce, David; MacMahon, Pamela; Rose, Nikki; Stimpson, Aimee; Nuttall, Jacqueline; Hood, Kerenza

2013-09-01

Many people with intellectual disabilities display high levels of anger, and cognitive-behavioural anger management interventions are used routinely. However, for these methods to be used optimally, a better understanding is needed of different forms of anger assessment. The aim of this study was to investigate the relationship of a range of measures to self- and carer reports of anger expression, including instruments used to assess mental health and challenging behaviour. Adults with intellectual disabilities, who had been identified as having problems with anger control, their key-workers and home carers all rated the service users' trait anger, using parallel versions of the same instrument (the Provocation Inventory). In addition, service users completed a battery of mental health assessments (the Glasgow Depression Scale, Glasgow Anxiety Scale and Rosenberg Self-Esteem Scale), and both groups of carers completed a battery of challenging behaviour measures (the Hyperactivity and Irritability domains of the Aberrant Behavior Checklist and the Modified Overt Anger Scale). Participants had high levels of mental health problems (depression: 34%; anxiety: 73%) and severe challenging behaviour (26%). Hierarchical linear regression analysis was used to explore the extent to which anger ratings by the three groups of respondents were predicted by demographic factors, mental health measures and challenging behaviour measures. Older service users rated themselves as less angry and were also rated as less angry by home carers, but not by key-workers. More intellectually able service users were rated as more angry by both sets of carers, but not by the service users themselves. Significantly, mental health status (but not challenging behaviour) predicted service users' self-ratings of anger, whereas challenging behaviour (but not mental health status) predicted carers' ratings of service users' anger. Service users and their carers appear to use different information when rating the service users' anger. Service users' self-ratings reflect their internal emotional state and mental health, as reflected by their ratings of anxiety and depression, whereas staff rate service users' anger on the basis of overt behaviours, as measured by challenging behaviour scales. © 2013 John Wiley & Sons Ltd.

Community Public Health Fact Sheet

EPA Pesticide Factsheets

EPA’s Community Public Health (CPH) project in the Office of Research and Development (ORD) produces high quality science and tools to understand and assess environmental risks and ecosystem goods and services (EGS) to decision-makers at all levels.

Challenges to HIV prevention in psychiatric settings: Perceptions of South African mental health care providers

PubMed Central

Collins, Pamela Y.

2009-01-01

Mental health services in South Africa increasingly feel the brunt of the AIDS epidemic. Despite the high prevalence of infection in the psychiatric setting, HIV risk reduction interventions targeting South Africans with psychiatric illness remain few and far between. The attitudes of mental health care providers about sexual relations and HIV among people with mental illness continue to influence the extent to which these issues are addressed in care settings. This study examines these attitudes through the use of a semi-structured interview administered to 46 mental health care providers in four provinces of South Africa. I found that personal, contextual and political factors in the clinic and the hospital create barriers to integrating prevention activities. In particular, providers face at least three challenges to intervening in the epidemic among their patients: their own views of psychiatric illness, the transitions occurring in the mental health care system, and shifting social attitudes toward sexuality. Barriers operate at the individual level, the institutional level, and the societal level. At the individual level providers’ perceptions of psychiatric symptoms shape their outlook on intervention with psychiatric patients. At the institutional level disruptive transitions in service delivery relegate HIV services to lesser importance. At the societal level, personal beliefs about sexuality and mental illness have remained slow to change despite major political changes. Minimizing barriers to implementing HIV prevention services requires institutional and health care policies that ensure adequate resources for treating people with mental illness and for staff development and support. PMID:16647793

The roles of individual and organizational factors in burnout among community-based mental health service providers.

PubMed

Green, Amy E; Albanese, Brian J; Shapiro, Nicole M; Aarons, Gregory A

2014-02-01

Public-sector mental health care providers are at high risk for burnout, which negatively affects not only provider well-being but also the quality of services for clients and the functioning of organizations. This study examines the influence of demographics, work characteristic, and organizational variables on levels of burnout among child and adolescent mental health service providers operating within a public-sector mental health service system. Additionally, given the dearth of research examining differences in burnout levels among mental health subdisciplines (e.g., social work, psychology, marital and family therapy) and mental health programs (e.g., outpatient, day treatment, wraparound, case management), analyses were conducted to compare levels of burnout among multiple mental health disciplines and program types. Surveys were completed by 285 providers across 49 mental health programs in a large urban public mental health system. Variables representing dimensions of organizational climate and transformational leadership accounted for the greatest amount of variance in provider reported burnout. Analyses demonstrated significantly lower levels of depersonalization among wraparound providers compared to traditional case managers. Age was the only demographic variable related to burnout. Additionally, no significant effects were found for provider discipline or for agency tenure and caseload size. Results suggest the need to consider organizational development strategies aimed at creating more functional and less stressful climates and increasing levels of transformational leadership behaviors in order to reduce levels of burnout among clinicians working in public mental health settings for youth and families. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Drug prescribing in rural health facilities in China: implications for service quality and cost.

PubMed

Zhan, S K; Tang, S L; Guo, Y D; Bloom, G

1998-01-01

Overuse of drugs in rural areas of China has led to a growing concern regarding service quality and cost. The study found evidence of high levels of drug use in some rural health facilities in comparison with a number of other developing countries. Such a result was significantly associated with the government policy of financing health care, regulation and monitoring of health services, and users' attitudes and behaviour. It underlines the need for measures to be taken in China to improve drug use in order to allow its population access to effective care at reasonable cost.

Pharmaceutical reform in South Korea and the lessons it provides.

PubMed

Kim, Hak-Ju; Ruger, Jennifer Prah

2008-01-01

Through implementation of its 2000 pharmaceutical reform, the South Korean government expected to reduce the cost of medications and improve service levels, medical appropriateness of care, and drug effectiveness. However, despite the reform's lofty goals, unintended consequences have distorted the supply of medical services and spending. These consequences have included increasing the use of uninsured services, prescribing high-price drugs, and a growing market share for multinational drug companies. Further reforms are needed to reduce the measure's adverse effects. This paper examines the Korean mandatory prescription system and offers an analysis of Korea's reforms.

Assessment of health facility capacity to provide newborn care in Bangladesh, Haiti, Malawi, Senegal, and Tanzania

PubMed Central

Winter, Rebecca; Yourkavitch, Jennifer; Wang, Wenjuan; Mallick, Lindsay

2017-01-01

Background Despite the importance of health facility capacity to provide comprehensive care, the most widely used indicators for global monitoring of maternal and child health remain contact measures which assess women’s use of services only and not the capacity of health facilities to provide those services; there is a gap in monitoring health facilities’ capacity to provide newborn care services in low and middle income countries. Methods In this study we demonstrate a measurable framework for assessing health facility capacity to provide newborn care using open access, nationally–representative Service Provision Assessment (SPA) data from the Demographic Health Surveys Program. In particular, we examine whether key newborn–related services are available at the facility (ie, service availability, measured by the availability of basic emergency obstetric care (BEmOC) signal functions, newborn signal functions, and routine perinatal services), and whether the facility has the equipment, medications, training and knowledge necessary to provide those services (ie, service readiness, measured by general facility requirements, equipment, medicines and commodities, and guidelines and staffing) in five countries with high levels of neonatal mortality and recent SPA data: Bangladesh, Haiti, Malawi, Senegal, and Tanzania. Findings In each country, we find that key services and commodities needed for comprehensive delivery and newborn care are missing from a large percentage of facilities with delivery services. Of three domains of service availability examined, scores for routine care availability are highest, while scores for newborn signal function availability are lowest. Of four domains of service readiness examined, scores for general requirements and equipment are highest, while scores for guidelines and staffing are lowest. Conclusions Both service availability and readiness tend to be highest in hospitals and facilities in urban areas, pointing to substantial equity gaps in the availability of essential newborn care services for rural areas and for people accessing lower–level facilities. Together, the low levels of both service availability and readiness across the five countries reinforce the vital importance of monitoring health facility capacity to provide care. In order to save newborn lives and improve equity in child survival, not only does women’s use of services need to increase, but facility capacity to provide those services must also be enhanced. PMID:29423186

The first national clinical audit for rheumatoid arthritis.

PubMed

Firth, J; Snowden, N; Ledingham, J; Rivett, A; Galloway, J; Dennison, E M; MacPhie, E; Ide, Z; Rowe, I; Kandala, N; Jameson, K

The first national audit for rheumatoid and early inflammatory arthritis has benchmarked care for the first 3 months of follow-up activity from first presentation to a rheumatology service. Access to care, management of early rheumatoid arthritis and support for self care were measured against National Institute for Health and Care Excellence quality standards; impact of early arthritis and experience of care were measured using patient-reported outcome and experience measures. The results demonstrate delays in referral and accessing specialist care and the need for service improvement in treating to target, suppression of high levels of disease activity and support for self-care. Improvements in patient-reported outcomes within 3 months and high levels of overall satisfaction were reported but these results were affected by low response rates. This article presents a summary of the national data from the audit and discusses the implications for nursing practice.

Practice nurse involvement in primary care depression management: an observational cost-effectiveness analysis

PubMed Central

2014-01-01

Background Most evidence on the effect of collaborative care for depression is derived in the selective environment of randomised controlled trials. In collaborative care, practice nurses may act as case managers. The Primary Care Services Improvement Project (PCSIP) aimed to assess the cost-effectiveness of alternative models of practice nurse involvement in a real world Australian setting. Previous analyses have demonstrated the value of high level practice nurse involvement in the management of diabetes and obesity. This paper reports on their value in the management of depression. Methods General practices were assigned to a low or high model of care based on observed levels of practice nurse involvement in clinical-based activities for the management of depression (i.e. percentage of depression patients seen, percentage of consultation time spent on clinical-based activities). Linked, routinely collected data was used to determine patient level depression outcomes (proportion of depression-free days) and health service usage costs. Standardised depression assessment tools were not routinely used, therefore a classification framework to determine the patient’s depressive state was developed using proxy measures (e.g. symptoms, medications, referrals, hospitalisations and suicide attempts). Regression analyses of costs and depression outcomes were conducted, using propensity weighting to control for potential confounders. Results Capacity to determine depressive state using the classification framework was dependent upon the level of detail provided in medical records. While antidepressant medication prescriptions were a strong indicator of depressive state, they could not be relied upon as the sole measure. Propensity score weighted analyses of total depression-related costs and depression outcomes, found that the high level model of care cost more (95% CI: -$314.76 to $584) and resulted in 5% less depression-free days (95% CI: -0.15 to 0.05), compared to the low level model. However, this result was highly uncertain, as shown by the confidence intervals. Conclusions Classification of patients’ depressive state was feasible, but time consuming, using the classification framework proposed. Further validation of the framework is required. Unlike the analyses of diabetes and obesity management, no significant differences in the proportion of depression-free days or health service costs were found between the alternative levels of practice nurse involvement. PMID:24422622

Dialoguing, Cultural Capital, and Student Engagement: Toward a Hip Hop Pedagogy in the High School and University Classroom

ERIC Educational Resources Information Center

Rodriguez, Louie F.

2009-01-01

Hip hop culture is typically excluded from conventional educational spaces within the U.S. Drawing on the experiences of an educator who works with urban high school students and university level pre- and in-service educators, this article examines the role of hip hop culture for student engagement in two settings--an alternative high school…

Availability of tobacco cessation services in substance use disorder treatment programs: Impact of state tobacco control policy.

PubMed

Abraham, Amanda J; Bagwell-Adams, Grace; Jayawardhana, Jayani

2017-08-01

Given the high prevalence of smoking among substance use disorder (SUD) patients, the specialty SUD treatment system is an important target for adoption and implementation of tobacco cessation (TC) services. While research has addressed the impact of tobacco control on individual tobacco consumption, largely overlooked in the literature is the potential impact of state tobacco control policies on availability of services for tobacco cessation. This paper examines the association between state tobacco control policy and availability of TC services in SUD treatment programs in the United States. State tobacco control and state demographic data (n=51) were merged with treatment program data from the 2012 National Survey of Substance Abuse Treatment Services (n=10.413) to examine availability of TC screening, counseling and pharmacotherapy services in SUD treatment programs using multivariate logistic regression models clustered at the state-level. Approximately 60% of SUD treatment programs offered TC screening services, 41% offered TC counseling services and 26% offered TC pharmacotherapy services. Results of multivariate logistic regression showed the odds of offering TC services were greater for SUD treatment programs located in states with higher cigarette excise taxes and greater spending on tobacco prevention and control. Findings indicate cigarette excise taxes and recommended funding levels may be effective policy tools for increasing access to TC services in SUD treatment programs. Coupled with changes to insurance coverage for TC under the Affordable Care Act, state tobacco control policy tools may further reduce tobacco use in the United States. Published by Elsevier Ltd.

Screening and identifying diabetes in optometric practice: a prospective study.

PubMed

Howse, Jennifer H; Jones, Steve; Hungin, A Pali S

2011-07-01

Unconventional settings, outside general medical practice, are an underutilised resource in the attempt to identify the large numbers of people with undiagnosed diabetes worldwide. The study investigated the feasibility of using optometry practices (opticians) as a setting for a diabetes screening service. Adults attending high street optometry practices in northern England who self-reported at least one risk factor for diabetes were offered a random capillary blood glucose (rCBG) test. Those with raised rCBG levels were asked to visit their GP for further investigations. Of 1909 adults attending practices for sight tests, 1303 (68.2%) reported risk factors for diabetes, of whom 1002 (76.9%) had rCBG measurements taken. Of these, 318 (31.7%) were found to have a rCBG level of ≥6.1 mmol/l, a level where further investigations are recommended by Diabetes UK; 1.6% of previously undiagnosed individuals were diagnosed with diabetes or pre-diabetes as a result of the service. Refining the number of risk factors for inclusion would have reduced those requiring screening by half and still have identified nearly 70% of the new cases of diabetes and pre-diabetes. Screening in optometric practices provides an efficient opportunity to screen at-risk individuals who do not present to conventional medical services, and is acceptable and appropriate. Optometrists represent a skilled worldwide resource that could provide a screening service. This service could be transferable to other settings.

Social capital, acculturation, mental health, and perceived access to services among Mexican American women.

PubMed

Valencia-Garcia, Dellanira; Simoni, Jane M; Alegría, Margarita; Takeuchi, David T

2012-04-01

We examined whether individual-level social capital-the intangible resources in a community available through membership in social networks or other social structures and perceived trust in the community-was associated with acculturation, depression and anxiety symptoms, and perceived access to services among women of Mexican ancestry. Recruited through venue-based targeted sampling in King County, Washington, 205 women of Mexican descent ages 18 to 64 years who differed in socioeconomic status and nativity completed a cross-sectional survey. Half completed the survey in Spanish and half in English. Structural equation modeling was used for model testing. Social capital increased with level of acculturation and was negatively related to depression and anxiety; it had no direct association with perceived access to services. Social capital mediated the relation between acculturation and both depression and anxiety symptoms. Acculturation had no direct association with psychological distress but was directly associated with perceived access to services. This community sample of women reported high levels of psychological distress, with 20% to 26% of women meeting diagnostic criteria for depression or anxiety. Social capital can be assessed at the individual level, increases with acculturation, and may be a potential target for interventions to improve mental health among Mexican American women residing in the United States. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Collaboration, integration and change in children's services: critical issues and key ingredients.

PubMed

Horwath, Jan; Morrison, Tony

2007-01-01

Government and state policy, irrespective of jurisdiction, increasingly require and indeed specify the nature of collaboration with regard to the delivery of child welfare services for maltreated children. The rationale for collaboration appears obvious in as much as it is aimed at promoting multidisciplinary practice in order to meet the needs of the vulnerable child. However, collaboration, whilst a useful and motivating concept, is in reality far from straightforward and contains complexities and ambiguities. The aim of this paper is to explore these complexities and ambiguities to provide an overview of key developmental frameworks relevant to the creation and maintenance of strategic high-level multiagency partnerships. The authors begin by exploring the characteristic features of different levels of multiagency collaboration that is communication, co-operation, co-ordination, coalition, and integration. As the emphasis in a variety of jurisdictions in the Western world is on the highest levels of collaboration namely coalition and service integration this is the focus of the paper. The authors synthesize the main literature in the field to consider the critical elements for effective collaborative endeavors at this level including predisposing factors, mandate, leadership, machinery, process, and outcomes. The paper concludes by recognizing that the drive towards integrated services is occurring in a climate of continuing change. The need to identify the impact of such an environment when managing multiagency partnerships is explored using five steps to change.

Frequency and Correlates of Service Access among Youth with Autism Transitioning to Adulthood

PubMed Central

Taylor, Julie Lounds; Henninger, Natalie A.

2014-01-01

This study examined service receipt and unmet service needs among youth with autism spectrum disorders (ASD) in their last year of high school, as well as the youth (intellectual disability, race/ethnicity, autism severity, comorbid psychiatric diagnoses, behavior problems, adaptive behavior) and family (income, parental health, parental depressive symptoms, parental anxiety) correlates of service access. Thirty-nine families of youth with ASD participated. Data were collected via parental interview/questionnaire and youth psychological evaluation. Results suggested that this sample was underserved relative to a nationally-representative cohort. Those with a comorbid psychiatric diagnosis and lower levels of adaptive behavior received more services. Greater unmet needs were reported for youth who were racial/ethnic minorities, who had more behavior problems, and whose parents had greater anxiety. PMID:25081594

Architecture of a Framework for Providing Information Services for Public Transport

PubMed Central

García, Carmelo R.; Pérez, Ricardo; Lorenzo, Álvaro; Quesada-Arencibia, Alexis; Alayón, Francisco; Padrón, Gabino

2012-01-01

This paper presents OnRoute, a framework for developing and running ubiquitous software that provides information services to passengers of public transportation, including payment systems and on-route guidance services. To achieve a high level of interoperability, accessibility and context awareness, OnRoute uses the ubiquitous computing paradigm. To guarantee the quality of the software produced, the reliable software principles used in critical contexts, such as automotive systems, are also considered by the framework. The main components of its architecture (run-time, system services, software components and development discipline) and how they are deployed in the transportation network (stations and vehicles) are described in this paper. Finally, to illustrate the use of OnRoute, the development of a guidance service for travellers is explained. PMID:22778585

Context aware adaptive security service model

NASA Astrophysics Data System (ADS)

Tunia, Marcin A.

2015-09-01

Present systems and devices are usually protected against different threats concerning digital data processing. The protection mechanisms consume resources, which are either highly limited or intensively utilized by many entities. The optimization of these resources usage is advantageous. The resources that are saved performing optimization may be utilized by other mechanisms or may be sufficient for longer time. It is usually assumed that protection has to provide specific quality and attack resistance. By interpreting context situation of business services - users and services themselves, it is possible to adapt security services parameters to countermeasure threats associated with current situation. This approach leads to optimization of used resources and maintains sufficient security level. This paper presents architecture of adaptive security service, which is context-aware and exploits quality of context data issue.

Understanding Cultural Influence on Health Behaviors of Latino Adolescent Parents. Latino Policy & Issues Brief. Number 12

ERIC Educational Resources Information Center

Gonzalez-Figueroa, Evelyn; Koniak-Griffin, Deborah

2006-01-01

Overall, Latino immigrants may be at greater risk for HIV due to lack of information, health services, and culturally relevant resources. Unfortunately, low levels of acculturation and traditional values combined with high levels of poverty and unemployment can negatively influence the risk for HIV. Non-US-born adolescents and those born to…

Computer-Aided Design of Drugs on Emerging Hybrid High Performance Computers

DTIC Science & Technology

2013-09-01

solutions to virtualization include lightweight, user-level implementations on Linux operating systems , but these solutions are often dependent on a...virtualization include lightweight, user-level implementations on Linux operating systems , but these solutions are often dependent on a specific version of...Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA, 22202-4302

Relationship between home care service use and changes in the care needs level of Japanese elderly.

PubMed

Kato, Gohei; Tamiya, Nanako; Kashiwagi, Masayo; Sato, Mikiya; Takahashi, Hideto

2009-12-21

With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels. The participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician. In the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to sustaining or improving the user's care needs level. There were different home service use in two groups (the sustained/improved group and the deteriorated group). Respite stay in a nursing home service use and more types of service use were related to experiencing a deterioration of care needs level in lower care needs level community-dwelling elderly persons in Japan. Further, medical management by a physician service was related to experiencing a deterioration of care needs level in higher care needs level community-dwelling elderly persons.

Factors determining access to oral health services among children aged less than 12 years in Peru.

PubMed

Azañedo, Diego; Hernández-Vásquez, Akram; Casas-Bendezú, Mixsi; Gutiérrez, César; Agudelo-Suárez, Andrés A; Cortés, Sandra

2017-01-01

Background: Understanding problems of access to oral health services requires knowledge of factors that determine access. This study aimed to evaluate factors that determine access to oral health services among children aged <12 years in Peru between 2014 and 2015. Methods: We performed a secondary data analysis of 71,614 Peruvian children aged <12 years and their caregivers. Data were obtained from the Survey on Demography and Family Health 2014-2015 (Encuesta Demográfica y de Salud Familiar - ENDES). Children's access to oral health services within the previous 6 months was used as the dependent variable (i.e. Yes/No), and the Andersen and col model was used to select independent variables. Predisposing (e.g., language spoken by  tutor or guardian, wealth level, caregivers' educational level, area of residence, natural region of residence, age, and sex) and enabling factors (e.g. type of health insurance) were considered. Descriptive statistics were calculated, and multivariate analysis was performed using generalized linear models (Poisson family). Results: Of all the children, 51% were males, 56% were aged <5 years, and 62.6% lived in urban areas. The most common type of health insurance was Integral Health Insurance (57.8%), and most respondents were in the first quintile of wealth (31.6%). Regarding caregivers, the most common educational level was high school (43.02%) and the most frequently spoken language was Spanish (88.4%). Univariate analysis revealed that all variables, except sex and primary educational level, were statistically significant. After adjustment, sex, area of residence, and language were insignificant, whereas the remaining variables were statistically significant. Conclusions: Wealth index, caregivers' education level, natural region of residence, age, and type of health insurance are factors that determine access to oral health services among children aged <12 years in Peru. These factors should be considered when devising strategies to mitigate against inequities in access to oral health services.

Factors determining access to oral health services among children aged less than 12 years in Peru

PubMed Central

Azañedo, Diego; Hernández-Vásquez, Akram; Casas-Bendezú, Mixsi; Gutiérrez, César; Agudelo-Suárez, Andrés A.; Cortés, Sandra

2017-01-01

Background: Understanding problems of access to oral health services requires knowledge of factors that determine access. This study aimed to evaluate factors that determine access to oral health services among children aged <12 years in Peru between 2014 and 2015. Methods: We performed a secondary data analysis of 71,614 Peruvian children aged <12 years and their caregivers. Data were obtained from the Survey on Demography and Family Health 2014-2015 (Encuesta Demográfica y de Salud Familiar - ENDES). Children’s access to oral health services within the previous 6 months was used as the dependent variable (i.e. Yes/No), and the Andersen and col model was used to select independent variables. Predisposing (e.g., language spoken by  tutor or guardian, wealth level, caregivers’ educational level, area of residence, natural region of residence, age, and sex) and enabling factors (e.g. type of health insurance) were considered. Descriptive statistics were calculated, and multivariate analysis was performed using generalized linear models (Poisson family). Results: Of all the children, 51% were males, 56% were aged <5 years, and 62.6% lived in urban areas. The most common type of health insurance was Integral Health Insurance (57.8%), and most respondents were in the first quintile of wealth (31.6%). Regarding caregivers, the most common educational level was high school (43.02%) and the most frequently spoken language was Spanish (88.4%). Univariate analysis revealed that all variables, except sex and primary educational level, were statistically significant. After adjustment, sex, area of residence, and language were insignificant, whereas the remaining variables were statistically significant. Conclusions: Wealth index, caregivers’ education level, natural region of residence, age, and type of health insurance are factors that determine access to oral health services among children aged <12 years in Peru. These factors should be considered when devising strategies to mitigate against inequities in access to oral health services. PMID:29527289

Providing a parallel and distributed capability for JMASS using SPEEDES

NASA Astrophysics Data System (ADS)

Valinski, Maria; Driscoll, Jonathan; McGraw, Robert M.; Meyer, Bob

2002-07-01

The Joint Modeling And Simulation System (JMASS) is a Tri-Service simulation environment that supports engineering and engagement-level simulations. As JMASS is expanded to support other Tri-Service domains, the current set of modeling services must be expanded for High Performance Computing (HPC) applications by adding support for advanced time-management algorithms, parallel and distributed topologies, and high speed communications. By providing support for these services, JMASS can better address modeling domains requiring parallel computationally intense calculations such clutter, vulnerability and lethality calculations, and underwater-based scenarios. A risk reduction effort implementing some HPC services for JMASS using the SPEEDES (Synchronous Parallel Environment for Emulation and Discrete Event Simulation) Simulation Framework has recently concluded. As an artifact of the JMASS-SPEEDES integration, not only can HPC functionality be brought to the JMASS program through SPEEDES, but an additional HLA-based capability can be demonstrated that further addresses interoperability issues. The JMASS-SPEEDES integration provided a means of adding HLA capability to preexisting JMASS scenarios through an implementation of the standard JMASS port communication mechanism that allows players to communicate.

A Semantic Cooperation and Interoperability Platform for the European Chambers of Commerce

NASA Astrophysics Data System (ADS)

Missikoff, Michele; Taglino, Francesco

The LD-CAST project aims at developing a semantic cooperation and interoperability platform for the European Chambers of Commerce. Some of the key issues that this platform addresses are: The variety and number of different kinds of resources (i.e., business processes, concrete services) that concur to achieve a business service The diversity of cultural and procedural models emerging when composing articulated cross-country services The limited possibility of reusing similar services in different contexts (for instance, supporting the same service between different countries: an Italian-Romanian cooperation is different from an Italian-Polish one) The objective of the LD-CAST platform, and in particular of the semantic services provided therein, is to address the above problems with flexible solutions. We aim at introducing high levels of flexibility, both at the time of development of business processes and concrete services (i.e., operational services offered by service providers), with the possibility of dynamically binding c-services to the selected BP, according to user needs. To this end, an approach based on semantic services and a reference ontology has been proposed.

A review of the incidence and transmission of Listeria monocytogenes in ready-to-eat products in retail and food service environments.

PubMed

Lianou, Alexandra; Sofos, John N

2007-09-01

Contamination of ready-to-eat products with Listeria monocytogenes may occur at several stages before consumption. Accessibility to the public and relatively limited control interventions at retail and food service establishments (compared with the processing sector of the food industry) and the lack of a specific regulatory framework increase the likelihood of introduction of this pathogen into some foods in these establishments. This review is a compilation of available information on the incidence and transmission of L. monocytogenes through ready-to-eat products at the retail and food service level. The potential transmission of L. monocytogenes within retail and food service operations has been indicated in epidemiological investigations and by survey data. Potential sources of the organism in these operations include the environment, food handlers, and incoming raw ingredients or processed products that have become contaminated after the lethality treatment at the manufacturing facility. L. monocytogenes may be present at retail and food service establishments in various ready-to-eat products, both prepackaged and those packaged in the store, and occasionally at high concentrations. This issue dictates the need for development and application of effective control measures, and potential control approaches are discussed here. Good manufacturing practices, appropriate cleaning, sanitation and hygiene programs, and temperature control required for prevention or inhibition of growth of the pathogen to high levels are critical for control of L. monocytogenes in the retail and food service sector. A comprehensive food safety system designed to be functional in retail and food service operations and based on the philosophy of hazard analysis and critical control point systems and a series of sound prerequisite programs can provide effective control of L. monocytogenes in these environments. However, competent delivery of food safety education and training to retail and food service managers and food handlers must be in place for successful implementation of such a system.

Infant mortality in India: use of maternal and child health services in relation to literacy status.

PubMed

Gokhale, Medha K; Rao, Shobha S; Garole, Varsha R

2002-06-01

Slow reduction in infant mortality rate in the last couple of decades is a major concern in India. State-level aggregate data from the National Family Health Survey 1992 and micro-level data on rural mothers (n=317) were used for examining the influence of female literacy on reduction of infant mortality through increased use of maternal and child health (MCH) services. Illiteracy of females was strongly associated with all variables relating to maternal care and also with infant mortality rate. States were grouped into best, medium, and worst on the basis of female illiteracy (about 11%, 48.5%, and 75% respectively). Infant mortality rate (per 1,000 livebirths) was significantly (p<0.01) higher among the worst group (90.99) than that among the medium (64.2) and the best (24.0) groups. Use of maternal health services increased in the worst to become the best groups for tetanus toxoid (from 48.0% to 84.4%), iron and folic acid tablets (36.6% to 76.2%), hospitalized deliveries (14.2% to 69.7%), and childcare services, such as vaccination (23.8% to 64.9%). Illiteracy of females had a more detrimental impact on rural than on urban areas. In the event of high female illiteracy, male literacy was beneficial for improving the use of services for reducing infant mortality rate. The micro-level study supported all major findings obtained for the national-level aggregate data. Programmes, like providing free education to girls, will yield long-term health benefits.

[Factors related to dissatisfaction and anger in parents of children treated at paediatric emergency services].

PubMed

Fernández-Castillo, A; Vílchez-Lara, M J

2015-01-01

Anger in patients and relatives is very frequent in health emergency services and is often associated with aggressiveness and emotional alterations. The aim of the present study is to explore anger in parents while their children are receiving care in paediatric emergency services, seeking the specific dimensions of dissatisfaction that may predict the onset of anger in parents. A cross-sectional descriptive study using a self-report questionnaire in 711 parents of children seen in paediatric emergency departments. The self-report questionnaires used were the State-Trait Anger Expression Inventory-2 (STAXI-2) and the Satisfaction with Healthcare Services Scale. The statistical analysis included descriptive, correlational, variance and multiple linear regression models. A total of 53 parents (7,5%) showed a moderate or high anger level. The mean score for satisfaction was 37.12 (SD=7.33). It was found that higher levels of overall satisfaction were significantly associated with lower levels of anger (r=-.29, p=.00). Among the variables studied, dissatisfaction with access to the service (β=-.172, p=.00), with the healthcare staff (β=-.121, p=.01), and perceived severity of the child's health status (β=.157, p=.00) predicted higher levels of anger. On the basis of our results, it is important to continue working to substantially improve access for patients and their families to the emergency department, as well as the information and communication process with the healthcare staff should be included in intervention initiatives. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

A Systematic Scheme for Multiple Access in Ethernet Passive Optical Access Networks

NASA Astrophysics Data System (ADS)

Ma, Maode; Zhu, Yongqing; Hiang Cheng, Tee

2005-11-01

While backbone networks have experienced substantial changes in the last decade, access networks have not changed much. Recently, passive optical networks (PONs) seem to be ready for commercial deployment as access networks, due to the maturity of a number of enabling technologies. Among the PON technologies, Ethernet PON (EPON) standardized by the IEEE 802.3ah Ethernet in the First Mile (EFM) Task Force is the most attractive one because of its high speed, low cost, familiarity, interoperability, and low overhead. In this paper, we consider the issue of upstream channel sharing in the EPONs. We propose a novel multiple-access control scheme to provide bandwidth-guaranteed service for high-demand customers, while providing best effort service to low-demand customers according to the service level agreement (SLA). The analytical and simulation results prove that the proposed scheme performs best in what it is designed to do compared to another well-known scheme that has not considered providing differentiated services. With business customers preferring premium services with guaranteed bandwidth and residential users preferring low-cost best effort services, our scheme could benefit both groups of subscribers, as well as the operators.

Engineering High Assurance Distributed Cyber Physical Systems

DTIC Science & Technology

2015-01-15

decisions: number of interacting agents and co-dependent decisions made in real-time without causing interference . To engineer a high assurance DART...environment specification, architecture definition, domain-specific languages, design patterns, code - generation, analysis, test-generation, and simulation...include synchronization between the models and source code , debugging at the model level, expression of the design intent, and quality of service

When Volunteering Is Mandatory: A Call for Research about Service Learning

ERIC Educational Resources Information Center

Cloyd, Melissa

2017-01-01

Stakeholders have long been concerned about high school drop-out rates and associated achievement gaps between groups, specifically racial, of high school students. While significant improvements have been made to these drop-out rates at the national level, the largest group of drop-out students continues to be those of Hispanic heritage. Research…

Do Gender and Ethnicity Affect Civic Engagement and Academic Progress? Working Paper 53

ERIC Educational Resources Information Center

Davila, Alberto; Mora, Marie T.

2007-01-01

Using panel data from the National Education Longitudinal Study of 1988 (NELS), the authors first analyze how civic engagement (measured in terms of community service and participation in student government) undertaken at the high school level varies across race/ethnicity and gender. The findings indicate that female high school students tend to…

The normalisation of substance abuse among young travellers in Ireland: implications for practice.

PubMed

Van Hout, Marie Claire; Connor, Sean

2008-01-01

This report presents the findings of an exploratory study aimed at assessing the nature and extent of drug use amongst a group of young Travellers (aged twelve to eighteen years) in the South Eastern Region of Ireland. The results are intended to inform the Irish policy debate by providing data on patterns of youth drug use, drug-related risk behaviours, the impact of drug use on the Traveller community and issues regarding access to services. The young Travellers exhibited similar trends to "settled" adolescents with regard to drug use trends and attitudes but reported poor levels of health awareness and knowledge of drug services. The social exclusion of young Travellers puts them at risk of problematic drug use due to issues of poor literacy levels, family crisis, discrimination, poor knowledge of service provision relating to drug education and treatment, and the location of halting sites in areas of high drug usage.

10 CFR 60.150 - Scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... components will perform satisfactorily in service. Quality assurance includes quality control, which... COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN GEOLOGIC REPOSITORIES Quality Assurance § 60.150 Scope. As used in this part, quality assurance comprises all those planned and systematic...

Experiences of health care providers with integrated HIV and reproductive health services in Kenya: a qualitative study.

PubMed

Mutemwa, Richard; Mayhew, Susannah; Colombini, Manuela; Busza, Joanna; Kivunaga, Jackline; Ndwiga, Charity

2013-01-11

There is broad consensus on the value of integration of HIV services and reproductive health services in regions of the world with generalised HIV/AIDS epidemics and high reproductive morbidity. Integration is thought to increase access to and uptake of health services; and improves their efficiency and cost-effectiveness through better use of available resources. However, there is still very limited empirical literature on health service providers and how they experience and operationalize integration. This qualitative study was conducted among frontline health workers to explore provider experiences with integration in order to ascertain their significance to the performance of integrated health facilities. Semi-structured in-depth interviews were conducted with 32 frontline clinical officers, registered nurses, and enrolled nurses in Kitui district (Eastern province) and Thika and Nyeri districts (Central province) in Kenya. The study was conducted in health facilities providing integrated HIV and reproductive health services (post-natal care and family planning). All interviews were conducted in English, transcribed and analysed using Nvivo 8 qualitative data analysis software. Providers reported delivering services in provider-level and unit-level integration, as well as a combination of both. Provider experiences of actual integration were mixed. At personal level, providers valued skills enhancement, more variety and challenge in their work, better job satisfaction through increased client-satisfaction. However, they also felt that their salaries were poor, they faced increased occupational stress from: increased workload, treating very sick/poor clients, and less quality time with clients. At operational level, providers reported increased service uptake, increased willingness among clients to take an HIV test, and reduced loss of clients. But the majority also reported infrastructural and logistic deficiencies (insufficient physical room space, equipment, drugs and other medical supplies), as well as increased workload, waiting times, contact session times and low staffing levels. The success of integration primarily depends on the performance of service providers which, in turn, depends on a whole range of facilitative organisational factors. The central Ministry of Health should create a coherent policy environment, spearhead strategic planning and ensure availability of resources for implementation at lower levels of the health system. Health facility staffing norms, technical support, cost-sharing policies, clinical reporting procedures, salary and incentive schemes, clinical supply chains, and resourcing of health facility physical space upgrades, all need attention. Yet, despite these system challenges, this study has shown that integration can have a positive motivating effect on staff and can lead to better sharing of workload - these are important opportunities that deserve to be built on.

Managers' experience of success criteria and barriers to implementing mobile radiography services in nursing homes in Norway: a qualitative study.

PubMed

Kjelle, Elin; Lysdahl, Kristin Bakke; Olerud, Hilde Merete; Myklebust, Aud Mette

2018-04-25

In order to meet the future challenges posed by ageing populations, new technology, telemedicine and a more personalized healthcare system are needed. Earlier research has shown mobile radiography services to be highly beneficial for nursing home residents in addition to being cost-effective. Despite the benefits, mobile radiography services are uncommon in Europe and Norway. The purpose of this study was to explore success criteria and barriers in the process of implementing mobile radiography services, from the point of view of the hospital and municipal managers. Eleven semi-structured interviews were conducted with managers from five hospitals and six municipalities in Norway where mobile radiography services had been implemented. Core issues in the interview guide were barriers and facilitators in the different phases of implementation. The framework method for thematic analysis was used for analysing the data inductively in a research team. Five main categories were developed through the success criteria and barriers experienced by the participants: national health policy, regional and municipal policy and conditions, inter-organizational implementation projects, experienced outcome, and professional skills and personal characteristics. The categories were allocated into three higher-order classifications: macro, meso and micro levels. The main barriers experienced by the managers were financial, procedural and structural. In particular, the reimbursement system, lack of management across healthcare levels and the lack of compatible information systems acted as barriers. The main facilitators were external funding, enthusiastic individuals in the organizations and good collaboration between hospitals and municipalities. The managers experienced financial, structural and procedural barriers. The main success criteria in the process were external funding, and the support and engagement from the individuals in the organizations. This commitment was mainly facilitated by the intuitive appeal of mobile radiography. Changes in healthcare management and in the financial system might facilitate services across healthcare levels. In addition, compatible information systems across healthcare levels are needed in order to facilitate the use of new technology and mobile services.

Structural Intervention With School Nurses Increases Receipt of Sexual Health Care Among Male High School Students.

PubMed

Dittus, Patricia J; Harper, Christopher R; Becasen, Jeffrey S; Donatello, Robin A; Ethier, Kathleen A

2018-01-01

Adolescent males are less likely to receive health care and have lower levels of sexual and reproductive health (SRH) knowledge than adolescent females. The purpose of this study was to determine if a school-based structural intervention focused on school nurses increases receipt of condoms and SRH information among male students. Interventions to improve student access to sexual and reproductive health care were implemented in six urban high schools with a matched set of comparison schools. Interventions included working with school nurses to improve access to sexual and reproductive health care, including the provision of condoms and information about pregnancy and sexually transmitted disease prevention and services. Intervention effects were assessed through five cross-sectional yearly surveys, and analyses include data from 13,740 male students. Nurses in intervention schools changed their interactions with male students who visited them for services, such that, among those who reported they went to the school nurse for any reason in the previous year, those in intervention schools reported significant increases in receipt of sexual health services over the course of the study compared with students in comparison schools. Further, these results translated into population-level effects. Among all male students surveyed, those in intervention schools were more likely than those in comparison schools to report increases in receipt of sexual health services from school nurses. With a minimal investment of resources, school nurses can become important sources of SRH information and condoms for male high school students. Published by Elsevier Inc.

Part of the job? Workplace violence in Massachusetts social service agencies.

PubMed

Zelnick, Jennifer R; Slayter, Elspeth; Flanzbaum, Beth; Butler, Nanci Ginty; Domingo, Beryl; Perlstein, Judith; Trust, Carol

2013-05-01

Workplace violence is a serious and surprisingly understudied occupational hazard in social service settings. The authors of this study conducted an anonymous, Internet-based survey of Massachusetts social service agencies to estimate the incidence of physical assault and verbal threat of violence in social service agencies, understand how social service agencies collect data on workplace violence, and identify disparities in who is at risk in terms of staff education and training level and the work setting. The study gathered general descriptions of each agency and compiled incidence data on workplace violence that were collected by agencies in fiscal year 2009. The key findings of this descriptive study showed high rates of workplace violence against social services providers and a pattern of risk disparity, with significantly more risk for direct care versus clinical staff. These results are based on data routinely collected by social service agencies that typically remain unexamined. A research agenda that is sensitive to potential occupational health disparities and focuses on maximizing workplace safety in social services is needed.

Experience-based co-design in an adult psychological therapies service.

PubMed

Cooper, Kate; Gillmore, Chris; Hogg, Lorna

2016-01-01

Experience-based co-design (EBCD) is a methodology for service improvement and development, which puts service-user voices at the heart of improving health services. The aim of this paper was to implement the EBCD methodology in a mental health setting, and to investigate the challenges which arise during this process. In order to achieve this, a modified version of the EBCD methodology was undertaken, which involved listening to the experiences of the people who work in and use the mental health setting and sharing these experiences with the people who could effect change within the service, through collaborative work between service-users, staff and managers. EBCD was implemented within the mental health setting and was well received by service-users, staff and stakeholders. A number of modifications were necessary in this setting, for example high levels of support available to participants. It was concluded that EBCD is a suitable methodology for service improvement in mental health settings.

Odyssey, an optimized personal communications satellite system

NASA Astrophysics Data System (ADS)

Rusch, Roger J.

Personal communications places severe demands on service providers and transmission facilities. Customers are not satisfied with the current levels of service and want improvements. Among the characteristics that users seek are: lower service rates, hand held convenience, acceptable time delays, ubiquitous service, high availability, reliability, and high quality. The space industry is developing commercial space systems for providing mobile communications to personal telephones. Provision of land mobile satellite service is fundamentally different from the fixed satellite service provided by geostationary satellites. In fixed service, the earth based antennas can depend on a clear path from user to satellite. Mobile users in a terrestrial environment commonly encounter blockage due to vegetation, terrain or buildings. Consequently, high elevation angles are of premium value. TRW studied the issues and concluded that a Medium Earth Orbit constellation is the best solution for Personal Communications Satellite Service. TRW has developed Odyssey, which uses twelve satellites in medium altitude orbit to provide personal communications satellite service. The Odyssey communications system projects a multibeam antenna pattern to the Earth. The attitude control system orients the satellites to ensure constant coverage of land mass and coastal areas. Pointing can be reprogrammed by ground control to ensure optimized coverage of the desired service areas. The payload architecture features non-processing, "bent pipe" transponders and matrix amplifiers to ensure dynamic power delivery to high demand areas. Circuit capacity is 3000 circuits per satellite. Each satellite weighs 1917 kg (4226 pounds) at launch and the solar arrays provide 3126 Watts of power. Satellites are launched in pairs on Ariane, Atlas, or other vehicles. Each satellite is placed in a circular orbit at an altitude of 10,354 km. There are three orbit planes inclined at 55° to the equatorial plane. Deployment of the satellites permits phased introduction of service. After only three launches, in which two satellites are launched into each plane, continuous service can be provided to most of the world. After three more launches for a total of 12 satellites, service can be expanded to all populated regions of the Earth with path diversity to most regions. The Odyssey system is superior to both geostationary satellites and low earth orbiting satellites. Odyssey provides many benefits to the end user which are described in the paper. These include: low cost, convenience, high availability, reliability, and acceptable time delay. Odyssey exhibits benefits for telecommunications operators: simple operations, incremental, phased startup, long space segment life-time, high profitability, dynamic flexibility for adjustment and short time to market. Since submission of an FCC application in 1991, TRW has continued to explore ways to further improve the Odyssey approach by expanding coverage to the entire world and reducing the initial investment while maintaining high quality service.

Odyssey, an optimized personal communications satellite system

NASA Astrophysics Data System (ADS)

Rusch, Roger J.

Personal communications places severe demands on service providers and transmission facilities. Customers are not satisfied with the current levels of service and want improvements. Among the characteristics that users seek are: lower service rates, hand held convenience, acceptable time delays, ubiquitous service, high availability, reliability, and high quality. The space industry in developing commercial space systems for providing mobile communications to personal telephones. Provision of land mobile satellite service is fundamentally different from the fixed satellite service provided by geostationary satellites. In fixed service, the earth based antennas can depend on a clear path from user to satellite. Mobile users in a terrestrial environment commonly encounter blockage due to vegetation, terrain or buildings. Consequently, high elevation angles are of premium value. TRW studied the issues and concluded that a Medium Earth Orbit constellation is the best solution for Personal Communications Satellite Service. TRW has developed Odyssey, which uses twelve satellites in medium altitude orbit to provide personal communications satellite service. The Odyssey communications system projects a multibeam antenna pattern to the Earth. The attitude control system orients the satellites to ensure constant coverage of land mass and coastal areas. Pointing can be reprogrammed by ground control to ensure optimized coverage of the desired service areas. The payload architecture features non-processing, 'bent pipe' transponders and matrix amplifiers to ensure dynamic power delivery to high demand areas. Circuit capacity is 3000 circuits per satellite. Each satellite weighs 1917 kg (4226 pounds) at launch and the solar arrays provide 3126 watts of power. Satellites are launched in pairs on Ariane, Atlas, or other vehicles. Each satellite is placed in a circular orbit at an altitude of 10,354 km.

Geographic footprint of electricity use for water services in the Western U.S.

PubMed

Tidwell, Vincent C; Moreland, Barbie; Zemlick, Katie

2014-01-01

A significant fraction of our nation's electricity use goes to lift, convey, and treat water, while the resulting expenditures on electricity represent a key budgetary consideration for water service providers. To improve understanding of the electricity-for-water interdependency, electricity used in providing water services is mapped at the regional, state and county level for the 17-conterminous states in the Western U.S. This study is unique in estimating electricity use for large-scale conveyance and agricultural pumping as well as mapping these electricity uses along with that for drinking and wastewater services at a state and county level. Results indicate that drinking and wastewater account for roughly 2% of total West-wide electricity use, while an additional 1.2% is consumed by large-scale conveyance projects and 2.6% is consumed by agricultural pumping. The percent of electricity used for water services varies strongly by state with some as high as 34%, while other states expend less than 1%. Every county in the West uses some electricity for water services; however, there is a large disparity in use ranging from 10 MWh/yr to 5.8 TWh/yr. These results support long-term transmission planning in the Western U.S. by characterizing an important component of the electric load.

[Association between sense of coherence and occupational stress of workers in modern service industry in Shanghai, China].

PubMed

Lu, X Y; Dai, J M; Wu, N; Shu, C; Gao, J L; Fu, H

2016-10-20

Objective: To investigate understand the current status of the sense of coherence and occupational stress in modern service workers, and to analyze the association between occupational stress and the sense of coherence. Methods: From March to April, 2016, 834 modern service workers from 3 companies in Shanghai, China (in air transportation industry, marketing industry, and travel industry) were surveyed by non-ran-dom sampling. The self-completion questionnaires were filled out anonymously given the informed consent of the workers. The occupational stress questionnaire was used to evaluate occupational stress, and the Chinese version of the Sense of Coherence Scale (SOC-13) was used to assess the mental health. Results: The mean score for the sense of coherence of the respondents was 61.54±10.46, and 50.1% of them were self-rated as having occupational stress. There were significant differences in SOC score between groups with different ages, marital status, positions, lengths of service, family per capita monthly income, and weekly work hours ( P <0.05). The occupational stress score differed significantly across groups with different marital status, lengths of service, and weekly work hours ( P <0.05). The scores for working autonomy, social support, and occupational stress differed significantly between groups with different SOC levels ( P< 0.05). There were significant differences in SOC score and the distribution of low-SOC respondents between groups with different levels of working autonomy, social support, and occupational stress. High SOC is a protective factor for occupational stress ( OR =0.39, 95% CI 0.26~ 0.59). Conclusion: Modern service workers in Shanghai have high SOC and moderate occupational stress. Therefore, improving SOC may reduce occupational stress.

Predicting nursing home placement among home- and community-based services program participants.

PubMed

Greiner, Melissa A; Qualls, Laura G; Iwata, Isao; White, Heidi K; Molony, Sheila L; Sullivan, M Terry; Burke, Bonnie; Schulman, Kevin A; Setoguchi, Soko

2014-12-01

Several states offer publicly funded-care management programs to prevent long-term care placement of high-risk Medicaid beneficiaries. Understanding participant risk factors and services that may prevent long-term care placement can facilitate efficient allocation of program resources. To develop a practical prediction model to identify participants in a home- and community-based services program who are at highest risk for long-term nursing home placement, and to examine participant-level and program-level predictors of nursing home placement. In a retrospective observational study, we used deidentified data for participants in the Connecticut Home Care Program for Elders who completed an annual assessment survey between 2005 and 2010. We analyzed data on patient characteristics, use of program services, and short-term facility admissions in the previous year. We used logistic regression models with random effects to predict nursing home placement. The main outcome measures were long-term nursing home placement within 180 days or 1 year of assessment. Among 10,975 study participants, 1249 (11.4%) had nursing home placement within 1 year of annual assessment. Risk factors included Alzheimer's disease (odds ratio [OR], 1.30; 95% CI, 1.18-1.43), money management dependency (OR, 1.33; 95% CI, 1.18-1.51), living alone (OR, 1.53; 95% CI, 1.31-1.80), and number of prior short-term skilled nursing facility stays (OR, 1.46; 95% CI, 1.31-1.62). Use of a personal care assistance service was associated with 46% lower odds of nursing home placement. The model C statistic was 0.76 in the validation cohort. A model using information from a home- and community-based service program had strong discrimination to predict risk of long-term nursing home placement and can be used to identify high-risk participants for targeted interventions.

Do Mental Health Outpatient Services Meet Users' Needs? Trial to Identify Factors Associated with Higher Needs for Care.

PubMed

Dobrzynska, Ewelina; Rymaszewska, Joanna; Biecek, Przemyslaw; Kiejna, Andrzej

2016-05-01

The study was conducted to investigate the extent to which services meet patients' needs and identify the factors associated with higher needs. 174 outpatients were assessed using CANSAS, BPRS and GSDS. The total number of unmet needs in persons with psychotic, eating, personality and affective disorders was higher than in patients with anxiety disorders. Being single, positive symptoms, depression/anxiety, hospitalizations and high social disability accounted for 50 % of the variance in level of unmet need. Persons with eating and personality disorders reported similar level of unmet needs to those with psychotic and affective disorders. The best correlates of unmet needs were depression/anxiety and social disability.

U.S. military service and the prevalence of metabolic syndrome: Findings from a cross-sectional analysis of the Cooper Center Longitudinal Study, 1979-2013.

PubMed

Janak, Jud C; Pérez, Adriana; Alamgir, Hasanat; Orman, Jean A; Cooper, Sharon P; Shuval, Kerem; DeFina, Laura; Barlow, Carolyn E; Gabriel, Kelley Pettee

2017-02-01

U.S. military service confers both health benefits and risks potentially associated with a clustering of cardiovascular risk factors called metabolic syndrome. However, the association between prior military service and metabolic syndrome has not sufficiently been examined. The purpose of the study was to compare the prevalence of metabolic syndrome by prior military service status. Among 42,370 men (887 with prior military service) examined from 1979 to 2013 at the Cooper Clinic (Dallas, TX), we used a cross-sectional study design to examine the association between military service and metabolic syndrome. First, an unadjusted log binomial regression model was performed by regressing the prevalence of metabolic syndrome on prior service. This was followed by performing Kleinbaum's modeling strategy for assessing confounding. The same methodology was used to explore the association between individual metabolic syndrome risk factors and prior service. Prior military service was not significantly associated with the prevalence of metabolic syndrome (PR=0.98, 0.89-1.07). None of the variables explored were identified as confounders. Participants with prior military service had lower prevalence of both elevated levels of triglycerides (PR=0.89, 0.80-0.99) and low levels of high-density lipoprotein-cholesterol (PR=0.78, 0.70-0.88). They had a higher prevalence of elevated resting systolic blood pressure (PR=1.23, 1.12-1.35). However, none of these associations were significant after adjusting for identified confounders: age; cardiorespiratory fitness; and exam year. Study findings indicate that military service was not independently associated with the prevalence of metabolic syndrome or its components. Future research is warranted longitudinally assessing the impact of military service on long-term outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries.

PubMed

Stepurko, Tetiana; Pavlova, Milena; Groot, Wim

2016-08-02

The measurement of consumer satisfaction is an essential part of the assessment of health care services in terms of service quality and health care system responsiveness. Studies across Europe have described various strategies health care users employ to secure services with good quality and quick access. In Central and Eastern European countries, such strategies also include informal payments to health care providers. This paper analyzes the satisfaction of health care users with the quality of and access to health care services. The study focuses on six Central and Eastern European countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). We use data on past experience with health care use collected in 2010 through uniform national surveys in these countries. Based on these data, we carry out a multi-country analysis to investigate factors associated with the satisfaction of health care users in the six countries. The results indicate that about 10-14 % of the service users are not satisfied with the quality of, or access to health care services they used in the preceding year. However, significant differences across countries and services are observed, e.g. the highest level of dissatisfaction with access to outpatient services (16.4 %) is observed among patients in Lithuania, while in Poland, the level of dissatisfaction with quality of outpatient and inpatient services are much lower than dissatisfaction with access. The study also analyses the association of users' satisfaction with factors such as making informal payments, inability to pay and relative importance of service attributes stated by the service users. These multi-country findings provide evidence for health policy making in the Central and Eastern European countries. Although the average rates of satisfactions per country are relatively high, the results suggest that there is ample room for improvements. Specifically, many service-users still report dissatisfaction especially those who pay informally and those unable to pay. The high shares of informal payments and inability of users to deal with the health expenditures lead to doubts about the fairness of the health care provision in Central and Eastern Europe. There is an urgent need for policy makers in the region to not only acknowledge but also to effectively address this key problem.

Patient experiences of in-hospital preparations for follow-up care at home.

PubMed

Keller, Gretchen; Merchant, Alefia; Common, Carol; Laizner, Andrea M

2017-06-01

To examine patient experiences of hospital-based discharge preparation for referral for follow-up home care services. To identify aspects of discharge preparation that will assist patients with their transition from hospital-based care to home-based follow-up care. To improve patients' transitions from hospital-based care to community-based home care, hospitals incorporate home care referral processes into discharge planning. This includes patient preparation for follow-up home care services. While there is evidence to support that such preparation needs to be more patient-centred to be effective, there is little knowledge of patient experiences of preparation that would guide improvements. Qualitative descriptive study. The study was carried out at a supra-regional hospital in Eastern Canada. Findings are based on thematic content analysis of 13 semi-structured interviews of patients requiring home care after hospitalisation on a medical or surgical unit. Most interviews were held within one week of discharge. Patient experiences were associated with patient attitudes and levels of engagement in preparation. Attitudes and levels of engagement were seen as related to one another. Those who 'didn't really think about it', had low engagement, while those with the attitude 'guide me', looked for partnership. Those who had an attitude of 'this is what I want', had a very high level of engagement. Previous experience with home care services influenced patients' level of trust in the health care system, and ultimately shaped their attitudes towards and levels of engagement in preparation. Patient preparation for follow-up home care can be improved by assessing their knowledge of and previous experiences with home care. Patients recognised as using a proactive approach may be highly vulnerable. © 2016 John Wiley & Sons Ltd.

Optimizability of OGC Standards Implementations - a Case Study

NASA Astrophysics Data System (ADS)

Misev, D.; Baumann, P.

2012-04-01

Why do we shop at Amazon? Because they have a unique offering that is nowhere else available? Certainly not. Rather, Amazon offers (i) simple, yet effective search; (ii) very simple payment; (iii) extremely rapid delivery. This is how scientific services will be distinguished in future: not for their data holding (there will be manifold choice), but for their service quality. We are facing the transition from data stewardship to service stewardship. One of the OGC standards which particularly enables flexible retrieval is the Web Coverage Processing Service (WCPS). It defines a high-level query language on large, multi-dimensional raster data, such as 1D timeseries, 2D EO imagery, 3D x/y/t image time series and x/y/z geophysical data, 4D x/y/z/t climate and ocean data. We have implemented WCPS based on an Array Database Management System, rasdaman, which is available in open source. In this demonstration, we study WCPS queries on 2D, 3D, and 4D data sets. Particular emphasis is placed on the computational load queries generate in such on-demand processing and filtering. We look at different techniques and their impact on performance, such as adaptive storage partitioning, query rewriting, and just-in-time compilation. Results show that there is significant potential for effective server-side optimization once a query language is sufficiently high-level and declarative.

High Resolution Nature Runs and the Big Data Challenge

NASA Technical Reports Server (NTRS)

Webster, W. Phillip; Duffy, Daniel Q.

2015-01-01

NASA's Global Modeling and Assimilation Office at Goddard Space Flight Center is undertaking a series of very computationally intensive Nature Runs and a downscaled reanalysis. The nature runs use the GEOS-5 as an Atmospheric General Circulation Model (AGCM) while the reanalysis uses the GEOS-5 in Data Assimilation mode. This paper will present computational challenges from three runs, two of which are AGCM and one is downscaled reanalysis using the full DAS. The nature runs will be completed at two surface grid resolutions, 7 and 3 kilometers and 72 vertical levels. The 7 km run spanned 2 years (2005-2006) and produced 4 PB of data while the 3 km run will span one year and generate 4 BP of data. The downscaled reanalysis (MERRA-II Modern-Era Reanalysis for Research and Applications) will cover 15 years and generate 1 PB of data. Our efforts to address the big data challenges of climate science, we are moving toward a notion of Climate Analytics-as-a-Service (CAaaS), a specialization of the concept of business process-as-a-service that is an evolving extension of IaaS, PaaS, and SaaS enabled by cloud computing. In this presentation, we will describe two projects that demonstrate this shift. MERRA Analytic Services (MERRA/AS) is an example of cloud-enabled CAaaS. MERRA/AS enables MapReduce analytics over MERRA reanalysis data collection by bringing together the high-performance computing, scalable data management, and a domain-specific climate data services API. NASA's High-Performance Science Cloud (HPSC) is an example of the type of compute-storage fabric required to support CAaaS. The HPSC comprises a high speed Infinib and network, high performance file systems and object storage, and a virtual system environments specific for data intensive, science applications. These technologies are providing a new tier in the data and analytic services stack that helps connect earthbound, enterprise-level data and computational resources to new customers and new mobility-driven applications and modes of work. In our experience, CAaaS lowers the barriers and risk to organizational change, fosters innovation and experimentation, and provides the agility required to meet our customers' increasing and changing needs