Indonesian infertility patients’ health seeking behaviour and patterns of access to biomedical infertility care: an interviewer administered survey conducted in three clinics

PubMed Central

2012-01-01

Background Indonesia has high levels of biological need for infertility treatment, great sociological and psychological demand for children, and yet existing infertility services are underutilized. Access to adequate comprehensive reproductive health services, including infertility care, is a basic reproductive right regardless of the economic circumstances in which individuals are born into. Thus, identifying and implementing strategies to improve access to assisted reproductive technology (ART) in Indonesia is imperative. The principle objectives of this article are to improve our understanding of infertility patients’ patterns of health seeking behaviour and their patterns of access to infertility treatment in Indonesia, in order to highlight the possibilities for improving access. Methods An interviewer-administered survey was conducted with 212 female infertility patients recruited through three Indonesian infertility clinics between July and September 2011. Participants were self-selected and data was subject to descriptive statistical analysis. Results Patients identified a number of barriers to access, including: low confidence in infertility treatment and high rates of switching between providers due to perceived treatment failure; the number and location of clinics; the lack of a well established referral system; the cost of treatment; and patients also experienced fear of receiving a diagnosis of sterility, of vaginal examinations and of embarrassment. Women’s age of marriage and the timing of their initial presentation to gynaecologists were not found to be barriers to timely access to infertility care. Conclusions The findings based on the responses of 212 female infertility patients indicated four key areas of opportunity for improving access to infertility care. Firstly, greater patient education about the nature and progression of infertility care was required among this group of women. Secondly, increased resources in terms of the number and distribution of infertility clinics would reduce the substantial travel required to access infertility care. Thirdly, improvements in the financial accessibility of infertility care would have promoted ease of access to care in this sample. Finally, the expansion of poorly developed referral systems would also have enhanced the efficiency with which this group of patients were able to access appropriate care. PMID:23020912

Does household access to improved water and sanitation in infancy and childhood predict better vocabulary test performance in Ethiopian, Indian, Peruvian and Vietnamese cohort studies?

PubMed Central

Dearden, Kirk A; Brennan, Alana T; Behrman, Jere R; Schott, Whitney; Crookston, Benjamin T; Humphries, Debbie L; Penny, Mary E; Fernald, Lia C H

2017-01-01

Objective Test associations between household water and sanitation (W&S) and children's concurrent and subsequent Peabody Picture Vocabulary Test (PPVT) scores. Design Prospective cohort study. Setting Ethiopia, India, Peru, Vietnam. Participants 7269 children. Primary outcome measures PPVT scores at 5 and 8 years. Key exposure variables were related to W&S, and collected at 1, 5 and 8 years, including ‘improved’ water (eg, piped, public tap or standpipe) and ‘improved’ toilets (eg, collection, storage, treatment and recycling of human excreta). Results Access to improved water at 1 year was associated with higher language scores at 5 years (3/4 unadjusted associations) and 8 years (4/4 unadjusted associations). Ethiopian children with access to improved water at 1 year had test scores that were 0.26 SD (95% CI 0.17 to 0.36) higher at 5 years than children without access. Access to improved water at 5 years was associated with higher concurrent PPVT scores (in 3/4 unadjusted associations), but not later scores (in 1/4 unadjusted associations). 5-year-old Peruvian children with access to improved water had better concurrent performance on the PPVT (0.44 SD, 95% CI 0.30 to 0.59) than children without access to improved water. Toilet access at 1 year was also associated with better PPVT scores at 5 years (3/4 unadjusted associations) and sometimes associated with test results at 8 years (2/4 unadjusted associations). Toilet access at 5 years was associated with concurrent PPVT scores (3/4 unadjusted associations). More than half of all associations in unadjusted models (water and toilets) persisted in adjusted models, particularly for toilets in India, Peru and Vietnam. Conclusions Access to ‘improved’ water and toilets had independent associations with children's PPVT scores that often persisted with adjustment for covariates. Our findings suggest that effects of W&S may go beyond subacute and acute infections and physical growth to include children's language performance, a critical component of cognitive development. PMID:28270388

Information Technology, Campus Libraries, and Patrons with Disabilities: Emerging issues and Access Strategies.

ERIC Educational Resources Information Center

Hilton-Chalfen, Danny

1992-01-01

Discussion of the potential for academic libraries to provide improved opportunities for patrons with disabilities focuses on access to online information, including online catalogs, campuswide information systems, CD-ROM products, graphical user interfaces, and electronic documents. Other considerations include location of online resources,…

Access Denied

ERIC Educational Resources Information Center

Villano, Matt

2008-01-01

Building access control (BAC)--a catchall phrase to describe the systems that control access to facilities across campus--has traditionally been handled with remarkably low-tech solutions: (1) manual locks; (2) electronic locks; and (3) ID cards with magnetic strips. Recent improvements have included smart cards and keyless solutions that make use…

Identifying Successful Practices to Overcome Access to Care Challenges in Community Health Centers: A "Positive Deviance" Approach.

PubMed

Toscos, Tammy; Carpenter, Maria; Flanagan, Mindy; Kunjan, Kislaya; Doebbeling, Bradley N

2018-01-01

Despite health care access challenges among underserved populations, patients, providers, and staff at community health clinics (CHCs) have developed practices to overcome limited access. These "positive deviant" practices translate into organizational policies to improve health care access and patient experience. To identify effective practices to improve access to health care for low-income, uninsured or underinsured, and minority adults and their families. Seven CHC systems, involving over 40 clinics, distributed across one midwestern state in the United States. Ninety-two key informants, comprised of CHC patients (42%) and clinic staff (53%), participated in semi-structured interviews. Interview transcripts were subjected to thematic analysis to identify patient-centered solutions for managing access challenges to primary care for underserved populations. Transcripts were coded using qualitative analytic software. Practices to improve access to care included addressing illiteracy and low health literacy, identifying cost-effective resources, expanding care offerings, enhancing the patient-provider relationship, and cultivating a culture of teamwork and customer service. Helping patients find the least expensive options for transportation, insurance, and medication was the most compelling patient-centered strategy. Appointment reminders and confirmation of patient plans for transportation to appointments reduced no-show rates. We identified nearly 35 practices for improving health care access. These were all patient-centric, uncovered by both clinic staff and patients who had successfully navigated the health care system to improve access.

The Digital Health Divide: Evaluating Online Health Information Access and Use among Older Adults

ERIC Educational Resources Information Center

Hall, Amanda K.; Bernhardt, Jay M.; Dodd, Virginia; Vollrath, Morgan W.

2015-01-01

Objective: Innovations in health information technology (HIT) provide opportunities to reduce health care spending, improve quality of care, and improve health outcomes for older adults. However, concerns relating to older adults' limited access and use of HIT, including use of the Internet for health information, fuel the digital health divide…

Implications of Direct Patient Online Access to Radiology Reports Through Patient Web Portals.

PubMed

Lee, Christoph I; Langlotz, Curtis P; Elmore, Joann G

2016-12-01

In an era of increasing health information transparency and informed decision making, more patients are being provided with direct online access to their medical records, including radiology reports, via web-based portals. Although radiologists' narrative reports have previously been the purview of referring physicians, patients are now reading these on their own. Many potential benefits may result from patients reviewing their radiology reports, including improvements in patients' own understanding of their health, promotion of shared decision making and patient-physician communication, and, ultimately, improvements in patient outcomes. However, there may also be negative consequences, including confusion and anxiety among patients and longer patient-physician interactions. The rapid adoption of this new technology has led to major questions regarding ethics and professionalism for radiologists, including the following: Who is the intended audience of radiology reports? How should content be presented or worded? How will open access influence radiologists' relationships with patients and referring physicians? What legal ramifications may arise from increased patient access? The authors describe the current practices and research findings associated with patient online access to medical records, including radiology reports, and discuss several implications of this growing trend for the radiology profession. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme

PubMed Central

Hetzel, Manuel W; Iteba, Nelly; Makemba, Ahmed; Mshana, Christopher; Lengeler, Christian; Obrist, Brigit; Schulze, Alexander; Nathan, Rose; Dillip, Angel; Alba, Sandra; Mayumana, Iddy; Khatib, Rashid A; Njau, Joseph D; Mshinda, Hassan

2007-01-01

Background Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. Project The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy is based on a set of integrated interventions, including social marketing for improved care seeking at community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities measuring the programme's performance and (health) impact. Baseline data demonstrated heterogeneity in the availability of malaria treatment, unavailability of medicines and treatment providers in certain areas as well as quality problems with regard to drugs and services. Conclusion The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services. PMID:17603898

Decreasing health disparities for people with disabilities through improved communication strategies and awareness.

PubMed

Sharby, Nancy; Martire, Katharine; Iversen, Maura D

2015-03-19

Factors influencing access to health care among people with disabilities (PWD) include: attitudes of health care providers and the public, physical barriers, miscommunication, income level, ethnic/minority status, insurance coverage, and lack of information tailored to PWD. Reducing health care disparities in a population with complex needs requires implementation at the primary, secondary and tertiary levels. This review article discusses common barriers to health care access from the patient and provider perspective, particularly focusing on communication barriers and how to address and ameliorate them. Articles utilized in this review were published from 2005 to present in MEDLINE and CINAHL and written in English that focused on people with disabilities. Topics searched for in the literature include: disparities and health outcomes, health care dissatisfaction, patient-provider communication and access issues. Ineffective communication has significant impacts for PWD. They frequently believe that providers are not interested in, or sensitive to their particular needs and are less likely to seek care or to follow up with recommendations. Various strategies for successful improvement of health outcomes for PWD were identified including changing the way health care professionals are educated regarding disabilities, improving access to health care services, and enhancing the capacity for patient centered care.

Using routinely recorded data in the UK to assess outcomes in a randomised controlled trial: The Trials of Access.

PubMed

Powell, G A; Bonnett, L J; Tudur-Smith, C; Hughes, D A; Williamson, P R; Marson, A G

2017-08-23

In the UK, routinely recorded data may benefit prospective studies including randomised controlled trials (RCTs). In an on-going study, we aim to assess the feasibility of access and agreement of routinely recorded clinical and non-clinical data compared to data collected during a RCT using standard prospective methods. This paper will summarise available UK routinely recorded data sources and discuss our experience with the feasibility of accessing routinely recorded data for participants of a RCT before finally proposing recommendations for improving the access and implementation of routinely recorded data in RCTs. Setting: the case study RCT is the Standard and New Antiepileptic Drugs II (SANAD II) trial, a pragmatic, UK, multicentre, phase IV RCT assessing the clinical and cost-effectiveness of antiepileptic drug treatments for newly diagnosed epilepsy. 98 participants have provided written consent to permit the request of routinely recorded data. Study procedures: routinely recorded clinical and non-clinical data were identified and data requested through formal applications from available data holders for the duration that participants have been recruited into SANAD II. The feasibility of accessing routinely recorded data during a RCT is assessed and recommendations for improving access proposed. Secondary-care clinical and socioeconomic data is recorded on a national basis and can be accessed, although there are limitations in the application process. Primary-care data are recorded by a number of organisations on a de-identified basis but access for specific individuals has not been feasible. Access to data recorded by non-clinical sources, including The Department for Work and Pensions and The Driving and Vehicle Licensing Agency, was not successful. Recommendations discussed include further research to assess the attributes of routinely recorded data, an assessment of public perceptions and the development of strategies to collaboratively improve access to routinely recorded data for research. International Standard Randomised Controlled Trials, ISRCTN30294119 . Registered on 3 July 2012. EudraCT No: 2012-001884-64. Registered on 9 May 2012.

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

PubMed

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

2005-10-01

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

Two-Step Optimization for Spatial Accessibility Improvement: A Case Study of Health Care Planning in Rural China

PubMed Central

Luo, Jing; Tian, Lingling; Luo, Lei; Yi, Hong

2017-01-01

A recent advancement in location-allocation modeling formulates a two-step approach to a new problem of minimizing disparity of spatial accessibility. Our field work in a health care planning project in a rural county in China indicated that residents valued distance or travel time from the nearest hospital foremost and then considered quality of care including less waiting time as a secondary desirability. Based on the case study, this paper further clarifies the sequential decision-making approach, termed “two-step optimization for spatial accessibility improvement (2SO4SAI).” The first step is to find the best locations to site new facilities by emphasizing accessibility as proximity to the nearest facilities with several alternative objectives under consideration. The second step adjusts the capacities of facilities for minimal inequality in accessibility, where the measure of accessibility accounts for the match ratio of supply and demand and complex spatial interaction between them. The case study illustrates how the two-step optimization method improves both aspects of spatial accessibility for health care access in rural China. PMID:28484707

Two-Step Optimization for Spatial Accessibility Improvement: A Case Study of Health Care Planning in Rural China.

PubMed

Luo, Jing; Tian, Lingling; Luo, Lei; Yi, Hong; Wang, Fahui

2017-01-01

A recent advancement in location-allocation modeling formulates a two-step approach to a new problem of minimizing disparity of spatial accessibility. Our field work in a health care planning project in a rural county in China indicated that residents valued distance or travel time from the nearest hospital foremost and then considered quality of care including less waiting time as a secondary desirability. Based on the case study, this paper further clarifies the sequential decision-making approach, termed "two-step optimization for spatial accessibility improvement (2SO4SAI)." The first step is to find the best locations to site new facilities by emphasizing accessibility as proximity to the nearest facilities with several alternative objectives under consideration. The second step adjusts the capacities of facilities for minimal inequality in accessibility, where the measure of accessibility accounts for the match ratio of supply and demand and complex spatial interaction between them. The case study illustrates how the two-step optimization method improves both aspects of spatial accessibility for health care access in rural China.

Energy access and living standards: some observations on recent trends

NASA Astrophysics Data System (ADS)

Rao, Narasimha D.; Pachauri, Shonali

2017-02-01

A subset of Sustainable Development Goals pertains to improving people’s living standards at home. These include the provision of access to electricity, clean cooking energy, improved water and sanitation. We examine historical progress in energy access in relation to other living standards. We assess regional patterns in the pace of progress and relative priority accorded to these different services. Countries in sub-Saharan Africa would have to undergo unprecedented rates of improvement in energy access in order to achieve the goal of universal electrification by 2030. World over, access to clean cooking fuels and sanitation facilities consistently lag improved water and electricity access by a large margin. These two deprivations are more concentrated among poor countries, and poor people in middle income countries. They are also correlated to health risks faced disproportionately by women. However, some Asian countries have been able to achieve faster progress in electrification at lower income levels compared to industrialized countries’ earlier efforts. These examples offer hope that future efforts need not be constrained by historical rates of progress.

Developing an agenda for research about policies to improve access to healthy foods in rural communities: a concept mapping study

PubMed Central

2014-01-01

Background Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda. Methods This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations. Results Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), “other” (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to build economic viability in rural communities, improve access to federal food and nutrition assistance programs, improve food retail systems, and increase the personal food production capacity of rural residents. Respondents also prioritized the development of valid and reliable research methodologies to measure variables associated with rural food access. Conclusions This collaborative, trans-disciplinary, participatory process, created a map to guide and prioritize research about polices to improve healthy, affordable food access in rural communities. PMID:24919425

Developing an agenda for research about policies to improve access to healthy foods in rural communities: a concept mapping study.

PubMed

Johnson, Donna B; Quinn, Emilee; Sitaker, Marilyn; Ammerman, Alice; Byker, Carmen; Dean, Wesley; Fleischhacker, Sheila; Kolodinsky, Jane; Pinard, Courtney; Pitts, Stephanie B Jilcott; Sharkey, Joseph

2014-06-12

Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda. This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations. Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), "other" (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to build economic viability in rural communities, improve access to federal food and nutrition assistance programs, improve food retail systems, and increase the personal food production capacity of rural residents. Respondents also prioritized the development of valid and reliable research methodologies to measure variables associated with rural food access. This collaborative, trans-disciplinary, participatory process, created a map to guide and prioritize research about polices to improve healthy, affordable food access in rural communities.

Reducing queues: demand and capacity variations.

PubMed

Eriksson, Henrik; Bergbrant, Ing-Marie; Berrum, Ingela; Mörck, Boel

2011-01-01

The aim of this paper is to investigate how waiting lists or queues could be reduced without adding more resources; and to describe what factors sustain reduced waiting-times. Cases were selected according to successful and sustained queue reduction. The approach in this study is action research. Accessibility improved as out-patient waiting lists for two clinics were reduced. The main success was working towards matching demand and capacity. It has been possible to sustain the improvements. Results should be viewed cautiously. Transferring and generalizing outcomes from this study is for readers to consider. However, accessible healthcare may be possible by paying more attention to existing solutions. The study indicates that queue reduction activities should include acquiring knowledge about theories and methods to improve accessibility, finding ways to monitor varying demand and capacity, and to improve patient processing by reducing variations. Accessibility is considered an important dimension when measuring service quality. However, there are few articles on how clinic staff sustain reduces waiting lists. This paper contributes accessible knowledge to the field.

Access and Quality of HIV-Related Point-of-Care Diagnostic Testing in Global Health Programs.

PubMed

Fonjungo, Peter N; Boeras, Debrah I; Zeh, Clement; Alexander, Heather; Parekh, Bharat S; Nkengasong, John N

2016-02-01

Access to point-of-care testing (POCT) improves patient care, especially in resource-limited settings where laboratory infrastructure is poor and the bulk of the population lives in rural settings. However, because of challenges in rolling out the technology and weak quality assurance measures, the promise of human immunodeficiency virus (HIV)-related POCT in resource-limited settings has not been fully exploited to improve patient care and impact public health. Because of these challenges, the Joint United Nations Programme on HIV/AIDS (UNAIDS), in partnership with other organizations, recently launched the Diagnostics Access Initiative. Expanding HIV programs, including the "test and treat" strategies and the newly established UNAIDS 90-90-90 targets, will require increased access to reliable and accurate POCT results. In this review, we examine various components that could improve access and uptake of quality-assured POC tests to ensure coverage and public health impact. These components include evaluation, policy, regulation, and innovative approaches to strengthen the quality of POCT. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

New neighborhood grocery store increased awareness of food access but did not alter dietary habits or obesity.

PubMed

Cummins, Steven; Flint, Ellen; Matthews, Stephen A

2014-02-01

National and local policies to improve diet in low-income US populations include increasing physical access to grocery stores and supermarkets in underserved neighborhoods. In a pilot study that evaluated the impacts of opening a new supermarket in a Philadelphia community considered a "food desert"-part of the Pennsylvania Fresh Food Financing Initiative-we found that the intervention moderately improved residents' perceptions of food accessibility. However, it did not lead to changes in reported fruit and vegetable intake or body mass index. The effectiveness of interventions to improve physical access to food and reduce obesity by encouraging supermarkets to locate in underserved areas therefore remains unclear. Nevertheless, the present findings suggest that simply improving a community's retail food infrastructure may not produce desired changes in food purchasing and consumption patterns. Complementary policy changes and interventions may be needed to help consumers bridge the gap between perception and action. The replication of our findings in other settings and research into the factors that influence community residents' receptivity to improved food access are urgently required.

Identifying Successful Practices to Overcome Access to Care Challenges in Community Health Centers

PubMed Central

Toscos, Tammy; Carpenter, Maria; Flanagan, Mindy; Kunjan, Kislaya; Doebbeling, Bradley N.

2018-01-01

Background: Despite health care access challenges among underserved populations, patients, providers, and staff at community health clinics (CHCs) have developed practices to overcome limited access. These “positive deviant” practices translate into organizational policies to improve health care access and patient experience. Objective: To identify effective practices to improve access to health care for low-income, uninsured or underinsured, and minority adults and their families. Participants: Seven CHC systems, involving over 40 clinics, distributed across one midwestern state in the United States. Methods: Ninety-two key informants, comprised of CHC patients (42%) and clinic staff (53%), participated in semi-structured interviews. Interview transcripts were subjected to thematic analysis to identify patient-centered solutions for managing access challenges to primary care for underserved populations. Transcripts were coded using qualitative analytic software. Results: Practices to improve access to care included addressing illiteracy and low health literacy, identifying cost-effective resources, expanding care offerings, enhancing the patient–provider relationship, and cultivating a culture of teamwork and customer service. Helping patients find the least expensive options for transportation, insurance, and medication was the most compelling patient-centered strategy. Appointment reminders and confirmation of patient plans for transportation to appointments reduced no-show rates. Conclusion: We identified nearly 35 practices for improving health care access. These were all patient-centric, uncovered by both clinic staff and patients who had successfully navigated the health care system to improve access. PMID:29552599

Challenges with access to healthcare from the perspective of patients living with HIV: a scoping review & framework synthesis.

PubMed

Asghari, Shabnam; Hurd, Jillian; Marshall, Zack; Maybank, Allison; Hesselbarth, Lydia; Hurley, Oliver; Farrell, Alison; Kendall, Claire E; Rourke, Sean B; Becker, Marissa; Johnston, Sharon; Lundrigan, Phil; Rosenes, Ron; Bibeau, Christine; Liddy, Clare

2018-08-01

Accessing healthcare can be difficult but the barriers multiply for people living with HIV (PLHIV). To improve access and the health of PLHIV, we must consider their perspectives and use them to inform standard practice. A better understanding of the current literature related to healthcare access from the perspective of PLHIV, can help to identify evidence gaps and highlight research priorities and opportunities. To identify relevant peer-reviewed publications, search strategies were employed. Electronic and grey literature databases were explored. Articles were screened based on their title and abstract and those that met the screening criteria, were reviewed in full. Data analysis was conducted using a collaborative approach that included knowledge user consultation. Initial concepts were extracted, summarized and through framework synthesis, developed into emerging and final themes. From 20,678 articles, 326 articles met the initial screening criteria and 64 were reviewed in full. The final themes identified, in order of most to least frequent were: Acceptability, Availability, Accessibility, Affordability, Other Barriers, Communication, Satisfaction, Accommodation, Preferences and Equity in Access. The most frequently discussed concepts related to negative interactions with staff, followed by long wait times, limited household resources or inability to pay fees, and fear of one's serostatus being disclosed. Knowledge users were in agreement with the categorization of initial concepts and final themes; however, some gaps in the literature were identified. Specific changes are critical to improving access to healthcare for PLHIV. These include improving availability by ensuring staff and healthcare professionals have proper training, cultivating acceptability and reducing stigma through improving HIV awareness, increasing accessibility through increased HIV information for PLHIV and improved dissemination of this information to increase patient knowledge and health awareness. Finally, ensuring proper protocols are implemented and followed to guarantee patient confidentiality and overall satisfaction with healthcare services are recommended.

25 CFR 170.128 - Are housing access roads and housing streets eligible for IRR Program funding?

Code of Federal Regulations, 2010 CFR

2010-04-01

... the transportation planning process as required in subpart D, may include housing access roads and housing street projects on the Tribal Transportation Improvement Program (TTIP). IRR Program funds are...

What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies.

PubMed

Reardon, Tessa; Harvey, Kate; Baranowska, Magdalena; O'Brien, Doireann; Smith, Lydia; Creswell, Cathy

2017-06-01

A minority of children and adolescents with mental health problems access treatment. The reasons for poor rates of treatment access are not well understood. As parents are a key gatekeeper to treatment access, it is important to establish parents' views of barriers/facilitators to accessing treatment. The aims of this study are to synthesise findings from qualitative and quantitative studies that report parents' perceptions of barriers/facilitators to accessing treatment for mental health problems in children/adolescents. A systematic review and narrative synthesis were conducted. Forty-four studies were included in the review and were assessed in detail. Parental perceived barriers/facilitators relating to (1) systemic/structural issues; (2) views and attitudes towards services and treatment; (3) knowledge and understanding of mental health problems and the help-seeking process; and (4) family circumstances were identified. Findings highlight avenues for improving access to child mental health services, including increased provision that is free to service users and flexible to their needs, with opportunities to develop trusting, supportive relationships with professionals. Furthermore, interventions are required to improve parents' identification of mental health problems, reduce stigma for parents, and increase awareness of how to access services.

Transparency in Canadian public drug advisory committees.

PubMed

Rosenberg-Yunger, Zahava R S; Bayoumi, Ahmed M

2014-11-01

Transparency in health care resource allocation decisions is a criterion of a fair process. We used qualitative methods to explore transparency across 11 Canadian drug advisory committees. We developed seven criteria to assess transparency (disclosure of members' names, disclosure of membership selection criteria, disclosure of conflict of interest guidelines and members' conflicts, public posting of decisions not to fund drugs, public posting of rationales for decisions, stakeholder input, and presence of an appeals mechanism) and two sub-criteria for when rationales were posted (direct website link and readability). We interviewed a purposeful sample of key informants who were conversant in English and a current or past member of either a committee or a stakeholder group. We analyzed data using a thematic approach. Interviewing continued until saturation was reached. We examined documents from 10 committees and conducted 27 interviews. The median number of criteria addressed by committees was 2 (range 0-6). Major interview themes included addressing: (1) accessibility issues, including stakeholders' degree of access to the decision making process and appeal mechanisms; (2) communication issues, including improving internal and external communication and public access to information; and (3) confidentiality issues, including the use of proprietary evidence. Most committees have some mechanisms to address transparency but none had a fully transparent process. The most important ways to improve transparency include creating formal appeal mechanisms, improving communication, and establishing consistent rules about the use of, and public access to, proprietary evidence. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

78 FR 51276 - Proposed Information Collection (Access to Care Dialysis Pilot Survey and Interview); Activity...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-20

... the treatment of End Stage Renal Disease (ESRD) to improve access to dialysis care for Veterans. DATES... performance of VHA's functions, including whether the information will have practical utility; (2) the...

Amplatzer vascular plug for arteriovenous hemodialysis access occlusion: initial experience.

PubMed

Bui, J T; Gaba, R C; Knuttinen, M G; West, D L; Owens, C A

2009-01-01

The Amplatzer Vascular Plug (AVP; AGA Medical, Golden Valley, MN) is a recently developed self-expanding metallic device indicated for peripheral vascular embolizations. Herein, we describe use of this device in the treatment of vascular complications related to arteriovenous hemodialysis fistulas and grafts. This HIPAA compliant retrospective study was approved by the institutional review board with informed consent waived. Six patients with problematic arteriovenous access underwent access occlusion using the AVP. Procedure indications included vascular steal syndrome in five patients, and enlarging vascular aneurysms in one patient. Contraindications for surgical correction were determined by the referring surgeon. AVP embolizations were performed using devices oversized by 50% introduced through vascular sheaths positioned within vein segments just beyond the arteriovenous anastomoses. Noninvasive evaluation of the involved extremity was performed pre- and post-embolization in addition to clinical follow-up examinations. Measured outcomes included success of angiographic occlusion, improvement in distal arterial flow, AVP number, AVP diameter, time to access occlusion, and clinical symptomatic improvement. Technical success was 100%, with complete arteriovenous access occlusion accomplished in all cases, with an average of 1.5 AVPs used per patient. Mean time to access occlusion was 19.3 minutes. Angiographic improvement in distal arterial flow was immediately evident and resolution of clinical symptoms occurred in all patients, with mean long-term follow-up of 16 months. No procedure-related complications were encountered. The Amplatzer Vascular Plug provides a minimally invasive and efficacious method for embolization of problematic arteriovenous hemodialysis access.

The Path to NGATS

NASA Technical Reports Server (NTRS)

Scardina, John

2006-01-01

NGATS operational Improvements and benefits include: 1) Broad area and precision navigation to access and capacity; 2) Airspace access and management to capacity; 3) 4D trajectory based ATM to capacity and efficiency; 4) Reduced separation between aircraft to capacity; 5) Flight deck situational awareness and delegation to capacity and safety; 6) ATM decision support to capacity; 7) Improved weather data and dissemination to capacity and safety; 8) Reduced cost to deliver ATM services to cost; 9) Greatly expanded airport network and improved terminals to capacity.

Decreasing Health Disparities for People with Disabilities through Improved Communication Strategies and Awareness

PubMed Central

Sharby, Nancy; Martire, Katharine; Iversen, Maura D.

2015-01-01

Factors influencing access to health care among people with disabilities (PWD) include: attitudes of health care providers and the public, physical barriers, miscommunication, income level, ethnic/minority status, insurance coverage, and lack of information tailored to PWD. Reducing health care disparities in a population with complex needs requires implementation at the primary, secondary and tertiary levels. This review article discusses common barriers to health care access from the patient and provider perspective, particularly focusing on communication barriers and how to address and ameliorate them. Articles utilized in this review were published from 2005 to present in MEDLINE and CINAHL and written in English that focused on people with disabilities. Topics searched for in the literature include: disparities and health outcomes, health care dissatisfaction, patient-provider communication and access issues. Ineffective communication has significant impacts for PWD. They frequently believe that providers are not interested in, or sensitive to their particular needs and are less likely to seek care or to follow up with recommendations. Various strategies for successful improvement of health outcomes for PWD were identified including changing the way health care professionals are educated regarding disabilities, improving access to health care services, and enhancing the capacity for patient centered care. PMID:25809511

In the right words: addressing language and culture in providing health care.

PubMed

2003-08-01

As part of its continuing mission to serve trustees, executives, and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of experts from philanthropy, research, health care practice, and policy on April 4, 2003, to discuss the roles of language and culture in providing effective health care. During this Issue Dialogue, In the Right Words: Addressing Language and Culture in Providing Health Care, health grantmakers and experts from policy and practice participated in an open exchange of ideas and perspectives on language access and heard from fellow grantmakers who are funding innovative programs in this area. Together they explored ways to effectively support comprehensive language services, including the use of interpreters and translation of written materials. This Issue Brief synthesizes key points from the day's discussion with a background paper previously prepared for Issue Dialogue participants. It focuses on the challenges and opportunities involved with ensuring language access for the growing number of people who require it. Sections include: recent immigration trends and demographic changes; the effect of language barriers on health outcomes and health care processes; laws and policies regarding the provision of language services to patients, including an overview of public financing mechanisms; strategies for improving language access, including enhancing access in delivery settings, promoting advocacy and policy change, improving interpreter training, and advancing research; and roles for foundations in supporting improved language access, including examples of current activities. The Issue Dialogue focused mainly on activities and programs that ensure linguistic access to health care for all patients. Although language and culture are clearly inseparable, a full exploration of the field of cultural competence and initiatives that promote its application to the health care setting are beyond the scope of this Issue Brief. The day's discussion did, however, raise provocative issues of culture that are reflected throughout this report.

Comparison of Standards for Accessible Design between America and China

NASA Astrophysics Data System (ADS)

Han, Ying; Tao, Xu Feng

2018-06-01

Aiming at the accessibility design and environmental constructions of China, comparing the differences of codes for accessibility design between domestic and abroad. It's including four aspects: the difference in audience of accessible design, content of the facilities, quantitative indexes and vision and hearing accessible design. It analyzed that the early stage of our country is backward in terms of accessibility and construction, mainly based on differences in values and professional education. In the end it put forward three suggestions to improve the construction of barrier-free environment in China.

Open access for operational research publications from low- and middle-income countries: who pays?

PubMed Central

Kumar, A. M. V.; Reid, A. J.; Van den Bergh, R.; Isaakidis, P.; Draguez, B.; Delaunois, P.; Nagaraja, S. B.; Ramsay, A.; Reeder, J. C.; Denisiuk, O.; Ali, E.; Khogali, M.; Hinderaker, S. G.; Kosgei, R. J.; van Griensven, J.; Quaglio, G. L.; Maher, D.; Billo, N. E.; Terry, R. F.; Harries, A. D.

2014-01-01

Open-access journal publications aim to ensure that new knowledge is widely disseminated and made freely accessible in a timely manner so that it can be used to improve people's health, particularly those in low- and middle-income countries. In this paper, we briefly explain the differences between closed- and open-access journals, including the evolving idea of the ‘open-access spectrum’. We highlight the potential benefits of supporting open access for operational research, and discuss the conundrum and ways forward as regards who pays for open access. PMID:26400799

The AAS Working Group on Accessibility and Disability (WGAD)

NASA Astrophysics Data System (ADS)

Monkiewicz, Jacqueline A.; Shanahan, J.; Murphy, Nicholas Arnold; Gilbert, Lauren

2016-06-01

The Working Group on Accessibility and Disability (WGAD) was formed by the Council of the American Astronomical Society in late 2015 in order to monitor and addresses issues of inclusivity in the astronomical community related to disability. WGAD promotes of the principles of universal accessibility and disability justice in both professional astronomy and astronomy education. The short term goals of WGAD for the next two years include producing a set of guidelines for a wide range of activities including supporting improved access to journals, data, and conferences. We will provide information and training regarding universal design as a guiding principle. The longer term goals of WGAD include integrating universal design as primary design strategy across the board in our many aspects of daily work life.

Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings

PubMed Central

Scanlon, Michael L; Vreeman, Rachel C

2013-01-01

The rollout of antiretroviral therapy (ART) significantly reduced human immunodeficiency virus (HIV)-related morbidity and mortality, but good clinical outcomes depend on access and adherence to treatment. In resource-limited settings, where over 90% of the world’s HIV-infected population resides, data on barriers to treatment are emerging that contribute to low rates of uptake in HIV testing, linkage to and retention in HIV care systems, and suboptimal adherence rates to therapy. A review of the literature reveals limited evidence to inform strategies to improve access and adherence with the majority of studies from sub-Saharan Africa. Data from observational studies and randomized controlled trials support home-based, mobile and antenatal care HIV testing, task-shifting from doctor-based to nurse-based and lower level provider care, and adherence support through education, counseling and mobile phone messaging services. Strategies with more limited evidence include targeted HIV testing for couples and family members of ART patients, decentralization of HIV care, including through home- and community-based ART programs, and adherence promotion through peer health workers, treatment supporters, and directly observed therapy. There is little evidence for improving access and adherence among vulnerable groups such as women, children and adolescents, and other high-risk populations and for addressing major barriers. Overall, studies are few in number and suffer from methodological issues. Recommendations for further research include health information technology, social-level factors like HIV stigma, and new research directions in cost-effectiveness, operations, and implementation. Findings from this review make a compelling case for more data to guide strategies to improve access and adherence to treatment in resource-limited settings. PMID:23326204

Improving Global Precipitation Product Access at the GES DISC

NASA Technical Reports Server (NTRS)

Liu, Z.; Vollmer, B.; Savtchenko, A.; Ostrenga, D.; DeShong, B.; Fang, F.; Albayrak, R,; Sherman, E.; Greene, M.; Li, A.;

Implementation and Sequencing of Practice Transformation in Urban Practices with Underserved Patients.

PubMed

Quigley, Denise D; Predmore, Zachary S; Chen, Alex Y; Hays, Ron D

Patient-centered medical home (PCMH) has gained momentum as a model for primary-care health services reform. We conducted interviews at 14 primary care practices undergoing PCMH transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. We found clinics pursued a common sequence of changes in PCMH transformation: Clinics began with National Committee for Quality Assurance (NCQA) level 3 recognition, adding care coordination staff, reorganizing data flow among teams, and integrating with a centralized quality improvement and accountability infrastructure. Next, they realigned to support continuity of care. Then, clinics improved access by adding urgent care, patient portals, or extending hours. Most then improved planning and management of patient visits. Only a handful worked explicitly on improving access with same day slots, scheduling processes, and test result communication. The clinics' changes align with specific NCQA PCMH standards but also include adding physicians and services, culture changes, and improved communication with patients. NCQA PCMH level 3 recognition is only the beginning of a continuous improvement process to become patient centered. Full PCMH transformation took time and effort and relied on a sequential approach, with an early focus on foundational changes that included use of a robust quality improvement strategy before changes to delivery of and access to care.

Access to Vocational Education. A Planning System for Local Secondary and Post-Secondary Program and Facility Accessibility. Step 1: Identifying Barriers.

ERIC Educational Resources Information Center

Rice, Eric; And Others

This guidebook focuses on the first of five steps included in a planning system for improving local secondary and postsecondary program and facilities accessibility: identifying barriers. The first five sections of the booklet are comprised of self-instructional descriptions of five needs-assessment procedures that can be used to identify…

Access to Vocational Education. A Planning System for Local Secondary and Post-Secondary Program and Facility Accessibility. Step 3: Generating Strategies.

ERIC Educational Resources Information Center

Rice, Eric; And Others

This guidebook focuses on the third of five steps included in a planning system for improving local secondary and postsecondary program and facilities accessibility: generating strategies. The guidebook is comprised of four sections, each describing a specific technique for generating strategies. Techniques presented are (1) nominal group…

Accessibility Trends among Academic Library and Library School Web Sites in the USA and Canada

ERIC Educational Resources Information Center

Schmetzke, Axel; Comeaux, David

2009-01-01

This paper focuses on the accessibility of North American library and library school Web sites for all users, including those with disabilities. Web accessibility data collected in 2006 are compared to those of 2000 and 2002. The findings of this follow-up study continue to give cause for concern: Despite improvements since 2002, library and…

What's in Your Techno-Future? Vendors Share Their Views.

ERIC Educational Resources Information Center

Gerber, Carole

1995-01-01

Examines vendors' views on the future of CD-ROM technology. Topics include the library role, single point access, costs, tape backup, user-friendly library automation systems and databases, improved quality, the growth of Internet access, and perspectives on technology in schools. (AEF)

A multi-center prospective cohort study to evaluate the effect of differential pricing and health systems strengthening on access to medicines and management of hypertension and diabetes in Ghana: A study protocol.

PubMed

Mobula, Linda Meta; Sarfo, Stephen; Arthur, Lynda; Burnham, Gilbert; Plange-Rhule, Jacob; Ansong, Daniel; Gavor, Edith; Ofori-Adjei, David

2018-02-07

Background: There is evidence to suggest that the prevalence of non-communicable diseases (NCDs), in particular cardiovascular diseases and diabetes, are being recognized as forming a substantial proportion of the burden of disease among populations in Low- and Middle-Income Countries (LMICs).  Access to treatment is likely a key barrier to the control and prevention of NCD outcomes.  Differential pricing, an approach used to price drugs based on the purchasing power of patients in different socioeconomic segments, has been shown to be beneficial and leads to improved access and affordability. Methods: This is a quasi-experimental study, with a pragmatic trial design, to be conducted over the course of three years. A mixed methods design will be used to evaluate the effects of health systems strengthening and differential pricing on the management of diabetes, hypertension and selected cancers in Ghana. A public private partnership was established between all sites that will receive multi-level interventions, including health systems strengthening  and access to medicines interventions. Study populations and sites: Study participants will include individuals with new or recently diagnosed hypertension and diabetes (n=3,300), who present to two major referral hospitals, Komfo Anokye Teaching Hospital and Tamale Teaching Hospital, as well as three district hospitals, namely Kings Medical Centre, Agogo Presbyterian District Hospital, and Atua Government Hospital. Discussion: The objective of this study aims to test approaches intended to improve access to drugs for the treatment of hypertension and diabetes, and improve disease control. Patients with these conditions will benefit from health systems strengthening interventions (education, counseling, improved management of disease), and increased access to innovative medicines via differential pricing. Pilot programs also will facilitate health system strengthening at the participating institutions, which includes training of clinicians and updating of guidelines and production of protocols for the treatment of diabetes, hypertension and cancer.

Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review.

PubMed

Williamson, Heather J; Contreras, Graciela M; Rodriguez, Erica S; Smith, Jennifer M; Perkins, Elizabeth A

2017-10-01

Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study's purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.

Improving pathways into mental health care for black and ethnic minority groups: a systematic review of the grey literature.

PubMed

Moffat, Joanne; Sass, Bernd; McKenzie, Kwame; Bhui, Kamaldeep

2009-01-01

Black and ethnic minorities show different pathways to care services and different routes out of care. These often involve non-statutory sector services. In order to improve access to services, and to develop appropriate and effective interventions, many innovations are described but the knowledge about how to improve pathways to recovery has not been synthesized. Much of this work is not formally published. Hence, this paper addresses this oversight and undertakes a review of the grey literature. The key components of effective pathway interventions include specialist services for ethnic minority groups, collaboration between sectors, facilitating referral routes between services, outreach and facilitating access into care, and supporting access to rehabilitation and moving out of care. Services that support collaboration, referral between services, and improve access seem effective, but warrant further evaluation. Innovative services must ensure that their evaluation frameworks meet minimum quality standards if the knowledge gained from the service is to be generalized, and if it is to inform policy.

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

ERIC Educational Resources Information Center

Harris, Lesley Ellen

2000-01-01

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

Improving outpatient access and patient experiences in academic ambulatory care.

PubMed

O'Neill, Sarah; Calderon, Sherry; Casella, Joanne; Wood, Elizabeth; Carvelli-Sheehan, Jayne; Zeidel, Mark L

2012-02-01

Effective scheduling of and ready access to doctor appointments affect ambulatory patient care quality, but these are often sacrificed by patients seeking care from physicians at academic medical centers. At one center, Beth Israel Deaconess Medical Center, the authors developed interventions to improve the scheduling of appointments and to reduce the access time between telephone call and first offered appointment. Improvements to scheduling included no redirection to voicemail, prompt telephone pickup, courteous service, complete registration, and effective scheduling. Reduced access time meant being offered an appointment with a physician in the appropriate specialty within three working days of the telephone call. Scheduling and access were assessed using monthly "mystery shopper" calls. Mystery shoppers collected data using standardized forms, rated the quality of service, and transcribed their interactions with schedulers. Monthly results were tabulated and discussed with clinical leaders; leaders and frontline staff then developed solutions to detected problems. Eighteen months after the beginning of the intervention (in June 2007), which is ongoing, schedulers had gone from using 60% of their registration skills to over 90%, customer service scores had risen from 2.6 to 4.9 (on a 5-point scale), and average access time had fallen from 12 days to 6 days. The program costs $50,000 per year and has been associated with a 35% increase in ambulatory volume across three years. The authors conclude that academic medical centers can markedly improve the scheduling process and access to care and that these improvements may result in increased ambulatory care volume.

"Finding my own time": examining the spatially produced experiences of rural RNs in the rural nursing certificate program.

PubMed

Place, Jessica; MacLeod, Martha; John, Norma; Adamack, Monica; Lindsey, A Elizabeth

2012-07-01

Rural nurses require access to education that exposes them to the most up-to-date information and skill development. However, since most education opportunities are located in urban centers and focused on providing skills to urban nurses, geography effectively acts as a barrier to accessing education that meets the needs of rural nurses. The Rural Nursing Certificate Program is a post-basic education program that addresses these concerns by providing rural-relevant content online, with limited campus sessions. Does online delivery of rural nursing curriculum overcome challenges related to geography? This study employed surveys with some open-ended questions. Analysis included descriptive statistics and content analysis. Students reported that online delivery improved access. Benefits included not having to relocate; being able to continue working; and, flexibility. Challenges included travel for practical experiences and time management related to staffing shortages, personal-professional overlap and family responsibilities. Online learning improved access to nursing education. However, the realities of rural nursing made it impossible to completely overcome geography: sense of obligation to work overtime, cost and time of traveling to workshops and practicums, uneven access to the Internet and computer services, and distance from peer and university support remained challenges. Copyright © 2011 Elsevier Ltd. All rights reserved.

Insights from the design and implementation of a single-entry model of referral for total joint replacement surgery: Critical success factors and unanticipated consequences.

PubMed

Damani, Zaheed; MacKean, Gail; Bohm, Eric; Noseworthy, Tom; Wang, Jenney Meng Han; DeMone, Brie; Wright, Brock; Marshall, Deborah A

2018-02-01

Single-entry models (SEMs) in healthcare allow patients to see the next-available provider and have been shown to improve waiting times, access and patient flow for preference-sensitive, scheduled services. The Winnipeg Central Intake Service (WCIS) for hip and knee replacement surgery was implemented to improve access in the Winnipeg Regional Health Authority. This paper describes the system's design/implementation; successes, challenges, and unanticipated consequences. On two occasions, during and following implementation, we interviewed all members of the WCIS project team, including processing engineers, waiting list coordinators, administrators and policy-makers regarding their experiences. We used semi-structured telephone interviews to collect data and qualitative thematic analysis to analyze and interpret the findings. Respondents indicated that the overarching objectives of the WCIS were being met. Benefits included streamlined processes, greater patient access, improved measurement and monitoring of outcomes. Challenges included low awareness, change readiness, and initial participation among stakeholders. Unanticipated consequences included workload increases, confusion around stakeholder expectations and under-reporting of data by surgeons' offices. Critical success factors for implementation included a requirement for clear communication, robust data collection, physician leadership and patience by all, especially implementation teams. Although successfully implemented, key lessons and critical success factors were learned related to change management, which if considered and applied, can reduce unanticipated consequences, improve uptake and benefit new models of care. Copyright © 2017 Elsevier B.V. All rights reserved.

Genome Consortium for Active Teaching: Meeting the Goals of BIO2010

PubMed Central

Ledbetter, Mary Lee S.; Hoopes, Laura L.M.; Eckdahl, Todd T.; Heyer, Laurie J.; Rosenwald, Anne; Fowlks, Edison; Tonidandel, Scott; Bucholtz, Brooke; Gottfried, Gail

2007-01-01

The Genome Consortium for Active Teaching (GCAT) facilitates the use of modern genomics methods in undergraduate education. Initially focused on microarray technology, but with an eye toward diversification, GCAT is a community working to improve the education of tomorrow's life science professionals. GCAT participants have access to affordable microarrays, microarray scanners, free software for data analysis, and faculty workshops. Microarrays provided by GCAT have been used by 141 faculty on 134 campuses, including 21 faculty that serve large numbers of underrepresented minority students. An estimated 9480 undergraduates a year will have access to microarrays by 2009 as a direct result of GCAT faculty workshops. Gains for students include significantly improved comprehension of topics in functional genomics and increased interest in research. Faculty reported improved access to new technology and gains in understanding thanks to their involvement with GCAT. GCAT's network of supportive colleagues encourages faculty to explore genomics through student research and to learn a new and complex method with their undergraduates. GCAT is meeting important goals of BIO2010 by making research methods accessible to undergraduates, training faculty in genomics and bioinformatics, integrating mathematics into the biology curriculum, and increasing participation by underrepresented minority students. PMID:17548873

Genome Consortium for Active Teaching: meeting the goals of BIO2010.

PubMed

Campbell, A Malcolm; Ledbetter, Mary Lee S; Hoopes, Laura L M; Eckdahl, Todd T; Heyer, Laurie J; Rosenwald, Anne; Fowlks, Edison; Tonidandel, Scott; Bucholtz, Brooke; Gottfried, Gail

2007-01-01

The Genome Consortium for Active Teaching (GCAT) facilitates the use of modern genomics methods in undergraduate education. Initially focused on microarray technology, but with an eye toward diversification, GCAT is a community working to improve the education of tomorrow's life science professionals. GCAT participants have access to affordable microarrays, microarray scanners, free software for data analysis, and faculty workshops. Microarrays provided by GCAT have been used by 141 faculty on 134 campuses, including 21 faculty that serve large numbers of underrepresented minority students. An estimated 9480 undergraduates a year will have access to microarrays by 2009 as a direct result of GCAT faculty workshops. Gains for students include significantly improved comprehension of topics in functional genomics and increased interest in research. Faculty reported improved access to new technology and gains in understanding thanks to their involvement with GCAT. GCAT's network of supportive colleagues encourages faculty to explore genomics through student research and to learn a new and complex method with their undergraduates. GCAT is meeting important goals of BIO2010 by making research methods accessible to undergraduates, training faculty in genomics and bioinformatics, integrating mathematics into the biology curriculum, and increasing participation by underrepresented minority students.

76 FR 26983 - Improving Wireless Coverage Through the Use of Signal Boosters

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-10

... Disabilities: To request materials in accessible formats for people with disabilities (braille, large [email protected] . 5. To request materials in accessible formats for people with disabilities (Braille, large... signal boosters. Specifically, the Commission proposes that marketing materials must include a...

Improving Vocational Rehabilitation Access and Return to Work and Career Outcomes among African American Wounded Warriors, Gulf War, and Vietnam War Era Veterans with Disabilities: A White Paper Series

ERIC Educational Resources Information Center

Moore, Corey L., Ed.: Johnson, Jean E., Ed.; Washington, Andre L., Ed.

2011-01-01

The purpose of this monograph is to present documents that discuss issues related to improving access to vocational rehabilitation services and return to work rates of African American Wounded Warriors, Gulf War and Vietnam War Era veterans with disabilities. This monograph also includes a review of relevant literature on barriers to employment…

Designing and Evaluating Interventions to Eliminate Racial and Ethnic Disparities in Health Care

PubMed Central

Cooper, Lisa A; Hill, Martha N; Powe, Neil R

2002-01-01

A large number of factors contribute to racial and ethnic disparities in health status. Health care professionals, researchers, and policymakers have believed for some time that access to care is the centerpiece in the elimination of these health disparities. The Institute of Medicine's (IOM) model of access to health services includes personal, financial, and structural barriers, health service utilization, and mediators of care. This model can be used to describe the interactions among these factors and their impact on health outcomes and equity of services among racial and ethnic groups. We present a modified version of the IOM model that incorporates the features of other access models and highlights barriers and mediators that are relevant for interventions designed to eliminate disparities in U.S. health care. We also suggest that interventions to eliminate disparities and achieve equity in health care services be considered within the broader context of improving quality of care. Some health service intervention studies have shown improvements in the health of disadvantaged groups. If properly designed and implemented, these interventions could be used to reduce health disparities. Successful features of interventions include the use of multifaceted, intense approaches, culturally and linguistically appropriate methods, improved access to care, tailoring, the establishment of partnerships with stakeholders, and community involvement. However, in order to be effective in reducing disparities in health care and health status, important limitations of previous studies need to be addressed, including the lack of control groups, nonrandom assignment of subjects to experimental interventions, and use of health outcome measures that are not validated. Interventions might be improved by targeting high-risk populations, focusing on the most important contributing factors, including measures of appropriateness and quality of care and health outcomes, and prioritizing dissemination efforts. PMID:12133164

Trends in access to water supply and sanitation in 31 major sub-Saharan African cities: an analysis of DHS data from 2000 to 2012.

PubMed

Hopewell, Mike R; Graham, Jay P

2014-02-28

By 2050, sub-Saharan Africa's (SSA) urban population is expected to grow from 414 million to over 1.2 billion. This growth will likely increase challenges to municipalities attempting to provide access to water supply and sanitation (WS&S). This study aims to characterize trends in access to WS&S in SSA cities and identify factors affecting those trends. DHS data collected between 2000 and 2012 were used for this analysis of thirty-one cities in SSA. Four categories of household access to WS&S were studied using data from demographic and health surveys--these included: 1) household access to an improved water supply, 2) household's time spent collecting water, 3) household access to improved sanitation, and 4) households reporting to engage in open defecation. An exploratory analysis of these measures was then conducted to assess the relationship of access to several independent variables. Among the 31 cities, there was wide variability in coverage levels and trends in coverage with respect to the four categories of access. The majority of cities were found to be increasing access in the categories of improved water supply and improved sanitation (65% and 83% of cities, respectively), while fewer were making progress in reducing the amount of time spent collecting water and reducing open defecation (50% and 38% of cities, respectively). Additionally, the prevalence of open defecation in study cities was found to be, on average, increasing. Based on DHS data, cities appeared to be making the most progress in gaining access to WS&S along metrics which reflect specified targets of the Millennium Development Goals. Nearly half of the cities, however, did not make progress in reducing open defecation or the time spent collecting water. This may reflect that the MDGs have led to a focus on "improved" services while other measures, potentially more relevant to the extreme poor, are being neglected. This study highlights the need to better characterize access, beyond definitions of improved and unimproved, as well as the need to target resources to cities where changes in WS&S access have stalled, or in some cases regressed.

Update on NASA Space Shuttle Earth Observations Photography on the laser videodisc for rapid image access

NASA Technical Reports Server (NTRS)

Lulla, Kamlesh

1994-01-01

There have been many significant improvements in the public access to the Space Shuttle Earth Observations Photography Database. New information is provided for the user community on the recently released videodisc of this database. Topics covered included the following: earlier attempts; our first laser videodisc in 1992; the new laser videodisc in 1994; and electronic database access.

U.S. Air Force Enlisted Accessions: Upgrading the Pipeline

DTIC Science & Technology

2010-02-17

of State Boards of Education (NASBE) and the Association for Career and Technical Education (ACTE). Specific collaboration efforts include improving...Accessions Command and the Association for Career and Technical Education . November 20, 2009. http://dev.armyedspace.com/news-updates/news...Understanding Between the U.S. Army Accessions Command and the Association for Career and Technical Education . November 20, 2009. http://dev.armyedspace.com

Incorporating information on predicted solvent accessibility to the co-evolution-based study of protein interactions.

PubMed

Ochoa, David; García-Gutiérrez, Ponciano; Juan, David; Valencia, Alfonso; Pazos, Florencio

2013-01-27

A widespread family of methods for studying and predicting protein interactions using sequence information is based on co-evolution, quantified as similarity of phylogenetic trees. Part of the co-evolution observed between interacting proteins could be due to co-adaptation caused by inter-protein contacts. In this case, the co-evolution is expected to be more evident when evaluated on the surface of the proteins or the internal layers close to it. In this work we study the effect of incorporating information on predicted solvent accessibility to three methods for predicting protein interactions based on similarity of phylogenetic trees. We evaluate the performance of these methods in predicting different types of protein associations when trees based on positions with different characteristics of predicted accessibility are used as input. We found that predicted accessibility improves the results of two recent versions of the mirrortree methodology in predicting direct binary physical interactions, while it neither improves these methods, nor the original mirrortree method, in predicting other types of interactions. That improvement comes at no cost in terms of applicability since accessibility can be predicted for any sequence. We also found that predictions of protein-protein interactions are improved when multiple sequence alignments with a richer representation of sequences (including paralogs) are incorporated in the accessibility prediction.

Creating a State-Wide Virtual Health Library: The Michigan Experience.

ERIC Educational Resources Information Center

Brenneise, Harvey

The AccessMichigan Electronic Community Health Information Initiative (AMECHII) is a response to a recommendation of the Michigan Information Technology Commission Report recommending improved access to high-quality health care information for all Michigan stakeholders. This project is multi-type, including public, general academic, academic…

Building Partnership to Improve Migrants' Access to Healthcare in Mumbai.

PubMed

Gawde, Nilesh Chandrakant; Sivakami, Muthusamy; Babu, Bontha V

2015-01-01

An intervention to improve migrants' access to healthcare was piloted in Mumbai with purpose of informing health policy and planning. This paper aims to describe the process of building partnership for improving migrants' access to healthcare of the pilot intervention, including the role played by different stakeholders and the contextual factors affecting the intervention. The process evaluation was based on Baranowski and Stables' framework. Observations in community and conversations with stakeholders as recorded in daily diaries, minutes of pre-intervention workshops, and stakeholder meetings served as data sources. Data were coded using the framework and descriptive summaries of evaluation components were prepared. Recruitment of stakeholders was easier than sustaining their interest. Community representatives led the intervention assisted by government officials. They planned community-level interventions to improve access to healthcare that involved predominantly information, education, and communication activities for which pre-existing formal and informal social networks and community events were used. Although the intervention reached migrants living with families, single male migrants neither participated nor did the intervention reach them consistently. Contextual factors such as culture differences between migrants and native population and illegality in the nature of the settlement, resulting in the exclusion from services, were the barriers. Inclusive multi-stakeholder partnership, including migrants themselves and using both formal and informal networks in community is a feasible strategy for health education and has potential to improve the migrants' access to healthcare. However, there are challenges to the partnership process and new strategies to overcome these challenges need to be tested such as peer-led models for involvement of single male migrants. For sustaining such efforts and mainstreaming migrants, addressing contextual factors and having formal mechanisms for their inclusion are equally important.

Improving access to surgery in a developing country: experience from a surgical collaboration in Sierra Leone.

PubMed

Kushner, Adam L; Kamara, Thaim B; Groen, Reinou S; Fadlu-Deen, Betsy D; Doah, Kisito S; Kingham, T Peter

2010-01-01

Although surgery is increasingly recognized as an essential component of primary health care, there has been little documentation of surgical programs in low- and middle-income countries. Surgeons OverSeas (SOS) is a New York-based organization with a mission to save lives in developing countries by improving surgical care. This article highlights the surgical program in Sierra Leone as a possible model to improve access to surgery. An SOS team conducted a needs assessment of surgical capacity in Sierra Leone in February 2008. Interventions were then developed and programs were implemented. A follow-up assessment was conducted in December 2009, which included interviews of key Sierra Leone hospital personnel and a review of operating room log books. Based on an initial needs assessment, a program was developed that included training, salary support, and the provision of surgical supplies and equipment. Two 3-day workshops were conducted for a total of 44 health workers, salary support given to over 100 staff, and 2 containers of supplies and equipment were donated. Access to surgery, as measured by the number of major operations at Connaught Hospital, increased from 460 cases in 2007 to 768 cases in 2009. The SOS program in Sierra Leone highlights a method for improving access to surgery that incorporates an initial needs assessment with minimal external support and local staff collaboration. The program functions as a catalyst by providing training, salary support, and supplies. The beneficial results of the program can then be used to advocate for additional resources for surgery from policy makers. This model could be beneficial in other resource-poor countries in which improved access to surgery is desired. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Impact of a dedicated cancer-associated thrombosis service on clinical outcomes: a mixed-methods evaluation of a clinical improvement exercise

PubMed Central

Noble, Simon; Pease, Nikki; Sui, Jessica; Davies, James; Lewis, Sarah; Malik, Usman; Alikhan, Raza; Prout, Hayley; Nelson, Annmarie

2016-01-01

Objectives Cancer-associated thrombosis (CAT) complex condition, which may present to any healthcare professional and at any point during the cancer journey. As such, patients may be managed by a number of specialties, resulting in inconsistent practice and suboptimal care. We describe the development of a dedicated CAT service and its evaluation. Setting Specialist cancer centre, district general hospital and primary care. Participants Patients with CAT and their referring clinicians. Intervention A cross specialty team developed a dedicated CAT service , including clear referral pathways, consistent access to medicines, patient's information and a specialist clinic. Primary and secondary outcome measures The service was evaluated using a mixed-methods evaluation , including audits of clinical practice, clinical outcomes, staff surveys and qualitative interviewing of patients and healthcare professionals. Results Data from 457 consecutive referrals over an 18-month period were evaluated. The CAT service has led to an 88% increase in safe and consistent community prescribing of low-molecular-weight heparin, with improved access to specialist advice and information. Patients reported improved understanding of their condition, enabling better self-management as well as better access to support and information. Referring clinicians reported better care standards for their patients with improved access to expertise and appropriate management. Conclusions A dedicated CAT service improves overall standards of care and is viewed positively by patients and clinicians alike. Further health economic evaluation would enhance the case for establishing this as the standard model of care. PMID:27895068

Impact of Advanced (Open) Access Scheduling on Patients With Chronic Diseases

PubMed Central

Degani, N

2013-01-01

Background The goal of advanced access scheduling is to eliminate wait times for physician visits by ensuring access to same-day appointments, regardless of urgency or health care need. The intent is to reduce delays in access, leading to improvements in clinical care and patient satisfaction, and reductions in the use of urgent care. Objective To evaluate whether implementation of an advanced access scheduling system reduced other types of health service utilization and/or improved clinical measures and patient satisfaction among adults with chronic diseases. Data Sources and Review Methods A literature search was performed on January 29, 2012, for studies published from 1946 (OVID) or 1980 (EMBASE) to January 29, 2012. Systematic reviews, randomized controlled trials, and observational studies were eligible if they evaluated advanced access implementation in adults with chronic diseases and reported health resource utilization, patient outcomes, or patient satisfaction. Results were summarized descriptively. Results One systematic review in a primary care population and 4 observational studies (5 papers) in chronic disease and/or geriatric populations were identified. The systematic review concluded that advanced access did not improve clinical outcomes, but there was no evidence of harm. Findings from the observational studies in chronic disease populations were consistent with those of the systematic review. Advanced access implementation was not consistently associated with changes in clinical outcomes, patient satisfaction, or health service utilization. Limitations All studies were retrospective: 3 studies (4 papers) included historical controls only, and 1 included contemporaneous controls. Findings were inconsistent across studies for a number of outcomes. Conclusions Based on low to very low quality evidence, advanced access did not have a statistically (or clinically) significant impact on health service utilization among patients with diabetes and/or coronary artery disease (CAD). Very low quality evidence showed a significant reduction in the proportion of patients with diabetes and CAD admitted to hospital whose length of stay was greater than 3 days. Evidence was inconsistent for changes in clinical outcomes for patients with diabetes or CAD. Very low quality evidence showed no increase in patient satisfaction with an advanced access scheduling system. Plain Language Summary Timeliness of health care access—reducing wait times and delays for those receiving and providing care—is a key measure of health system quality. However, in international comparison studies, Canada ranked either last or next to last when it came to timely access to regular doctors. Efforts in Ontario to address delays in access have included the implementation of the Advanced Access and Efficiency for Primary Care initiative through the Quality Improvement and Innovation Partnership, later incorporated into Health Quality Ontario. Advanced access is a physician appointment scheduling system that aims to eliminate wait times for physician visits and ensure same-day access for all patients, regardless of urgency or health care need. While it can generally be agreed that timely access to health care is necessary for all patients, same-day access may not always be required. Indeed, advanced access may adversely affect the care of patients with chronic diseases if clinics implement strict same-day appointment rules and patients cannot pre-book follow-up appointments. This review evaluated the effect of advanced access scheduling on clinical outcomes, patient satisfaction, and health service utilization in patients with selected chronic diseases, as part of the Optimizing Chronic Disease Management in the Outpatient (Community) Setting mega-analysis. In patients with diabetes or coronary artery disease, advanced access implementation had little or no impact on acute health care use (hospitalizations, emergency department visits, and/or urgent care visits) and had inconsistent effects on clinical outcomes (blood glucose, low-density lipoprotein [LDL] cholesterol, and blood pressure). Two studies reported reduced monitoring of patients with chronic diseases after implementation of advanced access. Another study reported improved patient management (regular blood glucose and cholesterol testing) after advanced access implementation, but this was attributed to improved provider continuity rather than to reduced appointment wait times. There was no increase in patient satisfaction with the advanced access scheduling system. The quality of the evidence ranged from low to very low. PMID:24133569

Reduced representation approaches to interrogate genome diversity in large repetitive plant genomes.

PubMed

Hirsch, Cory D; Evans, Joseph; Buell, C Robin; Hirsch, Candice N

2014-07-01

Technology and software improvements in the last decade now provide methodologies to access the genome sequence of not only a single accession, but also multiple accessions of plant species. This provides a means to interrogate species diversity at the genome level. Ample diversity among accessions in a collection of species can be found, including single-nucleotide polymorphisms, insertions and deletions, copy number variation and presence/absence variation. For species with small, non-repetitive rich genomes, re-sequencing of query accessions is robust, highly informative, and economically feasible. However, for species with moderate to large sized repetitive-rich genomes, technical and economic barriers prevent en masse genome re-sequencing of accessions. Multiple approaches to access a focused subset of loci in species with larger genomes have been developed, including reduced representation sequencing, exome capture and transcriptome sequencing. Collectively, these approaches have enabled interrogation of diversity on a genome scale for large plant genomes, including crop species important to worldwide food security. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Free access to hypertension and diabetes medicines among the elderly: a reality yet to be constructed.

PubMed

Paniz, Vera Maria Vieira; Fassa, Anaclaudia Gastal; Facchini, Luiz Augusto; Piccini, Roberto Xavier; Tomasi, Elaine; Thumé, Elaine; da Silveira, Denise Silva; Rodrigues, Maria Aparecida; Domingues, Marlos Rodrigues; Bertoldi, Andréa Dâmaso

2010-06-01

The study evaluated free access to hypertension and diabetes medicines and the reasons reported for lack of access. The sample included 4,003 elderly people living in Primary Care Unit coverage areas from 41 Southern and Northeastern Brazilian cities. Free access was higher in the Northeast (62.4%). The strategy of the Family Health Program (Programa Saúde da Família - PSF) was more effective in providing access than the traditional model, with higher results in the Northeast (61.2%) than in the South (39.6%). Around 20% of medicines included in the Hypertension and Diabetes Program and 26% of those included in the National Essential Medicines List (RENAME) were paid out of pocket. In the Northeast, 25% of insulin and 32% of oral antidiabetics were paid out of pocket. Unavailability in the public sector and a lack of money determined the lack of access. Although the PSF, Hypertension and Diabetes Program and RENAME expanded free access, supplies were insufficient. A greater connection between programs and a clear definition of responsibilities can improve medicine acquisition process, increasing the effectiveness of pharmaceutical assistance.

Improving access to important recovery information for heart patients with low health literacy: reflections on practice-based initiatives.

PubMed

Naccarella, Lucio; Biuso, Catuscia; Jennings, Amanda; Patsamanis, Harry

2018-05-29

Evidence exists for the association between health literacy and heart health outcomes. Cardiac rehabilitation is critical for recovery from heart attack and reducing hospital readmissions. Despite this, <30% of people participate in a program. Significant patient, hospital and health system challenges exist to improve recovery through increased heart health literacy. This brief case study reflects and documents practice-based initiatives by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. Three key initiatives, namely the Six Steps To Cardiac Recovery resource, the Love Your Heart book and the nurse ambassador program, were implemented informed by mixed methods that assessed need and capacity at the individual, organisational and systems levels. Key outcomes included increased access to recovery information for patients with low health literacy, nurse knowledge and confidence to engage with patients on recovery information, improved education of patients and improved availability and accessibility of information for patients in diverse formats. Given the challenges involved in addressing heart health literacy, multifaceted practice-based approaches are essential to improve access to recovery information for patients with low literacy levels. What is known about the topic? Significant challenges exist for patients with lower health literacy receiving recovery information after a heart attack in hospitals. What does this paper add? This case study provides insights into a practice-based initiative by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. What are the implications for practitioners? Strategies to improve recovery through increased heart health literacy must address the needs of patients, nursing staff and the health system within hospitals. Such strategies need to be multifaceted and designed to build the capacity of nurses, heart patients and their carers, as well as support from hospital management.

Cable Technology: A Challenge for Adult Educators.

ERIC Educational Resources Information Center

Palchinsky, Jo

The penetration of cable television throughout American communities makes it a potentially significant tool for improving the quality and accessibility of adult education. As cities begin to include in the cable franchise allotment monies for access by community members, adult educators need to become actively involved during the development of a…

Creating Connections: College Innovations in Flexibility, Access and Participation.

ERIC Educational Resources Information Center

Further Education Development Agency, London (England).

This document contains 14 papers explaining how 12 further education colleges in the United Kingdom used fellowship funds to maximize their use of current information and learning technologies and make other substantial innovations to improve their flexibility, accessibility, and rates of participation. The following papers are included:…

Improving access to electronic health records for people with intellectual disability: a qualitative study.

PubMed

van Dooren, Kate; Lennox, Nick; Stewart, Madeline

2013-01-01

People with intellectual disability represent ~2-3% of the Australian population and experience elevated rates of mortality and morbidity compared with the general population. People with intellectual disability, and their families and carers, must keep track of extensive medical information while also managing turnover of paid staff, general practitioners and other health professionals, making them beneficiaries of Australia's new eHealth record system. Although they are key users, there is a lack of knowledge about the accessibility of the system for individuals with intellectual disability, or those responsible for managing their health information. This is a missed opportunity to improve the lives of an already overlooked group. This study aimed to identify the facilitators and barriers to registering for an eHealth record network for people with intellectual disability and those supporting them to manage their health information. We interviewed potential users of eHealth records, including four people with intellectual disability, three family members and two residential support workers. Our findings suggest that decision-makers involved in the roll-out of the eHealth record networks should incorporate 'reasonable accommodations' to improve accessibility for people with intellectual disability and those who support them to manage their health information. This includes identifying and eliminating the barriers to accessibility of eHealth records and taking appropriate measures to promote access to individuals with intellectual disability. People with intellectual disability and the people who support them are a diverse group with a range of abilities. The translation of their views into practice will help to improve the eHealth system for this and other vulnerable population groups.

Access to Complex Abortion Care Service and Planning Improved through a Toll-Free Telephone Resource Line

PubMed Central

Norman, Wendy V.; Hestrin, Barbara; Dueck, Royce

2014-01-01

Background. Providing equitable access to the full range of reproductive health services over wide geographic areas presents significant challenges to any health system. We present a review of a service provision model which has provided improved access to abortion care; support for complex issues experienced by women seeking nonjudgmental family planning health services; and a mechanism to collect information on access barriers. The toll-free pregnancy options service (POS) of British Columbia Women's Hospital and Health Centre sought to improve access to services and overcome barriers experienced by women seeking abortion. Methods. We describe the development and implementation of a province-wide toll-free telephone counseling and access facilitation service, including establishment of a provincial network of local abortion service providers in the Canadian province of British Columbia from 1998 to 2010. Results. Over 2000 women annually access service via the POS line, networks of care providers are established and linked to central support, and central program planners receive timely information on new service gaps and access barriers. Conclusion. This novel service has been successful in addressing inequities and access barriers identified as priorities before service establishment. The service provided unanticipated benefits to health care planning and monitoring of provincial health care related service delivery and gaps. This model for low cost health service delivery may realize similar benefits when applied to other health care systems where access and referral barriers exist. PMID:24693291

Poverty and access to health care in developing countries.

PubMed

Peters, David H; Garg, Anu; Bloom, Gerry; Walker, Damian G; Brieger, William R; Rahman, M Hafizur

2008-01-01

People in poor countries tend to have less access to health services than those in better-off countries, and within countries, the poor have less access to health services. This article documents disparities in access to health services in low- and middle-income countries (LMICs), using a framework incorporating quality, geographic accessibility, availability, financial accessibility, and acceptability of services. Whereas the poor in LMICs are consistently at a disadvantage in each of the dimensions of access and their determinants, this need not be the case. Many different approaches are shown to improve access to the poor, using targeted or universal approaches, engaging government, nongovernmental, or commercial organizations, and pursuing a wide variety of strategies to finance and organize services. Key ingredients of success include concerted efforts to reach the poor, engaging communities and disadvantaged people, encouraging local adaptation, and careful monitoring of effects on the poor. Yet governments in LMICs rarely focus on the poor in their policies or the implementation or monitoring of health service strategies. There are also new innovations in financing, delivery, and regulation of health services that hold promise for improving access to the poor, such as the use of health equity funds, conditional cash transfers, and coproduction and regulation of health services. The challenge remains to find ways to ensure that vulnerable populations have a say in how strategies are developed, implemented, and accounted for in ways that demonstrate improvements in access by the poor.

Optical fiber cabling technologies for flexible access network

NASA Astrophysics Data System (ADS)

Tanji, Hisashi

2008-07-01

Fiber-to-the-home (FTTH) outside plant infrastructure should be so designed and constructed as to flexibly deal with increasing subscribers and system evolution to be expected in the future, taking minimization of total cost (CAPEX and OPEX) into consideration. With this in mind, fiber access architectures are reviewed and key technologies on optical fiber and cable for supporting flexible access network are presented. Low loss over wide wavelength (low water peak) and bend-insensitive single mode fiber is a future proof solution. Enhanced separable ribbon facilitates mid-span access to individual fibers in a cable installed, improving fiber utilizing efficiency and flexibility of distribution design. It also contributes to an excellent low PMD characteristic which could be required for video RF overlay system or high capacity long reach metro-access convergence network in the future. Bend-insensitive fiber based cabling technique including field installable connector greatly improves fiber/cable handling in installation and maintenance work.

Healthcare Access for Iraqi Refugee Children in Texas: Persistent Barriers, Potential Solutions, and Policy Implications.

PubMed

Vermette, David; Shetgiri, Rashmi; Al Zuheiri, Haidar; Flores, Glenn

2015-10-01

To identify access barriers to healthcare and potential interventions to improve access for Iraqi refugee children. Four focus groups were conducted using consecutive sampling of Iraqi refugee parents residing in the US for 8 months to 5 years. Eight key-informant interviews also were conducted with employees of organizations serving Iraqi refugee families, recruited using snowball sampling. Focus groups and interviews were audiotaped, transcribed, and analyzed using margin coding and grounded theory. Iraqi refugees identified provider availability, Medicaid maintenance and renewal, language issues, and inadequate recognition of post-traumatic stress disorder as barriers to care for their children. Interviewees cited loss of case-management services and difficulties in understanding the Medicaid renewal process as barriers. Potential interventions to improve access include community-oriented efforts to educate parents on Medicaid renewal, obtaining services, and accessing specialists. Given the enduring nature of language and Medicaid renewal barriers, policies addressing eligibility alone are insufficient.

Differing perspectives on parent access to their child's electronic medical record during neonatal intensive care hospitalization: a pilot study.

PubMed

Chung, Rebecca K; Kim, Una Olivia; Basir, Mir Abdul

2018-04-01

To improve informed medical decision-making, principles for family-centered neonatal care recommend that parents have access to their child's medical record on an ongoing basis during neonatal intensive unit care (NICU) hospitalization. Currently, many NICUs do not allow independent parent access to their child's electronic medical record (EMR) during hospitalization. We undertook a cross-sectional survey pilot study of medical professionals and parents to explore opinions regarding this practice. Inclusion criteria: 18-years old, English-literate, legal guardian of patients admitted to the NICU for 14 days. NICU medical professionals included physicians, nurse practitioners, nurses, and respiratory therapists. Medical professionals believed parent access would make their work more difficult, increase time documenting and updating families, making them more liable to litigation and hesitant to chart sensitive information. However, parents felt that they lacked control over their child's care and desired direct access to the EMR. Parents believed this would improve accuracy of their child's medical chart, and increase advocacy and understanding of their child's illness. NICU parents and medical professionals have differing perspectives on independent parental access to their child's EMR. More research is needed to explore the potential of independent parental EMR access to further improve family-centered neonatal care.

Can biosimilars help achieve the goals of US health care reform?

PubMed

Boccia, Ralph; Jacobs, Ira; Popovian, Robert; de Lima Lopes, Gilberto

2017-01-01

The US Patient Protection and Affordable Care Act (ACA) aims to expand health care coverage, contain costs, and improve health care quality. Accessibility and affordability of innovative biopharmaceuticals are important to the success of the ACA. As it is substantially more difficult to manufacture them compared with small-molecule drugs, many of which have generic alternatives, biologics may increase drug costs. However, biologics offer demonstrated improvements in patient care that can reduce expensive interventions, thus lowering net health care costs. Biosimilars, which are highly similar to their reference biologics, cost less than the originators, potentially increasing access through reduced prescription drug costs while providing equivalent therapeutic results. This review evaluates 1) the progress made toward enacting health care reform since the passage of the ACA and 2) the role of biosimilars, including the potential impact of expanded biosimilar use on access, health care costs, patient management, and outcomes. Barriers to biosimilar adoption in the USA are noted, including low awareness and financial disincentives relating to reimbursement. The evaluated evidence suggests that the ACA has partly achieved some of its aims; however, the opportunity remains to transform health care to fully achieve reform. Although the future is uncertain, increased use of biosimilars in the US health care system could help achieve expanded access, control costs, and improve the quality of care.

The crisis in access to essential medicines in India: key issues which call for action.

PubMed

Bhargava, Anurag; Kalantri, S P

2013-01-01

The government is planning to introduce free generic and essential medicines in public health facilities. Most people in India buy healthcare from the private sector, a compulsion that accounts for a high proportion of healthcare-related expenditure. To reduce the burden of healthcare costs, the government must improve availability and affordability of generic and essential medicines in the market. It can do so because India's large pharmaceutical industry is a major source of generic medicines worldwide. In this article, we discuss three factors that have impeded access to generic and essential medicines: (1) mistaken notions among policymakers, prescribers and patients about branded drugs and generic drugs in India; (2) high prices of medicines due to the progressive dismantling of the system of regulation of medicine prices, and (3) a drug approval and regulatory system that allows medicines (including fixed dose combinations) of doubtful efficacy, rationale, safety and public health relevance to dominate the market at the cost of access to affordable generic and essential medicines. The consequences of ill-health and wasted expenditure on drugs raise issues of public health ethics.Improving access to essential medicines in India is an urgent public health and ethical imperative. This should include improved public provisioning, a system of regulation of drug prices, and an evidence-based drug approval process.

Barriers to HIV testing among male clients of female sex workers in Indonesia.

PubMed

Fauk, Nelsensius Klau; Sukmawati, Anastasia Suci; Berek, Pius Almindu Leki; Ernawati; Kristanti, Elisabeth; Wardojo, Sri Sunaringsih Ika; Cahaya, Isaias Budi; Mwanri, Lillian

2018-05-30

Frequent engagement of men in sexual encounters with female sex workers (FSWs) without using condoms places them at a high risk for HIV infection. HIV testing has been noted to be among important strategies to prevent HIV transmission and acquisition. However, it is known that not all men willingly undertake an HIV test as a way to prevent HIV transmission and/or acquisition. This study aimed to identify barriers to accessing HIV testing services among men who are clients of FSWs (clients) in Belu and Malaka districts, Indonesia. A qualitative inquiry employing face to face open ended interviews was conducted from January to April 2017. The participants (n = 42) were clients of FSWs recruited using purposive and snowball sampling techniques. Data were analysed using a qualitative data analysis framework. Findings indicated three main barriers of accessing HIV testing services by clients. These included: (1) personal barriers (lack of knowledge of HIV/AIDS and HIV testing availability, and unwillingness to undergo HIV testing due to low self-perceived risk of HIV and fear of the test result); (2) health care service provision barriers (lack of trust in health professionals and limited availability of medication including antiretroviral (ARV)); and (3) social barriers (stigma and discrimination, and the lack of social supports). These findings indicated multilevelled barriers to accessing HIV testing services among participants, who are known to be among key population groups in HIV care. Actions to improve HIV/AIDS-related health services accessibility are required. The dissemination of the knowledge and information on HIV/AIDS and improved available of HIV/AIDS-related services are necessary actions to improve the personal levelled barriers. System wide barriers will need improved practices and health policies to provide patients friendly and accessible services. The societal levelled barriers will need a more broad societal approach including raising awareness in the community and enhanced discussions about HIV/AIDS issues in order to normalise HIV in the society.

45 CFR 158.150 - Activities that improve health care quality.

Code of Federal Regulations, 2014 CFR

2014-10-01

... required in § 158.110 of this subpart must include expenditures for activities that improve health care... 45 Public Welfare 1 2014-10-01 2014-10-01 false Activities that improve health care quality. 158... HEALTH CARE ACCESS ISSUER USE OF PREMIUM REVENUE: REPORTING AND REBATE REQUIREMENTS Disclosure and...

45 CFR 158.150 - Activities that improve health care quality.

Code of Federal Regulations, 2013 CFR

2013-10-01

... required in § 158.110 of this subpart must include expenditures for activities that improve health care... 45 Public Welfare 1 2013-10-01 2013-10-01 false Activities that improve health care quality. 158... HEALTH CARE ACCESS ISSUER USE OF PREMIUM REVENUE: REPORTING AND REBATE REQUIREMENTS Disclosure and...

45 CFR 158.150 - Activities that improve health care quality.

Code of Federal Regulations, 2011 CFR

2011-10-01

... required in § 158.110 of this subpart must include expenditures for activities that improve health care... 45 Public Welfare 1 2011-10-01 2011-10-01 false Activities that improve health care quality. 158... HEALTH CARE ACCESS ISSUER USE OF PREMIUM REVENUE: REPORTING AND REBATE REQUIREMENTS Disclosure and...

Open access in the patient-centered medical home: lessons from the Veterans Health Administration.

PubMed

True, Gala; Butler, Anneliese E; Lamparska, Bozena G; Lempa, Michele L; Shea, Judy A; Asch, David A; Werner, Rachel M

2013-04-01

The Veterans Health Administration (VHA) has undertaken a 5-year initiative to transform to a patient-centered medical home model. An early focus of implementation was on creating open access, defined as continuity and capacity in primary care. We describe the impact of readiness for implementation on efforts of pilot teams to make changes to improve access and identify successful strategies used by early adopters to overcome barriers to change. A qualitative, formative evaluation of the first 18 months of implementation in one Veterans Integrated Service Network (VISN) spread across six states. Members of local implementation teams including administrators, primary care providers, and staff from primary care clinics located at 10 medical centers and 45 outpatient clinics. We conducted site visits during the first 6 months of implementation, observations at Learning Collaboratives, semi-structured interviews, and review of internal organizational documents. All data collection took place between April 2010 and December 2011. Early adopters employed various strategies to enhance access, with a focus on decreasing demand for face-to-face care, increasing supply of different types of primary care encounters, and improving clinic efficiencies. Our interviews with key contacts revealed three important areas where readiness for implementation (or lack thereof) had an impact on interventions to improve access: leadership engagement, staffing resources, and access to information and knowledge. Key factors related to readiness for implementation had an impact on which interventions pilot teams could put into place, as well as the viability and sustainability of access gains. Wide variations in interventions to improve access occurring across sites situated within one organization have important implications for efforts to measure the impact of enhanced access on patient outcomes, costs, and other systems-level indicators of the Medical Home.

Expanding access to high-cost medicines through the E2 access program in Thailand: effects on utilisation, health outcomes and cost using an interrupted time-series analysis.

PubMed

Sruamsiri, Rosarin; Wagner, Anita K; Ross-Degnan, Dennis; Lu, Christine Y; Dhippayom, Teerapon; Ngorsuraches, Surachat; Chaiyakunapruk, Nathorn

2016-03-17

In 2008, the Thai government introduced the 'high-cost medicines E2 access program' as a part of the National List of Essential Medicines to increase patient access to medicines, improve clinical outcomes and make medicines more affordable. Our objective was to examine whether the 'high-cost medicines E2 access program' achieved its goals. Interrupted time-series design study. 3 tertiary hospitals in different regions of Thailand, January 2006 to December 2012. Patients with target acute and chronic disease diagnoses who newly met E2 program criteria for selected study medicines. High-cost medicines E2 access program. Level and trend changes over time in the proportions of eligible patients who received the indicated E2 medicines and who improved clinically, as well as in costs of treatment. A total of 2024 patients were included in utilisation analyses and 1375 patients with selected acute diseases contributed to analyses of clinical outcome. After 1 year of the E2 program implementation, the percentage of eligible patients receiving the indicated E2 program medicines increased significantly (relative change 12.7% (95% CI 4.4% to 21.0%), especially among those insured by the government's universal coverage scheme (relative change 19.9% (95% CI 9.5% to 30.5%)). The increase in the proportion of clinically improved patients with acute conditions was not significant (relative change 6.2% (95% CI -1.9% to 15.1%)). Quarterly healthcare costs per patient dropped significantly (relative change -13.5% (95% CI -26.9% to -1.7%)). In the study hospitals, the E2 access program seems to have facilitated patient access to specialty medicines, may have contributed to improved health outcomes, and decreased treatment costs. Routine monitoring is needed to assess effects of expanding the programme, including effects on quality of care and financial sustainability. 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/

Climate Change: Providing Equitable Access to a Rigorous and Engaging Curriculum

ERIC Educational Resources Information Center

Cardichon, Jessica; Roc, Martens

2013-01-01

This report examines how implementing rigorous and engaging curriculum aligned with college- and career-ready standards fosters positive school climates in which students are motivated to succeed, achievement gaps narrow, and learning and outcomes improve. It includes federal, state, and local recommendations for increasing access to high-quality,…

Access to Effective Teaching for Disadvantaged Students in 29 School Districts

ERIC Educational Resources Information Center

Isenberg, Eric; Max, Jeffrey; Gleason, Philip; Potamites, Liz; Santillano, Robert; Hock, Heinrich; Hansen, Michael

2014-01-01

Recent federal policy initiatives are aimed at improving disadvantaged students' access to effective teaching. These efforts, including Race to the Top and the Teacher Incentive Fund, arise from concerns that disadvantaged students are taught by less effective teachers. A growing body of research uses value-added analysis to measure teacher…

Windows on the brain: the emerging role of atlases and databases in neuroscience

NASA Technical Reports Server (NTRS)

Van Essen, David C.; VanEssen, D. C. (Principal Investigator)

2002-01-01

Brain atlases and associated databases have great potential as gateways for navigating, accessing, and visualizing a wide range of neuroscientific data. Recent progress towards realizing this potential includes the establishment of probabilistic atlases, surface-based atlases and associated databases, combined with improvements in visualization capabilities and internet access.

Impact of a dedicated cancer-associated thrombosis service on clinical outcomes: a mixed-methods evaluation of a clinical improvement exercise.

PubMed

Noble, Simon; Pease, Nikki; Sui, Jessica; Davies, James; Lewis, Sarah; Malik, Usman; Alikhan, Raza; Prout, Hayley; Nelson, Annmarie

2016-11-28

Cancer-associated thrombosis (CAT) complex condition, which may present to any healthcare professional and at any point during the cancer journey. As such, patients may be managed by a number of specialties, resulting in inconsistent practice and suboptimal care. We describe the development of a dedicated CAT service and its evaluation. Specialist cancer centre, district general hospital and primary care. Patients with CAT and their referring clinicians. A cross specialty team developed a dedicated CAT service , including clear referral pathways, consistent access to medicines, patient's information and a specialist clinic. The service was evaluated using a mixed-methods evaluation , including audits of clinical practice, clinical outcomes, staff surveys and qualitative interviewing of patients and healthcare professionals. Data from 457 consecutive referrals over an 18-month period were evaluated. The CAT service has led to an 88% increase in safe and consistent community prescribing of low-molecular-weight heparin, with improved access to specialist advice and information. Patients reported improved understanding of their condition, enabling better self-management as well as better access to support and information. Referring clinicians reported better care standards for their patients with improved access to expertise and appropriate management. A dedicated CAT service improves overall standards of care and is viewed positively by patients and clinicians alike. Further health economic evaluation would enhance the case for establishing this as the standard model of care. 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/.

Deaf women: experiences and perceptions of healthcare system access.

PubMed

Steinberg, Annie G; Wiggins, Erin A; Barmada, Carlin Henry; Sullivan, Vicki Joy

2002-10-01

The authors investigated the knowledge, attitudes, and healthcare experiences of Deaf women. Interviews with 45 deaf women who participated in focus groups in American Sign Language were translated, transcribed, and analyzed. Deaf women's understanding of women's health issues, knowledge of health vocabulary in both English and American Sign Language, common health concerns among Deaf women, and issues of access to information, including pathways and barriers, were examined. As a qualitative study, the results of this investigation are limited and should be viewed as exploratory. A lack of health knowledge was evident, including little understanding of the meaning or value of cancer screening, mammography, or Pap smears; purposes of prescribed medications, such as hormone replacement therapy (HRT); or necessity for other medical or surgical interventions. Negative experiences and avoidance or nonuse of health services were reported, largely due to the lack of a common language with healthcare providers. Insensitive behaviors were also described. Positive experiences and increased access to health information were reported with practitioners who used qualified interpreters. Providers who demonstrated minimal signing skills, a willingness to use paper and pen, and sensitivity to improving communication were appreciated. Deaf women have unique cultural and linguistic issues that affect healthcare experiences. Improved access to health information may be achieved with specialized resource materials, improved prevention and targeted intervention strategies, and self-advocacy skills development. Healthcare providers must be trained to become more effective communicators with Deaf patients and to use qualified interpreters to assure access to healthcare for Deaf women.

Direct access compared with referred physical therapy episodes of care: a systematic review.

PubMed

Ojha, Heidi A; Snyder, Rachel S; Davenport, Todd E

2014-01-01

Evidence suggests that physical therapy through direct access may help decrease costs and improve patient outcomes compared with physical therapy by physician referral. The purpose of this study was to conduct a systematic review of the literature on patients with musculoskeletal injuries and compare health care costs and patient outcomes in episodes of physical therapy by direct access compared with referred physical therapy. Ovid MEDLINE, CINAHL (EBSCO), Web of Science, and PEDro were searched using terms related to physical therapy and direct access. Included articles were hand searched for additional references. Included studies compared data from physical therapy by direct access with physical therapy by physician referral, studying cost, outcomes, or harm. The studies were appraised using the Centre for Evidence-Based Medicine (CEBM) levels of evidence criteria and assigned a methodological score. Of the 1,501 articles that were screened, 8 articles at levels 3 to 4 on the CEBM scale were included. There were statistically significant and clinically meaningful findings across studies that satisfaction and outcomes were superior, and numbers of physical therapy visits, imaging ordered, medications prescribed, and additional non-physical therapy appointments were less in cohorts receiving physical therapy by direct access compared with referred episodes of care. There was no evidence for harm. There is evidence across level 3 and 4 studies (grade B to C CEBM level of recommendation) that physical therapy by direct access compared with referred episodes of care is associated with improved patient outcomes and decreased costs. Primary limitations were lack of group randomization, potential for selection bias, and limited generalizability. Physical therapy by way of direct access may contain health care costs and promote high-quality health care. Third-party payers should consider paying for physical therapy by direct access to decrease health care costs and incentivize optimal patient outcomes.

Crossing the Barriers: An Analysis of Land Access Barriers to Geothermal Development and Potential Improvement Scenarios

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

Levine, Aaron L; Young, Katherine R

Developers have identified many non-technical barriers to geothermal power development, including access to land. Activities required for accessing land, such as environmental review and private and public leasing can take a considerable amount of time and can delay or prevent project development. This paper discusses the impacts to available geothermal resources and deployment caused by land access challenges, including tribal and cultural resources, environmentally sensitive areas, biological resources, land ownership, federal and state lease queues, and proximity to military installations. In this analysis, we identified challenges that have the potential to prevent development of identified and undiscovered hydrothermal geothermal resources.more » We found that an estimated 400 MW of identified geothermal resource potential and 4,000 MW of undiscovered geothermal resource potential were either unallowed for development or contained one or more significant barriers that could prevent development at the site. Potential improvement scenarios that could be employed to overcome these barriers include (1) providing continuous funding to the U.S. Forest Service (USFS) for processing geothermal leases and permit applications and (2) the creation of advanced environmental mitigation measures. The model results forecast that continuous funding to the USFS could result in deployment of an additional 80 MW of geothermal capacity by 2030 and 124 MW of geothermal capacity by 2050 when compared to the business-as-usual scenario. The creation of advanced environmental mitigation measures coupled with continuous funding to the USFS could result in deployment of an additional 97 MW of geothermal capacity by 2030 and 152 MW of geothermal capacity by 2050 when compared to the business-as-usual scenario. The small impact on potential deployment in these improvement scenarios suggests that these 4,400 MW have other barriers to development in addition to land access. In other words, simply making more resources available for development does not increase deployment; however, impacts to deployment could increase when coupled with other improvements (e.g., permitting, market and/or technology improvements).« less

Facilitators and barriers to accessing reproductive health care for migrant beer promoters in Cambodia, Laos, Thailand and Vietnam: a mixed methods study.

PubMed

Webber, Gail; Spitzer, Denise; Somrongthong, Ratana; Dat, Truong Cong; Kounnavongsa, Somphone

2012-07-02

The purpose of the research was to assess access to sexual and reproductive health services for migrant women who work as beer promoters. This mixed methods research was conducted in Phnom Penh, Cambodia, Bangkok, Thailand, Vientiane, Laos, and Hanoi, Vietnam during 2010 to 2011. Focus groups were held with beer promoters and separate focus groups or interviews with key informants to explore the factors affecting beer promoters' access to health care institutions for reproductive health care. The findings of the focus groups were used to develop a survey for beer promoters. This survey was conducted in popular health institutions for these women in each of the four Asian cities. Several common themes were evident. Work demands prevented beer promoters from accessing health care. Institutional factors affecting care included cost, location, environmental factors (e.g. waiting times, cleanliness and confidentiality) and service factors (e.g. staff attitudes, clinic hours, and availability of medications). Personal factors affecting access were shyness and fear, lack of knowledge, and support from family and friends.The survey of the beer promoters confirmed that cost, location and both environmental and service factors impact on access to health care services for beer promoters. Many beer promoters are sexually active, and a significant proportion of those surveyed rely on sex work to supplement their income. Many also drink with their clients. Despite a few differences amongst the surveyed population, the findings were remarkably similar across the four research sites. Recommendations from the research include the provision of evening and weekend clinic hours to facilitate access, free or low cost clinics, and health insurance through employer or government plans which are easy to access for migrants. Other improvements that would facilitate the access of beer promoters to these services include increased funding to hire more staff (reducing waiting times) and to stock more needed medications, mobile clinics to come to the workplace or free transportation for beer promoters to the clinics, improved training to reduce health care provider stigma against beer promoters, and public education about the importance of reproductive health care, including preventative services.

Facilitators and barriers to accessing reproductive health care for migrant beer promoters in Cambodia, Laos, Thailand and Vietnam: A mixed methods study

PubMed Central

2012-01-01

Background The purpose of the research was to assess access to sexual and reproductive health services for migrant women who work as beer promoters. This mixed methods research was conducted in Phnom Penh, Cambodia, Bangkok, Thailand, Vientiane, Laos, and Hanoi, Vietnam during 2010 to 2011. Methods Focus groups were held with beer promoters and separate focus groups or interviews with key informants to explore the factors affecting beer promoters’ access to health care institutions for reproductive health care. The findings of the focus groups were used to develop a survey for beer promoters. This survey was conducted in popular health institutions for these women in each of the four Asian cities. Results Several common themes were evident. Work demands prevented beer promoters from accessing health care. Institutional factors affecting care included cost, location, environmental factors (e.g. waiting times, cleanliness and confidentiality) and service factors (e.g. staff attitudes, clinic hours, and availability of medications). Personal factors affecting access were shyness and fear, lack of knowledge, and support from family and friends. The survey of the beer promoters confirmed that cost, location and both environmental and service factors impact on access to health care services for beer promoters. Many beer promoters are sexually active, and a significant proportion of those surveyed rely on sex work to supplement their income. Many also drink with their clients. Despite a few differences amongst the surveyed population, the findings were remarkably similar across the four research sites. Conclusions Recommendations from the research include the provision of evening and weekend clinic hours to facilitate access, free or low cost clinics, and health insurance through employer or government plans which are easy to access for migrants. Other improvements that would facilitate the access of beer promoters to these services include increased funding to hire more staff (reducing waiting times) and to stock more needed medications, mobile clinics to come to the workplace or free transportation for beer promoters to the clinics, improved training to reduce health care provider stigma against beer promoters, and public education about the importance of reproductive health care, including preventative services. PMID:22747607

Corporate social responsibility to improve access to medicines: the case of Brazil.

PubMed

Thorsteinsdóttir, Halla; Ovtcharenko, Natasha; Kohler, Jillian Clare

2017-02-21

Access to medicines and the development of a strong national pharmaceutical industry are two longstanding pillars of health policy in Brazil. This is reflected in a clear emphasis by Brazil's Federal Government on improving access to medicine in national health plans and industrial policies aimed at promoting domestic pharmaceutical development. This research proposes that such policies may act as incentives for companies to pursue a strategic Corporate Social Responsibility (CSR) agenda. CSR that supports Governmental priorities could help companies to benefit significantly from the Governmental industrial policy. We sought to determine whether CSR activities of Brazilian pharmaceutical firms are currently aligned with the Federal Government's health prioritization. To do so we examined key Brazilian health related policies since 2004, including the specific priorities of Brazil's 2012-2015 Health Plan, and compared these with CSR initiatives that are reported on the websites of select pharmaceutical firms in Brazil. Brazil's national health plans and industrial policies demonstrated that the Federal Government has followed diverse approaches for improving access to medicines, including strengthening health care infrastructure, increasing transparency, and supporting product development partnerships. Case studies of six pharmaceutical firms, representing both public and private companies of varying size, support the perspective that CSR is a priority for firms. However, while many programs target issues such as health infrastructure, health care training, and drug donation, more programs focus on areas other than health and do not seem to be connected to Governmental prioritization. This research suggests that there are loose connections between Governmental priorities and pharmaceutical firm CSR. However, there remains a significant opportunity for greater alignment, which could improve access to medicines in the country and foster a stronger relationship between the Government and industry.

Unifying Water Data Sources: How the CUAHSI Water Data Center is Enabling and Improving Access to a Growing Catalog of over 100 Data Providers

NASA Astrophysics Data System (ADS)

Pollak, J.; Berry, K.; Couch, A.; Arrigo, J.; Hooper, R. P.

2013-12-01

Scientific data about water are collected and distributed by numerous sources which can differ tremendously in scale. As competition for water resources increases, increasing access to and understanding of information about water will be critical. The mission of the new CUAHSI Water Data Center (WDC) is to provide those researchers who collect data a medium to publish their datasets and give those wanting to discover data the proper tools to efficiently find the data that they seek. These tools include standards-based data publication, data discovery tools based upon faceted and telescoping search, and a data analysis tool HydroDesktop that downloads and unifies data in standardized formats. The CUAHSI Hydrologic Information System (HIS) is a community developed and open source system for sharing water data. As a federated, web service oriented system it enables data publication for a diverse user population including scientific investigators (Research Coordination Networks, Critical Zone Observatories), government agencies (USGS, NASA, EPA), and citizen scientists (watershed associations). HydroDesktop is an end user application for data consumption in this system that the WDC supports. This application can be used for finding, downloading, and analyzing data from the HIS. It provides a GIS interface that allows users to incorporate spatial data that are not accessible via HIS, simple analysis tools to facilitate graphing and visualization, tools to export data to common file types, and provides an extensible architecture that developers can build upon. HydroDesktop, however, is just one example of a data access client for HIS. The web service oriented architecture enables data access by an unlimited number of clients provided they can consume the web services used in HIS. One such example developed at the WDC is the 'Faceted Search Client', which capitalizes upon exploratory search concepts to improve accuracy and precision during search. We highlight such features of the CUAHSI-HIS which make it particularly appropriate for providing unified access to several sources of water data. A growing community of researchers and educators are employing these tools for education; including sharing best practices around creating modules, supporting researchers and educators in accessing the services, and cataloging and sharing modules. The CUAHSI WDC is a community governed organization. Our agenda is driven by the community's voice through a Board of Directors and committees that decide strategic direction (new products), tactical decisions (product improvement), and evaluation of usability. By providing the aforementioned services within a community driven framework, we believe the WDC is providing critical services that include improving water data discoverability, accessibility and usability within a sustainable governance structure.

Features and selection of vascular access devices.

PubMed

Sansivero, Gail Egan

2010-05-01

To review venous anatomy and physiology, discuss assessment parameters before vascular access device (VAD) placement, and review VAD options. Journal articles, personal experience. A number of VAD options are available in clinical practice. Access planning should include comprehensive assessment, with attention to patient participation in the planning and selection process. Careful consideration should be given to long-term access needs and preservation of access sites. Oncology nurses are uniquely suited to perform a key role in VAD planning and placement. With knowledge of infusion therapy, anatomy and physiology, device options, and community resources, nurses can be key leaders in preserving vascular access and improving the safety and comfort of infusion therapy. Copyright 2010 Elsevier Inc. All rights reserved.

ChEBI in 2016: Improved services and an expanding collection of metabolites

PubMed Central

Hastings, Janna; Owen, Gareth; Dekker, Adriano; Ennis, Marcus; Kale, Namrata; Muthukrishnan, Venkatesh; Turner, Steve; Swainston, Neil; Mendes, Pedro; Steinbeck, Christoph

2016-01-01

ChEBI is a database and ontology containing information about chemical entities of biological interest. It currently includes over 46 000 entries, each of which is classified within the ontology and assigned multiple annotations including (where relevant) a chemical structure, database cross-references, synonyms and literature citations. All content is freely available and can be accessed online at http://www.ebi.ac.uk/chebi. In this update paper, we describe recent improvements and additions to the ChEBI offering. We have substantially extended our collection of endogenous metabolites for several organisms including human, mouse, Escherichia coli and yeast. Our front-end has also been reworked and updated, improving the user experience, removing our dependency on Java applets in favour of embedded JavaScript components and moving from a monthly release update to a ‘live’ website. Programmatic access has been improved by the introduction of a library, libChEBI, in Java, Python and Matlab. Furthermore, we have added two new tools, namely an analysis tool, BiNChE, and a query tool for the ontology, OntoQuery. PMID:26467479

Enhancing access to health information in Africa: a librarian's perspective.

PubMed

Gathoni, Nasra

2012-01-01

In recent years, tremendous progress has been made toward providing health information in Africa, in part because of technological advancements. Nevertheless, ensuring that information is accessible, comprehensible, and usable remains problematic, and there remain needs in many settings to address issues such as computer skills, literacy, and the infrastructure to access information. To determine how librarians might play a more strategic role in meeting information needs of health professionals in Africa, the author reviewed key components of information systems pertinent to knowledge management for the health sector, including access to global online resources, capacity to use computer technology for information retrieval, information literacy, and the potential for professional networks to play a role in improving access to and use of information. The author concluded that, in regions that lack adequate information systems, librarians could apply their knowledge and skills to facilitate access and use by information seekers. Ensuring access to and use of health information can also be achieved by engaging organizations and associations working to enhance access to health information, such as the Association for Health Information and Libraries in Africa. These groups can provide assistance through training, dissemination, information repackaging, and other approaches known to improve information literacy.

Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study

PubMed Central

Meyer, Johanna C.; Schellack, Natalie; Stokes, Jacobus; Lancaster, Ruth; Zeeman, Helecine; Defty, Douglas; Godman, Brian; Steel, Gavin

2017-01-01

Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction. Method: Principally a structured review of current and planned activities. Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through instigating stewardship programmes as well as improving adverse drug reaction reporting and associated activities. Conclusion: Overall, there are an appreciable number of ongoing activities within the public healthcare system in South Africa attempting to ensure and sustain universal healthcare. It is too early to assess their impact, which will be the subject of future research. PMID:29163151

Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study.

PubMed

Meyer, Johanna C; Schellack, Natalie; Stokes, Jacobus; Lancaster, Ruth; Zeeman, Helecine; Defty, Douglas; Godman, Brian; Steel, Gavin

2017-01-01

Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction. Method: Principally a structured review of current and planned activities. Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through instigating stewardship programmes as well as improving adverse drug reaction reporting and associated activities. Conclusion: Overall, there are an appreciable number of ongoing activities within the public healthcare system in South Africa attempting to ensure and sustain universal healthcare. It is too early to assess their impact, which will be the subject of future research.

Perspectives of People Living with HIV on Access to Health Care: Protocol for a Scoping Review.

PubMed

Asghari, Shabnam; Maybank, Allison; Hurley, Oliver; Modir, Hilary; Farrell, Alison; Marshall, Zack; Kendall, Claire; Johnston, Sharon; Hogel, Matthew; Rourke, Sean B; Liddy, Clare

2016-05-18

Strategies to improve access to health care for people living with human immunodeficiency virus (PLHIV) have demonstrated limited success. Whereas previous approaches have been informed by the views of health providers and decision-makers, it is believed that incorporating patient perspectives into the design and evaluations of health care programs will lead to improved access to health care services. We aim to map the literature on the perspectives of PLHIV concerning access to health care services, to identify gaps in evidence, and to produce an evidence-informed research action plan to guide the Living with HIV program of research. This scoping review includes peer-reviewed and grey literature from 1946 to May 2014 using double data extraction. Variations of the search terms "HIV", "patient satisfaction", and "health services accessibility" are used to identify relevant literature. The search strategy is being developed in consultation with content experts, review methodologists, and a librarian, and validated using gold standard studies identified by those stakeholders. The inclusion criteria are (1) the study includes the perspectives of PLHIV, (2) study design includes qualitative, quantitative, or mixed methods, and (3) outcome measures are limited to patient satisfaction, their implied needs, beliefs, and desires in relation to access to health care. The papers are extracted by two independent reviewers, including quality assessment. Data is then collated, summarized, and thematically analyzed. A total of 12,857 references were retrieved, of which 326 documents were identified as eligible in pre-screening, and 64 articles met the inclusion criteria (56% qualitative studies, 38% quantitative studies and 6% mixed-method studies). Only four studies were conducted in Canada. Data synthesis is in progress and full results are expected in June, 2016. This scoping review will record and characterize the extensive body of literature on perspectives of PLHIV regarding access to health care. A literature repository will be developed to assist stakeholders, decision-makers, and PLHIV in developing and implementing patient-oriented health care programs.

Practice improvement, part II: update on patient communication technologies.

PubMed

Roett, Michelle A; Coleman, Mary Thoesen

2013-11-01

Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Towards comprehensive early abortion service delivery in high income countries: insights for improving universal access to abortion in Australia.

PubMed

Dawson, Angela; Bateson, Deborah; Estoesta, Jane; Sullivan, Elizabeth

2016-10-22

Improving access to safe abortion is an essential strategy in the provision of universal access to reproductive health care. Australians are largely supportive of the provision of abortion and its decriminalization. However, the lack of data and the complex legal and service delivery situation impacts upon access for women seeking an early termination of pregnancy. There are no systematic reviews from a health services perspective to help direct health planners and policy makers to improve access comprehensive medical and early surgical abortion in high income countries. This review therefore aims to identify quality studies of abortion services to provide insight into how access to services can be improved in Australia. We undertook a structured search of six bibliographic databases and hand-searching to ascertain peer reviewed primary research in English between 2005 and 2015. Qualitative and quantitative study designs were deemed suitable for inclusion. A deductive content analysis methodology was employed to analyse selected manuscripts based upon a framework we developed to examine access to early abortion services. This review identified the dimensions of access to surgical and medical abortion at clinic or hospital-outpatient based abortion services, as well as new service delivery approaches utilising a remote telemedicine approach. A range of factors, mostly from studies in the United Kingdom and United States of America were found to facilitate improved access to abortion, in particular, flexible service delivery approaches that provide women with cost effective options and technology based services. Standards, recommendations and targets were also identified that provided services and providers with guidance regarding the quality of abortion care. Key insights for service delivery in Australia include the: establishment of standards, provision of choice of procedure, improved provider education and training and the expansion of telemedicine for medical abortion. However, to implement such directives leadership is required from Australian medical, nursing, midwifery and pharmacy practitioners, academic faculties and their associated professional associations. In addition, political will is needed to nationally decriminalise abortion and ensure dedicated public provision that is based on comprehensive models tailored for all populations.

Action, Not Rhetoric, Needed to Reverse the Opioid Overdose Epidemic.

PubMed

Davis, Corey; Green, Traci; Beletsky, Leo

2017-03-01

Despite shifts in rhetoric and some positive movement, Americans with the disease of addiction are still often stigmatized, criminalized, and denied access to evidencebased care. Dramatically reducing the number of lives unnecessarily lost to overdose requires an evidence-based, equity-focused, well-funded, and coordinated response. We present in this brief article evidence-based and promising practices for improving and refocusing the response to this simmering public health crisis. Topics covered include improving clinical decision-making, improving access to non-judgmental evidence-based treatment, investing in comprehensive public health approaches to problematic drug use, and changing the way law enforcement actors interact with people who use drugs.

Are Current Insulin Pumps Accessible to Blind and Visually Impaired People?

PubMed Central

Burton, Darren M.; Uslan, Mark M.; Blubaugh, Morgan V.; Clements, Charles W.

2009-01-01

Background In 2004, Uslan and colleagues determined that insulin pumps (IPs) on the market were largely inaccessible to blind and visually impaired persons. The objective of this study is to determine if accessibility status changed in the ensuing 4 years. Methods Five IPs on the market in 2008 were acquired and analyzed for key accessibility traits such as speech and other audio output, tactual nature of control buttons, and the quality of visual displays. It was also determined whether or not a blind or visually impaired person could independently complete tasks such as programming the IP for insulin delivery, replacing batteries, and reading manuals and other documentation. Results It was found that IPs have not improved in accessibility since 2004. None have speech output, and with the exception of the Animas IR 2020, no significantly improved visual display characteristics were found. Documentation is still not completely accessible. Conclusion Insulin pumps are relatively complex devices, with serious health consequences resulting from improper use. For IPs to be used safely and independently by blind and visually impaired patients, they must include voice output to communicate all the information presented on their display screens. Enhancing display contrast and the size of the displayed information would also improve accessibility for visually impaired users. The IPs must also come with accessible user documentation in alternate formats. PMID:20144301

Are current insulin pumps accessible to blind and visually impaired people?

PubMed

Burton, Darren M; Uslan, Mark M; Blubaugh, Morgan V; Clements, Charles W

2009-05-01

In 2004, Uslan and colleagues determined that insulin pumps (IPs) on the market were largely inaccessible to blind and visually impaired persons. The objective of this study is to determine if accessibility status changed in the ensuing 4 years. Five IPs on the market in 2008 were acquired and analyzed for key accessibility traits such as speech and other audio output, tactual nature of control buttons, and the quality of visual displays. It was also determined whether or not a blind or visually impaired person could independently complete tasks such as programming the IP for insulin delivery, replacing batteries, and reading manuals and other documentation. It was found that IPs have not improved in accessibility since 2004. None have speech output, and with the exception of the Animas IR 2020, no significantly improved visual display characteristics were found. Documentation is still not completely accessible. Insulin pumps are relatively complex devices, with serious health consequences resulting from improper use. For IPs to be used safely and independently by blind and visually impaired patients, they must include voice output to communicate all the information presented on their display screens. Enhancing display contrast and the size of the displayed information would also improve accessibility for visually impaired users. The IPs must also come with accessible user documentation in alternate formats. 2009 Diabetes Technology Society.

[The Efficacy of Near-Infrared Devices in Facilitating Peripheral Intravenous Access in Children: A Systematic Review and Subgroup Meta-Analysis].

PubMed

Kuo, Chia-Chi; Feng, I-Jung; Lee, Wei-Jing

2017-10-01

Peripheral intravenous access is a common and invasive procedure that is performed in pediatric clinical settings. Children often have difficult intravenous-access problems that may not only increase staff stress but also affect the timeliness of immediate treatments. To determine the efficacy of near-infrared devices in facilitating peripheral intravenous access in children, using a systematic review and meta-analysis. Six databases, namely the Index to Taiwan Periodical Literature System, Airiti Library, CINAHL, Cochrane Library, PubMed/MEDLINE, and ProQuest were searched for related articles that were published between the earliest year available and February 2017. The search was limited to studies on populations of children that used either a randomized controlled trial or controlled clinical trial approach and used the key words "near-infrared devices" AND "peripheral intravenous access." The 12 articles that met these criteria were included in the analysis. The Cochrane Collaboration bias assessment tool was used to assess the methodological quality. In addition, RevMan 5.3.5 software was used to conduct the meta-analysis. The near-infrared devices did not significantly improve the first-attempt success rate, number of attempts, or the procedural time of peripheral intravenous access in children. However, the subgroup analysis of difficult intravenous-access factors revealed a significant improvement in the first-attempt success rate of children with difficult intravenous access scores (OR = 1.83, p = .03). Near-infrared devices may improve the first-attempt success rate in children with difficult intravenous access by allowing healthcare professionals to visualize the peripheral veins. Therefore, we suggest that the difficult intravenous-access score be used as a screening tool to suggest when to apply near-infrared devices to children with difficult peripheral intravenous access in order to maximize efficacy of treatment.

Going "social" to access experimental and potentially life-saving treatment: an assessment of the policy and online patient advocacy environment for expanded access.

PubMed

Mackey, Tim K; Schoenfeld, Virginia J

2016-02-02

Social media is fundamentally altering how we access health information and make decisions about medical treatment, including for terminally ill patients. This specifically includes the growing phenomenon of patients who use online petitions and social media campaigns in an attempt to gain access to experimental drugs through expanded access pathways. Importantly, controversy surrounding expanded access and "compassionate use" involves several disparate stakeholders, including patients, manufacturers, policymakers, and regulatory agencies-all with competing interests and priorities, leading to confusion, frustration, and ultimately advocacy. In order to explore this issue in detail, this correspondence article first conducts a literature review to describe how the expanded access policy and regulatory environment in the United States has evolved over time and how it currently impacts access to experimental drugs. We then conducted structured web searches to identify patient use of online petitions and social media campaigns aimed at compelling access to experimental drugs. This was carried out in order to characterize the types of communication strategies utilized, the diseases and drugs subject to expanded access petitions, and the prevalent themes associated with this form of "digital" patient advocacy. We find that patients and their families experience mixed results, but still gravitate towards the use of online campaigns out of desperation, lack of reliable information about treatment access options, and in direct response to limitations of the current fragmented structure of expanded access regulation and policy currently in place. In response, we discuss potential policy reforms to improve expanded access processes, including advocating greater transparency for expanded access programs, exploring use of targeted economic incentives for manufacturers, and developing systems to facilitate patient information about existing treatment options. This includes leveraging recent legislative attention to reform expanded access through the CURE Act Provisions contained in the proposed U.S. 21st Century Cures Act. While expanded access may not be the best option for the majority of individuals, terminally ill patients and their families nevertheless deserve better processes, policies, and availability to potentially life-changing information, before they decide to pursue an online campaign in the desperate hope of gaining access to experimental drugs.

Evaluating the parent-adolescent communication toolkit: Usability and preliminary content effectiveness of an online intervention.

PubMed

Toombs, Elaine; Unruh, Anita; McGrath, Patrick

2018-01-01

This study aimed to assess the Parent-Adolescent Communication Toolkit, an online intervention designed to help improve parent communication with their adolescents. Participant preferences for two module delivery systems (sequential and unrestricted module access) were identified. Usability assessment of the PACT intervention was completed using pre-test and posttest comparisons. Usability data, including participant completion and satisfaction ratings were examined. Parents ( N  =   18) of adolescents were randomized to a sequential or unrestricted chapter access group. Parent participants completed pre-test measures, the PACT intervention and posttest measures. Participants provided feedback for the intervention to improve modules and provided usability ratings. Adolescent pre- and posttest ratings were evaluated. Usability ratings were high and parent feedback was positive. The sequential module access groups rated the intervention content higher and completed more content than the unrestricted chapter access group, indicating support for the sequential access design. Parent mean posttest communication scores were significantly higher ( p  <   .05) than pre-test scores. No significant differences were detected for adolescent participants. Findings suggest that the Parent-Adolescent Communication Toolkit has potential to improve parent-adolescent communication but further effectiveness assessment is required.

Website accessibility in the tourism industry: an analysis of official national tourism organization websites around the world.

PubMed

Domínguez Vila, Trinidad; Alén González, Elisa; Darcy, Simon

2017-08-09

To analyze the accessibility of official national tourism organization websites of countries around the world, in order to establish possible common patterns and rankings of those with exemplary practice through to those with the highest number of issues. The purpose for undertaking such an analysis is to provide a quasi-indicator of inclusive organizational practice for online accessibility for both destination managers and their accessible tourism consumers - domestic and overseas people with disability visiting the websites. The official tourism websites of 210 countries included in the latest World Tourism Organization report were analyzed. A website accessibility evaluation tool (website accessible test) was used in the analysis, according to AA and AAA levels of conformance to Web Content Accessibility Guidelines 2.0 requirements. Different patterns compliance to Web Content Accessibility Guidelines 2.0 were established for the clusters, which were rather similar for both AA and AAA conformance levels. The main issues in the least accessible websites were also identified, mainly focused on the following guidelines: navigable, compatible, adaptability, text alternatives and also referred to other assistive technologies. Once the main issues were established several alternatives are suggested to address them, such as implementing more prescriptive laws and regulations, complying with mandatory benchmark standards and/or having external agencies audit website designs. However, in addition to using benchmark standards, efforts to improve this situation should also be made by programmers, who should also rely on preexistent experiences and develop more dynamic knowledge. This knowledge may include text alternatives for any nontext content; creation of content that can be presented in different ways without losing information; provide ways to help users navigate, find content, determine where they are and navigate websites to maximize compatibility with assistive technologies and user agents. Implications for rehabilitation Access to information - in this case, online information - is an important factor in the process of rehabilitation for people with disability and those supporting them. Failure to apply homogeneous criteria for website accessibility around the world can hamper access to information by people with disabilities. Travel planning requires access to mainstream tourist distribution networks where online inclusive practice is a precursor to information searching. Documents for destination managers and programmers the main problems of accessibility to websites and examples of models or solutions to follow and not. Establish the main inclusive website design criteria on which to focus on improving the access of people with disabilities to websites (e.g., text alternatives, content presented in different ways, navigating and improving compatibility with assistive technologies etc.).

Use of Clinical Anatomy Resources by Musculoskeletal Outpatient Physiotherapists in Australian Public Hospitals: A Cross-Sectional Study

PubMed Central

Davies, Tilman M.; Cornwall, Jon

2015-01-01

ABSTRACT Purpose: To investigate how musculoskeletal outpatient physiotherapists in public hospitals interact with and perceive clinical anatomy resources in the workplace. Method: This cross-sectional study used a postal survey sent to musculoskeletal outpatient physiotherapists in 64 Australian public hospitals. Survey questions examined demographics, qualifications, experience, types of resources used, whether resources meet requirements, and what improvements could be made to current resources. Results: A total of 193 physiotherapists responded (75% response rate; 60% female), of whom 49% were age 35 years or younger; 67% had only an undergraduate qualification, and 37% had practised for 5 years or less. More experienced physiotherapists used resources significantly less frequently ([odds ratio]=1.35; 95% CI, 1.17–1.57), and we found no significant associations between preference for online versus printed resources and age, sex, qualifications, or experience. Trends included less experienced physiotherapists identifying the absence of online access as a barrier to resource use and provision of improved online facilities as necessary to improve access to clinical anatomy resources. Conclusion: Results indicate distinct trends in physiotherapists' use of clinical anatomy resources, including a desire for improved online resource access on the part of less experienced physiotherapists. The findings are relevant to hospital outpatient clinics, particularly those that employ less experienced physiotherapists. PMID:26839457

[Access to high-cost drugs in Brazil from the perspective of physicians, pharmacists and patients].

PubMed

Rover, Marina Raijche Mattozo; Vargas-Pelaez, Claudia Marcela; Rocha Farias, Mareni; Nair Leite, Silvana

2016-01-01

To explore perceptions on access to medication supplied by the Specialized Component of Pharmaceutical Assistance (CEAF) within the Brazilian Unified Health System (which includes high-cost drugs) by the actors involved in the healthcare services of this component. A descriptive, qualitative study was carried out by using a focal group with 7 users and 11 semi-structured interviews with health professionals (physicians and pharmacist) in the state of Santa Catarina. According to the participants, access to medicines had improved. Two main perceptions of the CEAF Clinical Guidelines were identified: the requirements constitute a bureaucracy that limits access, and the requisites increase the demand for tests and specialized healthcare services, exceeding the capacity of the healthcare services network. These assumptions generated the search for other means of access that revealed a lack of information and understanding of the right to health among the users. In addition, according to the participants, because of the difficulties of accessing services as a whole, full access to CEAF medicines is a goal that remains to be achieved. Although access to CEAF medicines has improved, there are still some difficulties in guaranteeing treatment access and comprehensiveness. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Variable disparity estimation based intermediate view reconstruction in dynamic flow allocation over EPON-based access networks

NASA Astrophysics Data System (ADS)

Bae, Kyung-Hoon; Lee, Jungjoon; Kim, Eun-Soo

2008-06-01

In this paper, a variable disparity estimation (VDE)-based intermediate view reconstruction (IVR) in dynamic flow allocation (DFA) over an Ethernet passive optical network (EPON)-based access network is proposed. In the proposed system, the stereoscopic images are estimated by a variable block-matching algorithm (VBMA), and they are transmitted to the receiver through DFA over EPON. This scheme improves a priority-based access network by converting it to a flow-based access network with a new access mechanism and scheduling algorithm, and then 16-view images are synthesized by the IVR using VDE. Some experimental results indicate that the proposed system improves the peak-signal-to-noise ratio (PSNR) to as high as 4.86 dB and reduces the processing time to 3.52 s. Additionally, the network service provider can provide upper limits of transmission delays by the flow. The modeling and simulation results, including mathematical analyses, from this scheme are also provided.

Can formalizing links among community health workers, accredited drug dispensing outlet dispensers, and health facility staff increase their collaboration to improve prompt access to maternal and child care? A qualitative study in Tanzania.

PubMed

Dillip, Angel; Kimatta, Suleiman; Embrey, Martha; Chalker, John C; Valimba, Richard; Malliwah, Mariam; Meena, John; Lieber, Rachel; Johnson, Keith

2017-06-19

In Tanzania, progress toward achieving the 2015 Millennium Development Goals for maternal and newborn health was slow. An intervention brought together community health workers, health facility staff, and accredited drug dispensing outlet (ADDO) dispensers to improve maternal and newborn health through a mechanism of collaboration and referral. This study explored barriers, successes, and promising approaches to increasing timely access to care by linking the three levels of health care provision. The study was conducted in the Kibaha district, where we applied qualitative approaches with in-depth interviews and focus group discussions. In-depth interview participants included retail drug shop dispensers (36), community health workers (45), and health facility staff members (15). We conducted one focus group discussion with district officials and four with mothers of newborns and children under 5 years old. Relationships among the three levels of care improved after the linkage intervention, especially for ADDO dispensers and health facility staff who previously had no formal communication pathway. The study participants perceptions of success included improved knowledge of case management and relationships among the three levels of care, more timely access to care, increased numbers of patients/customers, more meetings between community health workers and health facility staff, and a decrease in child and maternal mortality. Reported challenges included stock-outs of medicines at the health facility, participating ADDO dispensers who left to work in other regions, documentation of referrals, and lack of treatment available at health facilities on the weekend. The primary issue that threatens the sustainability of the intervention is that local council health management team members, who are responsible for facilitating the linkage, had not made any supervision visits and were therefore unaware of how the program was running. The study highlights the benefits of approaches that link different levels of care providers to improve access to maternal and child health care. To strengthen this collaboration further, health campaign platforms should include retail drug dispensers as a type of community health care provider. To increase linkage sustainability, the council health management team needs to develop feasible supervision plans.

Diabetes care and service access among elderly Vietnamese with type 2 diabetes.

PubMed

Carolan-Olah, Mary C; Cassar, Angie; Quiazon, Regina; Lynch, Sean

2013-10-29

Vietnamese patients are disproportionately represented in type 2 diabetes mellitus statistics and also incur high rates of diabetes complications. This situation is compounded by limited access to health care. The aim of this project was to gain a deeper understanding of the difficulties Vietnamese patients experience when accessing services and managing their type 2 diabetes mellitus, and to identify factors that are important in promoting health service use. Three focus groups with 15 Vietnamese participants with type 2 diabetes mellitus, 60 to >70 years of age, were conducted in Vietnamese. Open-ended questions were used and focussed on experiences of living with diabetes and access to healthcare services in the Inner Northwest Melbourne region. Audio recordings were transcribed and then translated into English. Data were analysed using a thematic analysis framework. Findings indicate four main themes, which together provide some insight into the experiences of living with diabetes and accessing ongoing care and support, for elderly Vietnamese with type 2 diabetes. Themes included: (1) the value of being healthy; (2) controlling diabetes; (3) staying healthy; and (4) improving services and information access. Participants in this study were encouraged to adhere to diabetes self-management principles, based largely on a fear of medical complications. Important aspects of healthcare access were identified as; being treated with respect, having their questions answered and having access to interpreters and information in Vietnamese. Attention to these details is likely to lead to improved access to healthcare services and ultimately to improve glycemic control and overall health status for this community.

Gregarious Data Re-structuring in a Many Core Architecture

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

Shrestha, Sunil; Manzano Franco, Joseph B.; Marquez, Andres

this paper, we have developed a new methodology that takes in consideration the access patterns from a single parallel actor (e.g. a thread), as well as, the access patterns of “grouped” parallel actors that share a resource (e.g. a distributed Level 3 cache). We start with a hierarchical tile code for our target machine and apply a series of transformations at the tile level to improve data residence in a given memory hierarchy level. The contribution of this paper includes (a) collaborative data restructuring for group reuse and (b) low overhead transformation technique to improve access pattern and bring closelymore » connected data elements together. Preliminary results in a many core architecture, Tilera TileGX, shows promising improvements over optimized OpenMP code (up to 31% increase in GFLOPS) and over our own previous work on fine grained runtimes (up to 16%) for selected kernels« less

The role of NASA's Water Resources applications area in improving access to water quality-related information and water resources management

NASA Astrophysics Data System (ADS)

Lee, C. M.

2016-02-01

The NASA Applied Sciences Program plays a unique role in facilitating access to remote sensing-based water information derived from US federal assets towards the goal of improving science and evidence-based decision-making in water resources management. The Water Resources Application Area within NASA Applied Sciences works specifically to develop and improve water data products to support improved management of water resources, with partners who are faced with real-world constraints and conditions including cost and regulatory standards. This poster will highlight the efforts and collaborations enabled by this program that have resulted in integration of remote sensing-based information for water quality modeling and monitoring within an operational context.

The role of NASA's Water Resources applications area in improving access to water quality-related information and water resources management

NASA Astrophysics Data System (ADS)

Lee, C. M.

2016-12-01

The NASA Applied Sciences Program plays a unique role in facilitating access to remote sensing-based water information derived from US federal assets towards the goal of improving science and evidence-based decision-making in water resources management. The Water Resources Application Area within NASA Applied Sciences works specifically to develop and improve water data products to support improved management of water resources, with partners who are faced with real-world constraints and conditions including cost and regulatory standards. This poster will highlight the efforts and collaborations enabled by this program that have resulted in integration of remote sensing-based information for water quality modeling and monitoring within an operational context.

Racial and Ethnic Disparity in Major Depressive Disorder.

PubMed

Shao, Zhili; Richie, William D; Bailey, Rahn Kennedy

2016-12-01

Major depressive disorder (MDD) is one of the most common and disabling psychiatric disorders in the USA. Early diagnosis and appropriate treatment are extremely important to prevent disability and improve quality of life. Recent studies have demonstrated racial and ethnic disparities in the diagnosis and treatment of MDD. African Americans (AA), Hispanics, and Asian Americans were significantly less likely to receive a depression diagnosis from a health-care provider than were non-Hispanic whites. The underdiagnosis of MDD in minority groups may be due to differences in socioeconomic status (SES), care affordability, cultural beliefs about depression, help-seeking patterns, access to culturally and linguistically appropriate care, patient-physician relationship, clinical presentation of depression, etc. Meanwhile, the likelihood of both having access to and receiving adequate care for depression was significantly low for AA, Hispanics, and Asian Americans, in contrast to whites. Similar disparities also exist in treatment outcomes. Besides the reasons for MDD underdiagnosis, additional contributing factors include access barriers to preferred mode of treatment, cultural concerns about antidepressants and different metabolism of antidepressants, etc. There are many ways to address these disparities and improve MDD care in minority populations, including universal depression screening, public financial incentives to ensure access to care in low-income and minority neighborhoods, quality improvement programs, cultural competency of mental health professionals, collaborative care management, community engagement and planning, and enhanced participation of minorities in clinical research.

Golf in the United States: an evolution of accessibility.

PubMed

Parziale, John R

2014-09-01

Golf affords physical and psychological benefits to persons who are physically challenged. Advances in adaptive technology, changes in golf course design, and rules modifications have enabled persons with neurological, musculoskeletal, and other impairments to play golf at a recreational, elite amateur, or professional level. The Americans with Disabilities Act has been cited in both federal and US Supreme Court rulings that have improved access for physically challenged golfers. Medical specialties, including physiatry, have played an important role in this process. This article reviews the history of golf's improvements in accessibility, and provides clinicians and physically challenged golfers with information that will facilitate participation in the sport. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Planning ahead for livable communities along the Powell–Division Bus Rapid Transit : neighborhood conditions and change.

DOT National Transportation Integrated Search

2017-07-04

New transit investments can be a double-edged sword for disadvantaged communities (e.g., those included in environmental justice and Title VI protected classes). Transit investments improve communities mobility and access, and may improve health w...

Do entrepreneurial food systems innovations impact rural economies and health? Evidence and gaps

PubMed Central

Sitaker, Marilyn; Kolodinsky, Jane; Jilcott Pitts, Stephanie B.; Seguin, Rebecca A.

2015-01-01

A potential solution for weakened rural economies is the development of local food systems, which include affordable foods sources for consumers and economically feasible structures for producers. Local food systems are purported to promote sustainability, improve local economies, increase access to healthy foods, and improve the local diets. Four entrepreneurial food systems innovations that support local economies include farmers’ markets, community supported agriculture, farm to institution programs and food hubs. We review current literature to determine whether innovations for aggregation, processing, distribution and marketing in local food systems: 1) enable producers to make a living; 2) improve local economies; 3) provide local residents with greater access to affordable, healthy food; and 4) contribute to greater consumption of healthy food among residents. While there is some evidence for each, more transdisciplinary research is needed to determine whether entrepreneurial food systems innovations provide economic and public health benefits. PMID:26613066

Do entrepreneurial food systems innovations impact rural economies and health? Evidence and gaps.

PubMed

Sitaker, Marilyn; Kolodinsky, Jane; Jilcott Pitts, Stephanie B; Seguin, Rebecca A

A potential solution for weakened rural economies is the development of local food systems, which include affordable foods sources for consumers and economically feasible structures for producers. Local food systems are purported to promote sustainability, improve local economies, increase access to healthy foods, and improve the local diets. Four entrepreneurial food systems innovations that support local economies include farmers' markets, community supported agriculture, farm to institution programs and food hubs. We review current literature to determine whether innovations for aggregation, processing, distribution and marketing in local food systems: 1) enable producers to make a living; 2) improve local economies; 3) provide local residents with greater access to affordable, healthy food; and 4) contribute to greater consumption of healthy food among residents. While there is some evidence for each, more transdisciplinary research is needed to determine whether entrepreneurial food systems innovations provide economic and public health benefits.

A Pilot Randomized Controlled Trial of the ACCESS Program: A Group Intervention to Improve Social, Adaptive Functioning, Stress Coping, and Self-Determination Outcomes in Young Adults with Autism Spectrum Disorder.

PubMed

Oswald, Tasha M; Winder-Patel, Breanna; Ruder, Steven; Xing, Guibo; Stahmer, Aubyn; Solomon, Marjorie

2018-05-01

The purpose of this pilot randomized controlled trial was to investigate the acceptability and efficacy of the Acquiring Career, Coping, Executive control, Social Skills (ACCESS) Program, a group intervention tailored for young adults with autism spectrum disorder (ASD) to enhance critical skills and beliefs that promote adult functioning, including social and adaptive skills, self-determination skills, and coping self-efficacy. Forty-four adults with ASD (ages 18-38; 13 females) and their caregivers were randomly assigned to treatment or waitlist control. Compared to controls, adults in treatment significantly improved in adaptive and self-determination skills, per caregiver report, and self-reported greater belief in their ability to access social support to cope with stressors. Results provide evidence for the acceptability and efficacy of the ACCESS Program.

Improving access to emergency contraception under the Scottish Sexual Health Strategy: can rates of unintended pregnancy be reduced?

PubMed

McGowan, James G

2013-09-01

Unintended pregnancy is a global sexual health problem. Outcomes of unintended pregnancy include unwanted childbirth and abortion, which may be associated with negative physical and psychosocial health implications for women. In Scotland, the Scottish Sexual Health Strategy has the stated goal of improving the sexual health of the people of Scotland. One aim of the Strategy is to reduce rates of unintended pregnancy and one policy designed to achieve this is 'widening access to emergency contraception'. This paper examines the success of this policy with reference to the implicit link it makes between expanding access to emergency contraception and increasing its effective use, aiming thereby to reduce rates of unintended pregnancy. Since there is evidence that previous policies and strategies expanding access to emergency contraception have failed to reduce such rates, alternative approaches to achieve a reduction in unintended pregnancies are discussed.

Improving Global Access to New Vaccines: Intellectual Property, Technology Transfer, and Regulatory Pathways

PubMed Central

2014-01-01

The 2012 World Health Assembly Global Vaccine Action Plan called for global access to new vaccines within 5 years of licensure. Current approaches have proven insufficient to achieve sustainable vaccine pricing within such a timeline. Paralleling the successful strategy of generic competition to bring down drug prices, a clear consensus is emerging that market entry of multiple suppliers is a critical factor in expeditiously bringing down prices of new vaccines. In this context, key target objectives for improving access to new vaccines include overcoming intellectual property obstacles, streamlining regulatory pathways for biosimilar vaccines, and reducing market entry timelines for developing-country vaccine manufacturers by transfer of technology and know-how. I propose an intellectual property, technology, and know-how bank as a new approach to facilitate widespread access to new vaccines in low- and middle-income countries by efficient transfer of patented vaccine technologies to multiple developing-country vaccine manufacturers. PMID:25211753

The promise of telemedicine for chronic neurological disorders: the example of Parkinson's disease.

PubMed

Schneider, Ruth B; Biglan, Kevin M

2017-07-01

Disparities in access to health care, particularly specialist care, exist worldwide. As the prevalence of chronic neurological disorders increases with ageing populations, access to neurologist care is likely to worsen in many regions if there are no changes to models of care. Telemedicine-defined here as the use of real-time, synchronous videoconferencing to deliver medical care-could be used to improve access to neurologist care for patients with a range of chronic neurological disorders. In Parkinson's disease, several studies have shown the feasibility and potential benefits of telemedicine-delivered care. Further research is needed to establish whether telemedicine can deliver on the promise of improved access to neurologist care and whether telemedicine-delivered care is comparable to in-person care in terms of clinical outcomes. Many barriers to widespread implementation of telemedicine services remain to be addressed, including reimbursement, legal considerations, and technological issues. Copyright © 2017 Elsevier Ltd. All rights reserved.

Affordability, accountability, and accessibility in health care reform: implications for cardiovascular and pulmonary rehabilitation.

PubMed

King, Marjorie L

2013-01-01

Because health care costs in the United States have been growing disproportionately compared to inflation for many years, without a clear connection to improved quality or increased access to care, employers and payers have begun to test new models of health care delivery and payment. These models are linked to the concepts of affordability, accountability, and accessibility and incorporate the premise that there must be shared responsibility for improving meaningful patient outcomes, with attention to the coordination of team-based and patient-centered care, and value for services purchased. This article explores emerging health care delivery and payment models, including expanded access to care related to the Affordable Care Act of 2010, patient-centered medical homes and neighborhoods, accountable and coordinated care organizations, and value-based purchasing and insurance design, with an emphasis on implications for cardiovascular and pulmonary rehabilitation programs and the American Association of Cardiovascular and Pulmonary Rehabilitation.

Improving global access to new vaccines: intellectual property, technology transfer, and regulatory pathways.

PubMed

Crager, Sara Eve

2014-11-01

The 2012 World Health Assembly Global Vaccine Action Plan called for global access to new vaccines within 5 years of licensure. Current approaches have proven insufficient to achieve sustainable vaccine pricing within such a timeline. Paralleling the successful strategy of generic competition to bring down drug prices, a clear consensus is emerging that market entry of multiple suppliers is a critical factor in expeditiously bringing down prices of new vaccines. In this context, key target objectives for improving access to new vaccines include overcoming intellectual property obstacles, streamlining regulatory pathways for biosimilar vaccines, and reducing market entry timelines for developing-country vaccine manufacturers by transfer of technology and know-how. I propose an intellectual property, technology, and know-how bank as a new approach to facilitate widespread access to new vaccines in low- and middle-income countries by efficient transfer of patented vaccine technologies to multiple developing-country vaccine manufacturers.

[Improving global access to new vaccines: intellectual property, technology transfer, and regulatory pathways].

PubMed

Crager, Sara Eve

2015-01-01

The 2012 World Health Assembly Global Vaccine Action Plan called for global access to new vaccines within 5 years of licensure. Current approaches have proven insufficient to achieve sustainable vaccine pricing within such a timeline. Paralleling the successful strategy of generic competition to bring down drug prices, a clear consensus is emerging that market entry of multiple suppliers is a critical factor in expeditiously bringing down prices of new vaccines. In this context, key target objectives for improving access to new vaccines include overcoming intellectual property obstacles, streamlining regulatory pathways for biosimilar vaccines, and reducing market entry timelines for developing-country vaccine manufacturers by transfer of technology and know-how. I propose an intellectual property, technology, and know-how bank as a new approach to facilitate widespread access to new vaccines in low- and middle-income countries by efficient transfer of patented vaccine technologies to multiple developing-country vaccine manufacturers.

Tribal Energy Program for California Indian Tribes

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

Singer, S.

A strategic plan is needed to catalyze clean energy in the more than 100 California Indian tribal communities with varying needs and energy resources. We propose to conduct a scoping study to identify tribal lands with clean energy potential, as well as communities with lack of grid-tied energy and communications access. The research focus would evaluate the energy mixture and alternatives available to these tribal communities, and evaluate greenhouse gas emissions associated with accessing fossil fuel used for heat and power. Understanding the baseline of energy consumption and emissions of communities is needed to evaluate improvements and advances from technology.more » Based on this study, we will develop a strategic plan that assesses solutions to address high energy fuel costs due to lack of electricity access and inform actions to improve economic opportunities for tribes. This could include technical support for tribes to access clean energy technologies and supporting collaboration for on-site demonstrations.« less

New Tools to Convert PDF Math Contents into Accessible e-Books Efficiently.

PubMed

Suzuki, Masakazu; Terada, Yugo; Kanahori, Toshihiro; Yamaguchi, Katsuhito

2015-01-01

New features in our math-OCR software to convert PDF math contents into accessible e-books are shown. A method for recognizing PDF is thoroughly improved. In addition, contents in any selected area including math formulas in a PDF file can be cut and pasted into a document in various accessible formats, which is automatically recognized and converted into texts and accessible math formulas through this process. Combining it with our authoring tool for a technical document, one can easily produce accessible e-books in various formats such as DAISY, accessible EPUB3, DAISY-like HTML5, Microsoft Word with math objects and so on. Those contents are useful for various print-disabled students ranging from the blind to the dyslexic.

Financing Facility Improvements for Out-of-School Time and Community School Programs. Strategy Brief. Vol. 1 No. 4.

ERIC Educational Resources Information Center

Flynn, Margaret

This strategy brief presents general principles and strategies for financing facility improvements and highlights five examples of innovative strategies found throughout the United States. The strategies described concern facility improvements for out-of-school time and community school programs and include the following: (1) accessing school…

A qualitative study on African immigrant and refugee families' experiences of accessing primary health care services in Manitoba, Canada: it's not easy!

PubMed

Woodgate, Roberta Lynn; Busolo, David Shiyokha; Crockett, Maryanne; Dean, Ruth Anne; Amaladas, Miriam R; Plourde, Pierre J

2017-01-09

Immigrant and refugee families form a growing proportion of the Canadian population and experience barriers in accessing primary health care services. The aim of this study was to examine the experiences of access to primary health care by African immigrant and refugee families. Eighty-three families originating from 15 African countries took part in multiple open ended interviews in western Canada. Qualitative data was collected in six different languages between 2013 and 2015. Data analysis involved delineating units of meaning from the data, clustering units of meaning to form thematic statements, and extracting themes. African immigrant and refugee families experienced challenges in their quest to access primary health care that were represented by three themes: Expectations not quite met, facing a new life, and let's buddy up to improve access. On the theme of expectations not quite met, families struggled to understand and become familiar with a new health system that presented with a number of barriers including lengthy wait times, a shortage of health care providers, high cost of medication and non-basic health care, and less than ideal care. On the theme of facing a new life, immigrant and refugee families talked of the difficulties of getting used to their new and unfamiliar environments and the barriers that impact their access to health care services. They talked of challenges related to transportation, weather, employment, language and cultural differences, and lack of social support in their quest to access health care services. Additionally, families expressed their lack of social support in accessing care. Privately sponsored families and families with children experienced even less social support. Importantly, in the theme of let's buddy up to improve access, families recommended utilizing networking approaches to engage and improve their access to primary health care services. African immigrant and refugee families experience barriers to accessing primary health care. To improve access, culturally relevant programs, collaborative networking approaches, and policies that focus on addressing social determinants of health are needed.

Third Annual Foreign Acquisitions Workshop: Improving Access to Foreign Gray Literature

NASA Technical Reports Server (NTRS)

1993-01-01

The theme of the Third Annual Foreign Acquisitions Workshop was the acquisition of and access to foreign (non-U.S.) gray literature. Individual presentations addressed general topics related to the value and scope of gray literature, specialized and foreign gray-literature sources, intellectual property issues, and U.S. Federal Agency activities. Additional topics focused on electronic access and evaluation techniques and the current and potential uses of networking technology. The workshop papers are presented in their entirety or in abstract or outline form. Appendices include a listing of databases that include foreign gray literature, a bibliography, and a report on U.S.-Japan cooperation in the use of scientific and technical information.

Priorities and realities: addressing the rich-poor gaps in health status and service access in Indonesia

PubMed Central

2011-01-01

Introduction Over the past four decades, the Indonesian health care system has greatly expanded and the health of Indonesian people has improved although the rich-poor gap in health status and service access remains an issue. The government has been trying to address these gaps and intensify efforts to improve the health of the poor following the economic crisis in 1998. Methods This paper examines trends and levels in socio-economic inequity of health and identifies critical factors constraining efforts to improve the health of the poor. Quantitative data were taken from the Indonesian Demographic Health Surveys and the National Socio-Economic Surveys, and qualitative data were obtained from interviews with individuals and groups representing relevant stakeholders. Results The health of the population has improved as indicated by child mortality decline and the increase in community access to health services. However, the continuing prevalence of malnourished children and the persisting socio-economic inequity of health suggest that efforts to improve the health of the poor have not yet been effective. Factors identified at institution and policy levels that have constrained improvements in health care access and outcomes for the poor include: the high cost of electing formal governance leaders; confused leadership roles in the health sector; lack of health inequity indicators; the generally weak capacity in the health care system, especially in planning and budgeting; and the leakage and limited coverage of programs for the poor. Conclusions Despite the government's efforts to improve the health of the poor, the rich-poor gap in health status and service access continues. Factors at institutional and policy levels are critical in contributing to the lack of efficiency and effectiveness for health programs that address the poor. PMID:22067727

Electronic medical record systems in critical access hospitals: leadership perspectives on anticipated and realized benefits.

PubMed

Mills, Troy R; Vavroch, Jared; Bahensky, James A; Ward, Marcia M

2010-04-01

The growth of electronic medical records (EMRs) is driven by the belief that EMRs will significantly improve healthcare providers' performance and reduce healthcare costs. Evidence supporting these beliefs is limited, especially for small rural hospitals. A survey that focused on health information technology (HIT) capacity was administered to all hospitals in Iowa. Structured interviews were conducted with the leadership at 15 critical access hospitals (CAHs) that had implemented EMRs in order to assess the perceived benefits of operational EMRs. The results indicate that most of the hospitals implemented EMRs to improve efficiency, timely access, and quality. Many CAH leaders also viewed EMR implementation as a necessary business strategy to remain viable and improve financial performance. While some reasons reflect external influences, such as perceived future federal mandates, other reasons suggest that the decision was driven by internal forces, including the hospital's culture and the desires of key leaders to embrace HIT. Anticipated benefits were consistent with goals; however, realized benefits were rarely obvious in terms of quantifiable results. These findings expand the limited research on the rationale for implementing EMRs in critical access hospitals.

Improving Cultural Competency and Disease Awareness among Oncology Nurses Caring for Adult T-Cell Leukemia and Lymphoma Patients

ERIC Educational Resources Information Center

Cortese-Peske, Marisa A.

2013-01-01

Foreign-born residents face significant challenges accessing and receiving quality healthcare in the U.S. These obstacles include a lack of information on how to access care, fear, as well as communication and cultural barriers (Portes, Fernandez-Kelly & Light, 2012). Increasing healthcare providers' knowledge regarding a patient's…

On Access to Knowledge in the Social Sciences and Humanities, From the Viewpoint of Cybernetics and Information Science.

ERIC Educational Resources Information Center

Heilprin, Laurence B.

The literature of knowledge is a very large system in the cybernetic sense of intractibility to control. Improving access to it needs some simplifying theory. A step in this direction is a hypothesis constructed from basic concepts. These include cybernetic concepts of variety and requisite variety; a version of the mathematical concept of…

Access to Health Care Services among Young People Exchanging Sex in Detroit.

PubMed

Knittel, Andrea K; Graham, Louis F; Peterson, Jerry; Lopez, William; Snow, Rachel C

2018-04-05

Within the related epidemics of sex exchange, drug use, and poverty, access to health care is shaped by intersecting identities, policy, and infrastructure. This study uses a unique survey sample of young adults in Detroit, who are exchanging sex on the street, in strip clubs, and at after-hours parties and other social clubs. Factors predicting access to free or affordable health care services, such as venue, patterns of sexual exchange influence, drug use and access to transportation, were examined using multivariable logistic regression and qualitative comparative analysis. The most significant predictors of low access to health care services were unstable housing and lack of access to reliable transportation. In addition, working on the street was associated with decreased access to services. Coordinated policy and programming changes are needed to increase health care access to this group, including improved access to transportation, housing, and employment, and integration of health care services.

38 CFR 21.216 - Special equipment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... aids to closed-circuit TV systems which amplify reading material for veterans with severe visual impairments. (3) Modifications to improve access. This category includes adaptations of environment not...

Using patient reported outcome measures in health services: a qualitative study on including people with low literacy skills and learning disabilities.

PubMed

Jahagirdar, Deepa; Kroll, Thilo; Ritchie, Karen; Wyke, Sally

2012-11-26

Patient reported outcome measures (PROMs) are self-report measures of health status increasingly promoted for use in healthcare quality improvement. However people with low literacy skills or learning disabilities may find PROMs hard to complete. Our study investigated stakeholder views on the accessibility and use of PROMs to develop suggestions for more inclusive practice. Taking PROMs recommended for chronic obstructive pulmonary disease (COPD) as an example, we conducted 8 interviews with people with low literacy skills and/or learning disabilities, and 4 focus groups with 20 health professionals and people with COPD. Discussions covered the format and delivery of PROMs using the EQ-5D and St George Respiratory Questionnaire as prompts. Thematic framework analysis focused on three main themes: Accessibility, Ease of Use, and Contextual factors. Accessibility included issues concerning the questionnaire format, and suggestions for improvement included larger font sizes and more white space. Ease of Use included discussion about PROMs' administration. While health professionals suggested PROMs could be completed in waiting rooms, patients preferred settings with more privacy and where they could access help from people they know. Contextual Factors included other challenges and wider issues associated with completing PROMs. While health professionals highlighted difficulties created by the system in managing patients with low literacy/learning disabilities, patient participants stressed that understanding the purpose of PROMs was important to reduce intimidation. Adjusting PROMs' format, giving an explicit choice of where patients can complete them, and clearly conveying PROMs' purpose and benefit to patients may help to prevent inequality when using PROMs in health services.

Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review

PubMed Central

2016-01-01

Background People who are homeless encounter barriers to primary care despite having greater needs for health care, on average, than people who are not homeless. We evaluated the effectiveness of interventions to improve access to primary care for people who are homeless. Methods We performed a systematic review to identify studies in English published between January 1, 1995, and July 8, 2015, comparing interventions to improve access to a primary care provider with usual care among people who are homeless. The outcome of interest was access to a primary care provider. The risk of bias in the studies was evaluated, and the quality of the evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. Results From a total of 4,047 citations, we identified five eligible studies (one randomized controlled trial and four observational studies). With the exception of the randomized trial, the risk of bias was considered high in the remaining studies. In the randomized trial, people who were homeless, without serious mental illness, and who received either an outreach intervention plus clinic orientation or clinic orientation alone, had improved access to a primary care provider compared with those receiving usual care. An observational study that compared integration of primary care and other services for people who are homeless with usual care did not observe any difference in access to a primary care provider between the two groups. A small observational study showed improvement among participants with a primary care provider after receiving an intervention consisting of housing and supportive services compared with the period before the intervention. The quality of the evidence was considered moderate for both the outreach plus clinic orientation and clinic orientation alone, and low to very low for the other interventions. Despite limitations, the literature identified reports of interventions developed to overcome barriers in access to primary care in people who are homeless. The interventions studied are complex and include multiple components that are consistent with proposed dimensions of access to care (availability, affordability, and acceptability). Conclusions Our systematic review of the literature identified various types of interventions that seek to improve access to primary care by attempting to address barriers to care encountered by people who are homeless. Moderate-quality evidence indicates that orientation to clinic services (either alone or combined with outreach) improves access to a primary care provider in adults who are homeless, without serious mental illness, and living in urban centres. PMID:27099645

Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review.

PubMed

2016-01-01

People who are homeless encounter barriers to primary care despite having greater needs for health care, on average, than people who are not homeless. We evaluated the effectiveness of interventions to improve access to primary care for people who are homeless. We performed a systematic review to identify studies in English published between January 1, 1995, and July 8, 2015, comparing interventions to improve access to a primary care provider with usual care among people who are homeless. The outcome of interest was access to a primary care provider. The risk of bias in the studies was evaluated, and the quality of the evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. From a total of 4,047 citations, we identified five eligible studies (one randomized controlled trial and four observational studies). With the exception of the randomized trial, the risk of bias was considered high in the remaining studies. In the randomized trial, people who were homeless, without serious mental illness, and who received either an outreach intervention plus clinic orientation or clinic orientation alone, had improved access to a primary care provider compared with those receiving usual care. An observational study that compared integration of primary care and other services for people who are homeless with usual care did not observe any difference in access to a primary care provider between the two groups. A small observational study showed improvement among participants with a primary care provider after receiving an intervention consisting of housing and supportive services compared with the period before the intervention. The quality of the evidence was considered moderate for both the outreach plus clinic orientation and clinic orientation alone, and low to very low for the other interventions. Despite limitations, the literature identified reports of interventions developed to overcome barriers in access to primary care in people who are homeless. The interventions studied are complex and include multiple components that are consistent with proposed dimensions of access to care (availability, affordability, and acceptability). Our systematic review of the literature identified various types of interventions that seek to improve access to primary care by attempting to address barriers to care encountered by people who are homeless. Moderate-quality evidence indicates that orientation to clinic services (either alone or combined with outreach) improves access to a primary care provider in adults who are homeless, without serious mental illness, and living in urban centres.

Telemedicine Enables Broader Access to Movement Disorders Curricula for Medical Students.

PubMed

Cubo, Esther; Doumbe, Jacques; López, Emiliano; Lopez, Guadalupe A; Gatto, Emilia; Persi, Gabriel; Guttman, Mark

2017-01-01

The impact of tele-education for movement disorders on medical students is unknown. The present study had three objectives. First, to create a tele-education program for medical students in regions with limited access to movement disorders curricula. Second, to analyze the feasibility, satisfaction, and improvement of medical knowledge. Third, to assess the main reasons of medical students for attending this course. In 2016, a program was piloted in a low-middle income (Cameroon) and a middle-high income (Argentina) country. Medical students were offered a free movement disorder tele-education program (four medical schools in Argentina, and 1 medical school in Cameroon). Six real-time videoconferences covering hyperkinetic and hypokinetic movement disorders were included. Evaluations included attendance, pre- and post-medical knowledge, and satisfaction questionnaires. The study included 151 undergraduate medical students (79.4% from Argentina, 20.6% from Cameroon). Feasibility was acceptable with 100% and 85.7% of the videoconferences completed in Argentina and Cameroon, respectively. Attendance was higher in Argentina compared to Cameroon (75% vs. 33.1%). According to student reports, the topics and innovative educational environment were the main reasons for attendance. Both groups ranked satisfaction as moderate to high, and medical knowledge improved similarly in both countries. Tele-education can improve movement disorders knowledge in medical schools in high-middle and low-middle income countries lacking access to other educational opportunities.

Enhancing healthcare accessibility measurements using GIS: A case study in Seoul, Korea

PubMed Central

Kim, Yeeun; Byon, Young-Ji

2018-01-01

With recent aging demographic trends, the needs for enhancing geo-spatial analysis capabilities and monitoring the status of accessibilities of its citizens with healthcare services have increased. The accessibility to healthcare is determined not only by geographic distances to service locations, but also includes travel time, available modes of transportation, and departure time. Having access to the latest and accurate information regarding the healthcare accessibility allows the municipal government to plan for improvements, including expansion of healthcare infrastructure, effective labor distribution, alternative healthcare options for the regions with low accessibilities, and redesigning the public transportation routes and schedules. This paper proposes a new method named, Seoul Enhanced 2-Step Floating Catchment Area (SE2SFCA), which is customized for the city of Seoul, where population density is higher and the average distance between healthcare-service locations tends to be shorter than the typical North American or European cities. The proposed method of SE2SFCA is found to be realistic and effective in determining the weak accessibility regions. It resolves the over-estimation issues of the past, arising from the assignment of high healthcare accessibility for the regions with large hospitals and high density of population and hospitals. PMID:29462194

Enhancing healthcare accessibility measurements using GIS: A case study in Seoul, Korea.

PubMed

Kim, Yeeun; Byon, Young-Ji; Yeo, Hwasoo

2018-01-01

With recent aging demographic trends, the needs for enhancing geo-spatial analysis capabilities and monitoring the status of accessibilities of its citizens with healthcare services have increased. The accessibility to healthcare is determined not only by geographic distances to service locations, but also includes travel time, available modes of transportation, and departure time. Having access to the latest and accurate information regarding the healthcare accessibility allows the municipal government to plan for improvements, including expansion of healthcare infrastructure, effective labor distribution, alternative healthcare options for the regions with low accessibilities, and redesigning the public transportation routes and schedules. This paper proposes a new method named, Seoul Enhanced 2-Step Floating Catchment Area (SE2SFCA), which is customized for the city of Seoul, where population density is higher and the average distance between healthcare-service locations tends to be shorter than the typical North American or European cities. The proposed method of SE2SFCA is found to be realistic and effective in determining the weak accessibility regions. It resolves the over-estimation issues of the past, arising from the assignment of high healthcare accessibility for the regions with large hospitals and high density of population and hospitals.

Crowdsourced Contributions to the Nation's Geodetic Elevation Infrastructure

NASA Astrophysics Data System (ADS)

Stone, W. A.

2014-12-01

NOAA's National Geodetic Survey (NGS), a United States Department of Commerce agency, is engaged in providing the nation's fundamental positioning infrastructure - the National Spatial Reference System (NSRS) - which includes the framework for latitude, longitude, and elevation determination as well as various geodetic models, tools, and data. Capitalizing on Global Navigation Satellite System (GNSS) technology for improved access to the nation's precise geodetic elevation infrastructure requires use of a geoid model, which relates GNSS-derived heights (ellipsoid heights) with traditional elevations (orthometric heights). NGS is facilitating the use of crowdsourced GNSS observations collected at published elevation control stations by the professional surveying, geospatial, and scientific communities to help improve NGS' geoid modeling capability. This collocation of published elevation data and newly collected GNSS data integrates together the two height systems. This effort in turn supports enhanced access to accurate elevation information across the nation, thereby benefiting all users of geospatial data. By partnering with the public in this collaborative effort, NGS is not only helping facilitate improvements to the elevation infrastructure for all users but also empowering users of NSRS with the capability to do their own high-accuracy positioning. The educational outreach facet of this effort helps inform the public, including the scientific community, about the utility of various NGS tools, including the widely used Online Positioning User Service (OPUS). OPUS plays a key role in providing user-friendly and high accuracy access to NSRS, with optional sharing of results with NGS and the public. All who are interested in helping evolve and improve the nationwide elevation determination capability are invited to participate in this nationwide partnership and to learn more about the geodetic infrastructure which is a vital component of viable spatial data for many disciplines, including the geosciences.

Cyberinfrastructure at IRIS: Challenges and Solutions Providing Integrated Data Access to EarthScope and Other Earth Science Data

NASA Astrophysics Data System (ADS)

Ahern, T. K.; Barga, R.; Casey, R.; Kamb, L.; Parastatidis, S.; Stromme, S.; Weertman, B. T.

2008-12-01

While mature methods of accessing seismic data from the IRIS DMC have existed for decades, the demands for improved interdisciplinary data integration call for new approaches. Talented software teams at the IRIS DMC, UNAVCO and the ICDP in Germany, have been developing web services for all EarthScope data including data from USArray, PBO and SAFOD. These web services are based upon SOAP and WSDL. The EarthScope Data Portal was the first external system to access data holdings from the IRIS DMC using Web Services. EarthScope will also draw more heavily upon products to aid in cross-disciplinary data reuse. A Product Management System called SPADE allows archive of and access to heterogeneous data products, presented as XML documents, at the IRIS DMC. Searchable metadata are extracted from the XML and enable powerful searches for products from EarthScope and other data sources. IRIS is teaming with the External Research Group at Microsoft Research to leverage a powerful Scientific Workflow Engine (Trident) and interact with the web services developed at centers such as IRIS to enable access to data services as well as computational services. We believe that this approach will allow web- based control of workflows and the invocation of computational services that transform data. This capability will greatly improve access to data across scientific disciplines. This presentation will review some of the traditional access tools as well as many of the newer approaches that use web services, scientific workflow to improve interdisciplinary data access.

Microbial quality of improved drinking water sources: evidence from western Kenya and southern Vietnam.

PubMed

Grady, Caitlin A; Kipkorir, Emmanuel C; Nguyen, Kien; Blatchley, E R

2015-06-01

In recent decades, more than 2 billion people have gained access to improved drinking water sources thanks to extensive effort from governments, and public and private sector entities. Despite this progress, many water sector development interventions do not provide access to safe water or fail to be sustained for long-term use. The authors examined drinking water quality of previously implemented water improvement projects in three communities in western Kenya and three communities in southern Vietnam. The cross-sectional study of 219 households included measurements of viable Escherichia coli. High rates of E. coli prevalence in these improved water sources were found in many of the samples. These findings suggest that measures above and beyond the traditional 'improved source' definition may be necessary to ensure truly safe water throughout these regions.

Facilitators and Barriers to Dental Care Among Mexican Migrant Women and Their Families in North San Diego County.

PubMed

Velez, Diane; Palomo-Zerfas, Ana; Nunez-Alvarez, Arcela; Ayala, Guadalupe X; Finlayson, Tracy L

2017-10-01

To qualitatively examine facilitators and barriers to dental care access and quality services among Mexican migrant women and their families living in North San Diego County, California. Six focus groups were conducted, with 52 participants. Three focus groups were with community residents (average group size of 10), and three were with community health workers/leaders (called Lideres; average group size of 7). The behavioral model for vulnerable populations theoretical framework guided qualitative data analyses. Predisposing factors to dental care access varied and included immigration status, language, and dental care experiences. Barriers to accessing quality dental services included high cost, lack of insurance coverage, dissatisfaction with providers, long wait times and discrimination. Participants expressed a desire for health policy changes, including affordable coverage for immigrants and their families. This study provided insights into how dental care providers, community health centers, and policymakers can improve dental care access and services to migrant populations.

Electrostatic particle collector with improved features for installing and/or removing its collector plates

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

Siegfried, Matthew J.; Radford, Daniel R.; Huffman, Russell K.

An electrostatic particle collector may generally include a housing having sidewalls extending lengthwise between a first end and a second end. The housing may define a plate slot that extends heightwise within the housing between a top end and a bottom end. The housing may further include a plate access window that provides access to the bottom end of the plate slot. The collector may also include a collector plate configured to be installed within the plate slot that extends heightwise between a top edge and a bottom edge. Additionally, when the collector plate is installed within the plate slot,more » the bottom edge of the collector plate may be accessible from an exterior of the housing via the plate access window so as to allow the bottom edge of the collector plate to be moved relative to the housing to facilitate removal of the collector plate from the housing.« less

Toward Improved Security and Privacy in Modern Healthcare

ERIC Educational Resources Information Center

Pagano, Matthew Wallach

2013-01-01

The conversion of paper-based medical records into electronic formats is set to bring many benefits to healthcare. This includes creating a more seamless exchange of electronic health records (EHRs) between providers, improving healthcare while lowering its costs, and providing patients with increased access to their EHRs. As more medical…

[Stents in dialysis vascular access--do they promise improved high quality prolonged access use].

PubMed

Klein, Osnat; Plotkin, Eleonora; Gritun, Igal; Verner, Myriam; Lehmann, J M; Rathaus, Mauro; Bernheim, Jacques

2008-02-01

The life expectancy of dialysis patients depends, to a large extent, on blood access which provides uninterrupted and efficient treatment. Dialysis access created by a direct anastomosis between artery and vein usually allows normal dialysis for many years. Blood access by a bridge graft between artery and vein functions for a much shorter time and occludes chiefly because of endothelial hyperplasia at the graft vein anastomosis. This type of fistula is created when the veins of the patient are small. During the last few years the dialysis population is increasingly composed of adult and elderly patients suffering from diabetes mellitus, hypertension, dyslipidemias and atheromatous vascular disease so that a relatively large proportion of dialysis accesses are created using a bridge graft. Since we currently do not have the knowledge of how to arrest or delay the processes which lead to access occlusion, attempts are made to implement prophylactic strategies, find stenoses and dilate them before the access fails. Up to date, controlled trials have not succeeded in proving that this method prolongs access use. These trials did not describe the use of stents following dilatation. Between July 2002 and May 2005, 238 angiographies were performed on blood accesses including 179 angioplasties of stenoses. In sixteen patients a stent was deployed during the angioplasty. In ten patients dialysis was performed using the same access up to the end of the study period, an average of 43 months from the creation of the access. Three patients died with a functioning access and in three the access occluded during the period of followup. This study shows that the use of stents following angioplasty of dialysis access stenoses can improve the duration of use of accesses created through grafts.

Contraception for adolescents in low and middle income countries: needs, barriers, and access

PubMed Central

2014-01-01

Substantial numbers of adolescents experience the negative health consequences of early, unprotected sexual activity - unintended pregnancy, unsafe abortions, pregnancy-related mortality and morbidity and Sexually Transmitted Infections including Human Immunodeficiency Virus; as well as its social and economic costs. Improving access to and use of contraceptives – including condoms - needs to be a key component of an overall strategy to preventing these problems. This paper contains a review of research evidence and programmatic experiences on needs, barriers, and approaches to access and use of contraception by adolescents in low and middle income countries (LMIC). Although the sexual activity of adolescents (ages 10–19) varies markedly for boys versus girls and by region, a significant number of adolescents are sexually active; and this increases steadily from mid-to-late adolescence. Sexually active adolescents – both married and unmarried - need contraception. All adolescents in LMIC - especially unmarried ones - face a number of barriers in obtaining contraception and in using them correctly and consistently. Effective interventions to improve access and use of contraception include enacting and implementing laws and policies requiring the provision of sexuality education and contraceptive services for adolescents; building community support for the provision of contraception to adolescents, providing sexuality education within and outside school settings, and increasing the access to and use of contraception by making health services adolescent-friendly, integrating contraceptive services with other health services, and providing contraception through a variety of outlets. Emerging data suggest mobile phones and social media are promising means of increasing contraceptive use among adolescents. PMID:24383405

Artificial intelligence, neural network, and Internet tool integration in a pathology workstation to improve information access

NASA Astrophysics Data System (ADS)

Sargis, J. C.; Gray, W. A.

1999-03-01

The APWS allows user friendly access to several legacy systems which would normally each demand domain expertise for proper utilization. The generalized model, including objects, classes, strategies and patterns is presented. The core components of the APWS are the Microsoft Windows 95 Operating System, Oracle, Oracle Power Objects, Artificial Intelligence tools, a medical hyperlibrary and a web site. The paper includes a discussion of how could be automated by taking advantage of the expert system, object oriented programming and intelligent relational database tools within the APWS.

Advancing career counseling and employment support for survivors: an intervention evaluation.

PubMed

Davidson, M Meghan; Nitzel, Camie; Duke, Alysondra; Baker, Cynthia M; Bovaird, James A

2012-04-01

The purpose of this research was to conduct a replication-based and extension study examining the effectiveness of a 5-week career group counseling intervention, Advancing Career Counseling and Employment Support for Survivors (ACCESS; Chronister, 2008). The present study was conducted in a markedly different geographic region within a larger community as compared with the original investigation conducted by Chronister and McWhirter (2006). Women survivors of intimate partner violence (N = 73) participated in ACCESS, with career-search self-efficacy, perceived career barriers, perceived career supports, anxiety, and depression assessed at preintervention, postintervention, and 8-week follow-up. Women survivors demonstrated significant improvements in career-search self-efficacy and perceived career barriers at postintervention. Moreover, these same improvements were maintained at the 8-week follow-up assessment with the addition of significant improvements in perceived future financial supports, anxiety, and depression compared with preintervention scores. This work replicates the initial findings regarding the effectiveness of ACCESS with respect to career-search self-efficacy (Chronister & McWhirter, 2006) as well as extends the initial research to include improvements in perceived career barriers and perceived career supports. Moreover, the present study extends the work to include the mental health outcomes of anxiety and depression; results demonstrated improvements in these areas at 8-week follow-up. This investigation begins to fill a critical need for evaluated career-focused interventions for the underserved population of women survivors of intimate partner violence.

Accessing external innovation in drug discovery and development.

PubMed

Tufféry, Pierre

2015-06-01

A decline in the productivity of the pharmaceutical industry research and development (R&D) pipeline has highlighted the need to reconsider the classical strategies of drug discovery and development, which are based on internal resources, and to identify new means to improve the drug discovery process. Accepting that the combination of internal and external ideas can improve innovation, ways to access external innovation, that is, opening projects to external contributions, have recently been sought. In this review, the authors look at a number of external innovation opportunities. These include increased interactions with academia via academic centers of excellence/innovation centers, better communication on projects using crowdsourcing or social media and new models centered on external providers such as built-to-buy startups or virtual pharmaceutical companies. The buzz for accessing external innovation relies on the pharmaceutical industry's major challenge to improve R&D productivity, a conjuncture favorable to increase interactions with academia and new business models supporting access to external innovation. So far, access to external innovation has mostly been considered during early stages of drug development, and there is room for enhancement. First outcomes suggest that external innovation should become part of drug development in the long term. However, the balance between internal and external developments in drug discovery can vary largely depending on the company strategies.

Taking action on the social determinants of health: improving health access for the urban poor in Mongolia

PubMed Central

2012-01-01

Introduction In recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning. Methods Principal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers. Findings The main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies. Conclusions Lessons from Mongolia mirror other international studies which point to the need to measure and take action on the social determinants of health at the local area level in order to adequately reduce persistent inequities in health care access for the urban poor. PMID:22429615

An Ongoing Revolution: Resource Sharing and OCLC.

ERIC Educational Resources Information Center

Nevins, Kate

1998-01-01

Discusses early developments in the Online Computer Library Center (OCLC) interlibrary loan, including use of OCLC for verification and request transmittal, improved service to patrons, internal cost control, affect on work flow and borrowing patterns. Describes advances in OCLC, including internationalization, electronic information access,…

Research on Clinical Preventive Services for Adolescents and Young Adults: Where Are We and Where Do We Need to Go?

PubMed Central

Harris, Sion K.; Aalsma, Matthew C.; Weitzman, Elissa R.; Garcia-Huidobro, Diego; Wong, Charlene; Hadland, Scott E.; Santelli, John; Park, M. Jane; Ozer, Elizabeth M.

2017-01-01

We reviewed research regarding system- and visit-level strategies to enhance clinical preventive service delivery and quality for adolescents and young adults. Despite professional consensus on recommended services for adolescents, a strong evidence base for services for young adults, and improved financial access to services with the Affordable Care Act’s provisions, receipt of preventive services remains suboptimal. Further research that builds off successful models of linking traditional and community clinics is needed to improve access to care for all youth. To optimize the clinical encounter, promising clinician-focused strategies to improve delivery of preventive services include screening and decision support tools, particularly when integrated into electronic medical record systems and supported by training and feedback. Although results have been mixed, interventions have moved beyond increasing service delivery to demonstrating behavior change. Research on emerging technology—such as gaming platforms, mobile phone applications, and wearable devices—suggests opportunities to expand clinicians’ reach; however, existing research is based on limited clinical settings and populations. Improved monitoring systems and further research are needed to examine preventive services facilitators and ensure that interventions are effective across the range of clinical settings where youth receive preventive care, across multiple populations, including young adults, and for more vulnerable populations with less access to quality care. PMID:28011064

Research on Clinical Preventive Services for Adolescents and Young Adults: Where Are We and Where Do We Need to Go?

PubMed

Harris, Sion K; Aalsma, Matthew C; Weitzman, Elissa R; Garcia-Huidobro, Diego; Wong, Charlene; Hadland, Scott E; Santelli, John; Park, M Jane; Ozer, Elizabeth M

2017-03-01

We reviewed research regarding system- and visit-level strategies to enhance clinical preventive service delivery and quality for adolescents and young adults. Despite professional consensus on recommended services for adolescents, a strong evidence base for services for young adults, and improved financial access to services with the Affordable Care Act's provisions, receipt of preventive services remains suboptimal. Further research that builds off successful models of linking traditional and community clinics is needed to improve access to care for all youth. To optimize the clinical encounter, promising clinician-focused strategies to improve delivery of preventive services include screening and decision support tools, particularly when integrated into electronic medical record systems and supported by training and feedback. Although results have been mixed, interventions have moved beyond increasing service delivery to demonstrating behavior change. Research on emerging technology-such as gaming platforms, mobile phone applications, and wearable devices-suggests opportunities to expand clinicians' reach; however, existing research is based on limited clinical settings and populations. Improved monitoring systems and further research are needed to examine preventive services facilitators and ensure that interventions are effective across the range of clinical settings where youth receive preventive care, across multiple populations, including young adults, and for more vulnerable populations with less access to quality care. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Can health care organizations improve health behavior and treatment adherence?

PubMed

Bender, Bruce G

2014-04-01

Many Americans are failing to engage in both the behaviors that prevent and those that effectively manage chronic health conditions, including pulmonary disorders, cardiovascular conditions, diabetes, and cancer. Expectations that health care providers are responsible for changing patients' health behaviors often do not stand up against the realities of clinical care that include large patient loads, limited time, increasing co-pays, and restricted access. Organizations and systems that might share a stake in changing health behavior include employers, insurance payers, health care delivery systems, and public sector programs. However, although the costs of unhealthy behaviors are evident, financial resources to address the problem are not readily available. For most health care organizations, the return on investment for developing behavior change programs appears highest when addressing treatment adherence and disease self-management, and lowest when promoting healthy lifestyles. Organizational strategies to improve adherence are identified in 4 categories: patient access, provider training and support, incentives, and information technology. Strategies in all 4 categories are currently under investigation in ongoing studies and have the potential to improve self-management of many chronic health conditions.

Impact of Patient-Centered Care Innovations on Access to Providers, Ambulatory Care Utilization, and Patient Clinical Indicators in the Veterans Health Administration.

PubMed

Burkhart, Lisa; Sohn, Min-Woong; Jordan, Neil; Tarlov, Elizabeth; Gampetro, Pamela; LaVela, Sherri L

2016-01-01

The Veterans Health Administration piloted patient-centered care (PCC) innovations beginning in 2010 to improve patient and provider experience and environment in ambulatory care. We use secondary data to look at longitudinal trends, evaluate system redesign, and identify areas for further quality improvement. This was a retrospective, observational study using existing secondary data from multiple US Department of Veteran Affairs sources to evaluate changes in veteran and facility outcomes associated with PCC innovations at 2 innovation and matched comparison sites between FY 2008-2010 (pre-PCC innovations) and FY 2011-2012 (post-PCC innovations). Outcomes included access to primary care providers (PCPs); primary, specialty, and emergency care use; and clinical indicators for chronic disease. Longitudinal trends revealed a different story at each site. One site demonstrated better PCP access, decrease in emergency and primary care use, increase in specialty care use, and improvement in diabetic glucose control. The other site demonstrated a decrease in PCP access and primary care use, no change in specialty care use, and an increase in diastolic blood pressure in relation to the comparison site. Secondary data analysis can reveal longitudinal trends associated with system changes, thereby informing program evaluation and identifying opportunities for quality improvement.

Perceptions, Attitudes, and Experience Regarding mHealth Among Homeless Persons in New York City Shelters.

PubMed

Asgary, Ramin; Sckell, Blanca; Alcabes, Analena; Naderi, Ramesh; Adongo, Philip; Ogedegbe, Gbenga

2015-01-01

Mobile health may be an effective means of providing access and education to the millions of homeless Americans. We conducted semi-structured interviews with 50 homeless people from different shelters in New York City to evaluate their perceptions, attitudes, and experiences regarding mobile health. Participants' average age was 51.66 (SD = 11.34) years; duration of homelessness was 2.0 (SD = 3.10) years. The majority had a mobile phone with the ability to receive and send text messages. Most participants attempted to maintain the same phone number over time. The homeless were welcoming and supportive of text messaging regarding health care issues, including appointment reminders, health education, or management of diseases considering their barriers and mobility, and believed it would help them access necessary health care. Overwhelmingly they preferred text reminders that were short, positively framed, and directive in nature compared to lengthy or motivational texts. The majority believed that free cell phone plans would improve their engagement with, help them navigate, and ultimately improve their access to care. These positive attitudes and experience could be effectively used to improve health care for the homeless. Policies to improve access to mobile health and adapted text messaging strategies regarding the health care needs of this mobile population should be considered.

The Global Opioid Policy Initiative: a wealth of information, but what is next?

PubMed

Scholten, Willem

2014-03-01

Recently, the outcomes were published of the Global Opioid Policy Initiative, evaluating the availability, cost of opioid medicines and the regulatory barriers that are possibly impeding access for the management of cancer pain in developing countries. Other studies have shown that the vast majority of the world population has no access to opioid analgesics. This study shows by country which opioid medicines are available, what they cost to the patient, and investigates the presence of barriers for access to these medicines. Data from the project will be an important resource for those who advocate for improved access to opioid analgesics. Yet, like so often, many more aspects of inadequate opioid analgesic consumption require exploration and reporting, including legislative barriers. The last publication on the project is a "What's next?" that is over focusing on palliative care, forgetting that outside palliative care is also a huge need for opioid analgesics in moderate and severe pain. While promoting access to palliative care and pain management, their recognition as a human right by UN bodies would be of great help. Moreover, WHO's Access to Controlled Medicines Programme, could be an important programme to support the countries in making these improvements.

Access to Archived Astronaut Data for Human Research Program Researchers: Update on Progress and Process Improvements

NASA Technical Reports Server (NTRS)

Lee, L. R.; Montague, K. A.; Charvat, J. M.; Wear, M. L.; Thomas, D. M.; Van Baalen, M.

2016-01-01

Since the 2010 NASA directive to make the Life Sciences Data Archive (LSDA) and Lifetime Surveillance of Astronaut Health (LSAH) data archives more accessible by the research and operational communities, demand for astronaut medical data has increased greatly. LSAH and LSDA personnel are working with Human Research Program on many fronts to improve data access and decrease lead time for release of data. Some examples include the following: Feasibility reviews for NASA Research Announcement (NRA) data mining proposals; Improved communication, support for researchers, and process improvements for retrospective Institutional Review Board (IRB) protocols; Supplemental data sharing for flight investigators versus purely retrospective studies; Work with the Multilateral Human Research Panel for Exploration (MHRPE) to develop acceptable data sharing and crew consent processes and to organize inter-agency data coordinators to facilitate requests for international crewmember data. Current metrics on data requests crew consenting will be presented, along with limitations on contacting crew to obtain consent. Categories of medical monitoring data available for request will be presented as well as flow diagrams detailing data request processing and approval steps.

Improving access in gastroenterology: The single point of entry model for referrals

PubMed Central

Novak, Kerri L; Van Zanten, Sander Veldhuyzen; Pendharkar, Sachin R

2013-01-01

In 2005, a group of academic gastroenterologists in Calgary (Alberta) adopted a centralized referral intake system known as central triage. This system provided a single point of entry model (SEM) for referrals rather than the traditional system of individual practitioners managing their own referrals and queues. The goal of central triage was to improve wait times and referral management. In 2008, a similar system was developed in Edmonton at the University of Alberta Hospital (Edmonton, Alberta). SEMs have subsequently been adopted by numerous subspecialties throughout Alberta. There are many benefits of SEMs including improved access and reduced wait times. Understanding and measuring complex patient flow systems is key to improving access, and centralized intake systems provide an opportunity to better understand total demand and system bottlenecks. This knowledge is particularly important for specialties such as gastroenterology (GI), in which demand exceeds supply. While it is anticipated that SEMs will reduce wait times for GI care in Canada, the lack of sufficient resources to meet the demand for GI care necessitates additional strategies. PMID:24040629

Improving access in gastroenterology: the single point of entry model for referrals.

PubMed

Novak, Kerri; Veldhuyzen Van Zanten, Sander; Pendharkar, Sachin R

2013-11-01

In 2005, a group of academic gastroenterologists in Calgary (Alberta) adopted a centralized referral intake system known as central triage. This system provided a single point of entry model (SEM) for referrals rather than the traditional system of individual practitioners managing their own referrals and queues. The goal of central triage was to improve wait times and referral management. In 2008, a similar system was developed in Edmonton at the University of Alberta Hospital (Edmonton, Alberta). SEMs have subsequently been adopted by numerous subspecialties throughout Alberta. There are many benefits of SEMs including improved access and reduced wait times. Understanding and measuring complex patient flow systems is key to improving access, and centralized intake systems provide an opportunity to better understand total demand and system bottlenecks. This knowledge is particularly important for specialties such as gastroenterology (GI), in which demand exceeds supply. While it is anticipated that SEMs will reduce wait times for GI care in Canada, the lack of sufficient resources to meet the demand for GI care necessitates additional strategies.

Reducing haemodialysis access infection rates.

PubMed

Dorman, Amanda; Dainton, Marissa

Infections are the second most common cause of vascular access loss in the long-term haemodialysis patient, and recent years have seen an increase in healthcare-associated infections (HCAIs) associated with vascular access (Suhail, 2009). There have been a number of drivers including publication guidelines (Department of Health, 2006; 2007) and local protocols providing evidence-based recommendations that, when implemented, can reduce the risk of these infections. In England, the selection of bloodstream infections caused by methicillin resistant staphylococcus aureus (MRSA) as a significant clinical outcome has led to a vast amount of work in this area. Root cause analysis of individual infections (by the clinical teams when these occur) in many specialities identified areas where practice could be improved, including practice relating to vascular access within the renal setting. Manufacturers have also supported this work by focusing on developing products that are designed to reduce the likelihood of infections occurring. One product identified and used within the NHS is Chloraprep.

The Digital Divide and Patient Portals: Internet Access Explained Differences in Patient Portal Use for Secure Messaging by Age, Race, and Income.

PubMed

Graetz, Ilana; Gordon, Nancy; Fung, Vick; Hamity, Courtnee; Reed, Mary E

2016-08-01

Online access to health records and the ability to exchange secure messages with physicians can improve patient engagement and outcomes; however, the digital divide could limit access to web-based portals among disadvantaged groups. To understand whether sociodemographic differences in patient portal use for secure messaging can be explained by differences in internet access and care preferences. Cross-sectional survey to examine the association between patient sociodemographic characteristics and internet access and care preferences; then, the association between sociodemographic characteristics and secure message use with and without adjusting for internet access and care preference. One thousand forty-one patients with chronic conditions in a large integrated health care delivery system (76% response rate). Internet access, portal use for secure messaging, preference for in-person or online care, and sociodemographic and health characteristics. Internet access and preference mediated some of the differences in secure message use by age, race, and income. For example, using own computer to access the internet explained 52% of the association between race and secure message use and 60% of the association between income and use (Sobel-Goodman mediation test, P<0.001 for both). Education and sex-related differences in portal use remained statistically significant when controlling for internet access and preference. As the availability and use of patient portals increase, it is important to understand which patients have limited access and the barriers they may face. Improving internet access and making portals available across multiple platforms, including mobile, may reduce some disparities in secure message use.

Patients' online access to their electronic health records and linked online services: a systematic review in primary care.

PubMed

Mold, Freda; de Lusignan, Simon; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Arvanitis, Theodoros N; Ellis, Beverley

2015-03-01

Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider. To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. A systematic review was conducted that focused on all studies about online record access and transactional services in primary care. Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King's Fund, Nuffield Health, PsycINFO, OpenGrey (1999-2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted. A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so. © British Journal of General Practice 2015.

Patients’ online access to their electronic health records and linked online services: a systematic review in primary care

PubMed Central

Mold, Freda; de Lusignan, Simon; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Arvanitis, Theodoros N; Ellis, Beverley

2015-01-01

Background Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider. Aim To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. Design and setting A systematic review was conducted that focused on all studies about online record access and transactional services in primary care. Method Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King’s Fund, Nuffield Health, PsycINFO, OpenGrey (1999–2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted. Results A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. Conclusion While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so. PMID:25733435

Geographical heterogeneity and inequality of access to improved drinking water supply and sanitation in Nepal.

PubMed

He, Wen-Jun; Lai, Ying-Si; Karmacharya, Biraj M; Dai, Bo-Feng; Hao, Yuan-Tao; Xu, Dong Roman

2018-04-02

Per United Nations' Sustainable Development Goals, Nepal is aspiring to achieve universal and equitable access to safe and affordable drinking water and provide access to adequate and equitable sanitation for all by 2030. For these goals to be accomplished, it is important to understand the country's geographical heterogeneity and inequality of access to its drinking-water supply and sanitation (WSS) so that resource allocation and disease control can be optimized. We aimed 1) to estimate spatial heterogeneity of access to improved WSS among the overall Nepalese population at a high resolution; 2) to explore inequality within and between relevant Nepalese administrative levels; and 3) to identify the specific administrative areas in greatest need of policy attention. We extracted cluster-sample data on the use of the water supply and sanitation that included 10,826 surveyed households from the 2011 Nepal Demographic and Health Survey, then used a Gaussian kernel density estimation with adaptive bandwidths to estimate the distribution of access to improved WSS conditions over a grid at 1 × 1 km. The Gini coefficient was calculated for the measurement of inequality in the distribution of improved WSS; the Theil L measure and Theil T index were applied to account for the decomposition of inequality. 57% of Nepalese had access to improved sanitation (range: 18.1% in Mahottari to 100% in Kathmandu) and 92% to drinking-water (range: 41.7% in Doti to 100% in Bara). The most unequal districts in Gini coefficient among improved sanitation were Saptari, Sindhuli, Banke, Bajura and Achham (range: 0.276 to 0.316); and Sankhuwasabha, Arghakhanchi, Gulmi, Bhojpur, Kathmandu (range: 0.110 to 0.137) among improved drinking-water. Both the Theil L and Theil T showed that within-province inequality was substantially greater than between-province inequality; while within-district inequality was less than between-district inequality. The inequality of several districts was higher than what is calculated by regression of the Gini coefficient and our estimates. This study showed considerable geographical heterogeneity and inequality not evidenced in previous national statistics. Our findings may be useful in prioritizing resources to reduce inequality and expand the coverage of improved water supply and sanitation in Nepal.

Captive insurance: is it the right choice for your insurance exposures?

PubMed

Frese, Richard C

2015-12-01

Potential benefits of a captive insurance company include: Broader coverage Improved cash flow and stability. Direct access to reinsurance markets. Tax advantages. Better handling and control of risk management and claims. Potential drawbacks and challenges include: Startup capitalization. Underwriting losses. Administration and commitment.

Storing and Viewing Electronic Documents.

ERIC Educational Resources Information Center

Falk, Howard

1999-01-01

Discusses the conversion of fragile library materials to computer storage and retrieval to extend the life of the items and to improve accessibility through the World Wide Web. Highlights include entering the images, including scanning; optical character recognition; full text and manual indexing; and available document- and image-management…

Communicative Access Measures for Stroke: Development and Evaluation of a Quality Improvement Tool.

PubMed

Kagan, Aura; Simmons-Mackie, Nina; Victor, J Charles; Chan, Melodie T

2017-11-01

To (1) develop a systems-level quality improvement tool targeting communicative access to information and decision-making for stroke patients with language disorders; and (2) evaluate the resulting tool-the Communicative Access Measures for Stroke (CAMS). Survey development and evaluation was in line with accepted guidelines and included item generation and reduction, survey formatting and composition, pretesting, pilot testing, and reliability assessment. Development and evaluation were carried out in hospital and community agency settings. The project used a convenience sample of 31 participants for the survey development, and 63 participants for the CAMS reliability study (broken down into 6 administrators/managers, 32 frontline staff, 25 participants with aphasia). Eligible participants invited to the reliability study included individuals from 45 community-based organizations in Ontario as well as 4400 individuals from communities of practice. Not applicable. Data were analyzed using kappa statistics and intraclass correlations for each item score on all surveys. A tool, the CAMS, comprising 3 surveys, was developed for health facilities from the perspectives of (1) administrators/policymakers, (2) staff/frontline health care providers, and (3) patients with aphasia (using a communicatively accessible version). Reliability for items on the CAMS-Administrator and CAMS-Staff surveys was moderate to high (kappa/intraclass correlation coefficients [ICCs], .54-1.00). As expected, reliability was lower for the CAMS-Patient survey, with most items having ICCs between 0.4 and 0.6. These findings suggest that CAMS may provide useful quality improvement information for health care facilities with an interest in improving care for patients with stroke and aphasia. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Accessing Biomedical Literature in the Current Information Landscape

PubMed Central

Khare, Ritu; Leaman, Robert; Lu, Zhiyong

2015-01-01

i. Summary Biomedical and life sciences literature is unique because of its exponentially increasing volume and interdisciplinary nature. Biomedical literature access is essential for several types of users including biomedical researchers, clinicians, database curators, and bibliometricians. In the past few decades, several online search tools and literature archives, generic as well as biomedicine-specific, have been developed. We present this chapter in the light of three consecutive steps of literature access: searching for citations, retrieving full-text, and viewing the article. The first section presents the current state of practice of biomedical literature access, including an analysis of the search tools most frequently used by the users, including PubMed, Google Scholar, Web of Science, Scopus, and Embase, and a study on biomedical literature archives such as PubMed Central. The next section describes current research and the state-of-the-art systems motivated by the challenges a user faces during query formulation and interpretation of search results. The research solutions are classified into five key areas related to text and data mining, text similarity search, semantic search, query support, relevance ranking, and clustering results. Finally, the last section describes some predicted future trends for improving biomedical literature access, such as searching and reading articles on portable devices, and adoption of the open access policy. PMID:24788259

Barriers to access and uptake of antiretroviral therapy among HIV-positive men who have sex with men in Hanoi, Vietnam: from HIV testing to treatment.

PubMed

Bui, Hao T M; Le, Giang M; Mai, Anh Q; Zablotska-Manos, Iryna; Maher, Lisa

2017-08-01

Little is known about the experiences of Vietnamese men who have sex with men in accessing HIV testing and treatment. We aimed to explore barriers to access and uptake of antiretroviral therapy (ART) among HIV-positive men who have sex with men in Hanoi. During 2015, we conducted qualitative interviews with 35 participants recruited using snowball sampling based on previous research and social networks. Key individual impediments to ART uptake included inadequate preparation for a positive diagnosis and the dual stigmatisation of homosexuality and HIV and its consequences, leading to fear of disclosure of HIV status. Health system barriers included lack of clarity and consistency about how to register for and access ART, failure to protect patient confidentiality and a reticence by providers to discuss sexual identity and same-sex issues. Results suggest fundamental problems in the way HIV testing is currently delivered in Hanoi, including a lack of client-centred counselling, peer support and clear referral pathways. Overcoming these barriers will require educating men who have sex with men about the benefits of routine testing, improving access to quality diagnostic services and building a safe, confidential treatment environment for HIV-positive men to access, receive and remain in care.

Encouraging consumption of water in school and child care settings: access, challenges, and strategies for improvement.

PubMed

Patel, Anisha I; Hampton, Karla E

2011-08-01

Children and adolescents are not consuming enough water, instead opting for sugar-sweetened beverages (sodas, sports and energy drinks, milks, coffees, and fruit-flavored drinks with added sugars), 100% fruit juice, and other beverages. Drinking sufficient amounts of water can lead to improved weight status, reduced dental caries, and improved cognition among children and adolescents. Because children spend most of their day at school and in child care, ensuring that safe, potable drinking water is available in these settings is a fundamental public health measure. We sought to identify challenges that limit access to drinking water; opportunities, including promising practices, to increase drinking water availability and consumption; and future research, policy efforts, and funding needed in this area.

A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination.

PubMed

Joshi, Chandni; Russell, Grant; Cheng, I-Hao; Kay, Margaret; Pottie, Kevin; Alston, Margaret; Smith, Mitchell; Chan, Bibiana; Vasi, Shiva; Lo, Winston; Wahidi, Sayed Shukrullah; Harris, Mark F

2013-11-07

Refugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care. A systematic review of the literature, including published systematic reviews, was undertaken. Studies between 1990 and 2011 were identified by searching Medline, CINAHL, EMBASE, Cochrane Library, Scopus, Australian Public Affairs Information Service - Health, Health and Society Database, Multicultural Australian and Immigration Studies and Google Scholar. A limited snowballing search of the reference lists of all included studies was also undertaken. A stakeholder advisory committee and international advisers provided papers from grey literature. Only English language studies of evaluated primary health care models of care for refugees in developed countries of resettlement were included. Twenty-five studies met the inclusion criteria for this review of which 15 were Australian and 10 overseas models. These could be categorised into six themes: service context, clinical model, workforce capacity, cost to clients, health and non-health services. Access was improved by multidisciplinary staff, use of interpreters and bilingual staff, no-cost or low-cost services, outreach services, free transport to and from appointments, longer clinic opening hours, patient advocacy, and use of gender-concordant providers. These services were affordable, appropriate and acceptable to the target groups. Coordination between the different health care services and services responding to the social needs of clients was improved through case management by specialist workers. Quality of care was improved by training in cultural sensitivity and appropriate use of interpreters. The elements of models most frequently associated with improved access, coordination and quality of care were case management, use of specialist refugee health workers, interpreters and bilingual staff. These findings have implications for workforce planning and training.

A narrative synthesis of the impact of primary health care delivery models for refugees in resettlement countries on access, quality and coordination

PubMed Central

2013-01-01

Introduction Refugees have many complex health care needs which should be addressed by the primary health care services, both on their arrival in resettlement countries and in their transition to long-term care. The aim of this narrative synthesis is to identify the components of primary health care service delivery models for such populations which have been effective in improving access, quality and coordination of care. Methods A systematic review of the literature, including published systematic reviews, was undertaken. Studies between 1990 and 2011 were identified by searching Medline, CINAHL, EMBASE, Cochrane Library, Scopus, Australian Public Affairs Information Service – Health, Health and Society Database, Multicultural Australian and Immigration Studies and Google Scholar. A limited snowballing search of the reference lists of all included studies was also undertaken. A stakeholder advisory committee and international advisers provided papers from grey literature. Only English language studies of evaluated primary health care models of care for refugees in developed countries of resettlement were included. Results Twenty-five studies met the inclusion criteria for this review of which 15 were Australian and 10 overseas models. These could be categorised into six themes: service context, clinical model, workforce capacity, cost to clients, health and non-health services. Access was improved by multidisciplinary staff, use of interpreters and bilingual staff, no-cost or low-cost services, outreach services, free transport to and from appointments, longer clinic opening hours, patient advocacy, and use of gender-concordant providers. These services were affordable, appropriate and acceptable to the target groups. Coordination between the different health care services and services responding to the social needs of clients was improved through case management by specialist workers. Quality of care was improved by training in cultural sensitivity and appropriate use of interpreters. Conclusion The elements of models most frequently associated with improved access, coordination and quality of care were case management, use of specialist refugee health workers, interpreters and bilingual staff. These findings have implications for workforce planning and training. PMID:24199588

Fecal contamination of drinking-water in low- and middle-income countries: a systematic review and meta-analysis.

PubMed

Bain, Robert; Cronk, Ryan; Wright, Jim; Yang, Hong; Slaymaker, Tom; Bartram, Jamie

2014-05-01

Access to safe drinking-water is a fundamental requirement for good health and is also a human right. Global access to safe drinking-water is monitored by WHO and UNICEF using as an indicator "use of an improved source," which does not account for water quality measurements. Our objectives were to determine whether water from "improved" sources is less likely to contain fecal contamination than "unimproved" sources and to assess the extent to which contamination varies by source type and setting. Studies in Chinese, English, French, Portuguese, and Spanish were identified from online databases, including PubMed and Web of Science, and grey literature. Studies in low- and middle-income countries published between 1990 and August 2013 that assessed drinking-water for the presence of Escherichia coli or thermotolerant coliforms (TTC) were included provided they associated results with a particular source type. In total 319 studies were included, reporting on 96,737 water samples. The odds of contamination within a given study were considerably lower for "improved" sources than "unimproved" sources (odds ratio [OR] = 0.15 [0.10-0.21], I2 = 80.3% [72.9-85.6]). However over a quarter of samples from improved sources contained fecal contamination in 38% of 191 studies. Water sources in low-income countries (OR = 2.37 [1.52-3.71]; p<0.001) and rural areas (OR = 2.37 [1.47-3.81] p<0.001) were more likely to be contaminated. Studies rarely reported stored water quality or sanitary risks and few achieved robust random selection. Safety may be overestimated due to infrequent water sampling and deterioration in quality prior to consumption. Access to an "improved source" provides a measure of sanitary protection but does not ensure water is free of fecal contamination nor is it consistent between source types or settings. International estimates therefore greatly overstate use of safe drinking-water and do not fully reflect disparities in access. An enhanced monitoring strategy would combine indicators of sanitary protection with measures of water quality.

The use of a policy dialogue to facilitate evidence-informed policy development for improved access to care: the case of the Winnipeg Central Intake Service (WCIS).

PubMed

Damani, Zaheed; MacKean, Gail; Bohm, Eric; DeMone, Brie; Wright, Brock; Noseworthy, Tom; Holroyd-Leduc, Jayna; Marshall, Deborah A

2016-10-18

Policy dialogues are critical for developing responsive, effective, sustainable, evidence-informed policy. Our multidisciplinary team, including researchers, physicians and senior decision-makers, comprehensively evaluated The Winnipeg Central Intake Service, a single-entry model in Winnipeg, Manitoba, to improve patient access to hip/knee replacement surgery. We used the evaluation findings to develop five evidence-informed policy directions to help improve access to scheduled clinical services across Manitoba. Using guiding principles of public participation processes, we hosted a policy roundtable meeting to engage stakeholders and use their input to refine the policy directions. Here, we report on the use and input of a policy roundtable meeting and its role in contributing to the development of evidence-informed policy. Our evidence-informed policy directions focused on formal measurement/monitoring of quality, central intake as a preferred model for service delivery, provincial scope, transparent processes/performance indicators, and patient choice of provider. We held a policy roundtable meeting and used outcomes of facilitated discussions to refine these directions. Individuals from our team and six stakeholder groups across Manitoba participated (n = 44), including patients, family physicians, orthopaedic surgeons, surgical office assistants, Winnipeg Central Intake team, and administrators/managers. We developed evaluation forms to assess the meeting process, and collected decision-maker partners' perspectives on the value of the policy roundtable meeting and use of policy directions to improve access to scheduled clinical services after the meeting, and again 15 months later. We analyzed roundtable and evaluation data using thematic analysis to identify key themes. Four key findings emerged. First, participants supported all policy directions, with revisions and key implementation considerations identified. Second, participants felt the policy roundtable meeting achieved its purpose (to engage stakeholders, elicit feedback, refine policy directions). Third, our decision-maker partners' expectations of the policy roundtable meeting were exceeded; they re-affirmed its value and described the refined policy directions as foundational to establishing the vocabulary, vision and framework for improving access to scheduled clinical services in Manitoba. Finally, our adaptation of key design elements was conducive to discussion of issues surrounding access to care. Our policy roundtable process was an effective tool for acquiring broad input from stakeholders, refining policy directions and forming the necessary consensus starting points to move towards evidence-informed policy.

Identifying strategies to improve access to credible and relevant information for public health professionals: a qualitative study

PubMed Central

LaPelle, Nancy R; Luckmann, Roger; Simpson, E Hatheway; Martin, Elaine R

2006-01-01

Background Movement towards evidence-based practices in many fields suggests that public health (PH) challenges may be better addressed if credible information about health risks and effective PH practices is readily available. However, research has shown that many PH information needs are unmet. In addition to reviewing relevant literature, this study performed a comprehensive review of existing information resources and collected data from two representative PH groups, focusing on identifying current practices, expressed information needs, and ideal systems for information access. Methods Nineteen individual interviews were conducted among employees of two domains in a state health department – communicable disease control and community health promotion. Subsequent focus groups gathered additional data on preferences for methods of information access and delivery as well as information format and content. Qualitative methods were used to identify themes in the interview and focus group transcripts. Results Informants expressed similar needs for improved information access including single portal access with a good search engine; automatic notification regarding newly available information; access to best practice information in many areas of interest that extend beyond biomedical subject matter; improved access to grey literature as well as to more systematic reviews, summaries, and full-text articles; better methods for indexing, filtering, and searching for information; and effective ways to archive information accessed. Informants expressed a preference for improving systems with which they were already familiar such as PubMed and listservs rather than introducing new systems of information organization and delivery. A hypothetical ideal model for information organization and delivery was developed based on informants' stated information needs and preferred means of delivery. Features of the model were endorsed by the subjects who reviewed it. Conclusion Many critical information needs of PH practitioners are not being met efficiently or at all. We propose a dual strategy of: 1) promoting incremental improvements in existing information delivery systems based on the expressed preferences of the PH users of the systems and 2) the concurrent development and rigorous evaluation of new models of information organization and delivery that draw on successful resources already operating to deliver information to clinical medical practitioners. PMID:16597331

Fostering Open Space and Recreation Plan Development: A Case Study of Findlay Township, Pennsylvania.

ERIC Educational Resources Information Center

Caruso, Christopher J.

1996-01-01

A plan adopted in 1992 by Findlay Township in rural Pennsylvania protects undeveloped land from urbanization and expanded and improved the township's park and recreational system. Improvements included a fitness trail, a pavilion, a handicap-accessible jungle gym, tennis and volleyball courts, restrooms, and flower beds and trees. (LP)

How to Get Data from NOAA Environmental Satellites: An Overview of Operations, Products, Access and Archive

NASA Astrophysics Data System (ADS)

Donoho, N.; Graumann, A.; McNamara, D. P.

2015-12-01

In this presentation we will highlight access and availability of NOAA satellite data for near real time (NRT) and retrospective product users. The presentation includes an overview of the current fleet of NOAA satellites and methods of data distribution and access to hundreds of imagery and products offered by the Environmental Satellite Processing Center (ESPC) and the Comprehensive Large Array-data Stewardship System (CLASS). In particular, emphasis on the various levels of services for current and past observations will be presented. The National Environmental Satellite, Data, and Information Service (NESDIS) is dedicated to providing timely access to global environmental data from satellites and other sources. In special cases, users are authorized direct access to NESDIS data distribution systems for environmental satellite data and products. Other means of access include publicly available distribution services such as the Global Telecommunication System (GTS), NOAA satellite direct broadcast services and various NOAA websites and ftp servers, including CLASS. CLASS is NOAA's information technology system designed to support long-term, secure preservation and standards-based access to environmental data collections and information. The National Centers for Environmental Information (NCEI) is responsible for the ingest, quality control, stewardship, archival and access to data and science information. This work will also show the latest technology improvements, enterprise approach and future plans for distribution of exponentially increasing data volumes from future NOAA missions. A primer on access to NOAA operational satellite products and services is available at http://www.ospo.noaa.gov/Organization/About/access.html. Access to post-operational satellite data and assorted products is available at http://www.class.noaa.gov

Setting the research agenda for induced abortion in Africa and Asia.

PubMed

Scott, Rachel H; Filippi, Veronique; Moore, Ann M; Acharya, Rajib; Bankole, Akinrinola; Calvert, Clara; Church, Kathryn; Cresswell, Jenny A; Footman, Katharine; Gleason, Joanne; Machiyama, Kazuyo; Marston, Cicely; Mbizvo, Mike; Musheke, Maurice; Owolabi, Onikepe; Palmer, Jennifer; Smith, Christopher; Storeng, Katerini; Yeung, Felicia

2018-05-10

Provision of safe abortion is widely recognized as vital to addressing the health and wellbeing of populations. Research on abortion is essential to meet the UN Sustainable Development Goals. Researchers in population health from university, policy, and practitioner contexts working on two multidisciplinary projects on family planning and safe abortion in Africa and Asia were brought together for a workshop to discuss the future research agenda on induced abortion. Research on care-seeking behavior, supply of abortion care services, and the global and national policy context will help improve access to and experiences of safe abortion services. A number of areas have potential in designing intervention strategies, including clinical innovations, quality improvement mechanisms, community involvement, and task sharing. Research on specific groups, including adolescents and young people, men, populations affected by conflict, marginalized groups, and providers could increase understanding of provision, access to and experiences of induced abortion. Methodological and conceptual advances, for example in the measurement of induced abortion incidence, complications, and client satisfaction, conceptualizations of induced abortion access and care, and methods for follow-up of patients who have induced abortions, will improve the accuracy of measurements of induced abortion, and add to understanding of women's experiences of induced abortions and abortion care. © 2018 International Federation of Gynecology and Obstetrics.

Factors associated with health care access and outcome.

PubMed

Paek, Min-So; Lim, Jung-Won

2012-01-01

This study aims to (1) assess ethnic differences in health care access and health outcome between Asian Americans and whites and between Asian American subgroups, (2) examine effects of cultural factors, and (3) investigate moderating effects of health risk behaviors between cultural characteristics and health care access and outcome. Data were derived from the 2007 California Health Interview Survey. Asian Americans (n = 4,462) and whites (n = 4,470) were included. There were significant ethnic differences in health care access and health perception between Asian Americans and Whites and across Asian American subgroups. Health risk behaviors moderated relationships between cultural factors and health care access and outcome. Findings reveal that ethnicity affects an individual's health care access and health perception, and their health behaviors are an important factor that may improve or worsen outcomes. This study may increase our knowledge base of research and interventions to enhance ethnic minority populations' health care accessibility and perceptions.

Benefit-risk of Patients' Online Access to their Medical Records: Consensus Exercise of an International Expert Group.

PubMed

Liyanage, Harshana; Liaw, Siaw-Teng; Konstantara, Emmanouela; Mold, Freda; Schreiber, Richard; Kuziemsky, Craig; Terry, Amanda L; de Lusignan, Simon

2018-04-22

 Patients' access to their computerised medical records (CMRs) is a legal right in many countries. However, little is reported about the benefit-risk associated with patients' online access to their CMRs.  To conduct a consensus exercise to assess the impact of patients' online access to their CMRs on the quality of care as defined in six domains by the Institute of Medicine (IoM), now the National Academy of Medicine (NAM).  A five-round Delphi study was conducted. Round One explored experts' (n = 37) viewpoints on providing patients with access to their CMRs. Round Two rated the appropriateness of statements arising from Round One (n = 16). The third round was an online panel discussion of findings (n = 13) with the members of both the International Medical Informatics Association and the European Federation of Medical Informatics Primary Health Care Informatics Working Groups. Two additional rounds, a survey of the revised consensus statements and an online workshop, were carried out to further refine consensus statements.  Thirty-seven responses from Round One were used as a basis to initially develop 15 statements which were categorised using IoM's domains of care quality. The experts agreed that providing patients online access to their CMRs for bookings, results, and prescriptions increased efficiency and improved the quality of medical records. Experts also anticipated that patients would proactively use their online access to share data with different health care providers, including emergencies. However, experts differed on whether access to limited or summary data was more useful to patients than accessing their complete records. They thought online access would change recording practice, but they were unclear about the benefit-risk of high and onerous levels of security. The 5-round process, finally, produced 16 consensus statements.  Patients' online access to their CMRs should be part of all CMR systems. It improves the process of health care, but further evidence is required about outcomes. Online access improves efficiency of bookings and other services. However, there is scope to improve many of the processes of care it purports to support, particularly the provision of a more effective interface and the protection of the vulnerable. Georg Thieme Verlag KG Stuttgart.

A Previsit Screening Checklist Improves Teamwork and Access to Preventive Services in a Medical Home Serving Low-Income Adolescent and Young Adult Patients.

PubMed

Allende-Richter, Sophie H; Johnson, Sydney T; Maloyan, Mariam; Glidden, Patricia; Rice, Kerrilynn; Epee-Bounya, Alexandra

2018-06-01

Publicly insured adolescents and young adults experience significant obstacles in accessing primary care services. As a result, they often present to their medical appointments with multiple unmet needs, adding time and complexity to the visit. The goal of this project was to optimize team work and access to primary care services among publicly insured adolescents and young adults attending an urban primary care clinic, using a previsit screening checklist to identify patient needs and delegate tasks within a care team to coordinate access to health services at the time of the visit. We conducted an interventional quality improvement initiative in a PDSA (Plan-Do-Study-Act) cycle format; 291 patients, 13 to 25 years old were included in the study over an 8-months period. The majority of patients were receptive to the previsit screening checklist; 85% of services requested were provided; nonclinician staff felt more involved in patient care; and providers' satisfaction increased.

A Qualitative Study on the Interconnected Nature of HIV, Water, and Family.

PubMed

Ramirez-Ortiz, Daisy; Zolnikov, Tara Rava

2017-03-01

Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) and poor access to water are two primary global health issues. Poor access to water may significantly affect families infected with HIV and result in adverse social and health consequences. A qualitative study used semi-structured interviews to understand health and social outcomes of families after the implementation of water interventions in rural Kenya. One major sub-theme emerged during this research, which included the effects of water on an HIV-affected family. Prior to the water interventions, common adverse health effects from lack of nutrition, water, and poor hygiene were experienced. After receiving access to water, nutrition and hygiene were improved and additional time was gained and used to reinforce relationships and spread awareness about HIV/AIDS. This study provides need-based evidence for access to safe drinking water in order to decrease adverse health outcomes and improve the quality of life for HIV-affected individuals.

Improved Financial Capability Can Reduce Material Hardship among Mothers.

PubMed

Huang, Jin; Nam, Yunju; Sherraden, Michael; Clancy, Margaret M

2016-10-01

This study draws on the theoretical framework of financial capability in investigating whether financial access (that is, availability of financial products and services) and financial knowledge (that is, understanding of basic financial concepts) can influence the risk of material hardship. Authors examine the possibility of direct associations as well as of indirect ones in which financial management (that is, individual financial behaviors) serves as a mediator. The probability sample of mothers with young children born in Oklahoma during 2007 (N = 2,529) was selected from Oklahoma birth certificates. Results from structural equation modeling analyses show that financial access is positively associated with financial management (p < 0.001) but that financial knowledge is not; both financial access (p < 0.001) and financial management (p < 0.001) are negatively correlated with material hardship. Similar results are obtained from analyses with a subsample of low-income mothers. Findings suggest that financial capability, particularly the financial access component, is critical for improving financial management and reducing the risk of material hardship among mothers with young children, including low-income mothers. Efforts to promote financial capability offer social workers an important strategy for improving their clients’ economic well-being.

Understanding the Health Needs and Barriers to Seeking Health Care of Veteran Students in the Community.

PubMed

Misra-Hebert, Anita D; Santurri, Laura; DeChant, Richard; Watts, Brook; Rothberg, Michael; Sehgal, Ashwini R; Aron, David C

2015-08-01

Access to care at Veterans Affairs facilities may be limited by long wait times; however, additional barriers may prevent US military veterans from seeking help at all. We sought to understand the health needs of veterans in the community to identify possible barriers to health-seeking behavior. Focus groups were conducted with veteran students at a community college until thematic saturation was reached. Qualitative data analysis involved both an inductive content analysis approach and deductive elements. A total of 17 veteran students participated in 6 separate focus groups. Health needs affecting health-seeking behavior were identified. Themes included lack of motivation to improve health, concern about social exclusion and stigma, social interactions and behavior, limited access to affordable and convenient health care, unmet basic needs for self and family, and academics competing with health needs. Veterans face a range of personal, societal, and logistical barriers to accessing care. In addition to decreasing wait times for appointments, efforts to improve the transition to civilian life; reduce stigma; and offer assistance related to work, housing, and convenient access to health care may improve health in veteran students.

Understanding the Health Needs and Barriers to Seeking Health Care of Veteran Students in the Community

PubMed Central

Misra-Hebert, Anita D.; Santurri, Laura; DeChant, Richard; Watts, Brook; Rothberg, Michael; Sehgal, Ashwini R.; Aron, David C.

2015-01-01

Objectives Access to care at Veterans Affairs facilities may be limited by long wait times; however, additional barriers may prevent US military veterans from seeking help at all. We sought to understand the health needs of veterans in the community to identify possible barriers to health-seeking behavior. Methods Focus groups were conducted with veteran students at a community college until thematic saturation was reached. Qualitative data analysis involved both an inductive content analysis approach and deductive elements. Results A total of 17 veteran students participated in 6 separate focus groups. Health needs affecting health-seeking behavior were identified. Themes included lack of motivation to improve health, concern about social exclusion and stigma, social interactions and behavior, limited access to affordable and convenient health care, unmet basic needs for self and family, and academics competing with health needs. Conclusions Veterans face a range of personal, societal, and logistical barriers to accessing care. In addition to decreasing wait times for appointments, efforts to improve the transition to civilian life, reduce stigma, and offer assistance related to work, housing, and convenient access to health care may improve health in veteran students. PMID:26280777

Progress toward a Semantic eScience Framework; building on advanced cyberinfrastructure

NASA Astrophysics Data System (ADS)

McGuinness, D. L.; Fox, P. A.; West, P.; Rozell, E.; Zednik, S.; Chang, C.

2010-12-01

The configurable and extensible semantic eScience framework (SESF) has begun development and implementation of several semantic application components. Extensions and improvements to several ontologies have been made based on distinct interdisciplinary use cases ranging from solar physics, to biologicl and chemical oceanography. Importantly, these semantic representations mediate access to a diverse set of existing and emerging cyberinfrastructure. Among the advances are the population of triple stores with web accessible query services. A triple store is akin to a relational data store where the basic stored unit is a subject-predicate-object tuple. Access via a query is provided by the W3 Recommendation language specification SPARQL. Upon this middle tier of semantic cyberinfrastructure, we have developed several forms of semantic faceted search, including provenance-awareness. We report on the rapid advances in semantic technologies and tools and how we are sustaining the software path for the required technical advances as well as the ontology improvements and increased functionality of the semantic applications including how they are integrated into web-based portals (e.g. Drupal) and web services. Lastly, we indicate future work direction and opportunities for collaboration.

Safe tractor access platforms: from guidance material to implementation.

PubMed

Day, L; Rechnitzer, G

2004-08-01

This article reports on the implementation of published guidelines for retrofitting tractors with safe access platforms, which were developed to reduce the risk of serious injuries and deaths associated with mounting and dismounting. Farmer interviews and engineering-based inspections of ten retrofitted tractors were conducted to gather information regarding benefits and disadvantages of the retrofitting and to assess the construction of the platforms. A scoring system was developed for platform retrofitting, and weighted scores between zero and ten were calculated for tractor access before and after retrofitting. Access was improved on all tractors, although to varying degrees. The average post-retrofit weighted score was 6.3 (range 2.6 to 9.7), compared with the pre-retrofit average of 0.9 (range 0.3 to 1.6). Five tractors received a post-retrofit score of 8.0 or higher. None of the lower-scoring tractors fully met the specifications for placement of the bottom step or rear wheel guard, two key characteristics for runover prevention. Other characteristics associated with a lower post-retrofit score included a low bottom step, high step rises, absence of colored nosing, and the front handrail space not being filled in. Platform retrofitting had little effect on tractor operations and substantially improved ease of access. This is the first published evaluation of a design-based solution for tractor runover injuries. This study shows that general guidelines for retrofitting of safe access platforms can be successfully applied. Mechanisms to increase adherence to the key criteria of bottom step positioning and rear wheel guarding should be included in future promotion.

Access to healthcare insurance and healthcare services among syringe exchange program clients in Massachusetts: qualitative findings from health navigators with the iDU ("I do") Care Collaborative.

PubMed

Stopka, Thomas J; Hutcheson, Marguerite; Donahue, Ashley

2017-05-18

Little is known about access to health insurance among people who inject drugs (PWID) who attend syringe exchange programs (SEPs). The goal of the current study was to assess perceptions of SEP staff, including health navigators and program managers, on access to health insurance and healthcare access among SEP clients following implementation of state and federal policies to enhance universal healthcare access in Massachusetts. Between December 2014 and January 2015, we conducted in-depth interviews (n = 14) with SEP staff, including both program managers and health navigators, to assess knowledge, attitudes, and beliefs related to health insurance enrollment and access to enhanced referrals among SEP clients. We developed a preliminary coding scheme from the interview guide and used a grounded theory approach to guide inclusion of subsequent thematic codes that emanated from the data. We analyzed the coded data thematically in an iterative fashion using a consensus-based approach. We identified five primary themes that emerged from the qualitative interviews, including high levels of health insurance enrollment among SEP clients; barriers to enrolling in health insurance; highly needed referrals to services, including improved access to substance use disorder treatment and hepatitis C virus treatment; barriers to referring clients to these highly needed services; and recommendations for policy change. While barriers to enrollment and highly needed referrals remain, access to and enrollment in healthcare insurance plans among PWID at SEPs in Massachusetts are high. With the uncertain stability of the Affordable Care Act following the US presidential election of 2016, our findings summarize the opportunities and challenges that are connected to health insurance and healthcare access in Massachusetts. SEPs can play an important role in facilitating access to health insurance and enhancing access to preventive health and primary care.

Access to water and sanitation among people with disabilities: results from cross-sectional surveys in Bangladesh, Cameroon, India and Malawi

PubMed Central

Mactaggart, Islay; Schmidt, Wolf-Peter; Bostoen, Kristof; Chunga, Joseph; Danquah, Lisa; Halder, Amal Krishna; Parveen Jolly, Saira; Polack, Sarah; Rahman, Mahfuzar; Snel, Marielle; Kuper, Hannah; Biran, Adam

2018-01-01

Objectives To assess access to adequate water, sanitation and hygiene (WASH) among people with disabilities at the household and individual level. Design Cross-sectional surveys. Setting Data were included from five district-level or regional-level surveys: two in Bangladesh (Bangladesh-1, Bangladesh-2), and one each in Cameroon, Malawi and India. Participants 99 252 participants were sampled across the datasets (range: 3567–75 767), including 2494 with disabilities (93–1374). Outcome Prevalence of access to WASH at household and individual level. Data analysis Age/sex disaggregated disability prevalence estimates were calculated accounting for survey design. The Unicef/WHO Joint Monitoring Programme definitions were used to classify facilities as improved/unimproved. Multivariable logistic regression was undertaken to compare between households with/without a person with a disability, and to identify predictors of access among people with disabilities. Results There were no differences in access to improved sanitation or water sources between households with/without members with disabilities across the datasets. In Bangladesh-2, households including a person with a disability were more likely to share facilities with other households (OR 1.3, 95% CI 1.1 to 1.5). Households with people with disabilities were more likely to spend >30 min (round-trip) collecting drinking water than households without in both Cameroon (OR 1.8, 95% CI 1.0 to 3.4) and India (OR 2.3, 95% CI 1.2 to 4.7). Within households, people with disabilities reported difficulties collecting water themselves (23%–80% unable to) and accessing the same sanitation facilities as other household members, particularly without coming into contact with faeces (up to 47% in Bangladesh-2). These difficulties were most marked for people with more severe impairments. Conclusions People with disabilities may not have poorer access to WASH at the household level, but may have poorer quality of access within their households. Further programmatic work is needed to ensure WASH facilities are inclusive of people with disabilities. PMID:29866723

Using evidence-based practice to create a venous access team: the Venous Access Task Force of the Children's Hospital of Denver.

PubMed

MacPhee, Maura

2002-12-01

The following article is an example of evidence-based practice applied to an institutional Quality Improvement (QI) project. QI originated in the 1980s and is best associated with the work of W. Deming (1986). It is also known as Continuous Quality Improvement, because a major principle of this approach is constant improvement of services or products. This improvement process contains other critical components: scientific method, employee participation and teamwork, accountable leadership, appropriate training and ongoing education, and client focus (Demming, 1986). QI has been globally successful and has helped transform American industry, including health care services. The following clinically based project illustrates the application of QI concepts and evidence-based practice to enhance outcomes. Copyright 2002, Elsevier Science (USA). All rights reserved.

Improving Access to Essential Medicines: How Health Concerns can be Prioritised in the Global Governance System

PubMed Central

Sridhar, Devi

2008-01-01

This paper discusses the politics of access to essential medicines and identifies ‘space’ in the current system where health concerns can be strengthened relative to trade. This issue is addressed from a global governance perspective focusing on the main actors who can have the greatest impact. These include developing country coalitions and citizens in developed countries though participation in civil society organisations. These actors have combined forces to tackle this issue successfully, resulting in the 2001 Doha Declaration on Public Health. The collaboration has been so powerful due to the assistance of the media as well as the decision to compromise with pharmaceutical companies and their host countries. To improve access to essential medicines, six C's are needed: coalitions, civil society, citizenship, compromise, communication and collaboration. PMID:19461853

Attacking the information access problem with expert systems

NASA Technical Reports Server (NTRS)

Ragusa, James M.; Orwig, Gary W.

1991-01-01

The results of applications research directed at finding an improved method of storing and accessing information are presented. Twelve microcomputer-based expert systems shells and five laser-optical formats have been studied, and the general and specific methods of interfacing these technologies are being tested in prototype systems. Shell features and interfacing capabilities are discussed, and results from the study of five laser-optical formats are recounted including the video laser, compact, and WORM disks, and laser cards and film. Interfacing, including laser disk device driver interfacing, is discussed and it is pointed out that in order to control the laser device from within the expert systems application, the expert systems shell must be able to access the device driver software. Potential integrated applications are investigated and an initial list is provided including consumer services, travel, law enforcement, human resources, marketing, and education and training.

Legislation: Legislation and Regulations Affecting Libraries in 2002; Legislation and Regulations Affecting Publishing in 2002.

ERIC Educational Resources Information Center

Sheketoff, Emily; Costabile, Mary R.; Adler, Allan

2003-01-01

Reviews legislation and regulations affecting libraries and the publishing industry, including the Museum and Library Services Act; Office of Educational Research and Improvement (OERI); copyright; access to electronic government information; telecommunications and technology; electronic surveillance and privacy, including the USA Patriot Act;…

YA 101: Do Not Let the Library Be Cool.

ERIC Educational Resources Information Center

Cox, Robin Overby

2000-01-01

Presents a tongue-in-cheek analysis of how to improve young adult services in libraries. Highlights include funding; providing technology that includes Internet access; comfortable furniture; food; longer evening hours; research needs; staff attitudes; job and volunteer service opportunities; restrictive rules and fees; and better books and media.…

Hanging Together To Avoid Hanging Separately: Opportunities for Academic Libraries and Consortia.

ERIC Educational Resources Information Center

Allen, Barbara McFadden; Hirshon, Arnold

1998-01-01

Discusses academic library consortia, examines types of consortia, and presents three case histories (OhioLINK, PALCI and CIC). Highlights include economic competition; changes in information access and delivery; growth of information technology; quality improvement; and future strategies, including pricing models for electronic information,…

Review of Evidence-Based Mathematics Interventions for Students with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Hart Barnett, Juliet E.; Cleary, Shannon

2015-01-01

Students with autism spectrum disorders (ASD) are being included more frequently in the general educational setting, and are therefore increasingly expected to access and master core curricular content, including mathematics. However, mathematics often presents challenges to students with ASD. Interventions to improve the mathematics skills of…

Google Analytics – Index of Resources

EPA Pesticide Factsheets

Find how-to and best practice resources and training for accessing and understanding EPA's Google Analytics (GA) tools, including how to create reports that will help you improve and maintain the web areas you manage.

Assessment of ADA Research and Development Needs

DOT National Transportation Integrated Search

1997-07-01

This report assesses the progress transit systems have made in improving the accessibility of their services and facilities. Specific objectives included the identification of innovative solutions developed by transit systems to meet the accessibilit...

Implementation of hospital-wide reform at improving access and flow: Impact on time to antibiotics in the emergency department.

PubMed

Roman, Cristina P; Poole, Susan G; Dooley, Michael J; Smit, De Villiers; Mitra, Biswadev

2016-04-01

ED overcrowding has been associated with increased mortality, morbidity and delays to essential treatment. It was hypothesised that hospital-wide reforms designed to improve patient access and flow, in addition to improving ED overcrowding, would impact on clinically important processes within the ED, such as timely delivery of antibiotics. A single pre-implementation and post-implementation prospective cohort study was conducted prior to and after a hospital-wide reform (Timely Quality Care (TQC)). Among patients who had intravenous antibiotics prescribed in the ED, data were prospectively collected on times of presentation, prescription and administration of antibiotics. Demographics and discharge diagnoses were retrospectively extracted. There were 380 cases included with 179 cases prior to introduction of the TQC model and 201 cases after its introduction. Time from presentation to administration of antibiotics improved significantly from 192 (99-320) min to 142 (81-209) min (P < 0.01). The time from presentation to prescription pre-TQC and post-TQC was 120 (51-230) min and 92 (49-153) min, respectively (P < 0.01). The times from prescription to administration pre-TQC and post-TQC were 43 (20-83) min and 34 (15-66) min, respectively (P = 0.03). Following implementation of hospital-wide reform directed at mitigating ED overcrowding through improved access and flow, times to administration of antibiotics were significantly reduced. These findings suggest that improved quality of care in this area may be achieved with processes aimed at improved hospital access and flow. Ongoing evaluation and vigilance is necessary to ensure sustainability and drive further improvements. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Current Landscape of Telemedicine Practice in Inflammatory Bowel Disease.

PubMed

Patil, Seema A; Cross, Raymond K

2018-04-28

Inflammatory bowel disease (IBD), comprised of Crohn's disease and ulcerative colitis, affects 1.6 million people in the United States. Although effective medical treatments exist to treat the disease, outcomes are still suboptimal. The reasons for poor outcomes vary but include nonadherence to therapy, inadequate monitoring of patients, limited access to IBD specialty care, concurrent psychiatric disease, limited patient knowledge of the disease and treatments, and patient provider discordance. Telemedicine is a candidate intervention that can be used to improve patient outcomes through more frequent monitoring, patient self-management, delivery of education (patient and provider), and to increase access to multidisciplinary IBD care. Telemedicine includes remote monitoring, telehealth, teleconsultation, and teleconferencing.Telemedicine systems have been used in patients with IBD with widespread patient acceptance of the technology. However, early clinical trials demonstrated high attrition rates among intervention patients. In general, use of telemedicine systems have been associated with improved quality of life, improved patient knowledge, and decreased utilization of health care resources. Early studies evaluating telehealth visits report high patient satisfaction, decreased indirect costs to patients, and no decrease in quality of care delivered.Due to widespread access to computers and smart phones among patients, telemedicine will continue to expand in the care of patients with IBD. To optimize use and effectiveness of telemedicine, barriers for use including concerns over increased liability, need for informed consent, licensure restrictions to providing interstate telehealth visits, and cybersecurity need to be addressed.

Can Economic Model Transparency Improve Provider Interpretation of Cost-effectiveness Analysis? Evaluating Tradeoffs Presented by the Second Panel on Cost-effectiveness in Health and Medicine.

PubMed

Padula, William V; McQueen, Robert Brett; Pronovost, Peter J

2017-11-01

The Second Panel on Cost-Effectiveness in Health and Medicine convened on December 7, 2016 at the National Academy of Medicine to disseminate their recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses (CEAs). Following its summary, panel proceedings included lengthy discussions including the field's struggle to disseminate findings efficiently through peer-reviewed literature to target audiences. With editors of several medical and outcomes research journals in attendance, there was consensus that findings of cost-effectiveness analyses do not effectively reach other researchers or health care providers. The audience members suggested several solutions including providing additional training to clinicians in cost-effectiveness research and requiring that cost-effectiveness models are made publicly available. However, there remains the questions of whether making economic modelers' work open-access through journals is fair under the defense that these models remain one's own intellectual property, or whether journals can properly manage the peer-review process specifically for cost-effectiveness analyses. In this article, we elaborate on these issues and provide some suggested solutions that may increase the dissemination and application of cost-effectiveness literature to reach its intended audiences and ultimately benefit the patient. Ultimately, it is our combined view as economic modelers and clinicians that cost-effectiveness results need to reach the clinician to improve the efficiency of medical practice, but that open-access models do not improve clinician access or interpretation of the economics of medicine.

Health care access for rural youth on equal terms? A mixed methods study protocol in northern Sweden.

PubMed

Goicolea, Isabel; Carson, Dean; San Sebastian, Miguel; Christianson, Monica; Wiklund, Maria; Hurtig, Anna-Karin

2018-01-11

The purpose of this paper is to propose a protocol for researching the impact of rural youth health service strategies on health care access. There has been no published comprehensive assessment of the effectiveness of youth health strategies in rural areas, and there is no clearly articulated model of how such assessments might be conducted. The protocol described here aims to gather information to; i) Assess rural youth access to health care according to their needs, ii) Identify and understand the strategies developed in rural areas to promote youth access to health care, and iii) Propose actions for further improvement. The protocol is described with particular reference to research being undertaken in the four northernmost counties of Sweden, which contain a widely dispersed and diverse youth population. The protocol proposes qualitative and quantitative methodologies sequentially in four phases. First, to map youth access to health care according to their health care needs, including assessing horizontal equity (equal use of health care for equivalent health needs,) and vertical equity (people with greater health needs should receive more health care than those with lesser needs). Second, a multiple case study design investigates strategies developed across the region (youth clinics, internet applications, public health programs) to improve youth access to health care. Third, qualitative comparative analysis of the 24 rural municipalities in the region identifies the best combination of conditions leading to high youth access to health care. Fourth, a concept mapping study involving rural stakeholders, care providers and youth provides recommended actions to improve rural youth access to health care. The implementation of this research protocol will contribute to 1) generating knowledge that could contribute to strengthening rural youth access to health care, as well as to 2) advancing the application of mixed methods to explore access to health care.

Access to Care Under Physician Payment Reform: A Physician-Based Analysis

PubMed Central

Meadow, Ann

1995-01-01

This article reports physician-based measures of access to care during the 3 years surrounding the 1989 physician payment reforms. Analysis was facilitated by a new system of physician identifiers in Medicare claims. Access measures include caseload per physician and related measures of the demographic composition of physicians' clientele, the proportion of physicians performing surgical and other procedures, and the assignment rate. The caseload and assignment measures were stable or improving over time, suggesting that reforms did not harm access. Procedure performance rates tended to decline between 1992 and 1993, but reductions were inversely related to the estimated fee changes, and several may be explainable by other factors. PMID:10172615

Perceived and geographic food access and food security status among households with children.

PubMed

Ma, Xiaoguang; Liese, Angela D; Bell, Bethany A; Martini, Lauren; Hibbert, James; Draper, Carrie; Burke, Michael P; Jones, Sonya J

2016-10-01

To examine the association of both perceived and geographic neighbourhood food access with food security status among households with children. This was a cross-sectional study in which participants' perceptions of neighbourhood food access were assessed by a standard survey instrument, and geographic food access was evaluated by distance to the nearest supermarket. Multinomial logistic regression models were used to examine the associations. The Midlands Family Study included 544 households with children in eight counties in South Carolina, USA. Food security status among participants was classified into three categories: food secure (FS), food insecure (FI) and very low food security among children (VLFS-C). Compared with FS households, VLFS-C households had lower odds of reporting easy access to adequate food shopping. VLFS-C households also had lower odds of reporting neighbourhood access to affordable fruits and vegetables compared with FS households and reported worse selection of fruits and vegetables, quality of fruits and vegetables, and selection of low-fat products. FI households had lower odds of reporting fewer opportunities to purchase fast food. None of the geographic access measures was significantly associated with food security status. Caregivers with children who experienced hunger perceived that they had less access to healthy affordable food in their community, even though grocery stores were present. Approaches to improve perceived access to healthy affordable food should be considered as part of the overall approach to improving food security and eliminating child hunger.

Perceived and Geographic Food Access and Food Security Status among Households with Children

PubMed Central

Ma, Xiaoguang; Liese, Angela D.; Bell, Bethany; Martini, Lauren; Hibbert, James; Draper, Carrie; Jones, Sonya J.

2017-01-01

Objective To examine the association of both perceived and geographic neighborhood food access with food security status among households with children. Design This was a cross-sectional study in which participants’ perceptions of neighborhood food access were assessed by a standard survey instrument, and geographic food access was evaluated by distance to the nearest supermarket. Multinomial logistic regression models were used to examine the associations. Subjects The Midlands Family Study included 544 households with children in eight counties in South Carolina. Food security status among participants was classified into three categories: food secure (FS), food insecure (FI) and very low food security among children (VLFS-C). Results Compared to FS households, VLFS-C households had lower odds of reporting easy access to adequate food shopping. VLFS-C households also had lower odds of reporting neighborhood access to affordable fruits and vegetables compared to FS households and reported worse selection of fruits and vegetables, quality of fruits and vegetables and selection of low-fat products. FI households had lower odds of reporting fewer opportunities to purchase fast food. None of the geographic access measures was significantly associated with food security status. Conclusions Caregivers with children that experienced hunger perceived that they had less access to healthy affordably food in their community, even though grocery stores were present. Approaches to improve perceived access to healthy affordable food should be considered as part of the overall approach to improving food security and eliminating child hunger. PMID:27133939

Migration and health in an increasingly diverse Europe.

PubMed

Rechel, Bernd; Mladovsky, Philipa; Ingleby, David; Mackenbach, Johan P; McKee, Martin

2013-04-06

The share of migrants in European populations is substantial and growing, despite a slowdown in immigration after the global economic crisis. This paper describes key aspects of migration and health in Europe, including the scale of international migration, available data for migrant health, barriers to accessing health services, ways of improving health service provision to migrants, and migrant health policies that have been adopted across Europe. Improvement of migrant health and provision of access for migrants to appropriate health services is not without challenges, but knowledge about what steps need to be taken to achieve these aims is increasing. Copyright © 2013 Elsevier Ltd. All rights reserved.

Overcoming Challenges to Childhood Immunizations Status.

PubMed

Sabnis, Svapna S; Conway, James H

2015-10-01

Vaccines are one of the greatest public health achievements, preventing both mortality and morbidity. However, overall immunization rates are still below the 90% target for Healthy People 2020. There remain significant disparities in immunization rates between children of different racial/ethnic groups, as well as among economically disadvantaged populations. There are systemic issues and challenges in providing access to immunization opportunities. In addition, vaccine hesitancy contributes to underimmunization. Multiple strategies are needed to improve immunization rates, including improving access to vaccines and minimizing financial barriers to families. Vaccine status should be assessed and vaccines given at all possible opportunities. Copyright © 2015 Elsevier Inc. All rights reserved.

From the voices of women: facilitating survivor access to IPV services.

PubMed

Simmons, Catherine A; Farrar, Melissa; Frazer, Kitty; Thompson, Mary Jane

2011-10-01

This mixed-method study investigated perceptions women domestic violence survivors/victims have about why women do not seek help from formal support structures and actions domestic helping agencies can take to facilitate survivor access to services. Congruent with previous research, quantitative analysis identified 17 reasons women do not seek help from formal support structures. Expanding current knowledge, concept mapping revealed six ways family violence programs can better reach women in abusive relationships, including (1) remove barriers to services, (2) improve comfort with services, (3) "talk about it," (4) improve community awareness, (5) victim-targeted marketing, and (6) "I honestly don't know."

Computerized clinical documentation system in the pediatric intensive care unit

PubMed Central

2001-01-01

Background To determine whether a computerized clinical documentation system (CDS): 1) decreased time spent charting and increased time spent in patient care; 2) decreased medication errors; 3) improved clinical decision making; 4) improved quality of documentation; and/or 5) improved shift to shift nursing continuity. Methods Before and after implementation of CDS, a time study involving nursing care, medication delivery, and normalization of serum calcium and potassium values was performed. In addition, an evaluation of completeness of documentation and a clinician survey of shift to shift reporting were also completed. This was a modified one group, pretest-posttest design. Results With the CDS there was: improved legibility and completeness of documentation, data with better accessibility and accuracy, no change in time spent in direct patient care or charting by nursing staff. Incidental observations from the study included improved management functions of our nurse manager; improved JCAHO documentation compliance; timely access to clinical data (labs, vitals, etc); a decrease in time and resource use for audits; improved reimbursement because of the ability to reconstruct lost charts; limited human data entry by automatic data logging; eliminated costs of printing forms. CDS cost was reasonable. Conclusions When compared to a paper chart, the CDS provided a more legible, compete, and accessible patient record without affecting time spent in direct patient care. The availability of the CDS improved shift to shift reporting. Other observations showed that the CDS improved management capabilities; helped physicians deliver care; improved reimbursement; limited data entry errors; and reduced costs. PMID:11604105

AccessMRS: integrating OpenMRS with smart forms on Android.

PubMed

Fazen, Louis E; Chemwolo, Benjamin T; Songok, Julia J; Ruhl, Laura J; Kipkoech, Carolyne; Green, James M; Ikemeri, Justus E; Christoffersen-Deb, Astrid

2013-01-01

We present a new open-source Android application, AccessMRS, for interfacing with an electronic medical record system (OpenMRS) and loading 'Smart Forms' on a mobile device. AccessMRS functions as a patient-centered interface for viewing OpenMRS data; managing patient information in reminders, task lists, and previous encounters; and launching patient-specific 'Smart Forms' for electronic data collection and dissemination of health information. We present AccessMRS in the context of related software applications we developed to serve Community Health Workers, including AccessInfo, AccessAdmin, AccessMaps, and AccessForms. The specific features and design of AccessMRS are detailed in relationship to the requirements that drove development: the workflows of the Kenyan Ministry of Health Community Health Volunteers (CHVs) supported by the AMPATH Primary Health Care Program. Specifically, AccessMRS was designed to improve the quality of community-based Maternal and Child Health services delivered by CHVs in Kosirai Division. AccessMRS is currently in use by more than 80 CHVs in Kenya and undergoing formal assessment of acceptability, effectiveness, and cost.

What are the determinants of food security among regional and remote Western Australian children?

PubMed

Godrich, Stephanie L; Davies, Christina R; Darby, Jill; Devine, Amanda

2017-01-22

To explore how determinants of food security affect children in regional and remote Western Australia (WA), across food availability, access and utilisation dimensions. The Determinants of Food Security framework guided the thematic analysis (using NVivo 10) of semi-structured interviews with 20 key informants. Food availability factors included availability, price, promotion, quality, location of outlets and variety. Food access factors included social support, financial resources, transport to food outlets, distance to food outlets and mobility. Food utilisation factors included nutrition knowledge and skills, children's food preferences, storage facilities, preparation and cooking facilities and time to purchase food. Key food availability recommendations include increasing local food supply options. Food access recommendations include ensuring equitable formal social support and empowering informal support options. Food utilisation recommendations include prioritising food literacy programs focusing on quick, healthy food preparation and budgeting skills. Implications for public health: Policymakers should invest in local food supply options, equitable social support services and experiential food literacy programs. Practitioners should focus child/parent programs on improving attitude, knowledge and skills. © 2017 Public Health Association of Australia.

Predictors of nonfunctional arteriovenous access at hemodialysis initiation and timing of access creation: A registry-based study

PubMed Central

Metzger, Marie; Labeeuw, Michel; Ayav, Carole; Jacquelinet, Christian; Massy, Ziad A.; Stengel, Bénédicte

2017-01-01

Determinants of nonfunctional arteriovenous (AV) access, including timing of AV access creation, have not been sufficiently described. We studied 29 945 patients who had predialysis AV access placement and were included in the French REIN registry from 2005 through 2013. AV access was considered nonfunctional when dialysis began with a catheter. We estimated crude and adjusted odds ratio (OR) with 95% confidence intervals (CI) of nonfunctional versus functional AV access associated with case-mix, facility characteristics, and timing of AV access creation. Analyses were stratified by dialysis start condition (planned or as an emergency) and comorbidity profile. Overall, 18% patients had nonfunctional AV access at hemodialysis initiation. In the group with planned dialysis start, female gender (OR 1.43, 95% CI 1.32–1.56), diabetes (OR 1.28, 95% CI 1.15–1.44), and a higher number of cardiovascular comorbidities (OR 1.27, 95% CI 1.09–1.49, and 1.31, 1.05–1.64, for 3 and >3 cardiovascular comorbidities versus none, respectively) were independent predictors of nonfunctional AV access. A higher percentage of AV access creation at the region level was associated with a lower rate of nonfunctional AV access (OR 0.98, 95% CI 0.98–0.99 per 1% increase). The odds of nonfunctional AV access decreased as time from creation to hemodialysis initiation increased up to 3 months in nondiabetic patients with fewer than 2 cardiovascular comorbidities and 6 months in patients with diabetes or 2 or more such comorbidities. In conclusion, both patient characteristics and clinical practices may play a role in successful AV access use at hemodialysis initiation. Adjusting the timing of AV access creation to patients’ comorbidity profiles may improve functional AV access rates. PMID:28749967

Predictors of nonfunctional arteriovenous access at hemodialysis initiation and timing of access creation: A registry-based study.

PubMed

Alencar de Pinho, Natalia; Coscas, Raphael; Metzger, Marie; Labeeuw, Michel; Ayav, Carole; Jacquelinet, Christian; Massy, Ziad A; Stengel, Bénédicte

2017-01-01

Determinants of nonfunctional arteriovenous (AV) access, including timing of AV access creation, have not been sufficiently described. We studied 29 945 patients who had predialysis AV access placement and were included in the French REIN registry from 2005 through 2013. AV access was considered nonfunctional when dialysis began with a catheter. We estimated crude and adjusted odds ratio (OR) with 95% confidence intervals (CI) of nonfunctional versus functional AV access associated with case-mix, facility characteristics, and timing of AV access creation. Analyses were stratified by dialysis start condition (planned or as an emergency) and comorbidity profile. Overall, 18% patients had nonfunctional AV access at hemodialysis initiation. In the group with planned dialysis start, female gender (OR 1.43, 95% CI 1.32-1.56), diabetes (OR 1.28, 95% CI 1.15-1.44), and a higher number of cardiovascular comorbidities (OR 1.27, 95% CI 1.09-1.49, and 1.31, 1.05-1.64, for 3 and >3 cardiovascular comorbidities versus none, respectively) were independent predictors of nonfunctional AV access. A higher percentage of AV access creation at the region level was associated with a lower rate of nonfunctional AV access (OR 0.98, 95% CI 0.98-0.99 per 1% increase). The odds of nonfunctional AV access decreased as time from creation to hemodialysis initiation increased up to 3 months in nondiabetic patients with fewer than 2 cardiovascular comorbidities and 6 months in patients with diabetes or 2 or more such comorbidities. In conclusion, both patient characteristics and clinical practices may play a role in successful AV access use at hemodialysis initiation. Adjusting the timing of AV access creation to patients' comorbidity profiles may improve functional AV access rates.

Barriers to access to education for young people with epilepsy in Northern Tanzania: A qualitative interview and focus group study involving teachers, parents and young people with epilepsy.

PubMed

Quereshi, Charlotte; Standing, Holly C; Swai, Amina; Hunter, Ewan; Walker, Richard; Owens, Stephen

2017-07-01

Educational outcomes for young people with epilepsy (YPE) in Hai District, Tanzania, are poor, as is commonly observed elsewhere in Sub-Saharan Africa. The reasons for this finding are not well understood, though stigma arising from supernatural concepts of epilepsy is frequently cited as a barrier to YPE accessing education. In this study, we aimed to explore the reasons why many YPE in Tanzania experience poor access to education, and elicit ways in which education could be improved for YPE according to teachers, parents and YPE. Ten focus group discussions with teachers were organized in Hai schools between March and May 2016. The themes arising from these discussions were identified, coded, analyzed and tested in semi-structured interviews with 19 YPE and 17 parents identified from a prevalent cohort of YPE identified in 2009. Behavioral problems and learning difficulties were cited as the main barriers to education for YPE. Other barriers included parental stigmatization, teachers' inadequate seizure management, and limited access to specialist schools. Teachers perceived that parents and YPE believe in spiritual etiology and traditional management for epilepsy. However, the majority of teachers, parents, and YPE cited biological etiology and management options, although understanding of epilepsy etiology and management could be improved amongst all groups. A multidimensional approach is needed to improve educational access, and hence outcomes, for YPE. Widespread community education is needed to improve knowledge of epilepsy etiology and management. Teachers require seizure management training, and parents need help to recognize YPE's right to education. Educational needs assessments would help to identify YPE requiring specialist schooling, and access to this could be improved. These interventions will likely reduce stigma, ensure appropriate academic and pastoral care at school, and thus enable YPE to attend, and succeed, in education. Copyright © 2017 Elsevier Inc. All rights reserved.

Study of the Feasibility of a NAEP Mathematics Accessible Block Alternative

ERIC Educational Resources Information Center

DeStefano, Lizanne; Johnson, Jeremiah

2013-01-01

This paper describes one of the first efforts by the National Assessment of Educational Progress (NAEP) to improve measurement at the lower end of the distribution, including measurement for students with disabilities (SD) and English language learners (ELLs). One way to improve measurement at the lower end is to introduce one or more…

Development of a Web-Enabled Learning Platform for Geospatial Laboratories: Improving the Undergraduate Learning Experience

ERIC Educational Resources Information Center

Mui, Amy B.; Nelson, Sarah; Huang, Bruce; He, Yuhong; Wilson, Kathi

2015-01-01

This paper describes a web-enabled learning platform providing remote access to geospatial software that extends the learning experience outside of the laboratory setting. The platform was piloted in two undergraduate courses, and includes a software server, a data server, and remote student users. The platform was designed to improve the quality…

Seizing the Moment: Community Colleges Collaborating with K-12 to Improve Student Success

ERIC Educational Resources Information Center

American Association of Community Colleges, 2016

2016-01-01

With the national spotlight on community colleges, the sector has a unique opportunity to seize the moment and collaborate with K-12 to increase student success. Efforts to increase community college access and open doors to more students must include a complementary focus on improving readiness. Otherwise, remediation rates will remain…

“Nothing About Me Without Me”: An Interpretative Review of Patient Accessible Electronic Health Records

PubMed Central

Callahan, Ryan; Sevdalis, Nick; Mayer, Erik K; Darzi, Ara

2015-01-01

Background Patient accessible electronic health records (PAEHRs) enable patients to access and manage personal clinical information that is made available to them by their health care providers (HCPs). It is thought that the shared management nature of medical record access improves patient outcomes and improves patient satisfaction. However, recent reviews have found that this is not the case. Furthermore, little research has focused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers. Objective We provide a systematic review of reviews of the impact of giving patients record access from both a patient and HCP point of view. The review covers a broad range of outcome measures, including patient safety, patient satisfaction, privacy and security, self-efficacy, and health outcome. Methods A systematic search was conducted using Web of Science to identify review articles on the impact of PAEHRs. Our search was limited to English-language reviews published between January 2002 and November 2014. A total of 73 citations were retrieved from a series of Boolean search terms including “review*” with “patient access to records”. These reviews went through a novel scoring system analysis whereby we calculated how many positive outcomes were reported per every outcome measure investigated. This provided a way to quantify the impact of PAEHRs. Results Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well as HCPs were found but eight were included for the analysis of outcome measures. We found mixed outcomes across both patient and HCP groups, with approximately half of the reviews showing positive changes with record access. Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered. Nurses are more likely than physicians to gain time efficiencies by using a PAEHR system with the main concern from physicians being the security of the PAEHRs. Conclusions This review implements a novel scoring system, which shows there is a lack of rigorous empirical testing that separates the effect of record access from other existing disease management programs. Current research is too targeted within certain clinical groups’ needs, and although there are positive signs for the adoption of PAEHRs, there is currently insufficient evidence about the effect of PAEHRs on health outcomes for patients or HCPs. PMID:26123476

Study of optoelectronic switch for satellite-switched time-division multiple access

NASA Technical Reports Server (NTRS)

Su, Shing-Fong; Jou, Liz; Lenart, Joe

1987-01-01

The use of optoelectronic switching for satellite switched time division multiple access will improve the isolation and reduce the crosstalk of an IF switch matrix. The results are presented of a study on optoelectronic switching. Tasks include literature search, system requirements study, candidate switching architecture analysis, and switch model optimization. The results show that the power divided and crossbar switching architectures are good candidates for an IF switch matrix.

Assessing Impacts on Unplanned Hospitalisations of Care Quality and Access Using a Structural Equation Method: With a Case Study of Diabetes

PubMed Central

Congdon, Peter

2016-01-01

Background: Enhanced quality of care and improved access are central to effective primary care management of long term conditions. However, research evidence is inconclusive in establishing a link between quality of primary care, or access, and adverse outcomes, such as unplanned hospitalisation. Methods: This paper proposes a structural equation model for quality and access as latent variables affecting adverse outcomes, such as unplanned hospitalisations. In a case study application, quality of care (QOC) is defined in relation to diabetes, and the aim is to assess impacts of care quality and access on unplanned hospital admissions for diabetes, while allowing also for socio-economic deprivation, diabetes morbidity, and supply effects. The study involves 90 general practitioner (GP) practices in two London Clinical Commissioning Groups, using clinical quality of care indicators, and patient survey data on perceived access. Results: As a single predictor, quality of care has a significant negative impact on emergency admissions, and this significant effect remains when socio-economic deprivation and morbidity are allowed. In a full structural equation model including access, the probability that QOC negatively impacts on unplanned admissions exceeds 0.9. Furthermore, poor access is linked to deprivation, diminished QOC, and larger list sizes. Conclusions: Using a Bayesian inference methodology, the evidence from the analysis is weighted towards negative impacts of higher primary care quality and improved access on unplanned admissions. The methodology of the paper is potentially applicable to other long term conditions, and relevant when care quality and access cannot be measured directly and are better regarded as latent variables. PMID:27598184

Assessing Impacts on Unplanned Hospitalisations of Care Quality and Access Using a Structural Equation Method: With a Case Study of Diabetes.

PubMed

Congdon, Peter

2016-09-01

Enhanced quality of care and improved access are central to effective primary care management of long term conditions. However, research evidence is inconclusive in establishing a link between quality of primary care, or access, and adverse outcomes, such as unplanned hospitalisation. This paper proposes a structural equation model for quality and access as latent variables affecting adverse outcomes, such as unplanned hospitalisations. In a case study application, quality of care (QOC) is defined in relation to diabetes, and the aim is to assess impacts of care quality and access on unplanned hospital admissions for diabetes, while allowing also for socio-economic deprivation, diabetes morbidity, and supply effects. The study involves 90 general practitioner (GP) practices in two London Clinical Commissioning Groups, using clinical quality of care indicators, and patient survey data on perceived access. As a single predictor, quality of care has a significant negative impact on emergency admissions, and this significant effect remains when socio-economic deprivation and morbidity are allowed. In a full structural equation model including access, the probability that QOC negatively impacts on unplanned admissions exceeds 0.9. Furthermore, poor access is linked to deprivation, diminished QOC, and larger list sizes. Using a Bayesian inference methodology, the evidence from the analysis is weighted towards negative impacts of higher primary care quality and improved access on unplanned admissions. The methodology of the paper is potentially applicable to other long term conditions, and relevant when care quality and access cannot be measured directly and are better regarded as latent variables.

Encouraging Consumption of Water in School and Child Care Settings: Access, Challenges, and Strategies for Improvement

PubMed Central

Hampton, Karla E.

2011-01-01

Children and adolescents are not consuming enough water, instead opting for sugar-sweetened beverages (sodas, sports and energy drinks, milks, coffees, and fruit-flavored drinks with added sugars), 100% fruit juice, and other beverages. Drinking sufficient amounts of water can lead to improved weight status, reduced dental caries, and improved cognition among children and adolescents. Because children spend most of their day at school and in child care, ensuring that safe, potable drinking water is available in these settings is a fundamental public health measure. We sought to identify challenges that limit access to drinking water; opportunities, including promising practices, to increase drinking water availability and consumption; and future research, policy efforts, and funding needed in this area. PMID:21680941

Cilostazol May Improve Maturation Rates and Durability of Vascular Access for Hemodialysis.

PubMed

Russell, Todd E; Kasper, Gregory C; Seiwert, Andrew J; Comerota, Anthony J; Lurie, Fedor

2017-04-01

Cilostazol is effective in controlling pathophysiological pathways similar or identical to those involved in nonmaturation and failure of the arteriovenous access. This case-control study examined whether cilostazol would improve maturation rates and durability of vascular access for hemodialysis. The treatment group included 33 patients who received cilostazol for ≥30 days prior to creation of a dialysis access and continued with cilostazol therapy for ≥60 days after surgery. The matched (gender, age, race, diabetes, and the year of surgery) control group included 116 patients who underwent the same procedure but did not receive cilostazol prior to and at least 3 months after surgery. Primary outcomes were maturation and, for those that matured, time of functioning access, defined as the time from the first use to irreparable failure of the access. Secondary outcomes were time to maturation, complications, and time to first complication. Study group patients were 3.8 times more likely to experience fistula maturation compared to the controls (88% vs 66%, RR = 3.8, 95% confidence interval: 1.3-11.6, P = .016). Fewer patients in the study group had complications (76% vs 92%, P = .025), and the time from construction of the fistula to the first complication was longer (345.6 ± 441 days vs 198.3 ± 185.0 days, P = .025). Time to maturation was similar in both groups (119.3 ± 62.9 days vs 100.2 ± 61.7 days, P = .2). However, once matured, time to failure was significantly longer in the treatment group (903.7 ± 543.6 vs 381.6 ± 317.2 days, P = .001). Multivariate analysis confirmed that the likelihood of maturation was significantly higher in the treatment group patients. These results suggest that dialysis access patients may benefit from preoperative and postoperative cilostazol therapy. If confirmed by a randomized trial, this treatment will have a major beneficial impact on patients dependent on a well-functioning access for their hemodialysis.

Mapping actions to improve access to medicines for mental disorders in low and middle income countries.

PubMed

Barbui, C; Dua, T; Kolappa, K; Saraceno, B; Saxena, S

2017-10-01

In recent years a number of intergovernmental initiatives have been activated in order to enhance the capacity of countries to improve access to essential medicines, particularly for mental disorders. In May 2013 the 66th World Health Assembly adopted the World Health Organization (WHO) Comprehensive Mental Health Action Plan 2013-2020, which builds upon the work of WHO's Mental Health Gap Action Programme. Within this programme, evidence-based guidelines for mental disorders were developed, including recommendations on appropriate use of medicines. Subsequently, the 67th World Health Assembly adopted a resolution on access to essential medicines, which urged Member States to improve national policies for the selection of essential medicines and to promote their availability, affordability and appropriate use. Following the precedent set by these important initiatives, this article presents eleven actions for improving access and appropriate use of psychotropic medicines. A 4 × 4 framework mapping actions as a function of the four components of access - selection, availability, affordability and appropriate use - and across four different health care levels, three of which belong to the supply side and one to the demand side, was developed. The actions are: developing a medicine selection process; promoting information and education activities for staff and end-users; developing a medicine regulation process; implementing a reliable supply system; implementing a reliable quality-control system; developing a community-based system of mental health care and promoting help-seeking behaviours; developing international agreements on medicine affordability; developing pricing policies and a sustainable financing system; developing or adopting evidence-based guidelines; monitoring the use of psychotropic medicines; promoting training initiatives for staff and end-users on critical appraisal of scientific evidence and appropriate use of psychotropic medicines. Activating these actions offers an unique opportunity to address the broader issue of increasing access to treatments and care for mental disorders, as current lack of attention to mental disorders is a central barrier across all domains of the 4 × 4 access framework.

Discrimination and Other Barriers to Accessing Health Care: Perspectives of Patients with Mild and Moderate Intellectual Disability and Their Carers

PubMed Central

Ali, Afia; Scior, Katrina; Ratti, Victoria; Strydom, Andre; King, Michael; Hassiotis, Angela

2013-01-01

Background People with intellectual disability have a higher prevalence of physical health problems but often experience disparities in accessing health care. In England, a number of legislative changes, policies and recommendations have been introduced to improve health care access for this population. The aim of this qualitative study was to examine the extent to which patients with intellectual disability and their carers experience discrimination or other barriers in accessing health services, and whether health care experiences have improved over the last decade years. Method and Main Findings Twenty nine participants (14 patient and carer dyads, and one carer) took part in semi-structured interviews. The interviews were audio-taped and transcribed and analysed using thematic analysis. Eight themes were identified. Half the participants thought that the patient had been treated unfairly or had been discriminated against by health services. There were accounts of negative staff attitudes and behaviour, and failure of services to make reasonable adjustments. Other barriers included problems with communication, and accessing services because of lack of knowledge of local services and service eligibility issues; lack of support and involvement of carers; and language problems in participants from minority ethnic groups. Most participants were able to report at least one example of good practice in health care provision. Suggestions for improving services are presented. Conclusion Despite some improvements to services as a result of health policies and recommendations, more progress is required to ensure that health services make reasonable adjustments to reduce both direct and indirect discrimination of people with intellectual disability. PMID:23951026

Human rights approach to maternal & child health: has India fared well?

PubMed

Ram, F; Singh, Abhishek; Ram, Usha

2013-04-01

The objectives of the study were to examine: right to access maternal health; right to access child health; and right to access improved water and sanitation in India. We used large-scale data sets like District Level Household Survey conducted in 2007-08 and National Family Health Surveys conducted during 1992-93, 1998-99, and 2005-06 to fulfil the objectives. The selection of the indicator variables was guided by the Human Rights' Framework for Health and Convention of the Rights of the Child- Articles 7, 24 and 27. We used univariate and bivariate analysis along with ratio of access among non-poor to access among poor to fulfil the objectives. Evidence clearly suggested gross violation of human rights starting from the birth of an individual. Even after 60 years of independence, significant proportions of women and children do not have access to basic services like improved drinking water and sanitation. There were enormous socio-economic and residence related inequalities in maternal and child health indicators included in the study. These inequalities were mostly to the disadvantage of the poor. The fulfilment of the basic human rights of women and children is likely to pay dividends in many other domains related to overall population and health in India.

Human rights approach to maternal & child health: Has India fared well?

PubMed Central

Ram, F.; Singh, Abhishek; Ram, Usha

2013-01-01

Background & objectives: The objectives of the study were to examine: right to access maternal health; right to access child health; and right to access improved water and sanitation in India. Methods: We used large-scale data sets like District Level Household Survey conducted in 2007-08 and National Family Health Surveys conducted during 1992-93, 1998-99, and 2005-06 to fulfil the objectives. The selection of the indicator variables was guided by the Human Rights’ Framework for Health and Convention of the Rights of the Child- Articles 7, 24 and 27. We used univariate and bivariate analysis along with ratio of access among non-poor to access among poor to fulfil the objectives. Results: Evidence clearly suggested gross violation of human rights starting from the birth of an individual. Even after 60 years of independence, significant proportions of women and children do not have access to basic services like improved drinking water and sanitation. Interpretation & conclusions: There were enormous socio-economic and residence related inequalities in maternal and child health indicators included in the study. These inequalities were mostly to the disadvantage of the poor. The fulfilment of the basic human rights of women and children is likely to pay dividends in many other domains related to overall population and health in India. PMID:23703339

DMSP SSJ4 Data Restoration, Classification, and On-Line Data Access

NASA Technical Reports Server (NTRS)

Wing, Simon; Bredekamp, Joseph H. (Technical Monitor)

2000-01-01

Compress and clean raw data file for permanent storage We have identified various error conditions/types and developed algorithms to get rid of these errors/noises, including the more complicated noise in the newer data sets. (status = 100% complete). Internet access of compacted raw data. It is now possible to access the raw data via our web site, http://www.jhuapl.edu/Aurora/index.html. The software to read and plot the compacted raw data is also available from the same web site. The users can now download the raw data, read, plot, or manipulate the data as they wish on their own computer. The users are able to access the cleaned data sets. Internet access of the color spectrograms. This task has also been completed. It is now possible to access the spectrograms from the web site mentioned above. Improve the particle precipitation region classification. The algorithm for doing this task has been developed and implemented. As a result, the accuracies improved. Now the web site routinely distributes the results of applying the new algorithm to the cleaned data set. Mark the classification region on the spectrograms. The software to mark the classification region in the spectrograms has been completed. This is also available from our web site.

PDBe: improved accessibility of macromolecular structure data from PDB and EMDB

PubMed Central

Velankar, Sameer; van Ginkel, Glen; Alhroub, Younes; Battle, Gary M.; Berrisford, John M.; Conroy, Matthew J.; Dana, Jose M.; Gore, Swanand P.; Gutmanas, Aleksandras; Haslam, Pauline; Hendrickx, Pieter M. S.; Lagerstedt, Ingvar; Mir, Saqib; Fernandez Montecelo, Manuel A.; Mukhopadhyay, Abhik; Oldfield, Thomas J.; Patwardhan, Ardan; Sanz-García, Eduardo; Sen, Sanchayita; Slowley, Robert A.; Wainwright, Michael E.; Deshpande, Mandar S.; Iudin, Andrii; Sahni, Gaurav; Salavert Torres, Jose; Hirshberg, Miriam; Mak, Lora; Nadzirin, Nurul; Armstrong, David R.; Clark, Alice R.; Smart, Oliver S.; Korir, Paul K.; Kleywegt, Gerard J.

2016-01-01

The Protein Data Bank in Europe (http://pdbe.org) accepts and annotates depositions of macromolecular structure data in the PDB and EMDB archives and enriches, integrates and disseminates structural information in a variety of ways. The PDBe website has been redesigned based on an analysis of user requirements, and now offers intuitive access to improved and value-added macromolecular structure information. Unique value-added information includes lists of reviews and research articles that cite or mention PDB entries as well as access to figures and legends from full-text open-access publications that describe PDB entries. A powerful new query system not only shows all the PDB entries that match a given query, but also shows the ‘best structures’ for a given macromolecule, ligand complex or sequence family using data-quality information from the wwPDB validation reports. A PDBe RESTful API has been developed to provide unified access to macromolecular structure data available in the PDB and EMDB archives as well as value-added annotations, e.g. regarding structure quality and up-to-date cross-reference information from the SIFTS resource. Taken together, these new developments facilitate unified access to macromolecular structure data in an intuitive way for non-expert users and support expert users in analysing macromolecular structure data. PMID:26476444

What Are the Factors Influencing Implementation of Advanced Access in Family Medicine Units? A Cross-Case Comparison of Four Early Adopters in Quebec

PubMed Central

Touati, Nassera; Maillet, Lara; Gaboury, Isabelle

2017-01-01

Introduction Advanced access is an organizational model that has shown promise in improving timely access to primary care. In Quebec, it has recently been introduced in several family medicine units (FMUs) with a teaching mission. The objectives of this paper are to analyze the principles of advanced access implemented in FMUs and to identify which factors influenced their implementation. Methods A multiple case study of four purposefully selected FMUs was conducted. Data included document analysis and 40 semistructured interviews with health professionals and staff. Cross-case comparison and thematic analysis were performed. Results Three out of four FMUs implemented the key principles of advanced access at various levels. One scheduling pattern was observed: 90% of open appointment slots over three- to four-week periods and 10% of prebooked appointments. Structural and organizational factors facilitated the implementation: training of staff to support change, collective leadership, and openness to change. Conversely, family physicians practicing in multiple clinical settings, lack of team resources, turnover of clerical staff, rotation of medical residents, and management capacity were reported as major barriers to implementing the model. Conclusion Our results call for multilevel implementation strategies to improve the design of the advanced access model in academic teaching settings. PMID:28775899

Access to pasture for dairy cows: responses from an online engagement.

PubMed

Schuppli, C A; von Keyserlingk, M A G; Weary, D M

2014-11-01

An online engagement exercise documented the views of Canadian and U.S. participants affiliated and unaffiliated with the dairy industry on the issue of pasture access for dairy cows. A total of 414 people participated in 10 independent web forums. Providing access to more natural living conditions, including pasture, was viewed as important for the large majority of participants, including those affiliated with the dairy industry. This finding is at odds with current practice on the majority of farms in North America that provide little or no access to pasture. Participant comments showed that the perceived value of pasture access for dairy cattle went beyond the benefits of eating grass; participants cited as benefits exposure to fresh air, ability to move freely, ability to live in social groups, improved health, and healthier milk products. To accommodate the challenges of allowing pasture access on farms, some participants argued in favor of hybrid systems that provide a mixture of indoor confinement housing and grazing. Understanding the beliefs and concerns of participants affiliated and unaffiliated with the dairy industry allows for the identification of contentious topics as well as areas of agreement; this is important in efforts to better harmonize industry practices with societal expectations.

Youth suicide prevention: does access to care matter?

PubMed

Campo, John V

2009-10-01

Recent increases in adolescent suicide rates after a decade of decline highlight the relevance of pediatric suicide prevention. Existing strategies to intervene with youth at risk for suicide are largely based on the premise that access to effective services is of critical importance. This review aims to examine the relationship between youth suicide and access to care. Promising reductions in suicidal thinking and behavior have been associated with the application of manualized psychotherapies, collaborative interventions in primary care, lithium for mood-disordered adults, and clozapine in schizophrenia. Suicide rates correlate inversely with indices of care access across the lifespan, including antidepressant prescription rates. Suicide is a preventable cause of death, and any public health relevant effort to prevent youth suicide must include improving access to effective care for at-risk youth as a strategy. Education and training of professionals and consumers, the integration of mental health services in primary care, and the use of novel technologies to track and maintain contact with at-risk youth are worthy of study. Additional research on the relationship between specific treatments, especially antidepressants, and youth suicide risk reduction is desperately needed.

Healthcare provider perspectives on barriers to HIV-care access and utilisation among Latinos living with HIV in the US-Mexico border.

PubMed

Servin, Argentina E; Muñoz, Fátima A; Zúñiga, María Luisa

2014-01-01

Latinos living with HIV residing in the US-Mexico border region frequently seek care on both sides of the border. Given this fact, a border health perspective to understanding barriers to care is imperative to improve patient health outcomes. This qualitative study describes and compares experiences and perceptions of Mexican and US HIV care providers regarding barriers to HIV care access for Latino patients living in the US-Mexico border region. In 2010, we conducted in-depth qualitative interviews with HIV care providers in Tijuana (n = 10) and San Diego (n = 9). We identified important similarities and differences between Mexican and US healthcare provider perspectives on HIV care access and barriers to service utilisation. Similarities included the fact that HIV-positive Latino patients struggle with access to ART medication, mental health illness, substance abuse and HIV-related stigma. Differences included Mexican provider perceptions of medication shortages and US providers feeling that insurance gaps influenced medication access. Differences and similarities have important implications for cross-border efforts to coordinate health services for patients who seek care in both countries.

Acceptable Care? Illness Constructions, Healthworlds, and Accessible Chronic Treatment in South Africa

PubMed Central

Harris, Bronwyn; Eyles, John; Moshabela, Mosa

2015-01-01

Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas—conversely—these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating “disease” to responding to “illness” by acknowledging and incorporating patients’ healthworlds in patient–provider interactions. PMID:25829509

Perspectives of People Living with HIV on Access to Health Care: Protocol for a Scoping Review

PubMed Central

Maybank, Allison; Hurley, Oliver; Modir, Hilary; Farrell, Alison; Marshall, Zack; Kendall, Claire; Johnston, Sharon; Hogel, Matthew; Rourke, Sean B; Liddy, Clare

2016-01-01

Background Strategies to improve access to health care for people living with human immunodeficiency virus (PLHIV) have demonstrated limited success. Whereas previous approaches have been informed by the views of health providers and decision-makers, it is believed that incorporating patient perspectives into the design and evaluations of health care programs will lead to improved access to health care services. Objective We aim to map the literature on the perspectives of PLHIV concerning access to health care services, to identify gaps in evidence, and to produce an evidence-informed research action plan to guide the Living with HIV program of research. Methods This scoping review includes peer-reviewed and grey literature from 1946 to May 2014 using double data extraction. Variations of the search terms “HIV”, “patient satisfaction”, and “health services accessibility” are used to identify relevant literature. The search strategy is being developed in consultation with content experts, review methodologists, and a librarian, and validated using gold standard studies identified by those stakeholders. The inclusion criteria are (1) the study includes the perspectives of PLHIV, (2) study design includes qualitative, quantitative, or mixed methods, and (3) outcome measures are limited to patient satisfaction, their implied needs, beliefs, and desires in relation to access to health care. The papers are extracted by two independent reviewers, including quality assessment. Data is then collated, summarized, and thematically analyzed. Results A total of 12,857 references were retrieved, of which 326 documents were identified as eligible in pre-screening, and 64 articles met the inclusion criteria (56% qualitative studies, 38% quantitative studies and 6% mixed-method studies). Only four studies were conducted in Canada. Data synthesis is in progress and full results are expected in June, 2016. Conclusions This scoping review will record and characterize the extensive body of literature on perspectives of PLHIV regarding access to health care. A literature repository will be developed to assist stakeholders, decision-makers, and PLHIV in developing and implementing patient-oriented health care programs. PMID:27193076

Remotely Sensed Imagery from USGS: Update on Products and Portals

NASA Astrophysics Data System (ADS)

Lamb, R.; Lemig, K.

2016-12-01

The USGS Earth Resources Observation and Science (EROS) Center has recently implemented a number of additions and changes to its existing suite of products and user access systems. Together, these changes will enhance the accessibility, breadth, and usability of the remotely sensed image products and delivery mechanisms available from USGS. As of late 2016, several new image products are now available for public download at no charge from USGS/EROS Center. These new products include: (1) global Level 1T (precision terrain-corrected) products from Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER), provided via NASA's Land Processes Distributed Active Archive Center (LP DAAC); and (2) Sentinel-2 Multispectral Instrument (MSI) products, available through a collaborative effort with the European Space Agency (ESA). Other new products are also planned to become available soon. In an effort to enable future scientific analysis of the full 40+ year Landsat archive, the USGS also introduced a new "Collection Management" strategy for all Landsat Level 1 products. This new archive and access schema involves quality-based tier designations that will support future time series analysis of the historic Landsat archive at the pixel level. Along with the quality tier designations, the USGS has also implemented a number of other Level 1 product improvements to support Landsat science applications, including: enhanced metadata, improved geometric processing, refined quality assessment information, and angle coefficient files. The full USGS Landsat archive is now being reprocessed in accordance with the new `Collection 1' specifications. Several USGS data access and visualization systems have also seen major upgrades. These user interfaces include a new version of the USGS LandsatLook Viewer which was released in Fall 2017 to provide enhanced functionality and Sentinel-2 visualization and access support. A beta release of the USGS Global Visualization Tool ("GloVis Next") was also released in Fall 2017, with many new features including data visualization at full resolution. The USGS also introduced a time-enabled web mapping service (WMS) to support time-based access to the existing LandsatLook "natural color" full-resolution browse image services.

Test-Enhanced Learning in an Immunology and Infectious Disease Medicinal Chemistry/Pharmacology Course.

PubMed

Hernick, Marcy

2015-09-25

Objective. To develop a series of active-learning modules that would improve pharmacy students' performance on summative assessments. Design. A series of optional online active-learning modules containing questions with multiple formats for topics in a first-year (P1) course was created using a test-enhanced learning approach. A subset of module questions was modified and included on summative assessments. Assessment. Student performance on module questions improved with repeated attempts and was predictive of student performance on summative assessments. Performance on examination questions was higher for students with access to modules than for those without access to modules. Module use appeared to have the most impact on low performing students. Conclusion. Test-enhanced learning modules with immediate feedback provide pharmacy students with a learning tool that improves student performance on summative assessments and also may improve metacognitive and test-taking skills.

Test-Enhanced Learning in an Immunology and Infectious Disease Medicinal Chemistry/Pharmacology Course

PubMed Central

2015-01-01

Objective. To develop a series of active-learning modules that would improve pharmacy students’ performance on summative assessments. Design. A series of optional online active-learning modules containing questions with multiple formats for topics in a first-year (P1) course was created using a test-enhanced learning approach. A subset of module questions was modified and included on summative assessments. Assessment. Student performance on module questions improved with repeated attempts and was predictive of student performance on summative assessments. Performance on examination questions was higher for students with access to modules than for those without access to modules. Module use appeared to have the most impact on low performing students. Conclusion. Test-enhanced learning modules with immediate feedback provide pharmacy students with a learning tool that improves student performance on summative assessments and also may improve metacognitive and test-taking skills. PMID:27168610

Survey Instruments to Assess Patient Experiences With Access and Coordination Across Health Care Settings: Available and Needed Measures.

PubMed

Quinn, Martha; Robinson, Claire; Forman, Jane; Krein, Sarah L; Rosland, Ann-Marie

2017-07-01

Improving access can increase the providers a patient sees, and cause coordination challenges. For initiatives that increase care across health care settings, measuring patient experiences with access and care coordination will be crucial. Map existing survey measures of patient experiences with access and care coordination expected to be relevant to patients accessing care across settings. Preliminarily examine whether aspects of access and care coordination important to patients are represented by existing measures. Structured literature review of domains and existing survey measures related to access and care coordination across settings. Survey measures, and preliminary themes from semistructured interviews of 10 patients offered VA-purchased Community Care, were mapped to identified domains. We identified 31 existing survey instruments with 279 items representing 6 access and 5 care coordination domains relevant to cross-system care. Domains frequently assessed by existing measures included follow-up coordination, primary care access, cross-setting coordination, and continuity. Preliminary issues identified in interviews, but not commonly assessed by existing measures included: (1) acceptability of distance to care site given patient's clinical situation; (2) burden on patients to access and coordinate care and billing; (3) provider familiarity with Veteran culture and VA processes. Existing survey instruments assess many aspects of patient experiences with access and care coordination in cross-system care. Systems assessing cross-system care should consider whether patient surveys accurately reflect the level of patients' concerns with burden to access and coordinate care, and adequately reflect the impact of clinical severity and cultural familiarity on patient preferences.

Genome-wide characterization of genetic diversity and population structure in Secale

PubMed Central

2014-01-01

Background Numerous rye accessions are stored in ex situ genebanks worldwide. Little is known about the extent of genetic diversity contained in any of them and its relation to contemporary varieties, since to date rye genetic diversity studies had a very limited scope, analyzing few loci and/ or few accessions. Development of high throughput genotyping methods for rye opened the possibility for genome wide characterizations of large accessions sets. In this study we used 1054 Diversity Array Technology (DArT) markers with defined chromosomal location to characterize genetic diversity and population structure in a collection of 379 rye accessions including wild species, landraces, cultivated materials, historical and contemporary rye varieties. Results Average genetic similarity (GS) coefficients and average polymorphic information content (PIC) values varied among chromosomes. Comparison of chromosome specific average GS within and between germplasm sub-groups indicated regions of chromosomes 1R and 4R as being targeted by selection in current breeding programs. Bayesian clustering, principal coordinate analysis and Neighbor Joining clustering demonstrated that source and improvement status contributed significantly to the structure observed in the analyzed set of Secale germplasm. We revealed a relatively limited diversity in improved rye accessions, both historical and contemporary, as well as lack of correlation between clustering of improved accessions and geographic origin, suggesting common genetic background of rye accessions from diverse geographic regions and extensive germplasm exchange. Moreover, contemporary varieties were distinct from the remaining accessions. Conclusions Our results point to an influence of reproduction methods on the observed diversity patterns and indicate potential of ex situ collections for broadening the genetic diversity in rye breeding programs. Obtained data show that DArT markers provide a realistic picture of the genetic diversity and population structure present in the collection of 379 rye accessions and are an effective platform for rye germplasm characterization and association mapping studies. PMID:25085433

Supportive and palliative care for patients with chronic mental illness including dementia.

PubMed

Lloyd-Williams, Mari; Abba, Katharine; Crowther, Jacqueline

2014-09-01

People with preexisting mental illness are known to have difficulty accessing healthcare services including palliative care and people with dementia have similar issues accessing palliative care. The review addressed the time period from January 2013 to March 2014. There were few articles addressing issues for palliative and supportive care for patients with preexisting mental health issues. The main factor that would improve care is interdisciplinary working between mental healthcare teams and palliative care teams. In contrast, there were many published articles on the palliative and supportive care needs for people with dementia. These articles included consensus statements, models of care; studies of why models of care, for example Advanced Care Planning were not being implemented; and carer reports of care in the last year of life. Urgent research is required as to how support for people with preexisting mental illness who require palliative care can be improved--excellent liaison between mental health and palliative care teams is essential. There is much research on palliative care needs for people with dementia but an apparent lack of innovative approaches to care including care of people within their family home.

The Virtual Dental Home: Implications for Policy and Strategy

PubMed Central

Glassman, Paul; Harrington, Maureen; Mertz, Elizabeth; Namakian, Maysa

2012-01-01

Widely recognized problems with the U.S. health care system, including rapidly increasing costs and disparities in access and outcomes also exist in oral health. If oral health systems are to meet the “Triple Aim” of improving the experience of care, improving the health of populations, and reducing per capita costs of health care, new and innovative strategies will be needed including new regulatory, delivery, and financing systems. The virtual dental home is one such system. PMID:22916382

Collaborative Care in Schools: Enhancing Integration and Impact in Youth Mental Health

PubMed Central

Lyon, Aaron R.; Whitaker, Kelly; French, William P.; Richardson, Laura P.; Wasse, Jessica Knaster; McCauley, Elizabeth

2016-01-01

Collaborative Care is an innovative approach to integrated mental health service delivery that focuses on reducing access barriers, improving service quality, and lowering healthcare expenditures. A large body of evidence supports the effectiveness of Collaborative Care models with adults and, increasingly, for youth. Although existing studies examining these models for youth have focused exclusively on primary care, the education sector is also an appropriate analog for the accessibility that primary care offers to adults. Collaborative Care aligns closely with the practical realities of the education sector and may represent a strategy to achieve some of the objectives of increasingly popular multi-tiered systems of supports frameworks. Unfortunately, no resources exist to guide the application of Collaborative Care models in schools. Based on the existing evidence for Collaborative Care models, the current paper (1) provides a rationale for the adaptation of Collaborative Care models to improve mental health service accessibility and effectiveness in the education sector; (2) presents a preliminary Collaborative Care model for use in schools; and (3) describes avenues for research surrounding school-based Collaborative Care, including the currently funded Accessible, Collaborative Care for Effective School-based Services (ACCESS) project. PMID:28392832

Medication coverage for lawmakers may worsen access for everyone else.

PubMed

Taglione, Michael S; Boozary, Andrew; Persaud, Nav

2018-03-01

Despite numerous recommendations for universal public coverage of prescription drugs in Canada based on evidence that millions of Canadians cannot afford medications, no province or territory has adopted first dollar coverage for all residents. However, one group unaffected by the lack of public coverage are lawmakers. Lawmakers receive excellent drug coverage plans for themselves and their immediate families. Evidence suggests that lawmakers' decisions are influenced by their personal circumstances; in this case, they are insulated from the effects of poor access to medications by their drug coverage plans. In contrast, a patchwork system of 46 programs across Canada provides some drug coverage to vulnerable populations. Reducing the disparity in prescription drug access between Canadian lawmakers and the public may promote progress towards better medication access for everyone. This could be achieved either by reducing lawmaker coverage or improving upon the public patchwork system. Since the goal should be to improve the overall access of medications for all Canadians, lawmakers included, the latter method is preferred. A universal drug plan with first dollar coverage could replace the current patchwork system and expand coverage to all Canadians. Copyright © 2017 Elsevier Inc. All rights reserved.

Mobile Multi-System Overview

NASA Technical Reports Server (NTRS)

Witoff, Robert J.; Doody, David F.

2012-01-01

At the time of this reporting, there are 2,589 rich mobile devices used at JPL, including 1,550 iPhones and 968 Blackberrys. Considering a total JPL population of 5,961 employees, mobile applications have a total addressable market of 43 percent of the employees at JPL, and that number is rising. While it was found that no existing desktop tools can realistically be replaced by a mobile application, there is certainly a need to improve access to these desktop tools. When an alarm occurs and an engineer is away from his desk, a convenient means of accessing relevant data can save an engineer a great deal of time and improve his job efficiency. To identify which data is relevant, an engineer benefits from a succinct overview of the data housed in 13+ tools. This need can be well met by a single, rich, mobile application that provides access to desired data across tools in the ops infrastructure.

Cost-effectiveness of Different Diabetic Retinopathy Screening Modalities

PubMed Central

Pasquel, Francisco J.; Hendrick, Andrew M.; Ryan, Martha; Cason, Emily; Ali, Mohammed K.; Narayan, K. M. Venkat

2015-01-01

Current screening strategies aimed at detection of diabetic retinopathy (DR) historically have poor compliance, but advancements in technology can enable improved access to care. Nearly 80% of all persons with diabetes live in low- and middle-income countries (LMICs), highlighting the importance of a cost effective screening program. Establishing mechanisms to reach populations with geographic and financial barriers to access is essential to prevent visual disability. Teleretinal programs leverage technology to improve access and reduce cost. The quality of currently employed screening modalities depends on many variables including the instrument used, use of pupillary mydriasis, number of photographic fields, and the qualifications of the photographer and image interpreter. Recent telemedicine and newer technological approaches have been introduced, but data for these technologies is yet limited. We present results of a systematic review of studies evaluating cost-effectiveness of DR screening, and discuss potential relevance for LMICs. PMID:26719134

Access to health care and community social capital.

PubMed

Hendryx, Michael S; Ahern, Melissa M; Lovrich, Nicholas P; McCurdy, Arthur H

2002-02-01

To test the hypothesis that variation in reported access to health care is positively related to the level of social capital present in a community. The 1996 Household Survey of the Community Tracking Study, drawn from 22 metropolitan statistical areas across the United States (n = 19,672). Additional data for the 22 communities are from a 1996 multicity broadcast media marketing database, including key social capital indicators, the 1997 National Profile of Local Health Departments survey, and Interstudy, American Hospital Association, and American Medical Association sources. The design is cross-sectional. Self-reported access to care problems is the dependent variable. Independent variables include individual sociodemographic variables, community-level health sector variables, and social capital variables. Data are merged from the various sources and weighted to be population representative and are analyzed using hierarchical categorical modeling. Persons who live in metropolitan statistical areas featuring higher levels of social capital report fewer problems accessing health care. A higher HMO penetration rate in a metropolitan statistical area was also associated with fewer access problems. Other health sector variables were not related to health care access. The results observed for 22 major U.S. cities are consistent with the hypothesis that community social capital enables better access to care, perhaps through improving community accountability mechanisms.

Cost-effectiveness of an improving access to psychological therapies service.

PubMed

Mukuria, Clara; Brazier, John; Barkham, Michael; Connell, Janice; Hardy, Gillian; Hutten, Rebecca; Saxon, Dave; Dent-Brown, Kim; Parry, Glenys

2013-03-01

Effective psychological therapies have been recommended for common mental health problems, such as depression and anxiety, but provision has been poor. Improving Access to Psychological Therapies (IAPT) may provide a cost-effective solution to this problem. To determine the cost-effectiveness of IAPT at the Doncaster demonstration site (2007-2009). An economic evaluation comparing costs and health outcomes for patients at the IAPT demonstration site with those for comparator sites, including a separate assessment of lost productivity. Sensitivity analyses were undertaken. The IAPT site had higher service costs and was associated with small additional gains in quality-adjusted life-years (QALYs) compared with its comparator sites, resulting in a cost per QALY gained of £29 500 using the Short Form (SF-6D). Sensitivity analysis using predicted EQ-5D scores lowered this to £16 857. Costs per reliable and clinically significant (RCS) improvement were £9440 per participant. Improving Access to Psychological Therapies provided a service that was probably cost-effective within the usual National Institute for Health and Clinical Excellence (NICE) threshold range of £20 000-30 000, but there was considerable uncertainty surrounding the costs and outcome differences.

Locomotive crashworthiness research : locomotive crew egress evaluation

DOT National Transportation Integrated Search

2002-05-01

The objectives of this study include the identification of aspects of locomotive design and operation related to crew egress or access by rescuers in accidents, with the goal of improving crew survivability. This work identifies the considerations an...

Hello! Is Anybody Out There?

ERIC Educational Resources Information Center

Caprio, M. W.

1997-01-01

Discusses problems such as redundancy caused by isolation of community colleges. Suggested means for overcoming institutional isolation and improving communication among community colleges include hosting conferences, accessing the Internet, instituting faculty exchange programs, offering faculty membership in professional societies, allowing…

Consumers' Interest In Provider Ratings Grows, And Improved Report Cards And Other Steps Could Accelerate Their Use.

PubMed

Findlay, Steven D

2016-04-01

Encouraging patients and consumers to use data and other information in choosing health care providers is an important way to enhance patient engagement and improve the quality of care. The growing use of technology, including smart phones and near-ubiquitous Internet access, provides consumers with easy access to websites that collect and report assessments and ratings of providers, primarily physicians and hospitals. In addition to new technology, recent laws and changes in society and the delivery of care are laying the foundation for greater use by consumers of provider performance report cards. Such use could be accelerated if the shortcomings of current report card efforts were addressed. Recommendations include making online report cards easier to use and more understandable, engaging, substantive, and relevant to consumers' health and medical concerns and choices. Project HOPE—The People-to-People Health Foundation, Inc.

Innovations in surgical stone disease.

PubMed

Antonelli, Jodi A

2016-05-01

Urinary stone disease is a condition characterized by a rich history of surgical innovation. Herein, we review the new ideas, devices and methods that are the cornerstones of contemporary surgical innovation in stone disease, specifically flexible ureteroscopy and percutaneous nephrolithotomy. The new ideas being applied to flexible ureteroscopy include extending the boundaries of surgical indications and eliminating the need for intraoperative fluoroscopy. Device advancements include disposable ureteroscopes and flexi semirigid ureteroscopes. Robotic flexible ureteroscopy, the use of magnets and mobile technology applications represent progress in methods of performing flexible ureteroscopy. Three-dimensional computed tomography and printing technology are enhancing percutaneous renal access. Novel image-guided access techniques are improving the accuracy of percutaneous surgery particularly for complex cases. New ideas, devices and methods are continuing to reshape the landscape of surgical stone treatment and in so doing not only have the potential to improve surgical outcomes but also to cultivate further scientific and technological advancements in this area.

Transforming cold chain performance and management in lower-income countries.

PubMed

Brison, Mike; LeTallec, Yann

2017-04-19

In many countries, one of the common factors limiting full and equitable access to effective immunization is the existence of gaps in cold chain and logistics (CCL) systems. This article focuses on the critical contribution that better management of CCL performance can make in addressing these barriers, as well as some essential practices needed to achieve and sustain these gains. These include (i) an emphasis on continuous improvement in CCL performance indicators, (ii) strong coordination and accountability across multiple stakeholders, and (iii) making the most of limited financial resources. This article is informed by the Clinton Health Access Initiative's (CHAI's) experience working with National Immunization Programs (NIPs) and immunization partners to improve the effectiveness and efficiency of CCL systems (including CCE deployment and maintenance, temperature monitoring and control, stock management and distribution) across ten Gavi-supported "focus" countries. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Prisons and public health: emerging issues in HIV treatment adherence.

PubMed

Frank, L

1999-01-01

Correctional facilities in the United States are faced with challenges in providing appropriate and timely HIV treatment to incarcerated HIV-infected inmates. Prison and jails, due to their structure, operation, and staff, may present many barriers to HIV treatment and adherence to complicated and expensive HIV treatment regimens. Changes and modifications of prison health care delivery are required to accommodate the needs of HIV-infected inmates. Approaches to improving correctional HIV care and treatment include training health care personnel, prevention education for inmates, increasing access to voluntary HIV testing, comprehensive treatment planning, and continuity of care. Policy changes for correctional systems include adopting current HIV care standards and immediate evaluation for and access to HIV treatment upon entry into the institution. These changes can have a significant impact on the quality of care for inmates, ultimately improving their quality of life and reducing the morbidity and mortality of HIV disease for incarcerated populations.

Patient-reported access to primary care in Ontario: effect of organizational characteristics.

PubMed

Muggah, Elizabeth; Hogg, William; Dahrouge, Simone; Russell, Grant; Kristjansson, Elizabeth; Muldoon, Laura; Devlin, Rose Anne

2014-01-01

To describe patient-reported access to primary health care across 4 organizational models of primary care in Ontario, and to explore how access is associated with patient, provider, and practice characteristics. Cross-sectional survey. One hundred thirty-seven randomly selected primary care practices in Ontario using 1 of 4 delivery models (fee for service, established capitation, reformed capitation, and community health centres). Patients included were at least 18 years of age, were not severely ill or cognitively impaired, were not known to the survey administrator, had consenting providers at 1 of the participating primary care practices, and were able to communicate in English or French either directly or through a translator. Patient-reported access was measured by a 4-item scale derived from the previously validated adult version of the Primary Care Assessment Tool. Questions were asked about physician availability during and outside of regular office hours and access to health information via telephone. Responses to the scale were normalized, with higher scores reflecting greater patient-reported access. Linear regressions were used to identify characteristics independently associated with access to care. Established capitation model practices had the highest patient-reported access, although the difference in scores between models was small. Our multilevel regression model identified several patient factors that were significantly (P = .05) associated with higher patient-reported access, including older age, female sex, good-to-excellent self-reported health, less mental health disability, and not working. Provider experience (measured as years since graduation) was the only provider or practice characteristic independently associated with improved patient-reported access. This study adds to what is known about access to primary care. The study found that established capitation models outperformed all the other organizational models, including reformed capitation models, independent of provider and practice variables save provider experience. This suggests that the capitation models might provide better access to care and that it might take time to realize the benefits of organizational reforms.

A quality improvement intervention to increase access to pediatric subspecialty practice.

PubMed

Heptulla, Rubina A; Choi, Steven J; Belamarich, Peter F

2013-02-01

To improve access to new pediatric endocrinology appointments in an urban academic hospital faculty-based practice. Three strategies were implemented to increase the number of appointment slots: new patient appointments were protected from conversion to follow-up appointments; all physicians, including senior faculty, were scheduled to see 3 to 4 new patients per session; and sessions devoted exclusively to follow-up appointments were added based on demand. The main outcomes for this quality improvement activity were waiting times for new and follow-up appointments, monthly visit volume, the per-provider visit volume, differences in the proportion of new visits, and clinic arrival rates pre- and postintervention. Thirteen months after the intervention, average wait for a new patient appointment decreased from 11.4 to 1.7 weeks (P < .001) and follow-up appointment wait time decreased from 8.2 to 2.9 weeks (P < .001). Mean monthly total visit volume increased from 284 to 366 patient visits (P < .01) and mean monthly visit volume per provider increased from 36.8 to 41.0 patients (P = .08). New patients were 27% of the visit volume and 35% after the intervention. Access to our pediatric specialty care clinic was improved without increasing the number of providers by improved scheduling.

What Rural Women Want the Public Health Community to Know About Access to Healthful Food: A Qualitative Study, 2011.

PubMed

Carnahan, Leslie R; Zimmermann, Kristine; Peacock, Nadine R

2016-04-28

Living in a rural food desert has been linked to poor dietary habits. Understanding community perspectives about available resources and feasible solutions may inform strategies to improve food access in rural food deserts. The objective of our study was to identify resources and solutions to the food access problems of women in rural, southernmost Illinois. Fourteen focus groups with women (n = 110 participants) in 4 age groups were conducted in a 7-county region as part of a community assessment focused on women's health. We used content analysis with inductive and deductive approaches to explore food access barriers and facilitators. Similar to participants in previous studies, participants in our study reported insufficient local food sources, which they believe contributed to poor dietary habits, high food prices, and the need to travel for healthful food. Participants identified existing local activities and resources that help to increase access, such as home and community gardens, food pantries, and public transportation, as well as local solutions, such as improving nutrition education and public transportation options. Multilevel and collaborative strategies and policies are needed to address food access barriers in rural communities. At the individual level, education may help residents navigate geographic and economic barriers. Community solutions include collaborative strategies to increase availability of healthful foods through traditional and nontraditional food sources. Policy change is needed to promote local agriculture and distribution of privately grown food. Understanding needs and strengths in rural communities will ensure responsive and effective strategies to improve the rural food environment.

What Rural Women Want the Public Health Community to Know About Access to Healthful Food: A Qualitative Study, 2011

PubMed Central

Zimmermann, Kristine; Peacock, Nadine R.

2016-01-01

Introduction Living in a rural food desert has been linked to poor dietary habits. Understanding community perspectives about available resources and feasible solutions may inform strategies to improve food access in rural food deserts. The objective of our study was to identify resources and solutions to the food access problems of women in rural, southernmost Illinois. Methods Fourteen focus groups with women (n = 110 participants) in 4 age groups were conducted in a 7-county region as part of a community assessment focused on women’s health. We used content analysis with inductive and deductive approaches to explore food access barriers and facilitators. Results Similar to participants in previous studies, participants in our study reported insufficient local food sources, which they believe contributed to poor dietary habits, high food prices, and the need to travel for healthful food. Participants identified existing local activities and resources that help to increase access, such as home and community gardens, food pantries, and public transportation, as well as local solutions, such as improving nutrition education and public transportation options. Conclusion Multilevel and collaborative strategies and policies are needed to address food access barriers in rural communities. At the individual level, education may help residents navigate geographic and economic barriers. Community solutions include collaborative strategies to increase availability of healthful foods through traditional and nontraditional food sources. Policy change is needed to promote local agriculture and distribution of privately grown food. Understanding needs and strengths in rural communities will ensure responsive and effective strategies to improve the rural food environment. PMID:27126555

AquaUsers: Improving access to remotely sensed data for non-specialists

NASA Astrophysics Data System (ADS)

Clements, Oliver; Walker, Peter; Calton, Ben; Miller, Peter

2015-04-01

In recent years more and more complex remotely sensed data have been made available to the public by national and international agencies. These data are also reprocessed by different organisations to produce secondary products that are of specific need to a community. For instance the production of chlorophyll concentration maps from ocean colour data provided by NASA for the marine community. Providing access to such data has normally been focused on simply making the data available with appropriate metadata so that domain specialists can make use of it. One area that has seen significant investment, both of time and money, has been in the production of web based data portals. Primarily these have focused on spatial data. By providing a web map visualisation users are able to quickly assess both spatial coverage and data values. Data portal improvements have been possible thanks to advancements in back end data servers such as Thredds and ncWMS as well as improvements in front-end libraries for data visualisation including OpenLayers and D3. Data portals that make use of these technological advancements have aimed at improving the access and use of data by trained scientific domain specialists. There is now a push to improve access to these systems by non-scientific domain specialists through several European Commission funded projects, including OPEC and AquaUsers. These projects have improved upon an open source web GIS portal created by Plymouth Marine Laboratory [https://github.com/pmlrsg/GISportal]. We will present the latest version of our GIS portal, discuss the designs steps taken to achieve the latest build and share user stories as to how non-domain specialists are now able to utilise the system and get benefits from remotely sensed data. A first version was produced and disseminated to end users for feedback. At this stage the end users included government advisors, fish farmers and scientific groups with no specific GIS training or knowledge. This iteration produced some pretty harsh responses. The product looked good, it seemed to have a large volume of data available but it was too difficult to get any added value from without specific training in its functionality. The feedback we gathered lead to the involvement of a user experience specialist. This was a first for both our development team and the specialist. Through a focused iteration process we created a design that would reduce the steps necessary to get meaningful output from the portal, we minimised the amount of information shown initially by using a keyword system similar to online shopping. The interface for analysing the data was greatly simplified as well, allowing easier and quicker access to time series or subsetting of data.

When are food deserts? Integrating time into research on food accessibility.

PubMed

Widener, Michael J; Shannon, Jerry

2014-11-01

The food desert concept is used as a means for defining regions as having inadequate spatial and socioeconomic access to vendors selling nutritious foods. This primarily aggregate-level and static method for understanding the food environment is commonly used by researchers and policy makers seeking to improve health outcomes of those affected by reduced access. However, recent research findings have brought the association between living in a food desert and adverse health outcomes into question. In this viewpoint, we put forward the idea that the food desert concept, and food accessibility research more generally, should be expanded to include a temporal component, and note potential avenues for future research. Copyright © 2014 Elsevier Ltd. All rights reserved.

Integrate Data into Scientific Workflows for Terrestrial Biosphere Model Evaluation through Brokers

NASA Astrophysics Data System (ADS)

Wei, Y.; Cook, R. B.; Du, F.; Dasgupta, A.; Poco, J.; Huntzinger, D. N.; Schwalm, C. R.; Boldrini, E.; Santoro, M.; Pearlman, J.; Pearlman, F.; Nativi, S.; Khalsa, S.

2013-12-01

Terrestrial biosphere models (TBMs) have become integral tools for extrapolating local observations and process-level understanding of land-atmosphere carbon exchange to larger regions. Model-model and model-observation intercomparisons are critical to understand the uncertainties within model outputs, to improve model skill, and to improve our understanding of land-atmosphere carbon exchange. The DataONE Exploration, Visualization, and Analysis (EVA) working group is evaluating TBMs using scientific workflows in UV-CDAT/VisTrails. This workflow-based approach promotes collaboration and improved tracking of evaluation provenance. But challenges still remain. The multi-scale and multi-discipline nature of TBMs makes it necessary to include diverse and distributed data resources in model evaluation. These include, among others, remote sensing data from NASA, flux tower observations from various organizations including DOE, and inventory data from US Forest Service. A key challenge is to make heterogeneous data from different organizations and disciplines discoverable and readily integrated for use in scientific workflows. This presentation introduces the brokering approach taken by the DataONE EVA to fill the gap between TBMs' evaluation scientific workflows and cross-organization and cross-discipline data resources. The DataONE EVA started the development of an Integrated Model Intercomparison Framework (IMIF) that leverages standards-based discovery and access brokers to dynamically discover, access, and transform (e.g. subset and resampling) diverse data products from DataONE, Earth System Grid (ESG), and other data repositories into a format that can be readily used by scientific workflows in UV-CDAT/VisTrails. The discovery and access brokers serve as an independent middleware that bridge existing data repositories and TBMs evaluation scientific workflows but introduce little overhead to either component. In the initial work, an OpenSearch-based discovery broker is leveraged to provide a consistent mechanism for data discovery. Standards-based data services, including Open Geospatial Consortium (OGC) Web Coverage Service (WCS) and THREDDS are leveraged to provide on-demand data access and transformations through the data access broker. To ease the adoption of broker services, a package of broker client VisTrails modules have been developed to be easily plugged into scientific workflows. The initial IMIF has been successfully tested in selected model evaluation scenarios involved in the NASA-funded Multi-scale Synthesis and Terrestrial Model Intercomparison Project (MsTMIP).

Improving access to optometry services for people at risk of preventable sight loss: a qualitative study in five UK locations.

PubMed

Leamon, S; Hayden, C; Lee, H; Trudinger, D; Appelbee, E; Hurrell, D-L; Richardson, I

2014-12-01

Reducing preventable sight loss is an increasing priority for public health and health care providers. We examined the factors affecting people's use of optometry services in population groups at increased risk of sight loss. This is a qualitative study in five UK locations. In England, participants were from the Pakistani and Black Caribbean communities; in Scotland from the Pakistani community; and in Northern Ireland and Wales from white socio-economically deprived communities. Thirty-four focus groups were conducted (n = 289). The study included people who attend optometry services and people not engaged with services. Barriers to access included limited awareness of eye health and eye disease, concern about the cost of spectacles and the appropriateness of optometry in a commercial setting. Attendance at the optometrist was primarily symptom led. A positive previous experience or continuing relationship with the optometrist helped to alleviate the barriers and promote attendance. Addressing the disparity between the broader messages about eye health and the current perception of the function of optometry could help improve access to services. Uptake may be improved through the co-production of interventions that better resonate with local communities. Non-retail service delivery options should be explored. © The Author 2014, Published by Oxford University Press on behalf of Faculty of Public Health.

Improved Aeroprediction Code. Part 1. Summary of New Methods and Comparison with Experiment

DTIC Science & Technology

1993-05-01

and the results stored in tabular form as functions of Mach number, altitude, and angle of attack. This information can then be accessed by an...WIGBD9AI3OFGRAINUE 10 VALIDATIO ..... PRO .. SS7 . ..CON .......U... 5 ....... ... ........ .. . .. .. ...4-6 0 .......... NSWCDD/TR-93/9 I 256 AP 01 APIS3 1...Unit Block 13. Abstract. Include a brief (Maximum 200 Element Accession No. words) factual summary of the most significant information contained in

Medicaid: State and Federal Actions Have Been Taken to Improve Children's Access to Dental Services, but Gaps Remain. Report to Congressional Requesters. GAO-09-723

ERIC Educational Resources Information Center

US Government Accountability Office, 2009

2009-01-01

Children's access to Medicaid dental services is a long-standing concern. The tragic case of a 12-year-old boy who died from an untreated infected tooth that led to a fatal brain infection renewed attention to this issue. He was enrolled in Medicaid--a joint federal and state program that provides health care coverage, including dental care, for…

Reply to "transforming oncology care": advancing value, accessing innovation.

PubMed

Paradis, Rebecca

2015-09-01

Alternative payment models in oncology are already successfully standardizing care, curbing costs, and improving the patient experience. Yet, it is unclear whether decision makers are adequately considering patient access to innovation when creating these models, which could have severe consequences for a robust innovation ecosystem and the lives of afflicted patients. The suggested chart includes recommendations on: Allowing for the adoption of new, promising therapies; Promoting the measurement of patient-centered outcomes; and Providing support for personalized medicine.

Tackling corruption in the pharmaceutical systems worldwide with courage and conviction.

PubMed

Cohen, J C; Mrazek, M; Hawkins, L

2007-03-01

Poor drug access continues to be one of the main global health problems. Global inequalities in access to pharmaceuticals are caused by a number of variables including poverty, high drug prices, poor health infrastructure, and fraud and corruption--the latter being the subject of this article. There is growing recognition among policy makers that corruption in the pharmaceutical system can waste valuable resources allocated to pharmaceutical products and services. This, in turn, denies those most in need from life-saving or life-enhancing medicines. As a result, international organizations, including the World Health Organization and the World Bank are beginning to address the issue of corruption in the health sector broadly and the pharmaceutical system specifically. This is encouraging news for improving drug access for the global poor who are most harmed by corruption as they tend to purchase less expensive drugs from unqualified or illegal drug sellers selling counterfeit or sub-standard drugs. In our paper, we illuminate what are the core issues that relate to corruption in the pharmaceutical sector. We argue that corruption in the pharmaceutical system can be detrimental to a country's ability to improve the health of its population. Moreover, unless policy makers deal with the issue of corruption, funding allocated to the pharmaceutical system to treat health conditions may simply be wasted and the inequality between rich and poor in access to health and pharmaceutical products will be aggravated.

Challenges of using new and repurposed drugs for the treatment of multidrug-resistant tuberculosis in children.

PubMed

Schaaf, H Simon; Garcia-Prats, Anthony J; McKenna, Lindsay; Seddon, James A

2018-03-01

New and repurposed antituberculosis drugs are urgently needed to more safely and effectively treat multidrug-resistant (MDR) tuberculosis (TB) in children. Multiple challenges limit timely access to new MDR-TB treatments in children. Areas covered: Diagnosis of MDR-TB in children remains a barrier, with few children with MDR-TB diagnosed and treated. Other barriers to timely access to new and repurposed drugs are discussed, and include delayed initiation of paediatric trials, limited funding for paediatric drug development, fragmented regulatory systems and operational challenges. The status of access to current repurposed and novel drugs is presented. Expert commentary: More timely initiation of paediatric trials is needed and paediatric work should happen and be funded in parallel with each phase of adult trials. Better quality data, increased regulator resources and expertise, harmonization of regulatory requirements across borders/organisations and registration fee waivers would improve registration timelines. Improved diagnosis, recording and reporting will establish better demand. Improved systems for procurement and supply chain management would reduce in-country operational barriers to getting medications to children. The challenges must be addressed to ensure timely and equitable access to new drugs and regimens that are urgently needed for effective, safe and shorter treatment of children with MDR-TB.

Strategic purchasing reform in Estonia: Reducing inequalities in access while improving care concentration and quality.

PubMed

Habicht, Triin; Habicht, Jarno; van Ginneken, Ewout

2015-08-01

As of 2014, the Estonian Health Insurance Fund has adopted new purchasing procedures and criteria, which it now has started to implement in specialist care. Main changes include (1) redefined access criteria based on population need rather than historical supply, which aim to achieve more equal access of providers and specialties; (2) stricter definition and use of optimal workload criteria to increase the concentration of specialist care (3) better consideration of patient movement; and (4) an increased emphasis on quality to foster quality improvement. The new criteria were first used in the contract cycle that started in 2014 and resulted in fewer contracted providers for a similar volume of care compared to the previous contract cycle. This implies that provision of specialized care has become concentrated at fewer providers. It is too early to draw firm conclusions on the impact on care quality or on actors, but the process has sparked debate on the role of selective contracting and the role of public and private providers in Estonian health care. Lastly, the Estonian experience may hold important lessons for other countries looking to overcome inequalities in access while concentrating care and improving care quality. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Finding Food Deserts: A Comparison of Methods Measuring Spatial Access to Food Stores.

PubMed

Jaskiewicz, Lara; Block, Daniel; Chavez, Noel

2016-05-01

Public health research has increasingly focused on how access to resources affects health behaviors. Mapping environmental factors, such as distance to a supermarket, can identify intervention points toward improving food access in low-income and minority communities. However, the existing literature provides little guidance on choosing the most appropriate measures of spatial access. This study compared the results of different measures of spatial access to large food stores and the locations of high and low access identified by each. The data set included U.S. Census population data and the locations of large food stores in the six-county area around Chicago, Illinois. Six measures of spatial access were calculated at the census block group level and the results compared. The analysis found that there was little agreement in the identified locations of high or low access between measures. This study illustrates the importance of considering the access measure used when conducting research, interpreting results, or comparing studies. Future research should explore the correlation of different measures with health behaviors and health outcomes. © 2015 Society for Public Health Education.

Practice management companies improve practices' financial position.

PubMed

Dupell, T

1997-11-01

To maintain control over healthcare delivery and financial decisions, as well as increase access to capital markets, some group practices are forming their own physician practice management companies. These companies should be organized to balance the expectations of physicians with the values of capital markets. This organization should include retained earnings, financial reporting in accordance with generally accepted accounting principles (GAAP), predictable earnings and cash flow, physician ownership and leadership, and incentives for high-quality management. Three large, primary care and multispecialty clinics that merged to form a new physician practice management company increased their access to capital markets and improved their overall financial position, which will help them achieve long-term survival.

Global prevention, funding, accountability debated in fight against HIV / AIDS.

PubMed

1999-10-18

World leaders, physicians, economists, governmental health organizations, and pharmaceutical manufacturers attended the Third International Conference on Healthcare Resource Allocation for HIV/AIDS and Other Life-threatening Illnesses in Vienna, Austria. The conference participants discussed the economic, ethical, and human rights issues underlying health care resource allocation. Some highlights of the meeting included: the prevention strategies in fighting AIDS virus; the use of high medical ethical standards; the affordability and accessibility of essential therapies; the economic aspects affecting the medical assistance mechanisms; the need to improve the pharmaceutical industry; the need to improve HIV/AIDS care access in developing countries; promoting the development of HIV/AIDS vaccines; and developing rapid diagnosis of HIV.

Barriers to Using Nonpharmacologic Approaches and Reducing Opioid Use in Primary Care.

PubMed

Giannitrapani, Karleen F; Ahluwalia, Sangeeta C; McCaa, Matthew; Pisciotta, Maura; Dobscha, Steven; Lorenz, Karl A

2017-10-20

Opioid prescribing for chronic pain, including the potential for over-reliance and misuse, is a public health concern. In the context of Veterans Administration (VA) primary care team-based pain management, we aimed to understand providers' perceptions of barriers to reducing opioid use and improving the use of nonpharmacologic pain management therapies (NPTs) for chronic pain. A semistructured interview elucidated provider experiences with assessing and managing pain. Emergent themes were mapped to known dimensions of VA primary care access. Informants included 60 primary care providers, registered nurses, licensed practical nurses, clerks, psychologists, and social workers at two VA Medical Centers. Nine multidisciplinary focus groups. Provider perceptions of barriers to reducing opioids and improving use of NPTs for patients with chronic pain clustered around availability and access. Barriers to NPT access included the following subthemes: geographical (patient distance from service), financial (out-of-pocket cost to patient), temporal (treatment time delays), cultural (belief that NPTs increased provider workload, perception of insufficient training on NPTs, perceptions of patient resistance to change, confrontation avoidance, and insufficient leadership support), and digital (measure used for pain assessment, older patients hesitant to use technology, providers overwhelmed by information). Decreasing reliance on opioids for chronic pain requires a commitment to local availability and provider-facing strategies that increase efficacy in prescribing NPTs. Policies and interventions for decreasing utilization of opioids and increasing use of NPTs should comprehensively consider access barriers. 2017 American Academy of Pain Medicine. This work is written by US Government employees and is in the public domain in the US.

Household trends in access to improved water sources and sanitation facilities in Vietnam and associated factors: findings from the Multiple Indicator Cluster Surveys, 2000-2011.

PubMed

Tuyet-Hanh, Tran Thi; Lee, Jong-Koo; Oh, Juhwan; Van Minh, Hoang; Ou Lee, Chul; Hoan, Le Thi; Nam, You-Seon; Long, Tran Khanh

2016-01-01

Despite progress made by the Millennium Development Goal (MDG) number 7.C, Vietnam still faces challenges with regard to the provision of access to safe drinking water and basic sanitation. This paper describes household trends in access to improved water sources and sanitation facilities separately, and analyses factors associated with access to improved water sources and sanitation facilities in combination. Secondary data from the Vietnam Multiple Indicator Cluster Survey in 2000, 2006, and 2011 were analyzed. Descriptive statistics and tests of significance describe trends over time in access to water and sanitation by location, demographic and socio-economic factors. Binary logistic regressions (2000, 2006, and 2011) describe associations between access to water and sanitation, and geographic, demographic, and socio-economic factors. There have been some outstanding developments in access to improved water sources and sanitation facilities from 2000 to 2011. In 2011, the proportion of households with access to improved water sources and sanitation facilities reached 90% and 77%, respectively, meeting the 2015 MDG targets for safe drinking water and basic sanitation set at 88% and 75%, respectively. However, despite these achievements, in 2011, only 74% of households overall had access to combined improved drinking water and sanitation facilities. There were also stark differences between regions. In 2011, only 47% of households had access to both improved water and sanitation facilities in the Mekong River Delta compared with 94% in the Red River Delta. In 2011, households in urban compared to rural areas were more than twice as likely (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.9-2.5) to have access to improved water and sanitation facilities in combination, and households in the highest compared with the lowest wealth quintile were over 40 times more likely (OR: 42.3; 95% CI: 29.8-60.0). More efforts are required to increase household access to both improved water and sanitation facilities in the Mekong River Delta, South East and Central Highlands regions of Vietnam. There is also a need to address socio-economic factors associated with inadequate access to improved sanitation facilities.

75 FR 19670 - Notice of Availability of the Record of Decision for the I-65 to US 31W Access Improvement Final...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-15

...)] Notice of Availability of the Record of Decision for the I-65 to US 31W Access Improvement Final... implement the I-65 to US 31W Access Improvement project in Warren County, Kentucky. The Division... US 31W Access Improvement project can be viewed and downloaded from the project Web site at http...

Factors influencing householders' access to improved water in low-income urban areas of Accra, Ghana.

PubMed

Mahama, Ayisha Matuamo; Anaman, Kwabena Asomanin; Osei-Akoto, Isaac

2014-06-01

We analysed householders' access to improved water for drinking and other domestic uses in five selected low-income urban areas of Accra, Ghana using a survey of 1,500 households. Our definitions of improved water were different from those suggested by the World Health Organization (WHO). The results revealed that only 4.4% of the respondents had access to improved drinking water compared to 40.7% using the WHO definition. However, 88.7% of respondents had access to improved water for domestic uses compared to 98.3% using the WHO definition. Using logistic regression analysis, we established that the significant determinant of householders' access to improved drinking water was income. However, for access to improved water for other domestic uses, the significant factors were education, income and location of the household. Compared to migrants, indigenous people and people from mixed areas were less likely to have access to improved water for other domestic purposes. For the analysis using the WHO definitions, most of the independent variables were not statistically significant in determining householders' access, and those variables that were significant generated parameter estimates inconsistent with evidence from the literature and anecdotal evidence from officials of public health and water supply companies in Ghana.

Infant nutrition in Saskatoon: barriers to infant food security.

PubMed

Partyka, Brendine; Whiting, Susan; Grunerud, Deanna; Archibald, Karen; Quennell, Kara

2010-01-01

We explored infant nutrition in Saskatoon by assessing current accessibility to all forms of infant nourishment, investigating challenges in terms of access to infant nutrition, and determining the use and effectiveness of infant nutrition programs and services. We also examined recommendations to improve infant food security in Saskatoon. Semi-structured community focus groups and stakeholder interviews were conducted between June 2006 and August 2006. Thematic analysis was used to identify themes related to infant feeding practices and barriers, as well as recommendations to improve infant food security in Saskatoon. Our study showed that infant food security is a concern among lower-income families in Saskatoon. Barriers that limited breastfeeding sustainability or nourishing infants through other means included knowledge of feeding practices, lack of breastfeeding support, access and affordability of infant formula, transportation, and poverty. Infant nutrition and food security should be improved by expanding education and programming opportunities, increasing breastfeeding support, and identifying acceptable ways to provide emergency formula. If infant food security is to be addressed successfully, discussion and change must occur in social policy and family food security contexts.

Beyond equality: Providing equitable care for persons with disabilities

PubMed Central

Wakeham, Scott; Heung, Sally; Lee, Janet; Sadowski, Cheryl A.

2017-01-01

Background: Almost 14% of Canadians have a disability, and older adults are most commonly affected. People living with disabilities have challenges accessing health care services, including medications and other services provided in pharmacies. Methods: A literature review was conducted regarding disability and pharmacy services. Resources regarding accessibility were also incorporated. Results: A number of organizations provide guidance on caring for those with disabilities. A primary concern for these vulnerable individuals relates to being invisible or overlooked by the health care system. There are also the stresses of physical, communication and attitudinal barriers. Pharmacists may be unaware of these barriers and may actually be contributing to them. To understand their patients’ accessibility needs, pharmacists can consider physical and nonphysical barriers and engage in education, advocacy and communications training to improve their patient-centred care for individuals with disabilities. Discussion and Conclusion: Pharmacists can improve the care of individuals with disabilities by learning more about accessibility. Within the community pharmacy environment, there are physical and nonphysical interventions that pharmacists can implement to ensure that patient-centred care is prioritized. PMID:29163726

"In rape cases we can use this pill": a multimethods assessment of emergency contraception knowledge, access, and needs on the Thailand-Burma border.

PubMed

Hobstetter, Margaret; Sietstra, Cari; Walsh, Meredith; Leigh, Jennifer; Foster, Angel M

2015-08-01

To evaluate availability, service delivery, and barriers to access to emergency contraceptive pills (ECPs) along the Thailand-Burma border. From June 2010 to May 2011 we undertook a multimethods qualitative assessment among cross-border populations, migrants, and refugees. We conducted 46 key informant interviews with representatives from 25 organizations, 18 focus group discussions with migrant adults, migrant adolescents, and healthcare workers, and a service mapping exercise with 22 stakeholders. We found low use of ECPs among the target populations. Structural barriers and lack of evidence-based reproductive health protocols, education, and information restrict access to the limited family planning resources available in this region. Misinformation about ECPs was widespread among health workers and organizational policies were often non-evidence based. Potential policy and program interventions to improve access to ECPs along the Thailand-Burma border include integrating evidence-based practices into community efforts, expanding training opportunities for health workers, and improving communication and coordination among organizations serving populations on both sides of the border. Copyright © 2015. Published by Elsevier Ireland Ltd.

A Needs Assessment of Health Issues Related to Maternal Mortality Rates in Afghanistan: A Pilot Study.

PubMed

Naim, Ali; Feldman, Robert; Sawyer, Robin

2015-01-01

Maternal death rates in Afghanistan were among the highest in the world during the reign of the Taliban. Although these figures have improved, current rates are still alarming. The aim of this pilot study was to develop a needs assessment of the major health issues related to the high maternal mortality rates in Afghanistan. In-depth interviews were conducted with managerial midwives, clinical midwives, and mothers. Results of the interviews indicate that the improvement in the maternal mortality rate may be attributed to the increase in the involvement of midwives in the birthing process. However, barriers to decreasing maternal mortality still exist. These include transportation, access to care, and sociocultural factors such as the influence of the husband and mother-in-law in preventing access to midwives. Therefore, any programs to decrease maternal mortality need to address infrastructure issues (making health care more accessible) and sociocultural factors (including husbands and mother-in-laws in maternal health education). However, it should be noted that these findings are based on a small pilot study to help develop a larger scale need assessment. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

CROI 2018: Highlights of Viral Hepatitis.

PubMed

Luetkemeyer, Anne F; Wyles, David L

2018-05-01

At the 2018 Conference on Retroviruses and Opportunistic Infections (CROI), there was a major focus on hepatitis C virus (HCV) elimination and improving each component of the hepatitis C care cascade. Several countries and cohorts have demonstrated the remarkable impact that universal HCV testing and unrestricted access to hepatitis C treatment can have on markedly reducing incident HCV infections and HCV infection prevalence, including in people who inject drugs and HIV/HCV-coinfected populations. However, in many settings, substantial barriers to widespread HCV treatment remain, including undiagnosed HCV infection, particularly in populations outside the standard "baby boomer" birth cohort (ie, born 1945-1965); restricted access to hepatitis C treatment in those with known HCV infection; reinfection with HCV; and migration of HCV-infected populations. Many innovative programs have successfully implemented HCV testing and treatment outside of traditional care settings, expanding access for harder-to-reach populations, which will be crucial to successful elimination efforts. Outbreaks of hepatitis A virus (HAV) infection continue to occur in among men who have sex with men and homeless populations in the United States, Europe, and Southeast Asia, highlighting the need for improved HAV vaccination programs for populations at risk.

Facilitators and Barriers of Electronic Health Record Patient Portal Adoption by Older Adults: A Literature Study.

PubMed

Wildenbos, Gaby Anne; Peute, Linda; Jaspers, Monique

2017-01-01

Patient portal usage by older adults, patients aged 50 years old and above, is intended to improve their access and quality of care. Acceptance of patient portals by this target group is low. This paper discusses the results of a literature review to determine the facilitators and barriers that drive or inhibit older patients to adopt patient portals. Articles were included when they described an acceptance, adoption or usability evaluation study of a patient portal. From a total of 245 potentially relevant articles, 8 articles were finally included. We used the Unified Theory of Acceptance and Use of Technology (UTAUT) as a classification model to analyze factors influencing older adults' acceptance of patient portals. Main facilitators for acceptance were 'performance expectancy' and 'voluntariness of use' related to a higher level of education and experienced health. Main barriers were limited health literacy and motivation related to involuntariness to use a patient portal. Poor facilitation conditions (limited technology access and no prior knowledge on existence of a patient portal) hampered access to a portal. More thorough insight into the latter is needed to improve the reach and effectiveness of patient portals among older patients.

SIMON: Integration of mobility and parking solutions for people with disabilities.

PubMed

Ferreras, Alberto; Barberà, Ricard; Durá-Gil, Juan Vicente; Solaz, José; Muñoz, Eva María; Serrano, Manuel; Marqués, Antonio

2015-01-01

Mobility and parking in urban areas are often difficult for people with disabilities. Obstacles include lack of accessible information on routes, transport alternatives and parking availability, as well as fraud in the use of the specific services intended for these citizens. The SIMON project aims to improve this situation through the integration of different ICT solutions. SIMON is enhancing the European Parking Card for disable people with contactless technologies and integrates mobile solutions to support user unique identification in existing parking areas whilst preserving privacy. SIMON will also promote better mobility solutions for mobility including information, navigation and access to restricted areas.

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya

PubMed Central

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-01-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility’s bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers’ motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need. Process evaluations tracking (un)intended consequences of interventions can contribute to regional financing and decentralization debates. PMID:25920355

Tracking implementation and (un)intended consequences: a process evaluation of an innovative peripheral health facility financing mechanism in Kenya.

PubMed

Waweru, Evelyn; Goodman, Catherine; Kedenge, Sarah; Tsofa, Benjamin; Molyneux, Sassy

2016-03-01

In many African countries, user fees have failed to achieve intended access and quality of care improvements. Subsequent user fee reduction or elimination policies have often been poorly planned, without alternative sources of income for facilities. We describe early implementation of an innovative national health financing intervention in Kenya; the health sector services fund (HSSF). In HSSF, central funds are credited directly into a facility's bank account quarterly, and facility funds are managed by health facility management committees (HFMCs) including community representatives. HSSF is therefore a finance mechanism with potential to increase access to funds for peripheral facilities, support user fee reduction and improve equity in access. We conducted a process evaluation of HSSF implementation based on a theory of change underpinning the intervention. Methods included interviews at national, district and facility levels, facility record reviews, a structured exit survey and a document review. We found impressive achievements: HSSF funds were reaching facilities; funds were being overseen and used in a way that strengthened transparency and community involvement; and health workers' motivation and patient satisfaction improved. Challenges or unintended outcomes included: complex and centralized accounting requirements undermining efficiency; interactions between HSSF and user fees leading to difficulties in accessing crucial user fee funds; and some relationship problems between key players. Although user fees charged had not increased, national reduction policies were still not being adhered to. Finance mechanisms can have a strong positive impact on peripheral facilities, and HFMCs can play a valuable role in managing facilities. Although fiduciary oversight is essential, mechanisms should allow for local decision-making and ensure that unmanageable paperwork is avoided. There are also limits to what can be achieved with relatively small funds in contexts of enormous need. Process evaluations tracking (un)intended consequences of interventions can contribute to regional financing and decentralization debates. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

A framework for improving access and customer service times in health care: application and analysis at the UCLA Medical Center.

PubMed

Duda, Catherine; Rajaram, Kumar; Barz, Christiane; Rosenthal, J Thomas

2013-01-01

There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics.

The Battered Teacher

ERIC Educational Resources Information Center

Bloch, Alfred M.

1977-01-01

Methods for the prevention and control of stress and trauma in physically assaulted teachers include preparedness training, formation of crisis intervention teams, and morale-improving techniques such as staff support, rotation of teaching assignments, and direct access to schoolboards for grievance reports. (MJB)

Promotion of health information access via Grateful Med and Loansome Doc: why isn't it working?

PubMed Central

Burnham, J F; Perry, M

1996-01-01

Information gathered from Grateful Med and Loansome Doc outreach projects, including one involving seven health centers in rural southwest Alabama, raises questions about the effectiveness of such programs. This paper presents a review of the literature on Grateful Med as well as of information access and usage behaviors of physicians, an overview of the Alabama project, and data from other projects. Analysis of the responses and observations of the researchers reveal some strategies for enhancing the outcomes of such projects and improving access to medical care literature by health care professionals at rural sites. PMID:8913552

Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: prospective longitudinal qualitative study

PubMed Central

Worth, Allison; Irshad, Tasneem; Bhopal, Raj; Brown, Duncan; Lawton, Julia; Grant, Elizabeth; Murray, Scott; Kendall, Marilyn; Adam, James; Gardee, Rafik

2009-01-01

Objectives To examine the care experiences of South Asian Sikh and Muslim patients in Scotland with life limiting illness and their families and to understand the reasons for any difficulties with access to services and how these might be overcome. Design Prospective, longitudinal, qualitative design using in-depth interviews. Setting Central Scotland. Participants 25 purposively selected South Asian Sikh and Muslim patients, 18 family carers, and 20 key health professionals. Results 92 interviews took place. Most services struggled to deliver responsive, culturally appropriate care. Barriers to accessing effective end of life care included resource constrained services; institutional and, occasionally, personal racial and religious discrimination; limited awareness and understanding among South Asian people of the role of hospices; and difficulty discussing death. The most vulnerable patients, including recent migrants and those with poor English language skills, with no family advocate, and dying of non-malignant diseases were at particularly high risk of inadequate care. Conclusions Despite a robust Scottish diversity policy, services for South Asian Sikh and Muslim patients with life limiting illness were wanting in many key areas. Active case management of the most vulnerable patients and carers, and “real time” support, from where professionals can obtain advice specific to an individual patient and family, are the approaches most likely to instigate noticeable improvements in access to high quality end of life care. Improving access to palliative care for all, particularly those with non-malignant illnesses, as well as focusing on the specific needs of ethnic minority groups, is required. PMID:19190015

Perceived Barriers Affecting Access to Preventive Dental Services: Application of DEMATEL Method.

PubMed

Bahadori, Mohammadkarim; Ravangard, Ramin; Asghari, Baratali

2013-08-01

Identifying perceived access barriers to preventive dental services is one of the basic steps to improve the public health. This study aimed to determine the perceived barriers affecting access to preventive dental services in one of Tehran dental clinics in 2012. This research was a cross-sectional descriptive-analytical study conducted in one of Tehran dental clinics in 2012 using decision-making trial and evaluation laboratory (DEMATEL) method. The study sample included all patients (100 patients) who had referred to the endodontic treatment department from 26 - 31 May, 2012. The required data were collected using a questionnaire. Collected data were analyzed using SPSS 18.0 and MATLAB 7.9.0 SPSSS 18.0, as well as, some descriptive and analytical tests including Mean, Standard Deviation (SD), and Independent T- Test. The five determinants of cost, inconvenience, fear, organization, and patient-dentist relationship were determined as barriers to access to dental services among which the cost and patient-dentist relationship were identified as the first and last priorities with the coordinates (1.4 and 1.4) and (1.25 and -0.65), respectively. High cost of dental care has led to not referring patients to the clinic. Oral health costs are too high; however insurance organizations have no commitment to support such services. Policymakers, administrators, and insurance organizations have a major role in improving access to dental services. These decision-makers in making their policies can provide the required financial resources, shift the available resources towards preventive care and periodic checkups, and consider providing proper and sufficient places for dental care facilities.

Gender dynamics affecting maternal health and health care access and use in Uganda.

PubMed

Morgan, Rosemary; Tetui, Moses; Muhumuza Kananura, Rornald; Ekirapa-Kiracho, Elizabeth; George, A S

2017-12-01

Despite its reduction over the last decade, the maternal mortality rate in Uganda remains high, due to in part a lack of access to maternal health care. In an effort to increase access to care, a quasi-experimental trial using vouchers was implemented in Eastern Uganda between 2009 and 2011. Findings from the trial reported a dramatic increase in pregnant women's access to institutional delivery. Sustainability of such interventions, however, is an important challenge. While such interventions are able to successfully address immediate access barriers, such as lack of financial resources and transportation, they are reliant on external resources to sustain them and are not designed to address the underlying causes contributing to women's lack of access, including those related to gender. In an effort to examine ways to sustain the intervention beyond external financial resources, project implementers conducted a follow-up qualitative study to explore the root causes of women's lack of maternal health care access and utilization. Based on emergent findings, a gender analysis of the data was conducted to identify key gender dynamics affecting maternal health and maternal health care. This paper reports the key gender dynamics identified during the analysis, by detailing how gender power relations affect maternal health care access and utilization in relation to: access to resources; division of labour, including women's workload during and after pregnancy and lack of male involvement at health facilities; social norms, including perceptions of women's attitudes and behaviour during pregnancy, men's attitudes towards fatherhood, attitudes towards domestic violence, and health worker attitudes and behaviour; and decision-making. It concludes by discussing the need for integrating gender into maternal health care interventions if they are to address the root causes of barriers to maternal health access and utilization and improve access to and use of maternal health care in the long term. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Economic models for prevention: making a system work for patients

PubMed Central

2015-01-01

The purpose of this article is to describe alternative means of providing patient centered, preventive based, services using an alternative non-profit, economic model. Hard to reach, vulnerable groups, including children, adults and elders, often have difficulties accessing traditional dental services for a number of reasons, including economic barriers. By partnering with community organizations that serve these groups, collaborative services and new opportunities for access are provided. The concept of a dental home is well accepted as a means of providing care, and, for these groups, provision of such services within community settings provides a sustainable means of delivery. Dental homes provided through community partnerships can deliver evidence based dental care, focused on a preventive model to achieve and maintain oral health. By using a non-profit model, the entire dental team is provided with incentives to deliver measurable quality improvements in care, rather than a more traditional focus on volume of activity alone. Examples are provided that demonstrate how integrated oral health services can deliver improved health outcomes with the potential to reduce total costs while improving quality. PMID:26391814

Quality of cancer care in Spain: recommendations of a patients' jury.

PubMed

Arrighi, E; Blancafort, S; Jovell, A J; Navarro Rubio, M D

2015-05-01

The aim of the study was to evaluate quality of cancer care in Spain through patient's views, experiences and perceptions; with the purpose of making recommendations to improve cancer care. A modified citizen's jury was organised with the participation of 30 members and four experts as witnesses. For 1 day jurors representing 13 of 17 Spanish Autonomous Communities were met to make recommendations for improving the quality of cancer care in Spain. Concerns were identified regarding care fragmentation, test delays, duplications and poor social and emotional support. Some recommendations highlighted the need to improve the access to psycho-oncology care as well as support in social care and counselling, addressing patients to specific care. Some strategies proposed by the jury included a 24-h call centre, continuity in palliative care and appropriate follow-up and support after the end of therapy. In conclusion, the experience of cancer should include access to multiple specialists, effective coordination of care, accurate information about the disease and treatment options, and timely attention to symptoms and psychosocial needs. © 2014 John Wiley & Sons Ltd.

Using technology to support HIV self-testing among MSM.

PubMed

LeGrand, Sara; Muessig, Kathryn E; Horvath, Keith J; Rosengren, Anna L; Hightow-Weidman, Lisa B

2017-09-01

Technology-based HIV self-testing (HST) interventions have the potential to improve access to HIV testing among gay, bisexual, and other MSM, as well as address concerns about HST use, including challenges with linkage to appropriate follow-up services. This review examines studies that use technology-based platforms to increase or improve the experience of HST among MSM. Seven published studies and eight funded studies were included in this review. Comprehensive prevention interventions with free HST kit distribution and interventions that provide free HST kits and support the HST process address a greater number of barriers (e.g., access, correct use of testing kits, and correct interpretation of results) than studies that only distribute free HST kits through technology-based platforms. By addressing HIV-testing barriers and specific HST concerns, these interventions address a critical need to improve first time and repeat testing rates among MSM. Additional research is needed to determine the efficacy of recent formative HST interventions. If proven efficacious, scale-up of these strategies have the potential to increase HIV testing among MSM via expanded HST uptake.

Accessibility to primary healthcare in the capital city of a northeastern state of Brazil: an evaluation of the results of a programme.

PubMed

Vieira-da-Silva, Ligia Maria; Chaves, Sonia Cristina Lima; Esperidião, Monique Azevedo; Lopes-Martinho, Rosana Machado

2010-12-01

Organisational barriers to primary healthcare are still relevant in developing countries. Although descriptive reports of some experiences focusing on improving accessibility have been published, few studies have evaluated specific interventions aimed at overcoming the organisational obstacles. To evaluate the results of a project designed to improve accessibility to healthcare services in Salvador, Bahia, Brazil. An evaluative, cross-sectional, ex post facto study that included a control group was carried out in a random sample of 710 users of 25 healthcare units of the primary municipal healthcare network. The association between the project implementation degree and outcome variables was measured by prevalence ratios (PR) and statistical inference was based on Taylor series 95% CIs. Better access to primary healthcare was found in units in which the intervention had been implemented than in those in which it had not been implemented, particularly with respect to reducing avoidable queues, the waiting time for scheduling a consultation (PR=0.23; 95% CI 0.15 to 0.34); the time of arrival in the queue (PR=0.16; 95% CI 0.09 to 0.31) and the introduction of a system for scheduling appointments by telephone (PR=0.76; 95% CI 0.70 to 0.83). Owing to the simplicity of the programme and the impact it achieved, it may be reproduced in other underdeveloped countries to improve access to healthcare services. In addition, some of the instruments may be used in routine programme evaluation.

Measuring school health center impact on access to and quality of primary care.

PubMed

Gibson, Erica J; Santelli, John S; Minguez, Mara; Lord, Alyssa; Schuyler, Ashley C

2013-12-01

School health centers (SHC) that provide comprehensive health care may improve access and quality of care for students; however, published impact data are limited. We evaluated access and quality of health services at an urban high school with a SHC compared with a school without a SHC, using a quasiexperimental research design. Data were collected at the beginning of the school year, using a paper and pencil classroom questionnaire (n = 2,076 students). We measured SHC impact in several ways including grade by school interaction terms. Students at the SHC school were more likely to report having a regular healthcare provider, awareness of confidential services, support for health services in their school, and willingness to utilize those services. Students in the SHC school reported higher quality of care as measured by: respect for their health concerns, adequate time with the healthcare provider, understandable provider communications, and greater provider discussion at their last visit on topics such as sexual activity, birth control, emotions, future plans, diet, and exercise. Users of the SHC were also more likely to report higher quality of care, compared with either nonusers or students in the comparison school. Access to comprehensive health services via a SHC led to improved access to health care and improved quality of care. Impact was measureable on a school-wide basis but was greater among SHC users. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Expanding Early Learning Time: Accessing Full-Day Preschool and Kindergarten in California. An EdSource Report

ERIC Educational Resources Information Center

Freedberg, Louis; Frey, Susan

2017-01-01

Compelling research shows that attending high-quality, full-day preschool and kindergarten is associated with improved outcomes for students. These outcomes include greater school readiness in a number of areas including language development, higher academic performance in math and reading, and less likelihood of being retained in later elementary…

39 CFR 3050.11 - Proposals to change an accepted analytical principle applied in the Postal Service's annual...

Code of Federal Regulations, 2010 CFR

2010-07-01

...) To improve the quality, accuracy, or completeness of the data or analysis of data contained in the... include the data, analysis, and documentation on which the proposal is based, and, where feasible, include... the petitioner requests access to data from the Postal Service to support the assertions or...

Kindergarten/Elementary School Teachers and Web-based Oral Health-Related Resources: An Exploration.

PubMed

Inglehart, Marita Rohr; Zuzo, Gabrielle A; Wilson, Joshua J

The percentage of U.S. children with poor oral health continues to be high. Kindergarten/elementary school educators could play an important role in teaching students about oral health promotion. The objectives were to assess which oral health-related web-based resources teachers consider most helpful and how teachers' attitudes, knowledge, and behavioural intentions concerning oral health-related teaching change between before and after having access to a resource website. Web-based survey data were collected from 95 kindergarten/elementary school educators before and after they accessed a website with oral health-related information for teachers (web-link: http://media.dent.umich.edu/teachoralhealth/index.html). Most teachers accessed lesson plans about 'Teeth and smiling' (90%) and 'Taking care of your teeth' (88%) and the fewest accessed information about 'Nutrition and health' (42%) and 'Information for parents' (39%). On average, all materials were perceived as useful (5-point scale with 5 = 'very useful', range = 3.80 to 4.04). Responses to the question on how important dental health is for a child's ability to learn improved significantly from before to after the educational intervention (5-point scale with 5 = 'very important', 3.78 vs 4.44). Knowledge increased and behavioural intentions improved as well. The percentage of teachers who reported that they had included oral health-related material in the past was 47% and the percentage who intended to include it in the future was 65% (p < 0.001). Providing kindergarten/elementary school educators with web-based resource materials improves their attitudes, increases their knowledge and leads to positive behavioural intentions concerning educating their students about oral health.

Attitudes toward information and communication technology (ICT) in residential aged care in Western Australia.

PubMed

Loh, Poh-Kooi; Flicker, Leon; Horner, Barbara

2009-07-01

Determine why introduction of health consulting services via Telehealth video conference consultations failed in residential aged care facilities (RACF). Semistructured interview groups and quantitative survey. Two participating not-for-profit RACF. Managers, employed carers, physiotherapist, occupational therapist, registered nurses, and residents from RACF. A survey initially followed by focus groups that centered on 4 questions. How can computers help improve care? What kind of electronic services and products could help improve care? Who should have access to the technology and why was the technology not used? The survey revealed there was awareness of information and communication technology (ICT) in RACF. However, respondents were uncertain of potential benefits provided to their clients. Only 43% of respondents thought a minority of clients would receive the benefits of ICT use. The focus groups revealed several themes regarding the attitudes toward ICT in RACF. Positive attitudes to ICT included themes of saving time, easier doctor access, cost saving, and improved communications. Negative attitudes included themes of loss of human contact, inadequate training, security barriers, not user friendly, limited ability to comply with suggestions, privacy issues, and capital cost. Residents were also concerned about confidentiality and loss of human interaction with the use of Telehealth in residential aged facilities. More training for staff is required to enable them to use ICT efficiently. ICT hardware and software at the user interface must be designed to maintain confidentiality with ease of access. Access to Telehealth services should not impede the routine delivery of personal care and human contact for residents. Studies are required as to where human input to residents is unable to be replaced by Telehealth services.

Changing access to mental health care and social support when people living with HIV/AIDS become service providers.

PubMed

Li, Alan Tai-Wai; Wales, Joshua; Wong, Josephine Pui-Hing; Owino, Maureen; Perreault, Yvette; Miao, Andrew; Maseko, Precious; Guiang, Charlie

2015-01-01

As people living with HIV/AIDS (PHAs) achieve more stable health, many have taken on active peer support and professional roles within AIDS service organizations. Although the increased engagement has been associated with many improved health outcomes, emerging program and research evidence have identified new challenges associated with such transition. This paper reports on the results of a qualitative interpretive study that explored the effect of this role transition on PHA service providers' access to mental health support and self care. A total of 27 PHA service providers of diverse ethno-racial backgrounds took part in the study. Results show that while role transition often improves access to financial and health-care benefits, it also leads to new stress from workload demands, emotional triggers from client's narratives, feeling of burnout from over-immersion in HIV at both personal and professional levels, and diminished self care. Barriers to seeking support included: concerns regarding confidentiality; self-imposed and enacted stigma associated with accessing mental health services; and boundary issues resulting from changes in relationships with peers and other service providers. Evolving support mechanisms included: new formal and informal peer support networks amongst colleagues or other PHA service providers to address both personal and professional challenges, and having access to professional support offered through the workplace. The findings suggest the need for increased organizational recognition of HIV support work as a form of emotional labor that places complex demands on PHA service providers. Increased access to employer-provided mental health services, supportive workplace policies, and adequate job-specific training will contribute to reduced work-related stress. Community level strategies that support expansion of social networks amongst PHA service providers would reduce isolation. Systemic policies to increase access to insurance benefits and enhance sector-wide job preparedness and post-employment support will sustain long-term and meaningful involvement of PHAs in service provision.

Defining Priorities to Improve Patient Experience in Non-Muscle Invasive Bladder Cancer.

PubMed

Garg, Tullika; Connors, Jill Nault; Ladd, Ilene G; Bogaczyk, Tyler L; Larson, Sharon L

2018-01-20

Although approximately 75% of bladder cancers are non-muscle invasive (NMIBC) at diagnosis, most research tends to focus on invasive disease (e.g., experiences related to radical cystectomy and urinary diversion). There is a lack of studies on quality of life, and especially qualitative research, in bladder cancer generally. As a result, relatively little is known about the experiences and needs of NMIBC patients. To understand patient experience, define care priorities, and identify targets for care improvement in NMIBC across the cancer continuum. Through focus groups, patients treated for NMIBC (stage

Identifying priorities for quality improvement at an emergency Department in Ghana.

PubMed

DeWulf, Annelies; Otchi, Elom H; Soghoian, Sari

2017-08-30

Healthcare quality improvement (QI) is a global priority, and understanding the perspectives of frontline healthcare workers can help guide sustainable and meaningful change. We report a qualitative investigation of emergency department (ED) staff priorities for QI at a tertiary care hospital in Ghana. The aims of the study were to educate staff about the World Health Organization's (WHO) definition of quality in healthcare, and to identify an initial focus for building a departmental QI program. Semi-structured interviews were conducted with ED staff using open-ended questions to probe their understanding and valuation of the six dimensions of quality defined by the WHO. Participants were then asked to rank the dimensions in order of importance for QI. Qualitative responses were thematically analyzed, and ordinal rank-order was determined for quantitative data regarding QI priorities. Twenty (20) members of staff of different cadres participated, including ED physicians, nurses, orderlies, a security officer, and an accountant. A majority of participants (61%) ranked access to emergency healthcare as high priority for QI. Two recurrent themes - financial accessibility and hospital bed availability - accounted for the majority of discussions, each linked to all the dimensions of healthcare quality. ED staff related all of the WHO quality dimensions to their work, and prioritized access to emergency care as the most important area for improvement. Participants expressed a high degree of motivation to improve healthcare quality, and the study helped with the development of a departmental QI program focused on the broad topic of access to ED services.

Evaluating the cost-effectiveness of cancer patient navigation programs: conceptual and practical issues.

PubMed

Ramsey, Scott; Whitley, Elizabeth; Mears, Victoria Warren; McKoy, June M; Everhart, Rachel M; Caswell, Robert J; Fiscella, Kevin; Hurd, Thelma C; Battaglia, Tracy; Mandelblatt, Jeanne

2009-12-01

Patient navigators-individuals who assist patients through the healthcare system to improve access to and understanding of their health and healthcare-are increasingly used for underserved individuals at risk for or with cancer. Navigation programs can improve access, but it is unclear whether they improve the efficiency and efficacy of cancer diagnostic and therapeutic services at a reasonable cost, such that they would be considered cost-effective. In the current study, the authors outline a conceptual model for evaluating the cost-effectiveness of cancer navigation programs. They describe how this model is being applied to the Patient Navigation Research Program, a multicenter study supported by the National Cancer Institute's Center to Reduce Cancer Health Disparities. The Patient Navigation Research Program is testing navigation interventions that aim to reduce time to delivery of quality cancer care (noncancer resolution or cancer diagnosis and treatment) after identification of a screening abnormality. Examples of challenges to evaluating cost-effectiveness of navigation programs include the heterogeneity of navigation programs, the sometimes distant relation between navigation programs and outcome of interest (eg, improving access to prompt diagnostic resolution and life-years gained), and accounting for factors in underserved populations that may influence both access to services and outcomes. In this article, the authors discuss several strategies for addressing these barriers. Evaluating the costs and impact of navigation will require some novel methods, but will be critical in recommendations concerning dissemination of navigation programs. (c) 2009 American Cancer Society.

Transforming primary care in the New Orleans safety-net: the patient experience.

PubMed

Schmidt, Laura A; Rittenhouse, Diane R; Wu, Kevin J; Wiley, James A

2013-02-01

The patient-centered medical home (PCMH) is a key service delivery innovation in health reform. However, there are growing questions about whether the changes in clinics promoted by the PCMH model lead to improvements in the patient experience. To test the hypothesis that PCMH improvements in safety-net primary care clinics are associated with a more positive patient experience. Multilevel cross-sectional analysis of patients nested within the primary care clinics that serve them. Primary care clinic leaders and patients throughout the City of New Orleans health care safety-net. Dependent variables included patient ratings of accessibility, coordination, and confidence in the quality/safety of care. The key independent variable was a score measuring PCMH structural and process improvements at the clinic level. Approximately two thirds of patients in New Orleans gave positive ratings to their clinics on access and quality/safety, but only one third did for care coordination. In all but the largest clinics, patient experiences of care coordination were positively associated with the clinic's use of PCMH structural and process changes. Results for patient ratings of access and quality/safety were mixed. Among primary care clinics in the New Orleans safety-net, use of more PCMH improvements at the clinic level led to more positive patient rating of care coordination, but not of accessibility or confidence in quality/safety. Ongoing efforts to pilot, demonstrate, implement, and evaluate the PCMH should consider how the impact of medical practice transformation could vary across different aspects of the patient experience.

JANIS-2: An Improved Version of the NEA Java-based Nuclear Data Information System

NASA Astrophysics Data System (ADS)

Soppera, N.; Henriksson, H.; Nouri, A.; Nagel, P.; Dupont, E.

2005-05-01

JANIS (JAva-based Nuclear Information Software) is a display program designed to facilitate the visualisation and manipulation of nuclear data. Its objective is to allow the user of nuclear data to access numerical and graphical representations without prior knowledge of the storage format. It offers maximum flexibility for the comparison of different nuclear data sets. Features included in the latest release are described such as direct access to centralised databases through JAVA Servlet technology.

Abbreviated MRI Protocols: Wave of the Future for Breast Cancer Screening.

PubMed

Chhor, Chloe M; Mercado, Cecilia L

2017-02-01

The purpose of this article is to describe the use of abbreviated breast MRI protocols for improving access to screening for women at intermediate risk. Breast MRI is not a cost-effective modality for screening women at intermediate risk, including those with dense breast tissue as the only risk. Abbreviated breast MRI protocols have been proposed as a way of achieving efficiency and rapid throughput. Use of these abbreviated protocols may increase availability and provide women with greater access to breast MRI.

JANIS-2: An Improved Version of the NEA Java-based Nuclear Data Information System

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

Soppera, N.; Henriksson, H.; Nagel, P.

2005-05-24

JANIS (JAva-based Nuclear Information Software) is a display program designed to facilitate the visualisation and manipulation of nuclear data. Its objective is to allow the user of nuclear data to access numerical and graphical representations without prior knowledge of the storage format. It offers maximum flexibility for the comparison of different nuclear data sets. Features included in the latest release are described such as direct access to centralised databases through JAVA Servlet technology.

Virtual Interactive Classroom: A New Technology for Distance Learning Developed

NASA Technical Reports Server (NTRS)

York, David W.; Babula, Maria

1999-01-01

The Virtual Interactive Classroom (VIC) allows Internet users, specifically students, to remotely control and access data from scientific equipment. This is a significant advantage to school systems that cannot afford experimental equipment, have Internet access, and are seeking to improve science and math scores with current resources. A VIC Development Lab was established at Lewis to demonstrate that scientific equipment can be controlled by remote users over the Internet. Current projects include a wind tunnel, a room camera, a science table, and a microscope.

Tapping Into Water: Key Considerations for Achieving Excellence in School Drinking Water Access

PubMed Central

Hecht, Kenneth; Hampton, Karla E.; Grumbach, Jacob M.; Braff-Guajardo, Ellen; Brindis, Claire D.

2014-01-01

Objectives. We examined free drinking water access in schools. Methods. We conducted cross-sectional interviews with administrators from 240 California public schools from May to November 2011 to examine the proportion of schools that met excellent water access criteria (i.e., location, density, type, maintenance, and appeal of water sources), school-level characteristics associated with excellent water access, and barriers to improvements. Results. No schools met all criteria for excellent water access. High schools and middle schools had lower fountain:student ratios than elementary schools (odds ratio [OR] = 0.06; 95% confidence interval [CI] = 0.02, 0.20; OR = 0.30, 95% CI = 0.12, 0.70). Rural schools were more likely to offer a nonfountain water source than city schools (OR = 5.0; 95% CI = 1.74, 14.70). Newer schools were more likely to maintain water sources than older schools (OR = 0.98; 95% CI = 0.97, 1.00). Schools that offered free water in food service areas increased from pre- to postimplementation of California’s school water policy (72%–83%; P < .048). Barriers to improving school water included cost of programs and other pressing concerns. Conclusions. Awareness of the benefits related to school drinking water provision and funding may help communities achieve excellence in drinking water access. PMID:24832141

PDBe: improved accessibility of macromolecular structure data from PDB and EMDB.

PubMed

Velankar, Sameer; van Ginkel, Glen; Alhroub, Younes; Battle, Gary M; Berrisford, John M; Conroy, Matthew J; Dana, Jose M; Gore, Swanand P; Gutmanas, Aleksandras; Haslam, Pauline; Hendrickx, Pieter M S; Lagerstedt, Ingvar; Mir, Saqib; Fernandez Montecelo, Manuel A; Mukhopadhyay, Abhik; Oldfield, Thomas J; Patwardhan, Ardan; Sanz-García, Eduardo; Sen, Sanchayita; Slowley, Robert A; Wainwright, Michael E; Deshpande, Mandar S; Iudin, Andrii; Sahni, Gaurav; Salavert Torres, Jose; Hirshberg, Miriam; Mak, Lora; Nadzirin, Nurul; Armstrong, David R; Clark, Alice R; Smart, Oliver S; Korir, Paul K; Kleywegt, Gerard J

2016-01-04

The Protein Data Bank in Europe (http://pdbe.org) accepts and annotates depositions of macromolecular structure data in the PDB and EMDB archives and enriches, integrates and disseminates structural information in a variety of ways. The PDBe website has been redesigned based on an analysis of user requirements, and now offers intuitive access to improved and value-added macromolecular structure information. Unique value-added information includes lists of reviews and research articles that cite or mention PDB entries as well as access to figures and legends from full-text open-access publications that describe PDB entries. A powerful new query system not only shows all the PDB entries that match a given query, but also shows the 'best structures' for a given macromolecule, ligand complex or sequence family using data-quality information from the wwPDB validation reports. A PDBe RESTful API has been developed to provide unified access to macromolecular structure data available in the PDB and EMDB archives as well as value-added annotations, e.g. regarding structure quality and up-to-date cross-reference information from the SIFTS resource. Taken together, these new developments facilitate unified access to macromolecular structure data in an intuitive way for non-expert users and support expert users in analysing macromolecular structure data. © The Author(s) 2015. Published by Oxford University Press on behalf of Nucleic Acids Research.

The Performance Improvement of the Lagrangian Particle Dispersion Model (LPDM) Using Graphics Processing Unit (GPU) Computing

DTIC Science & Technology

2017-08-01

access to the GPU for general purpose processing .5 CUDA is designed to work easily with multiple programming languages , including Fortran. CUDA is a...Using Graphics Processing Unit (GPU) Computing by Leelinda P Dawson Approved for public release; distribution unlimited...The Performance Improvement of the Lagrangian Particle Dispersion Model (LPDM) Using Graphics Processing Unit (GPU) Computing by Leelinda

Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

PubMed

Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E

2002-12-01

Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children.

Methodological proceedings to evaluate the physical accessibility in urban historic sites.

PubMed

Ribeiro, Gabriela Sousa; Martins, Laura Bezerra; Monteiro, Circe Maria Gama

2012-01-01

Historic urban sites are set by cultural and social diversities, generating multiple activities and use and access to these sites should be available to all people including those with disabilities. Taking into consideration that using the same methodology that was used in different historic sites researches with positive results facilitates replication, we aimed to develop methodological procedures that identify conditions of physical accessibility in open public spaces and access to public buildings in historic urban sites to support proposals about design requirements for improvements to the problems diagnosed and control inadequacies of the physical environment. The study methods and techniques from different areas of knowledge culminated in a proposal built with an emphasis on user participation that could be applied with low cost and in relatively short period of time.

Considering Governance for Patient Access to E-Medical Records.

PubMed

Day, Karen; Wells, Susan

2015-01-01

People having access to their medical records could have a transformative improvement effect on healthcare delivery and use. Our research aimed to explore the concerns and attitudes of giving people electronic access to their medical records through patient portals. We conducted 28 semi-structured interviews with 30 people, asking questions about portal design, organisational implications and governance. We report the findings of the governance considerations raised during the interviews. These revealed that (1) there is uncertainty about the possible design and extent of giving people access to their medical records to view/use, (2) existing policies about patient authentication, proxy, and privacy require modification, and (3) existing governance structures and functions require further examination and adjustment. Future research should include more input from patients and health informaticians.

Perceptions of Medicaid Beneficiaries Regarding the Usefulness of Accessing Personal Health Information and Services through a Patient Internet Portal

PubMed Central

Lobach, David F.; Willis, Janese M.; Macri, Jennifer M.; Simo, Jessica; Anstrom, Kevin J.

2006-01-01

Increasing emphasis is being placed on the importance of information technology to improve the safety and quality of healthcare. However, concern is growing that these potential benefits will not be equally distributed across the population because of a widening digital divide along racial and socioeconomic lines. In this pilot study, we surveyed 31 Medicaid beneficiaries to ascertain their interest in and projected use of a healthcare patient Internet portal. We found that most Medicaid beneficiaries (or their parents/guardians) were very interested in accessing personal health information about themselves (or their dependents) online. Additionally, they were interested in accessing healthcare services online. We also found that many Medicaid beneficiaries have Internet access, including a slight majority with access to high-speed Internet connections. Our study revealed significant concern about the privacy of online health information. PMID:17238393

Health care access and utilization among children of single working and nonworking mothers in the United States.

PubMed

Clarke, Tainya C; Arheart, Kristopher L; Muennig, Peter; Fleming, Lora E; Caban-Martinez, Alberto J; Dietz, Noella; Lee, David J

2011-01-01

To examine indicators of health care access and utilization among children of working and nonworking single mothers in the United States, the authors used data on unmarried women participating in the 1997-2008 National Health Interview Survey who financially supported children under 18 years of age (n = 21,842). Stratified by maternal employment, the analyses assessed health care access and utilization for all children. Outcome variables included delayed care, unmet care, lack of prescription medication, no usual place of care, no well-child visit, and no doctor's visit. The analyses reveal that maternal employment status was not associated with health care access and utilization. The strongest predictors of low access/utilization included no health insurance and intermittent health insurance in the previous 12 months, relative to those with continuous private health insurance coverage (odds ratio ranges 3.2-13.5 and 1.3-10.3, respectively). Children with continuous public health insurance compared favorably with those having continuous private health insurance on three of six access/utilization indicators (odds ratio range 0.63-0.85). As these results show, health care access and utilization for the children of single mothers are not optimal. Passage of the U.S. Healthcare Reform Bill (HR 3590) will probably increase the number of children with health insurance and improve these indicators.

Household trends in access to improved water sources and sanitation facilities in Vietnam and associated factors: findings from the Multiple Indicator Cluster Surveys, 2000–2011

PubMed Central

Tuyet-Hanh, Tran Thi; Lee, Jong-Koo; Oh, Juhwan; Van Minh, Hoang; Ou Lee, Chul; Hoan, Le Thi; Nam, You-Seon; Long, Tran Khanh

2016-01-01

Background Despite progress made by the Millennium Development Goal (MDG) number 7.C, Vietnam still faces challenges with regard to the provision of access to safe drinking water and basic sanitation. Objective This paper describes household trends in access to improved water sources and sanitation facilities separately, and analyses factors associated with access to improved water sources and sanitation facilities in combination. Design Secondary data from the Vietnam Multiple Indicator Cluster Survey in 2000, 2006, and 2011 were analyzed. Descriptive statistics and tests of significance describe trends over time in access to water and sanitation by location, demographic and socio-economic factors. Binary logistic regressions (2000, 2006, and 2011) describe associations between access to water and sanitation, and geographic, demographic, and socio-economic factors. Results There have been some outstanding developments in access to improved water sources and sanitation facilities from 2000 to 2011. In 2011, the proportion of households with access to improved water sources and sanitation facilities reached 90% and 77%, respectively, meeting the 2015 MDG targets for safe drinking water and basic sanitation set at 88% and 75%, respectively. However, despite these achievements, in 2011, only 74% of households overall had access to combined improved drinking water and sanitation facilities. There were also stark differences between regions. In 2011, only 47% of households had access to both improved water and sanitation facilities in the Mekong River Delta compared with 94% in the Red River Delta. In 2011, households in urban compared to rural areas were more than twice as likely (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.9–2.5) to have access to improved water and sanitation facilities in combination, and households in the highest compared with the lowest wealth quintile were over 40 times more likely (OR: 42.3; 95% CI: 29.8–60.0). Conclusions More efforts are required to increase household access to both improved water and sanitation facilities in the Mekong River Delta, South East and Central Highlands regions of Vietnam. There is also a need to address socio-economic factors associated with inadequate access to improved sanitation facilities. PMID:26950563

Maternal body mass index and access to antenatal care: a retrospective analysis of 619,502 births in England.

PubMed

Barber, Charlotte; Rankin, Judith; Heslehurst, Nicola

2017-09-06

Late access to antenatal care increases risks of adverse outcomes including maternal and perinatal mortality. There is evidence that BMI influences patient engagement with health services, such as cancer screening services and delayed access to treatment; this association has not been fully explored in the context of antenatal care. This study investigated the association between the stage of pregnancy women access antenatal care, BMI, and other socio-demographic factors. Retrospective analysis of routine hospital data from 34 NHS maternity units in England, UK, including 619,502 singleton births between 1989 and 2007. Analyses used logistic regression to investigate the association between maternal BMI categories and stage of pregnancy women accessed antenatal care. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were used to estimate associations, adjusting for maternal age, ethnic group, parity, Index of Multiple Deprivation score and employment status. The primary outcome was late access to antenatal care (>13 +6  weeks). Secondary outcomes were trimester of access, and the association between late access and other socio-demographic variables. Women with an overweight or obese BMI accessed antenatal care later than women with a recommended BMI (aOR 1.11, 95%CI 1.09-1.12; aOR 1.04, 95%CI 1.02-1.06 respectively), and underweight women accessed care earlier (aOR 0.77, 95%CI 0.74-0.81). Women with obesity were 42% more likely to access care in the third trimester compared with women with a recommended BMI. Additional significant socio-demographic associations with late access included women from minority ethnic groups, teenagers, unemployment and deprivation. The greatest association was observed among Black/Black British women accessing care in the third trimester (aOR 5.07, 95% CI 4.76, 5.40). There are significant and complex socio-demographic inequalities associated with the stage of pregnancy women access maternity care, particularly for women with obesity accessing care very late in their pregnancy, and among BME groups, teenagers, deprived and unemployed women. These populations are at increased risk of adverse maternal and fetal outcomes and require support to address inequalities in access to antenatal care. Interventions to facilitate earlier access to care should address the complex and inter-related nature of these inequalities to improve pregnancy outcomes among high-risk groups.

Remote eye care screening for rural veterans with Technology-based Eye Care Services: a quality improvement project.

PubMed

Maa, April Y; Wojciechowski, Barbara; Hunt, Kelly; Dismuke, Clara; Janjua, Rabeea; Lynch, Mary G

2017-01-01

Veterans are at high risk for eye disease because of age and comorbid conditions. Access to eye care is challenging within the entire Veterans Hospital Administration's network of hospitals and clinics in the USA because it is the third busiest outpatient clinical service and growing at a rate of 9% per year. Rural and highly rural veterans face many more barriers to accessing eye care because of distance, cost to travel, and difficulty finding care in the community as many live in medically underserved areas. Also, rural veterans may be diagnosed in later stages of eye disease than their non-rural counterparts due to lack of access to specialty care. In March 2015, Technology-based Eye Care Services (TECS) was launched from the Atlanta Veterans Affairs (VA) as a quality improvement project to provide eye screening services for rural veterans. By tracking multiple measures including demographic and access to care metrics, data shows that TECS significantly improved access to care, with 33% of veterans receiving same-day access and >98% of veterans receiving an appointment within 30 days of request. TECS also provided care to a significant percentage of homeless veterans, 10.6% of the patients screened. Finally, TECS reduced healthcare costs, saving the VA up to US$148 per visit and approximately US$52 per patient in round trip travel reimbursements when compared to completing a face-to-face exam at the medical center. Overall savings to the VA system in this early phase of TECS totaled US$288,400, about US$41,200 per month. Other healthcare facilities may be able to use a similar protocol to extend care to at-risk patients.

Implementation of national body contouring surgery guidelines following massive weight loss: A national cross-sectional survey of commissioning in England.

PubMed

Dunne, Jonathan A; Wormald, Justin C R; Ghedia, Reshma; Soldin, Mark

2017-01-01

National guidelines for commissioning of body contouring surgery (BCS) following massive weight loss (MWL) in England were published in 2014. Nearly three-quarters of patients who have MWL seek BCS; however, access is known to vary according to the region. The aim of national guidelines was to standardise access. The purpose of this study was to determine implementation of the national guidelines by clinical commissioning groups (CCGs) in England. A cross-sectional, web-based survey was sent to all CCG chairs in England. Of 211 potential respondents, 108 completed the survey or provided funding guidelines (response rate = 52%). Eight CCGs (7%) had implemented the guidelines. A total of 69 CCGs were aware of the new guidelines (64%), and 66 CCGs stated that they fund BCS after MWL (61%). A total of 81 CCGs (75%) identified local funding guidelines, while 15 CCGs (14%) cited individual funding requests (IFRs) as the means of accessing funding. To improve patient access to BCS; 58 of 65 respondents (89%) stated cost-effectiveness, whereas 56 of 75 respondents (75%) thought patient-reported outcome measures were key. Qualitative data to improve access included an integrated pathway from bariatric surgery to BCS, an improved evidence base and greater CCG finances. One CCG stated that it cannot afford to fund cosmetic procedures. The purpose of national guidelines was to simplify the pathway to BCS after MWL and create fair distribution of funds across the country to needy patients; however, their uptake has been poor. Access to funding for BCS across England varies according to the location. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

"Helping my neighbour is like giving a loan…" -the role of social relations in chronic illness in rural Uganda.

PubMed

Amurwon, Jovita; Hajdu, Flora; Yiga, Dominic Bukenya; Seeley, Janet

2017-11-09

Understanding individuals' experience of accessing care and tending to various other needs during chronic illness in a rural context is important for health systems aiming to increase access to healthcare and protect poor populations from unreasonable financial hardship. This study explored the impact on households of access to free healthcare and how they managed to meet needs during chronic illness. Rich data from the life stories of individuals from 22 households in rural south-western Uganda collected in 2009 were analysed. The data revealed that individuals and households depend heavily on their social relations in order to meet their needs during illness, including accessing the free healthcare and maintaining vital livelihood activities. The life stories illustrated ways in which households draw upon social relations to achieve the broader social protection necessary to prevent expenses becoming catastrophic, but also demonstrated the uncertainty in relying solely on informal relations. Improving access to healthcare in a rural context greatly depends on broader social protection. Thus, the informal social protection that already exists in the form of strong reciprocal social relations must be acknowledged, supported and included in health policy planning.

Healthcare provider perspectives on barriers to HIV-care access and utilisation among Latinos living with HIV in the US-Mexico border

PubMed Central

Servin, Argentina E.; Muñoz, Fátima A.; Zúñiga, María Luisa

2015-01-01

Latinos living with HIV residing in the US-Mexico border region frequently seek care on both sides of the border. Given this fact, a border health perspective to understanding barriers to care is imperative to improve patient health outcomes. This qualitative study describes and compares experiences and perceptions of Mexican and US HIV care providers regarding barriers to HIV care access for Latino patients living in the US-Mexico border region. In 2010, we conducted in-depth qualitative interviews with HIV care providers in Tijuana (n = 10) and San Diego (n = 9). We identified important similarities and differences between Mexican and US healthcare provider perspectives on HIV care access and barriers to service utilisation. Similarities included the fact that HIV-positive Latino patients struggle with access to ART medication, mental health illness, substance abuse and HIV-related stigma. Differences included Mexican provider perceptions of medication shortages and US providers feeling that insurance gaps influenced medication access. Differences and similarities have important implications for cross-border efforts to coordinate health services for patients who seek care in both countries. PMID:24592920

Medication safety infrastructure in critical-access hospitals in Florida.

PubMed

Winterstein, Almut G; Hartzema, Abraham G; Johns, Thomas E; De Leon, Jessica M; McDonald, Kathie; Henshaw, Zak; Pannell, Robert

2006-03-01

The medication safety infrastructure of critical-access hospitals (CAHs) in Florida was evaluated. Qualitative assessments, including a self-administered survey and site visits, were conducted in seven of nine CAHs between January and June 2003. The survey consisted of the Institute for Safe Medication Practices Medication Safety Self-assessment, the 2003 Joint Commission on Accreditation of Healthcare Organizations patient safety goals, health information technology (HIT) questions, and medication-use-process flow charts. On-site visits included interviews of CAH personnel who had safety responsibility and inspections of pharmacy facilities. The findings were compiled into a matrix reflecting structural and procedural components of the CAH medication safety infrastructure. The nine characteristics that emerged as targets for quality improvement (QI) were medication accessibility and storage, sterile product compounding, access to drug information, access to and utilization of patient information in medication order review, advanced safety technology, drug formularies and standardized medication protocols, safety culture, and medication reconciliation. Based on weighted importance and feasibility, QI efforts in CAHs should focus on enhancing medication order review systems, standardizing procedures for handling high-risk medications, promoting an appropriate safety culture, involvement in seamless care, and investment in HIT.

Southwest Watershed Research Center Data Access Project

NASA Astrophysics Data System (ADS)

Nichols, M. H.; Anson, E.

2008-05-01

Hydrologic data, including rainfall and runoff data, have been collected on experimental watersheds operated by the U.S. Department of Agriculture Agricultural Research Service (USDA-ARS) in southern Arizona since the 1950s. These data are of national and international importance and make up one of the most comprehensive semiarid watershed data sets in the world. The USDA-ARS Southwest Watershed Research Center has recently developed an electronic data processing system that includes an online interface (http://tucson.ars.ag.gov/dap) to provide public access to the data. The goal of the system is to promote analyses and interpretations of historic and current data by improving data access. Data are collected from sensors in the field and are transmitted to computers in the office. The data are then processed, quality checked, and made available to users via the Internet. The publicly accessible part of the system consists of an interactive Web site, which provides an interface to the data, and a relational database, which is used to process, store, and manage data. The system was released to the public in October 2003, and since that time the online data access Web site has received more than 4500 visitors.

STS-61B Astronaut Ross During ACCESS Extravehicular Activity

NASA Technical Reports Server (NTRS)

1985-01-01

The crew assigned to the STS-61B mission included Bryan D. O'Conner, pilot; Brewster H. Shaw, commander; Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission's primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Australia); and SATCOM KU-2 (RCA Americom). Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, VA and the Marshall Space Flight Center (MSFC), ACCESS and EASE were developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). In this STS-61B onboard photo, astronaut Ross was working on the ACCESS experiment during an Extravehicular Activity (EVA). The primary objective of this experiment was to test the ACCESS structural assembly concept for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction.

Estimating financial resources for universal access to sexual reproductive health care: Evidence from two states in India.

PubMed

Rout, Sarit Kumar; Pradhan, Jalandhar; Choudhury, Sarmistha

2016-10-01

India has made insignificant progress towards achieving universal access to sexual and reproductive health (SRH). One of the key inputs for achieving universal access to SRH is financial resources. Given this, many international agencies including the UN are emphasising on monitoring the financial progress towards achieving SRH. To generate evidence on spending on SRH from various sources - (government, household, international donors and NGOs) to improve the accountability of the government towards SRH goal. Adapting a sub account framework of the NHA, this paper investigated the SRH expenditure of the two divergent states of India. The data were collected from government, households (NSSO), and foreign donors and were classified as per the International Classification of Health Accounts (ICHA). Total SRH expenditure is less than one percent of SGDP from all sources in each state. Among the sources, government's spending on SRH is more than household. A large part of household spending is on curative care which has implications for accessing services by the poor. In spite of data constraints, this paper presents a comprehensive analysis on SRH spending, which is critical for monitoring the commitment towards universal access to SRH. This evidence can be used for further improving data quality for RCH account in LMICs. Copyright © 2016 Elsevier B.V. All rights reserved.

Patients' experiences of an open access follow up arrangement in managing inflammatory bowel disease

PubMed Central

Rogers, A; Kennedy, A; Nelson, E; Robinson, A

2004-01-01

Background: Improving access is a key policy issue in improving quality of care and extending patient choice and participation. People's experience of changing from fixed outpatient appointments to more flexible direct access arrangements for chronic disease has been underexplored. Objectives: To examine patients' views on using an open system of access compared with fixed outpatient appointments as part of a guided self-management intervention for inflammatory bowel disease (IBD). Design: Embedded qualitative study undertaken alongside a randomised controlled trial. Semi-structured interviews were undertaken to obtain an in depth understanding of patients' experience of the change in access arrangements. Participants: A purposive sample (n = 30) was drawn from the intervention group (n = 700) according to a range of responses to the trial baseline and follow up quantitative measures. Results: 28 interviews were included in the analysis. Compared with the previous system of fixed appointments, preference for the new open access system was based on enhanced personal control in contacting services and the view that it fitted better with everyday routine management and the requirement for urgent medical contact when symptoms fail to respond to medication. Preference for retaining fixed appointments was based on a sense of security from gaining access which did not require the individual to initiate the request for medical help. Conclusions: Open access may fit better with patients' self-management of their condition and everyday routines, roles and responsibilities. Ensuring that outpatient organisational arrangements and personnel are responsive to patient initiated requests for appointments is likely to impact on the acceptability of this type of access arrangement. Some people may continue to prefer the fixed appointment system which should be retained if patient choice is to be respected. PMID:15465941

Accessibility and socio-economic development of human settlements.

PubMed

Hasan, Samiul; Wang, Xiaoming; Khoo, Yong Bing; Foliente, Greg

2017-01-01

Access to facilities, services and socio-economic opportunities plays a critical role in the growth and decline of cities and human settlements. Previous attempts to explain changes in socio-economic indicators by differences in accessibility have not been convincing as countries with highly developed transport infrastructure have only seen marginal benefits of infrastructure improvements. Australia offers an ideal case for investigating the effects of accessibility on development since it is seen as home to some of the most liveable cities in the world while, at the same time, it also has some of the most isolated settlements. We investigate herein the connectivity and accessibility of all 1814 human settlements (population centers exceeding 200 persons) in Australia, and how they relate to the socio-economic characteristics of, and opportunities in, each population center. Assuming population as a proxy indicator of available opportunities, we present a simple ranking metric for a settlement using the number of population and the distance required to access all other settlements (and the corresponding opportunities therein). We find a strikingly unequal distribution of access to opportunities in Australia, with a marked prominence of opportunities in capital cities in four of the eight states. The two largest cities of Sydney and Melbourne have a dominant position across all socio-economic indicators, compared to all the other cities. In general, we observe across all the settlements that a decrease in access to opportunities is associated with relatively greater socio-economic disadvantage including increased median age and unemployment rate and decreased median household income. Our methodology can be used to better understand the potential benefits of improved accessibility based on infrastructure development, especially for remote areas and for cities and towns with many socio-economically disadvantaged population.

Accessibility and socio-economic development of human settlements

PubMed Central

Wang, Xiaoming; Khoo, Yong Bing; Foliente, Greg

2017-01-01

Access to facilities, services and socio-economic opportunities plays a critical role in the growth and decline of cities and human settlements. Previous attempts to explain changes in socio-economic indicators by differences in accessibility have not been convincing as countries with highly developed transport infrastructure have only seen marginal benefits of infrastructure improvements. Australia offers an ideal case for investigating the effects of accessibility on development since it is seen as home to some of the most liveable cities in the world while, at the same time, it also has some of the most isolated settlements. We investigate herein the connectivity and accessibility of all 1814 human settlements (population centers exceeding 200 persons) in Australia, and how they relate to the socio-economic characteristics of, and opportunities in, each population center. Assuming population as a proxy indicator of available opportunities, we present a simple ranking metric for a settlement using the number of population and the distance required to access all other settlements (and the corresponding opportunities therein). We find a strikingly unequal distribution of access to opportunities in Australia, with a marked prominence of opportunities in capital cities in four of the eight states. The two largest cities of Sydney and Melbourne have a dominant position across all socio-economic indicators, compared to all the other cities. In general, we observe across all the settlements that a decrease in access to opportunities is associated with relatively greater socio-economic disadvantage including increased median age and unemployment rate and decreased median household income. Our methodology can be used to better understand the potential benefits of improved accessibility based on infrastructure development, especially for remote areas and for cities and towns with many socio-economically disadvantaged population. PMID:28636630

The views of stakeholders on controlled access schemes for high-cost antirheumatic biological medicines in Australia

PubMed Central

Lu, Christine Y; Ritchie, Jan; Williams, Ken; Day, Ric

2007-01-01

Background In Australia, government-subsidised access to high-cost medicines is "targeted" to particular sub-sets of patients under the Pharmaceutical Benefits Scheme to achieve cost-effective use. In order to determine how this access system could be improved, the opinions of key stakeholders on access to biological agents for rheumatoid arthritis were explored. Methods Thirty-six semi-structured interviews were conducted with persons from relevant stakeholder groups. These were transcribed verbatim, and analysed thematically. Results Controlled access to expensive medicines was considered to be equitable and practical; however, there was disagreement as to the method of defining the target patient populations. Other concerns included timeliness of access, excessive bureaucracy, and the need for additional resources to facilitate the scheme. Collaboration between stakeholders was deemed important because it allows more equitable distribution of limited resources. The majority considered that stakeholder consultation should have been broader. Most wanted increased transparency of the decision-making process, ongoing and timely review of access criteria, and an increased provision of information for patients. More structured communication between stakeholders was proposed. Conclusion The Pharmaceutical Benefit Scheme is adapting to meet the changing needs of patients. Provision of subsidised access to high-cost medicines in a manner that is affordable for individuals and society, and that is equitable and efficiently managed is challenging. The views of stakeholders on targeted access to anti-rheumatic biological medicines in Australia acknowledged this challenge and provided a number of suggestions for modifications. These could serve as a basis to inform the debate on how to change the processes and policies so as to improve the scheme. PMID:18096055

Medical Devices Transition to Information Systems: Lessons Learned

PubMed Central

Charters, Kathleen G.

2012-01-01

Medical devices designed to network can share data with a Clinical Information System (CIS), making that data available within clinician workflow. Some lessons learned by transitioning anesthesia reporting and monitoring devices (ARMDs) on a local area network (LAN) to integration of anesthesia documentation within a CIS include the following categories: access, contracting, deployment, implementation, planning, security, support, training and workflow integration. Areas identified for improvement include: Vendor requirements for access reconciled with the organizations’ security policies and procedures. Include clauses supporting transition from stand-alone devices to information integrated into clinical workflow in the medical device procurement contract. Resolve deployment and implementation barriers that make the process less efficient and more costly. Include effective field communication and creative alternatives in planning. Build training on the baseline knowledge of trainees. Include effective help desk processes and metrics. Have a process for determining where problems originate when systems share information. PMID:24199054

Systemic barriers accessing HIV treatment among people who inject drugs in Russia: a qualitative study.

PubMed

Sarang, Anya; Rhodes, Tim; Sheon, Nicolas

2013-10-01

Achieving 'universal access' to antiretroviral HIV treatment (ART) in lower income and transitional settings is a global target. Yet, access to ART is shaped by local social condition and is by no means universal. Qualitative studies are ideally suited to describing how access to ART is socially situated. We explored systemic barriers to accessing ART among people who inject drugs (PWID) in a Russian city (Ekaterinburg) with a large burden of HIV treatment demand. We undertook 42 in-depth qualitative interviews with people living with HIV with current or recent experience of injecting drug use. Accounts were analysed thematically, and supplemented here with an illustrative case study. Three core themes were identified: 'labyrinthine bureaucracy' governing access to ART; a 'system Catch 22' created by an expectation that access to ART was conditional upon treated drug use in a setting of limited drug treatment opportunity; and 'system verticalization', where a lack of integration across HIV, tuberculosis (TB) and drug treatment compromised access to ART. Taken together, we find that systemic factors play a key role in shaping access to ART with the potential adverse effects of reproducing treatment initiation delay and disengagement from treatment. We argue that meso-level systemic factors affecting access to ART for PWID interact with wider macro-level structural forces, including those related to drug treatment policy and the social marginalization of PWID. We note the urgent need for systemic and structural changes to improve access to ART for PWID in this setting, including to simplify bureaucratic procedures, foster integrated HIV, TB and drug treatment services, and advocate for drug treatment policy reform.

Progress on Broadband Access to the Internet and Use of Mobile Devices in the United States.

PubMed

Serrano, Katrina J; Thai, Chan L; Greenberg, Alexandra J; Blake, Kelly D; Moser, Richard P; Hesse, Bradford W

Healthy People 2020 (HP2020) aims to improve population health outcomes through several objectives, including health communication and health information technology. We used 7 administrations of the Health Information National Trends Survey to examine HP2020 goals toward access to the Internet through broadband and mobile devices (N = 34 080). We conducted descriptive analyses and obtained predicted marginals, also known as model-adjusted risks, to estimate the association between demographic characteristics and use of mobile devices. The HP2020 target (7.7% of the US population) for accessing the Internet through a cellular network was surpassed in 2014 (59.7%), but the HP2020 target (83.2%) for broadband access fell short (63.8%). Sex and age were associated with accessing the Internet through a cellular network throughout the years (Wald F test, P <.05). The increase in the percentage of people accessing the Internet through mobile devices presents an opportunity for technology-based health interventions that should be explored.

Progress on Broadband Access to the Internet and Use of Mobile Devices in the United States

PubMed Central

Thai, Chan L.; Greenberg, Alexandra J.; Blake, Kelly D.; Moser, Richard P.; Hesse, Bradford W.

2016-01-01

Healthy People 2020 (HP2020) aims to improve population health outcomes through several objectives, including health communication and health information technology. We used 7 administrations of the Health Information National Trends Survey to examine HP2020 goals toward access to the Internet through broadband and mobile devices (N = 34 080). We conducted descriptive analyses and obtained predicted marginals, also known as model-adjusted risks, to estimate the association between demographic characteristics and use of mobile devices. The HP2020 target (7.7% of the US population) for accessing the Internet through a cellular network was surpassed in 2014 (59.7%), but the HP2020 target (83.2%) for broadband access fell short (63.8%). Sex and age were associated with accessing the Internet through a cellular network throughout the years (Wald F test, P <.05). The increase in the percentage of people accessing the Internet through mobile devices presents an opportunity for technology-based health interventions that should be explored. PMID:28005473

Exploring patients' perceptions of accessing electronic health records: Innovation in healthcare.

PubMed

Wass, Sofie; Vimarlund, Vivian; Ros, Axel

2017-04-01

The more widespread implementation of electronic health records has led to new ways of providing access to healthcare information, allowing patients to view their medical notes, test results, medicines and so on. In this article, we explore how patients perceive the possibility to access their electronic health record online and whether this influences patient involvement. The study includes interviews with nine patients and a survey answered by 56 patients. Our results show that patients perceive healthcare information to be more accessible and that electronic health record accessibility improves recall, understanding and patient involvement. However, to achieve the goal of involving patients as active decision-makers in their own treatment, electronic health records need to be fully available and test results, referrals and information on drug interactions need to be offered. As patient access to electronic health records spreads, it is important to gain a deeper understanding of how documentation practices can be changed to serve healthcare professionals and patients.

Acceptable care? Illness constructions, healthworlds, and accessible chronic treatment in South Africa.

PubMed

Fried, Jana; Harris, Bronwyn; Eyles, John; Moshabela, Mosa

2015-05-01

Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas-conversely-these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating "disease" to responding to "illness" by acknowledging and incorporating patients' healthworlds in patient-provider interactions. © The Author(s) 2015.

Barriers to accessing adequate maternal care in Central and Eastern European countries: A systematic literature review.

PubMed

Miteniece, Elina; Pavlova, Milena; Rechel, Bernd; Groot, Wim

2017-03-01

Maternal health outcomes in Central and Eastern Europe (CEE) compare unfavorable with those in Western Europe, despite macro-indicators that suggest well-designed maternal care systems. However, macro-indicators at the system level only capture capacity, funding and utilization of care and not the actual allocation of financial and human resources, the quality of care and access to it. It is these latter which are problematic in the CEE region. In this study service-related indicators of access to maternal care in CEE are examined. These include availability, appropriateness, affordability, approachability and acceptability of maternal care. This study uses a qualitative systematic literature review, analyzing information of peer-reviewed articles published since 2004. Other inclusion criteria included language, setting and publication purpose. The included articles were analyzed using a framework analysis technique and quality was assessed using standardized evaluation checklists. Results indicate improvements in maternal care. However, availability of care is limited by outdated equipment and training curricula, and the lack of professionals and pharmaceuticals. Geographical distance to healthcare institutions, inappropriate communication of providers and waiting times are the main approachability barriers. Some mothers are unaware of the importance of care or are discouraged to utilize healthcare services because of cultural aspects. Finally, a major barrier in accessing maternal care in the CEE is the inability to pay for it. Our findings indicate that major gaps in evidence exist and that more representative and better quality data should be collected. Governments in CEE countries need to establish a reliable system for measuring and monitoring a suitable set of indicators, as well as deal with the general social and economic problem of informality. Medical curricula in the CEE region need to be overhauled and there should be a focus on improving the allocation of medical staff and institutions as well as protecting vulnerable population groups to ensure universal access to care. Copyright © 2017 Elsevier Ltd. All rights reserved.

AP-8 trapped proton environment for solar maximum and solar minimum. [Computer accessible models

NASA Technical Reports Server (NTRS)

Sawyer, D. M.; Vette, J. I.

1976-01-01

Data sets from Ov-3 and Azur indicate a need for improvement in models of the stably trapped proton flux with energies between 0.1 and 400 MeV. Two computer accessible models are described: AP8MAX and AP8MIN. The models are presented in the form of nomographs, B-L plots, R-lambda plots, and equatorial radial profiles. Nomographs of the orbit-integrated fluxes are also discussed. The models are compared with each other, with the data, and with previous AP models. Requirements for future improvements include more complete data coverage and periodic comparisons with new data sets as they become available. The machine-sensible format in which the models are available are described.

The DOI Is Coming.

ERIC Educational Resources Information Center

Scharf, Davida

2002-01-01

Discussion of improving accessibility to copyrighted electronic content focuses on the Digital Object Identifier (DOI) and the Open URL standard and linking software. Highlights include work of the World Wide Web consortium; URI (Uniform Resource Identifier); URL (Uniform Resource Locator); URN (Uniform Resource Name); OCLC's (Online Computer…

The Americans with Disabilities Act: Implications for Camp Programming.

ERIC Educational Resources Information Center

Bedini, Leandra A.; And Others

1992-01-01

Discusses the effect of the Americans with Disabilities Act (ADA) on camp programing and provides strategies to improve camp accessibility for people with disabilities. Discusses obstacles to integrated programing including ecological and architectural barriers, attitudinal barriers, transportation barriers, barriers of omission, economic…

Workforce Training: Employed Worker Programs Focus on Business Needs, But Revised Performance Measures Could Improve Access for Some Workers. Report to Congressional Requesters.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC.

The General Accounting Office (GAO) examined publicly supported training programs for employed workers, including low-wage workers. The GAO surveyed local workforce boards nationwide and received responses from 470 boards. Two-thirds of the responding boards provided assistance to train employed workers, including partnering with employers to…

Bloodstream infection rates in outpatient hemodialysis facilities participating in a collaborative prevention effort: a quality improvement report.

PubMed

Patel, Priti R; Yi, Sarah H; Booth, Stephanie; Bren, Virginia; Downham, Gemma; Hess, Sally; Kelley, Karen; Lincoln, Mary; Morrissette, Kathy; Lindberg, Curt; Jernigan, John A; Kallen, Alexander J

2013-08-01

Bloodstream infections (BSIs) cause substantial morbidity in hemodialysis patients. In 2009, the US Centers for Disease Control and Prevention (CDC) sponsored a collaborative project to prevent BSIs in outpatient hemodialysis facilities. We sought to assess the impact of a set of interventions on BSI and access-related BSI rates in participating facilities using data reported to the CDC's National Healthcare Safety Network (NHSN). Quality improvement project. Patients in 17 outpatient hemodialysis facilities that volunteered to participate. Facilities reported monthly event and denominator data to NHSN, received guidance from the CDC, and implemented an evidence-based intervention package that included chlorhexidine use for catheter exit-site care, staff training and competency assessments focused on catheter care and aseptic technique, hand hygiene and vascular access care audits, and feedback of infection and adherence rates to staff. Crude and modeled BSI and access-related BSI rates. Up to 12 months of preintervention (January 2009 through December 2009) and 15 months of intervention period (January 2010 through March 2011) data from participating centers were analyzed. Segmented regression analysis was used to assess changes in BSI and access-related BSI rates during the preintervention and intervention periods. Most (65%) participating facilities were hospital based. Pooled mean BSI and access-related BSI rates were 1.09 and 0.73 events per 100 patient-months during the preintervention period and 0.89 and 0.42 events per 100 patient-months during the intervention period, respectively. Modeled rates decreased 32% (P = 0.01) for BSIs and 54% (P < 0.001) for access-related BSIs at the start of the intervention period. Participating facilities were not representative of all outpatient hemodialysis centers nationally. There was no control arm to this quality improvement project. Facilities participating in a collaborative successfully decreased their BSI and access-related BSI rates. The decreased rates appeared to be maintained in the intervention period. These findings suggest that improved implementation of recommended practices can reduce BSIs in hemodialysis centers. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc.

Analysis of Internet Usage Among Cancer Patients in a County Hospital Setting: A Quality Improvement Initiative

PubMed Central

Lilley, Lisa; Lodrigues, William; Dreadin-Pulliam, Julie; Xie, Xian-Jin; Mathur, Sakshi; Rao, Madhu; Harvey, Valorie; Leitch, Ann Marilyn; Rao, Roshni

2014-01-01

Background Cancer is one of the most common diseases that patients research on the Internet. The Commission on Cancer (CoC) recommended that Parkland Memorial Hospital (PMH) improve the oncology services website. PMH is Dallas County’s public health care facility, serving a largely uninsured, minority population. Most research regarding patient Internet use has been conducted in insured, Caucasian populations, raising concerns that the needs of PMH patients may not be extrapolated from available data. The PMH Cancer Committee, therefore, adopted a quality improvement initiative to understand patients’ Internet usage. Objective The objective of the study was to obtain and analyze data regarding patients’ Internet usage in order to make targeted improvements to the oncology services section of the institutional website. Methods A task force developed an 11-question survey to ascertain what proportion of our patients have Internet access and use the Internet to obtain medical information as well as determine the specific information sought. Between April 2011 and August 2011, 300 surveys were administered to newly diagnosed cancer patients. Multivariate analyses were performed. Results Of 300 surveys, 291 were included. Minorities, primarily African-American and Hispanic, represented 78.0% (227/291) of patients. Only 37.1% (108/291) of patients had Internet access, most (256/291, 87.9%) having access at home. Younger patients more commonly had Internet access, with a mean age of 47 versus 58 years for those without (P<.001). Education beyond high school was associated with Internet access (P<.001). The most common reason for Internet research was to develop questions for discussion with one’s physician. Patients most frequently sought information regarding cancer treatment options, outcomes, and side effects. Conclusions Less than one-half of PMH oncology patients have Internet access. This is influenced by age, educational level, and ethnicity. Those with access use it to obtain information related to their cancer diagnosis. The most effective way of addressing our patients’ needs using the institutional website is to provide links to reputable disease-specific sites. PMID:24824330

MORS Workshop on Improving Defense Analysis through Better Data Practices, held in Alexandria, Virginia on March 25, 26 and 27, 2003

DTIC Science & Technology

2004-12-03

other process improvements could also enhance DoD data practices. These include the incorporation of library science techniques as well as processes to...coalition communities as well as adapting the approaches and lessons of the library science community. Second, there is a need to generate a plan of...Best Practices (2 of 2) - Processes - Incorporate library science techniques in repository design - Improve visibility and accessibility of DoD data

Constraints and opportunities for implementing nutrition-specific, agricultural and market-based approaches to improve nutrient intake adequacy among infants and young children in two regions of rural Kenya.

PubMed

Hotz, Christine; Pelto, Gretel; Armar-Klemesu, Margaret; Ferguson, Elaine F; Chege, Peter; Musinguzi, Enock

2015-12-01

Several types of interventions can be used to improve nutrient intake adequacy in infant and young child (IYC) diets, including fortified foods, home fortification, nutrition education and behaviour change communication (BCC) in addition to agricultural and market-based strategies. However, the appropriate selection of interventions depends on the social, cultural, physical and economic context of the population. Derived from two rural Kenyan populations, this analysis combined information from: (1) a quantitative analysis to derive a set of food-based recommendations (FBRs) to fill nutrient intake gaps in IYC diets and identify 'problem nutrients' for which intake gaps require solutions beyond currently available foods and dietary patterns, and (2) an ethnographic qualitative analysis to identify contextual factors posing opportunities or constraints to implementing the FBRs, including perceptions of cost, convenience, accessibility and appropriateness of the recommended foods for IYC diets and other social or physical factors that determine accessibility of those foods. Opportunities identified included BCC to increase the acceptability and utilisation of green leafy vegetables (GLV) and small fish and agronomic interventions to increase the productivity of GLV and millet. Value chains for millet, beans, GLV, milk and small fish should be studied for opportunities to increase their accessibility in local markets. Processor-level interventions, such as partially cooked fortified dry porridge mixes or unfortified cereal mixes incorporating millet and beans, may increase the accessibility of foods that provide increased amounts of the problem nutrients. Multi-sectoral actors and community stakeholders should be engaged to assess the feasibility of implementing these locally appropriate strategies. © 2015 John Wiley & Sons Ltd.

Implementing new care models: learning from the Greater Manchester demonstrator pilot experience.

PubMed

Elvey, Rebecca; Bailey, Simon; Checkland, Kath; McBride, Anne; Parkin, Stephen; Rothwell, Katy; Hodgson, Damian

2018-06-19

Current health policy focuses on improving accessibility, increasing integration and shifting resources from hospitals to community and primary care. Initiatives aimed at achieving these policy aims have supported the implementation of various 'new models of care', including general practice offering 'additional availability' appointments during evenings and at weekends. In Greater Manchester, six 'demonstrator sites' were funded: four sites delivered additional availability appointments, other services included case management and rapid response. The aim of this paper is to explore the factors influencing the implementation of services within a programme designed to improve access to primary care. The paper consists of a qualitative process evaluation undertaken within provider organisations, including general practices, hospitals and care homes. Semi-structured interviews, with the data subjected to thematic analysis. Ninety-one people participated in interviews. Six key factors were identified as important for the establishment and running of the demonstrators: information technology; information governance; workforce and organisational development; communications and engagement; supporting infrastructure; federations and alliances. These factors brought to light challenges in the attempt to provide new or modify existing services. Underpinning all factors was the issue of trust; there was consensus amongst our participants that trusting relationships, particularly between general practices, were vital for collaboration. It was also crucial that general practices trusted in the integrity of anyone external who was to work with the practice, particularly if they were to access data on the practice computer system. A dialogical approach was required, which enabled staff to see themselves as active rather than passive participants. The research highlights various challenges presented by the context within which extended access is implemented. Trust was the fundamental underlying issue; there was consensus amongst participants that trusting relationships were vital for effective collaboration in primary care.

An annotated bibliography of selected guides for stream habitat improvement in the Pacific Northwest

USGS Publications Warehouse

Keim, R.F.; Price, A.B.; Hardin, T. S.; Skaugset, Arne E.; Bateman, D.S.; Gresswell, R.E.; Tesch, S. D.

2004-01-01

This annotated bibliography is a response to widespread interest in stream habitat improvement in the Pacific Northwest by land managers, governmental and nongovernmental organizations, and the lay public. Several guides to stream habitat improvement have been written in the past, but may not be easily accessible to people from diverse backgrounds. This annotated bibliography reviews 11 guides to stream habitat improvement so that readers can find literature appropriate to their needs. All reviews begin with summaries of the contents, stated audiences, and goals of each guide. Reviews also include subjective comments on the strengths and weaknesses of each guide. Finally, this bibliography includes recommendations of guides and combinations of guides judged most useful for a range of purposes. 

International summit on the nutrition of adolescent girls and young women: consensus statement

PubMed Central

Krebs, Nancy; Bagby, Susan; Bhutta, Zulfiqar A.; Dewey, Kathryn; Fall, Caroline; Gregory, Fred; Hay, William; Rhuman, Lisa; Caldwell, Christine Wallace

2017-01-01

An international summit focusing on the difficult challenge of providing adequate nutrition for adolescent girls and young women in low‐ and middle‐income countries was held in Portland, Oregon in 2015. Sixty‐seven delegates from 17 countries agreed on a series of recommendations that would make progress toward improving the nutritional status of girls and young women in countries where their access to nutrition is compromised. Delegate recommendations include: (1) elevate the urgency of nutrition for girls and young women to a high international priority, (2) raise the social status of girls and young women in all regions of the world, (3) identify major knowledge gaps in the biology of adolescence that could be filled by robust research efforts, (4) and improve access to nutrient‐rich foods for girls and young women. Attention to these recommendations would improve the health of young women in all nations of the world. PMID:28722768

Performance Optimization of Marine Science and Numerical Modeling on HPC Cluster

PubMed Central

Yang, Dongdong; Yang, Hailong; Wang, Luming; Zhou, Yucong; Zhang, Zhiyuan; Wang, Rui; Liu, Yi

2017-01-01

Marine science and numerical modeling (MASNUM) is widely used in forecasting ocean wave movement, through simulating the variation tendency of the ocean wave. Although efforts have been devoted to improve the performance of MASNUM from various aspects by existing work, there is still large space unexplored for further performance improvement. In this paper, we aim at improving the performance of propagation solver and data access during the simulation, in addition to the efficiency of output I/O and load balance. Our optimizations include several effective techniques such as the algorithm redesign, load distribution optimization, parallel I/O and data access optimization. The experimental results demonstrate that our approach achieves higher performance compared to the state-of-the-art work, about 3.5x speedup without degrading the prediction accuracy. In addition, the parameter sensitivity analysis shows our optimizations are effective under various topography resolutions and output frequencies. PMID:28045972

Provision of genetics services on Guam.

PubMed

McWalter, Kirsty; Hasegawa, Lianne; Au, Sylvia Mann

2013-12-01

Guam's geographic isolation and lack of community resources have resulted in unique healthcare needs. In 2006, the Western States Genetic Services Collaborative (WSGSC) conducted a genetics needs assessment and found that professional development is limited, families lack access to genetic services, and improved coverage of genetic testing is needed. With funding from the WSGSC, a Guam genetics outreach clinic was established and staffed by genetic counselors and a medical geneticist from Hawaii. Four clinics have been held to date. Although several challenges have been encountered, including minimal coverage of genetic testing by Guam insurance companies, limited referrals for families with private insurance, and inappropriate referral indications, the outreach clinic has been successful at increasing access to genetic services and improving professional development. With more collaborative work by staff from Guam, Hawaii, and the WSGSC, provision and reimbursement of genetic services and testing will continue to improve.

Health equity and migrants in the Greater Mekong Subregion

PubMed Central

McMichael, Celia; Healy, Judith

2017-01-01

ABSTRACT Background: Migrant health is receiving increasing international attention, reflecting recognition of the health inequities experienced among many migrant populations and the need for health systems to adapt to diverse migrant populations. In the Greater Mekong Subregion (GMS) there is increasing migration associated with uneven economic integration and growth, socio-economic vulnerabilities, and disparities between countries. There has been limited progress, however, in improving migrant access to health services in the Subregion. This paper examines the health needs, access barriers, and policy responses to cross-border migrants in five GMS countries. Methods: A review of published literature and research was conducted on migrant health and health service access in Cambodia, Lao People’s Democratic Republic, Myanmar, Thailand, and Viet Nam, as well as analysis of current migration trends and universal health coverage (UHC) indicators in the Subregion. The review included different migrant types: i.e. migrant workers, irregular migrants, victims of trafficking, refugees and asylum seekers, and casual cross-border migrants. Results: There is substantial diversity in the capacity of GMS health systems to address migrant populations. Thailand has sought to enhance migrant health coverage, including development of migrant health policies/programs, bilateral migrant worker agreements, and migrant health insurance schemes; Viet Nam provides health protection for emigrant workers. Overall, however, access to good quality health care remains weak for many citizens in GMS countries let alone migrants. Migrant workers – and irregular migrants in particular – face elevated health risks yet are not adequately covered and incur high out-of-pocket (OOP) payments for health services. Conclusions: UHC implies equity: UHC is only achieved when everyone has the opportunity to access and use good-quality health care. Efforts to achieve UHC in the GMS require deliberate policy decisions to include migrants. The emergence of the UHC agenda, and the focus on migrant health among policy makers and partners, present an opportunity to tackle barriers to health service access, extend coverage, and strengthen partnerships in order to improve migrant health. This is an opportune time for GMS countries to develop migrant-inclusive health systems. PMID:28452652

Caring for the Unseen: Using Linking Social Capital to Improve Healthcare Access to Irregular Migrants in Spain

PubMed Central

2016-01-01

Abstract Purpose To describe a novel strategy using linking social capital to provide healthcare access to irregular migrants with low literacy, low numeracy, and limited cultural assimilation in a European metropolitan area. Organizing Construct Public data show numerous shortcomings in meeting the healthcare needs of refugees and irregular migrants surging into Europe. Many irregular migrants living in European communities are unable to access information, care, or services due to lack of social capital. An overview of the problem and traditional charity strategies, including their barriers, are briefly described. A novel strategy using linking social capital to improve healthcare access of irregular migrants is explored and described. Information regarding the impact of this approach on the target population is provided. The discussion of nursing's role in employing linking social capital to care for the vulnerable is presented. Conclusions Immigration and refugee data show that issues related to migration will continue. The novel strategy presented can be implemented by nurses with limited financial and physical resources in small community settings frequented by irregular migrants to improve health care. Clinical Relevance The health and well‐being of irregular migrants has an impact on community health. Nurses must be aware of and consider implementing novel strategies to ensure that all community members’ healthcare needs, which are a basic human right, are addressed. PMID:27355488

The Use of Enhanced Appointment Access Strategies by Medical Practices.

PubMed

Rodriguez, Hector P; Knox, Margae; Hurley, Vanessa; Rittenhouse, Diane R; Shortell, Stephen M

2016-06-01

Strategies to enhance appointment access are being adopted by medical practices as part of patient-centered medical home (PCMH) implementation, but little is known about the use of these strategies nationally. We examine practice use of open access scheduling and after-hours care. Data were analyzed from the Third National Study of Physician Organizations (NSPO3) to examine which enhanced appointment access strategies are more likely to be used by practices with more robust PCMH capabilities and with greater external incentives. Logistic regression estimated the effect of PCMH capabilities and external incentives on practice use of open access scheduling and after-hours care. Physician organizations with >20% primary care physicians (n=1106). PCMH capabilities included team-based care, health information technology capabilities, quality improvement orientation, and patient experience orientation. External incentives included public reporting, pay-for-performance (P4P), and accountable care organization participation. A low percentage of practices (19.8%) used same-day open access scheduling, while after-hours care (56.1%) was more common. In adjusted analyses, system-owned practices and practices with greater use of team-based care, health information technology capabilities, and public reporting were more likely to use open access scheduling. Accountable care organization-affiliated practices and practices with greater use of public reporting and P4P were more likely to provide after-hours care. Open access scheduling may be most effectively implemented by practices with robust PCMH capabilities. External incentives appear to influence practice adoption of after-hours care. Expanding open access scheduling and after-hours care will require distinct policies and supports.

42 CFR 480.111 - QIO access to records and information of institutions and practitioners.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Access to Information § 480.111 QIO access to records and...

Using Genetic Technologies To Reduce, Rather Than Widen, Health Disparities

PubMed Central

Smith, Caren E.; Fullerton, Stephanie M.; Dookeran, Keith A.; Hampel, Heather; Tin, Adrienne; Maruthur, Nisa M.; Schisler, Jonathan C.; Henderson, Jeffrey A.; Tucker, Katherine L.; Ordovás, José M.

2016-01-01

Evidence shows that both biological and nonbiological factors contribute to health disparities. Genetics, in particular, plays a part in how common diseases manifest themselves. Today, unprecedented advances in genetically based diagnoses and treatments provide opportunities for personalized medicine. However, disadvantaged groups may lack access to these advances, and treatments based on research on non-Hispanic whites might not be generalizable to members of minority groups. Unless genetic technologies become universally accessible, existing disparities could be widened. Addressing this issue will require integrated strategies, including expanding genetic research, improving genetic literacy, and enhancing access to genetic technologies among minority populations in a way that avoids harms such as stigmatization. PMID:27503959

Action research to improve methods of delivery and feedback in an Access Grid Room environment

NASA Astrophysics Data System (ADS)

McArthur, Lynne C.; Klass, Lara; Eberhard, Andrew; Stacey, Andrew

2011-12-01

This article describes a qualitative study which was undertaken to improve the delivery methods and feedback opportunity in honours mathematics lectures which are delivered through Access Grid Rooms. Access Grid Rooms are facilities that provide two-way video and audio interactivity across multiple sites, with the inclusion of smart boards. The principal aim was to improve the student learning experience, given the new environment. The specific aspects of the course delivery that the study focused on included presentation of materials and provision of opportunities for interaction between the students and between students and lecturers. The practical considerations in the delivery of distance learning are well documented in the literature, and similar problems arise in the Access Grid Room environment; in particular, those of limited access to face-to-face interaction and the reduction in peer support. The nature of the Access Grid Room classes implies that students studying the same course can be physically situated in different cities, and possibly in different countries. When studying, it is important that students have opportunity to discuss new concepts with others; particularly their peers and their lecturer. The Access Grid Room environment also presents new challenges for the lecturer, who must learn new skills in the delivery of materials. The unique nature of Access Grid Room technology offers unprecedented opportunity for effective course delivery and positive outcomes for students, and was developed in response to a need to be able to interact with complex data, other students and the instructor, in real-time, at a distance and from multiple sites. This is a relatively new technology and as yet there has been little or no studies specifically addressing the use and misuse of the technology. The study found that the correct placement of cameras and the use of printed material and smart boards were all crucial to the student experience. In addition, the inclusion of special tutorial type sessions were necessary to provide opportunities to students for one-on-one discussion with both lecturer and other students. This study contributes to the broader understanding of distance education in general and future Access Grid Room course delivery in particular.

Vertebrate species introductions in the United States and its territories

USGS Publications Warehouse

Witmer, Gary W.; Fuller, Pam L.

2011-01-01

At least 1,065 introduced vertebrate species have been introduced in the United States and its territories, including at least 86 mammalian, 127 avian, 179 reptilian/amphibian, and 673 fish species. Examples in each major taxonomic group include domestic cat, small Indian mongoose, red fox, goat, pig, rabbit, rats, house mouse, gray squirrel, nutria, starling, Indian common myna, red-vented bulbul, brown treesnake, red-eared slider, brown trout, tilapia, and grass carp. We briefly review some of these species and the types of damage they cause. We then review the basic types of methods used for control or eradication of each taxonomic group, including physical, chemical, biological, and cultural methods. We discuss some of the challenges in managing these species, including issues with the use of toxicants, land access, public attitudes, and monitoring difficulties. Finally, we list some ongoing research and future research needs, including improved detection methods, improved attractants, improved barriers, improved capture methods, fertility control, and risk assessment methods.

The modern history and evolution of percutaneous nephrolithotomy.

PubMed

Patel, Sutchin R; Nakada, Stephen Y

2015-02-01

Serendipity, innovative physicians, evolving techniques for renal access, and improvements in equipment and radiology led to the evolution of percutaneous nephrolithotomy (PCNL). We searched urology texts and the literature for sources pertaining to the history and development of PCNL. In 1941, Rupel and Brown performed the first nephroscopy when a rigid cystoscope was passed into the kidney following open surgery. Willard Goodwin, in 1955, while trying to perform a renal arteriogram, placed a needle into the collecting system of a hydronephrotic kidney and performed the first antegrade nephrostogram. He left a tube to drain the kidney, thereby placing the first nephrostomy tube. By 1976, Fernström and Johansson were the first to describe a technique for extracting renal calculi through a percutaneous nephrostomy under radiological control. In 1978, Arthur Smith, would describe the first antegrade stent placement when he introduced a Gibbons stent through a percutaneous nephrostomy in a patient with a reimplanted ureter. Dr. Smith would coin the term "endourology" to describe closed, controlled manipulation of the genitourinary tract. His collaboration with Kurt Amplatz, an interventional radiologist and medical inventor, would lead to numerous innovations that would further advance PCNL. In the 1980s the process of renal access and tract dilation was improved upon and the use of a rigid cystoscope was replaced by offset nephroscopes with a large straight working channel. Radiographic innovations, including improvements in fluoroscopy would further aid in renal access. The development of various lithotripsy devices and the introduction of the holmium laser improved the efficiency of stone fragmentation and clearance. The increased clinical experience and utilization of PCNL would lead to the characterization of stone-free rates and complications for the procedure. Serendipity, innovations in renal access, optics, radiology, and improvements in lithotripsy all contributed to the modern day PCNL.

Reducing Hospital Toxicity: Impact on Patient Outcomes.

PubMed

Milani, Richard V; Bober, Robert M; Lavie, Carl J; Wilt, Jonathan K; Milani, Alexander R; White, Christopher J

2018-05-02

Circadian rhythms are endogenous 24-hour oscillations in biologic processes that drive nearly all physiologic and behavioral functions. Disruption in circadian rhythms can adversely impact short and long-term health outcomes. Routine hospital care often causes significant disruption in sleep-wake patterns that is further compounded by loss of personal control of health information and health decisions. We wished to evaluate measures directed at improving circadian rhythm and access to daily health information on hospital outcomes. We evaluated 3,425 consecutive patients admitted to a medical-surgical unit comprised of an intervention wing (n=1,185) or standard control wing (n=2,240) over a 2.5-year period. Intervention patients received measures to improve sleep that included reduction of nighttime noise, delay of routine morning phlebotomy, passive vital sign monitoring, and use of red-enriched lighting after sunset, as well as access to daily health information utilizing an inpatient portal. Intervention patients accessed the inpatient portal frequently during hospitalization seeking personal health and care team information. Measures impacting the quality and quantity of sleep were significantly improved. LOS was 8.6 hours less (p=0.04), 30 and 90-day readmission rates were 16% and 12% lower, respectively (both p≤ 0.02), and self-rated emotional/mental health was higher (69.2% vs. 52.4%; p=0.03) in the intervention group compared to controls. Modest changes in routine hospital care can improve the hospital environment impacting sleep and access to health knowledge, leading to improvements in hospital outcomes. Sleep-wake patterns of hospitalized patients represent a potential avenue for further enhancing hospital quality and safety. Copyright © 2018. Published by Elsevier Inc.

A re-conceptualization of access for 21st century healthcare.

PubMed

Fortney, John C; Burgess, James F; Bosworth, Hayden B; Booth, Brenda M; Kaboli, Peter J

2011-11-01

Many e-health technologies are available to promote virtual patient-provider communication outside the context of face-to-face clinical encounters. Current digital communication modalities include cell phones, smartphones, interactive voice response, text messages, e-mails, clinic-based interactive video, home-based web-cams, mobile smartphone two-way cameras, personal monitoring devices, kiosks, dashboards, personal health records, web-based portals, social networking sites, secure chat rooms, and on-line forums. Improvements in digital access could drastically diminish the geographical, temporal, and cultural access problems faced by many patients. Conversely, a growing digital divide could create greater access disparities for some populations. As the paradigm of healthcare delivery evolves towards greater reliance on non-encounter-based digital communications between patients and their care teams, it is critical that our theoretical conceptualization of access undergoes a concurrent paradigm shift to make it more relevant for the digital age. The traditional conceptualizations and indicators of access are not well adapted to measure access to health services that are delivered digitally outside the context of face-to-face encounters with providers. This paper provides an overview of digital "encounterless" utilization, discusses the weaknesses of traditional conceptual frameworks of access, presents a new access framework, provides recommendations for how to measure access in the new framework, and discusses future directions for research on access.

Attitudes and Perceptions Towards Access and Use of the Formal Healthcare Sector in Northern Malawi.

PubMed

Fisher, Emily; Lazarus, Rebecca; Asgary, Ramin

2017-01-01

We evaluated community attitudes, perceptions, and experiences regarding access and use of health care systems in Northern Malawi. Through a qualitative descriptive approach, 12 focus group discussions were conducted in 2014 with community members (n=71) in Mzimba North, Malawi. Data were transcribed and analyzed for major themes. Both formal health care systems and traditional medicine were widely used as complementary. Health care-seeking behavior was governed by previous treatment history and by whether a disease was believed to be biological or spiritual in nature, the latter being best treated with traditional medicine. Barriers to using formal health care included cost, hospital resources/environment, socio-cultural beliefs, and transportation. Transportation was a significant barrier, often linked to increased mortality. Support of local strategies to address transportation, structural approaches to improve hospital capabilities and environment, and community education reconciling traditional beliefs and modern medicine may mitigate access issues and improve use of the health care system.

Do school-based health centers improve adolescents' access to health care, health status, and risk-taking behavior?

PubMed

Kisker, E E; Brown, R S

1996-05-01

The purpose of this investigation was to assess the School-Based Adolescent Health Care Program, which provided comprehensive health-related services in 24 school-based health centers. The outcomes evaluation compared a cohort of students attending 19 participating schools and a national sample of urban youths, using logit models to control for observed differences between the two groups of youths. Outcome measures included self-reports concerning health center utilization, use of other health care providers, knowledge of key health facts, substance use, sexual activity, contraceptive use, pregnancies and births, and health status. The health centers increased students' access to health care and improved their health knowledge. However, the estimated impacts on health status and risky behaviors were inconsistent, and most were small and not statistically significant. School-based health centers can increase students' health knowledge and access to health-related services, but more intensive or different services are needed if they are to significantly reduce risk-taking behaviors.

Usability evaluation of user interface of thesis title review system

NASA Astrophysics Data System (ADS)

Tri, Y.; Erna, A.; Gellysa, U.

2018-03-01

Presentation of programs with user interface that can be accessed online through the website of course greatly provide user benefits. User can easily access the program they need. There are usability values that serve as a benchmark for the success of a user accessible program, ie efficiency, effectiveness, and convenience. These usability values also determine the development of the program for the better use. Therefore, on the review title thesis program that will be implemented in STT Dumai was measured usability evaluation. It aims to see which sides are not yet perfect and need to be improved to improve the performance and utilization of the program. Usability evaluation was measured by using smartPLS software. Database used was the result of respondent questionnaires that include questions about the experience when they used program. The result of a review of thesis title program implemented in STT Dumai has an efficiency value of 22.615, the effectiveness of 20.612, and satisfaction of 33.177.

Patients' knowledge, attitudes, behaviour and health care experiences on the prevention, detection, management and control of hypertension in Colombia: a qualitative study.

PubMed

Legido-Quigley, Helena; Camacho Lopez, Paul Anthony; Balabanova, Dina; Perel, Pablo; Lopez-Jaramillo, Patricio; Nieuwlaat, Robby; Schwalm, J-D; McCready, Tara; Yusuf, Salim; McKee, Martin

2015-01-01

Hypertension is a leading cause of premature death worldwide and the most important modifiable risk factor for cardiovascular disease. Effective screening programs, communication with patients, regular monitoring, and adherence to treatment are essential to successful management but may be challenging in health systems facing resource constraints. This qualitative study explored patients' knowledge, attitudes, behaviour and health care seeking experiences in relation to detection, treatment and control of hypertension in Colombia. We conducted in-depth interviews and focus group discussions with 26 individuals with hypertension and 4 family members in two regions. Few participants were aware of ways to prevent high blood pressure. Once diagnosed, most reported taking medication but had little information about their condition and had a poor understanding of their treatment regime. The desire for good communication and a trusting relationship with the doctor emerged as key themes in promoting adherence to medication and regular attendance at medical appointments. Barriers to accessing treatment included co-payments for medication; costs of transport to health care facilities; unavailability of drugs; and poor access to specialist care. Some patients overcame these barriers with support from social networks, family members and neighbours. However, those who lacked such support, experienced loneliness and struggled to access health care services. The health insurance scheme was frequently described as administratively confusing and those accessing the state subsidized system believed that the treatment was inferior to that provided under the compulsory contributory system. Measures that should be addressed to improve hypertension management in Colombia include better communication between health care professionals and patients, measures to improve understanding of the importance of adherence to treatment, reduction of co-payments and transport costs, and easier access to care, especially in rural areas.

The Effects of Child-Only Insurance Coverage and Family Coverage on Health Care Access and Use: Recent Findings among Low-Income Children in California

PubMed Central

Guendelman, Sylvia; Wier, Megan; Angulo, Veronica; Oman, Doug

2006-01-01

Objective To compare the extent with which child-only and family coverage (child and parent insured) ensure health care access and use for low income children in California and discuss the policy implications of extending the State Children's Health Insurance Program (California's Healthy Families) to uninsured parents of child enrollees. Data Sources/Setting We used secondary data from the 2001 California Health Interview Survey (CHIS), a representative telephone survey. Study Design We conducted a cross-sectional study of 5,521 public health insurance–eligible children and adolescents and their parents to examine the effects of insurance (family coverage, child-only coverage, and no coverage) on measures of health care access and utilization including emergency room visits and hospitalizations. Data Collection We linked the CHIS adult, child, and adolescent datasets, including the adolescent insurance supplement. Findings Among the sampled children, 13 percent were uninsured as were 22 percent of their parents. Children without insurance coverage were more likely than children with child-only coverage to lack a usual source of care and to have decreased use of health care. Children with child-only coverage fared worse than those with family coverage on almost every access indicator, but service utilization was comparable. Conclusions While extending public benefits to parents of children eligible for Healthy Families may not improve child health care utilization beyond the gains that would be obtained by exclusively insuring the children, family coverage would likely improve access to a regular source of care and private sector providers, and reduce perceived discrimination and breaks in coverage. These advantages should be considered by states that are weighing the benefits of expanding health insurance to parents. PMID:16430604

Perceived Barriers Affecting Access to Preventive Dental Services: Application of DEMATEL Method

PubMed Central

Bahadori, Mohammadkarim; Ravangard, Ramin; Asghari, Baratali

2013-01-01

Background Identifying perceived access barriers to preventive dental services is one of the basic steps to improve the public health. Objectives This study aimed to determine the perceived barriers affecting access to preventive dental services in one of Tehran dental clinics in 2012. Patients and Methods This research was a cross-sectional descriptive-analytical study conducted in one of Tehran dental clinics in 2012 using decision–making trial and evaluation laboratory (DEMATEL) method. The study sample included all patients (100 patients) who had referred to the endodontic treatment department from 26 - 31 May, 2012. The required data were collected using a questionnaire. Collected data were analyzed using SPSS 18.0 and MATLAB 7.9.0 SPSSS 18.0, as well as, some descriptive and analytical tests including Mean, Standard Deviation (SD), and Independent T- Test. Results The five determinants of cost, inconvenience, fear, organization, and patient-dentist relationship were determined as barriers to access to dental services among which the cost and patient-dentist relationship were identified as the first and last priorities with the coordinates (1.4 and 1.4) and (1.25 and -0.65), respectively. Conclusions High cost of dental care has led to not referring patients to the clinic. Oral health costs are too high; however insurance organizations have no commitment to support such services. Policymakers, administrators, and insurance organizations have a major role in improving access to dental services. These decision-makers in making their policies can provide the required financial resources, shift the available resources towards preventive care and periodic checkups, and consider providing proper and sufficient places for dental care facilities. PMID:24578831

Patients’ Knowledge, Attitudes, Behaviour and Health Care Experiences on the Prevention, Detection, Management and Control of Hypertension in Colombia: A Qualitative Study

PubMed Central

Legido-Quigley, Helena; Camacho Lopez, Paul Anthony; Balabanova, Dina; Perel, Pablo; Lopez-Jaramillo, Patricio; Nieuwlaat, Robby; Schwalm, J-D; McCready, Tara; Yusuf, Salim; McKee, Martin

2015-01-01

Hypertension is a leading cause of premature death worldwide and the most important modifiable risk factor for cardiovascular disease. Effective screening programs, communication with patients, regular monitoring, and adherence to treatment are essential to successful management but may be challenging in health systems facing resource constraints. This qualitative study explored patients’ knowledge, attitudes, behaviour and health care seeking experiences in relation to detection, treatment and control of hypertension in Colombia. We conducted in-depth interviews and focus group discussions with 26 individuals with hypertension and 4 family members in two regions. Few participants were aware of ways to prevent high blood pressure. Once diagnosed, most reported taking medication but had little information about their condition and had a poor understanding of their treatment regime. The desire for good communication and a trusting relationship with the doctor emerged as key themes in promoting adherence to medication and regular attendance at medical appointments. Barriers to accessing treatment included co-payments for medication; costs of transport to health care facilities; unavailability of drugs; and poor access to specialist care. Some patients overcame these barriers with support from social networks, family members and neighbours. However, those who lacked such support, experienced loneliness and struggled to access health care services. The health insurance scheme was frequently described as administratively confusing and those accessing the state subsidized system believed that the treatment was inferior to that provided under the compulsory contributory system. Measures that should be addressed to improve hypertension management in Colombia include better communication between health care professionals and patients, measures to improve understanding of the importance of adherence to treatment, reduction of co-payments and transport costs, and easier access to care, especially in rural areas. PMID:25909595

NASA World Wind Near Real Time Data for Earth

NASA Astrophysics Data System (ADS)

Hogan, P.

2013-12-01

Innovation requires open standards for data exchange, not to mention ^access to data^ so that value-added, the information intelligence, can be continually created and advanced by the larger community. Likewise, innovation by academia and entrepreneurial enterprise alike, are greatly benefited by an open platform that provides the basic technology for access and visualization of that data. NASA World Wind Java, and now NASA World Wind iOS for the iPhone and iPad, provides that technology. Whether the interest is weather science or climate science, emergency response or supply chain, seeing spatial data in its native context of Earth accelerates understanding and improves decision-making. NASA World Wind open source technology provides the basic elements for 4D visualization, using Open Geospatial Consortium (OGC) protocols, while allowing for customized access to any data, big or small, including support for NetCDF. NASA World Wind includes access to a suite of US Government WMS servers with near real time data. The larger community can readily capitalize on this technology, building their own value-added applications, either open or proprietary. Night lights heat map Glacier National Park

Factors influencing health care access perceptions and care-seeking behaviors of immigrant Latino sexual minority men and transgender individuals: baseline findings from the HOLA intervention study.

PubMed

Tanner, Amanda E; Reboussin, Beth A; Mann, Lilli; Ma, Alice; Song, Eunyoung; Alonzo, Jorge; Rhodes, Scott D

2014-11-01

Little is known about immigrant Latino sexual minorities’ health seeking behaviors. This study examined factors associated with perceptions of access and actual care behaviors among this population in North Carolina. A community-based participatory research partnership recruited 180 Latino sexual minority men and transgender individuals within preexisting social networks to participate in a sexual health intervention. Mixed-effects logistic regression models and GIS mapping examined factors influencing health care access perceptions and use of services (HIV testing and routine check-ups). Results indicate that perceptions of access and actual care behaviors are low and affected by individual and structural factors, including: years living in NC, reported poor general health, perceptions of discrimination, micro-, meso-, and macro-level barriers, and residence in a Medically Underserved Area. To improve Latino sexual minority health, focus must be placed on multiple levels, including: individual characteristics (e.g., demographics), clinic factors (e.g., provider competence and clinic environment), and structural factors (e.g., discrimination).

Emerging new practices in technology to support independent community access for people with intellectual and cognitive disabilities.

PubMed

Stock, Steven E; Davies, Daniel K; Wehmeyer, Michael L; Lachapelle, Yves

2011-01-01

The concept of community access is a multidimensional term, which may involve issues related to physical access, knowledge and information, power and control, relationships and communications, advocacy, participation and quality of life [21]. This paper discusses historical and emerging practices and interventions related to physical access to community and community based information for individuals with cognitive disabilities such as intellectual disability, autism or traumatic brain injury. While much societal attention has been paid to features of independent community access for populations such as individuals with hearing, vision or physical disabilities, less attention has focused on independent community access for people with intellectual and other significant cognitive disabilities. Attitudes and actions by families and professional service communities are often mixed for some individuals in this population. The somewhat limited research base in these areas is explored, including a case study review and results from several promising feasibility studies. The paper concludes with comments concerning future prospects and recommendations for improving independent community access for persons with significant cognitive disabilities.

Obstacles to implementation of an intervention to improve surgical services in an Ethiopian hospital: a qualitative study of an international health partnership project.

PubMed

Aveling, Emma-Louise; Zegeye, Desalegn Tegabu; Silverman, Michael

2016-08-17

Access to safe surgical care represents a critical gap in healthcare delivery and development in many low- and middle-income countries, including Ethiopia. Quality improvement (QI) initiatives at hospital level may contribute to closing this gap. Many such quality improvement initiatives are carried out through international health partnerships. Better understanding of how to optimise quality improvement in low-income settings is needed, including through partnership-based approaches. Drawing on a process evaluation of an intervention to improve surgical services in an Ethiopian hospital, this paper offers lessons to help meet this need. We conducted a qualitative process evaluation of a quality improvement project which aimed to improve access to surgical services in an Ethiopian referral hospital through better management. Data was collected longitudinally and included: 66 in-depth interviews with surgical staff and project team members; observation (135 h) in the surgery department and of project meetings; project-related documentation. Thematic analysis, guided by theoretical constructs, focused on identifying obstacles to implementation. The project largely failed to achieve its goals. Key barriers related to project design, partnership working and the implementation context, and included: confusion over project objectives and project and partner roles and responsibilities; logistical challenges concerning overseas visits; difficulties in communication; gaps between the time and authority team members had and that needed to implement and engage other staff; limited strategies for addressing adaptive-as opposed to technical-challenges; effects of hierarchy and resource scarcity on QI efforts. While many of the obstacles identified are common to diverse settings, our findings highlight ways in which some features of low-income country contexts amplify these common challenges. We identify lessons for optimising the design and planning of quality improvement interventions within such challenging healthcare contexts, with specific reference to international partnership-based approaches. These include: the need for a funded lead-in phase to clarify and agree goals, roles, mutual expectations and communication strategies; explicitly incorporating adaptive, as well as technical, solutions; transparent management of resources and opportunities; leadership which takes account of both formal and informal power structures; and articulating links between project goals and wider organisational interests.

Educational Resources for Global Health in Otolaryngology.

PubMed

Hancock, Melyssa; Hoa, Michael; Malekzadeh, Sonya

2018-06-01

Advances in modern communications and information technology have helped to improve access to, and quality of, health care and education. These enhancements include a variety of World Wide Web-based and mobile learning platforms, such as eLearning, mLearning, and open education resources. This article highlights the innovative approaches that have fostered improved collaboration and coordination of global health efforts in otolaryngology. Copyright © 2018 Elsevier Inc. All rights reserved.

How Can Pricing and Reimbursement Policies Improve Affordable Access to Medicines? Lessons Learned from European Countries.

PubMed

Vogler, Sabine; Paris, Valérie; Ferrario, Alessandra; Wirtz, Veronika J; de Joncheere, Kees; Schneider, Peter; Pedersen, Hanne Bak; Dedet, Guillaume; Babar, Zaheer-Ud-Din

2017-06-01

This article discusses pharmaceutical pricing and reimbursement policies in European countries with regard to their ability to ensure affordable access to medicines. A frequently applied pricing policy is external price referencing. While it provides some benchmark for policy-makers and has been shown to be able to generate savings, it may also contribute to delay in product launch in countries where medicine prices are low. Value-based pricing has been proposed as a policy that promotes access while rewarding useful innovation; however, implementing it has proven quite challenging. For high-priced medicines, managed-entry agreements are increasingly used. These agreements allow policy-makers to manage uncertainty and obtain lower prices. They can also facilitate earlier market access in case of limited evidence about added therapeutic value of the medicine. However, these agreements raise transparency concerns due to the confidentiality clause. Tendering as used in the hospital and offpatent outpatient sectors has been proven to reduce medicine prices but it requires a robust framework and appropriate design with clear strategic goals in order to prevent shortages. These pricing and reimbursement policies are supplemented by the widespread use of Health Technology Assessment to inform decision-making, and by strategies to improve the uptake of generics, and also biosimilars. While European countries have been implementing a set of policy options, there is a lack of thorough impact assessments of several pricing and reimbursement policies on affordable access. Increased cooperation between authorities, experience sharing and improving transparency on price information, including the disclosure of confidential discounts, are opportunities to address current challenges.

Exploring health services accessibility by indigenous women in Asia and identifying actions to improve it: a scoping review.

PubMed

Thummapol, Onouma; Park, Tanya; Barton, Sylvia

2018-05-03

The aim of this scoping review was to uncover and summarize what is known in the literature about the experiences of Indigenous women in Asia regarding access to health services. The study was informed by the scoping review methodology proposed by Arksey and O'Malley [2005. "Scoping Studies: Towards a Methodological Framework." International Journal of Social Research Methodology 8 (1): 19-32. doi: 10.1080/1364557032000119616 ]. A comprehensive search of the databases for peer-reviewed studies and grey literature was conducted between January 2000 and December 2016. The data of selected papers and abstracts were analysed by three independent researchers through a protocol of data charting, descriptive numerical summary, and thematic analysis. Sixteen articles and two abstracts met the inclusion criteria for this scoping review. These 18 peer-reviewed documents consisted of eight qualitative studies, seven quantitative studies, and three mixed-method studies, which included the peer-reviewed poster and oral presentation abstracts from international conferences. The findings were sorted and grouped under the following themes: health care access for Indigenous women in Asia, facilitators to accessing healthcare services, barriers to accessing healthcare services, and cultural contexts impacting health and access. There is limited information about the experiences, facilitators, barriers, and cultural contexts faced by Indigenous women in Asia related to health services accessibility, and even less information related to improving health services accessibility and health outcomes. This scoping review in particular highlights the dearth of literature relating to Indigenous women's postpartum health and access to postnatal supports and services. Generally, it indicates that Indigenous women in Asia are more vulnerable to poor health in comparison to non-Indigenous women, and continue to face challenges and barriers in accessing quality and equitable health services. The barriers identified in this review are useful in explaining why inequities in health and access to health care for Indigenous women living in Asia continue to exist. Recommendations for future research directions are described.

The ethics of improving African traditional medical practice: scientific or African traditional research methods?

PubMed

Nyika, Aceme

2009-11-01

The disease burden in Africa, which is relatively very large compared with developed countries, has been attributed to various factors that include poverty, food shortages, inadequate access to health care and unaffordability of Western medicines to the majority of African populations. Although for 'old diseases' knowledge about the right African traditional medicines to treat or cure the diseases has been passed from generation to generation, knowledge about traditional medicines to treat newly emerging diseases has to be generated in one way or another. In addition, the existing traditional medicines have to be continuously improved, which is also the case with Western scientific medicines. Whereas one school of thought supports the idea of improving medicines, be they traditional or Western, through scientific research, an opposing school of thought argues that subjecting African traditional medicines to scientific research would be tantamount to some form of colonization and imperialism. This paper argues that continuing to use African traditional medicines for old and new diseases without making concerted efforts to improve their efficacy and safety is unethical since the disease burden affecting Africa may continue to rise in spite of the availability and accessibility of the traditional medicines. Most importantly, the paper commends efforts being made in some African countries to improve African traditional medicine through a combination of different mechanisms that include the controversial approach of scientific research on traditional medicines.

Performance Analysis of Ivshmem for High-Performance Computing in Virtual Machines

NASA Astrophysics Data System (ADS)

Ivanovic, Pavle; Richter, Harald

2018-01-01

High-Performance computing (HPC) is rarely accomplished via virtual machines (VMs). In this paper, we present a remake of ivshmem which can change this. Ivshmem was a shared memory (SHM) between virtual machines on the same server, with SHM-access synchronization included, until about 5 years ago when newer versions of Linux and its virtualization library libvirt evolved. We restored that SHM-access synchronization feature because it is indispensable for HPC and made ivshmem runnable with contemporary versions of Linux, libvirt, KVM, QEMU and especially MPICH, which is an implementation of MPI - the standard HPC communication library. Additionally, MPICH was transparently modified by us to get ivshmem included, resulting in a three to ten times performance improvement compared to TCP/IP. Furthermore, we have transparently replaced MPI_PUT, a single-side MPICH communication mechanism, by an own MPI_PUT wrapper. As a result, our ivshmem even surpasses non-virtualized SHM data transfers for block lengths greater than 512 KBytes, showing the benefits of virtualization. All improvements were possible without using SR-IOV.

Rural relevant quality measures for critical access hospitals.

PubMed

Casey, Michelle M; Moscovice, Ira; Klingner, Jill; Prasad, Shailendra

2013-01-01

To identify current and future relevant quality measures for Critical Access Hospitals (CAHs). Three criteria (patient volume, internal usefulness for quality improvement, and external usefulness for public reporting and payment reform) were used to analyze quality measures for their relevance for CAHs. A 6-member panel with expertise in rural hospital quality measurement and improvement provided input regarding the final measure selection. The relevant quality measures for CAHs include measures that are ready for reporting now and measures that need specifications to be finalized and/or a data reporting mechanism to be established. They include inpatient measures for specific medical conditions, global measures that address appropriate care across multiple medical conditions, and Emergency Department measures. All CAHs should publicly report on relevant quality measures. Acceptance of a single consolidated set of quality measures with common specifications for CAHs by all entities involved in regulation, accreditation, and payment; a phased process to implement the relevant measures; and the provision of technical assistance would help CAHs meet the challenge of reporting. © 2012 National Rural Health Association.

Health information exchange associated with improved emergency department care through faster accessing of patient information from outside organizations.

PubMed

Everson, Jordan; Kocher, Keith E; Adler-Milstein, Julia

2017-04-01

To assess whether electronic health information exchange (HIE) is associated with improved emergency department (ED) care processes and utilization through more timely clinician viewing of information from outside organizations. Our data included 2163 patients seen in the ED of a large academic medical center for whom clinicians requested and viewed outside information from February 14, 2014, to February 13, 2015. Outside information requests w.ere fulfilled via HIE (Epic's Care Everywhere) or fax/scan to the electronic health record (EHR). We used EHR audit data to capture the time between the information request and when a clinician accessed the data. We assessed whether the relationship between method of information return and ED outcomes (length of visit, odds of imaging [computed tomography (CT), magnetic resonance imaging (MRI), radiographs] and hospitalization, and total charges) was mediated by request-to-access time, controlling for patient demographics, case mix, and acuity. In multivariate analysis, there was no direct association between return of information via HIE vs fax/scan and ED outcomes. HIE was associated with faster outside information access (58.5 minutes on average), and faster access was associated with changes in ED care. For each 1-hour reduction in access time, visit length was 52.9 minutes shorter, the likelihood of imaging was lower (by 2.5, 1.6, and 2.4 percentage points for CT, MRI, and radiographs, respectively), the likelihood of admission was 2.4 percentage points lower, and average charges were $1187 lower ( P  ≤ .001 for all). The relationship between HIE and improved care processes and reduced utilization in the ED is mediated by faster accessing of information from outside organizations. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Federal Health Care Center: VA and DOD Need to Develop Better Information to Monitor Operations and Improve Efficiency

DTIC Science & Technology

2017-01-01

delivery of health care that would be more accessible and less expensive than operating two federal medical centers serving VA and DOD beneficiaries in...departments—including DOD’s operational readiness mission—by integrating services previously provided by the former North Chicago VA Medical Center...1VA beneficiaries include veterans of military service and certain dependents and survivors. DOD beneficiaries include active duty

Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management.

PubMed

Kuupiel, Desmond; Bawontuo, Vitalis; Mashamba-Thompson, Tivani P

2017-11-29

Access to point-of-care (POC) diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving the accessibility and efficiency of POC diagnostics services, particularly in resource-limited settings, may be a promising route to improving healthcare outcomes. In this review, the accessibility of POC testing is defined as the distance/proximity to the nearest healthcare facility for POC diagnostics service. This review provides an overview of the impact of POC diagnostics on healthcare outcomes in low- and middle-income countries (LMICs) and factors contributing to the accessibility of POC testing services in LMICs, focusing on characteristics of the supply chain management and quality systems management, characteristics of the geographical location, health infrastructure, and an enabling policy framework for POC diagnostics services. Barriers and challenges related to the accessibility of POC diagnostics in LMICs were also discussed. Bearing in mind the reported barriers and challenges as well as the disease epidemiology in LMICs, we propose a lean and agile supply chain management framework for improving the accessibility and efficiency of POC diagnostics services in these settings.

Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management

PubMed Central

Kuupiel, Desmond; Bawontuo, Vitalis

2017-01-01

Access to point-of-care (POC) diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving the accessibility and efficiency of POC diagnostics services, particularly in resource-limited settings, may be a promising route to improving healthcare outcomes. In this review, the accessibility of POC testing is defined as the distance/proximity to the nearest healthcare facility for POC diagnostics service. This review provides an overview of the impact of POC diagnostics on healthcare outcomes in low- and middle-income countries (LMICs) and factors contributing to the accessibility of POC testing services in LMICs, focusing on characteristics of the supply chain management and quality systems management, characteristics of the geographical location, health infrastructure, and an enabling policy framework for POC diagnostics services. Barriers and challenges related to the accessibility of POC diagnostics in LMICs were also discussed. Bearing in mind the reported barriers and challenges as well as the disease epidemiology in LMICs, we propose a lean and agile supply chain management framework for improving the accessibility and efficiency of POC diagnostics services in these settings. PMID:29186013

Systemic barriers accessing HIV treatment among people who inject drugs in Russia: a qualitative study

PubMed Central

Sarang, Anya; Rhodes, Tim; Sheon, Nicolas

2013-01-01

Achieving ‘universal access’ to antiretroviral HIV treatment (ART) in lower income and transitional settings is a global target. Yet, access to ART is shaped by local social condition and is by no means universal. Qualitative studies are ideally suited to describing how access to ART is socially situated. We explored systemic barriers to accessing ART among people who inject drugs (PWID) in a Russian city (Ekaterinburg) with a large burden of HIV treatment demand. We undertook 42 in-depth qualitative interviews with people living with HIV with current or recent experience of injecting drug use. Accounts were analysed thematically, and supplemented here with an illustrative case study. Three core themes were identified: ‘labyrinthine bureaucracy’ governing access to ART; a ‘system Catch 22’ created by an expectation that access to ART was conditional upon treated drug use in a setting of limited drug treatment opportunity; and ‘system verticalization’, where a lack of integration across HIV, tuberculosis (TB) and drug treatment compromised access to ART. Taken together, we find that systemic factors play a key role in shaping access to ART with the potential adverse effects of reproducing treatment initiation delay and disengagement from treatment. We argue that meso-level systemic factors affecting access to ART for PWID interact with wider macro-level structural forces, including those related to drug treatment policy and the social marginalization of PWID. We note the urgent need for systemic and structural changes to improve access to ART for PWID in this setting, including to simplify bureaucratic procedures, foster integrated HIV, TB and drug treatment services, and advocate for drug treatment policy reform. PMID:23197431

Balancing investments in Federally Qualified Health Centers and Medicaid for improved access and coverage in Pennsylvania.

PubMed

Griffin, Paul M; Lee, Hyunji; Scherrer, Christina; Swann, Julie L

2014-12-01

Two common health disparities in the US include a lack of access to care and a lack of insurance coverage. To help address these disparities, healthcare reform will provide $11B to expand Federally Qualified Health Centers (FQHCs) over the next 5 years. In 2014, Medicaid rules will be modified so that more people will become eligible. There are, however, important tradeoffs in the investment in these two programs. We find a balanced investment between FQHC expansion and relaxing Medicaid eligibility to improve both access (by increasing the number of FQHCs) and coverage (by FQHC and Medicaid expansion) for the state of Pennsylvania. The comparison is achieved by integrating multi-objective mathematical models with several public data sets that allow for specific estimations of healthcare need. Demand is estimated based on current access and coverage status in order to target groups to be considered preferentially. Results show that for Pennsylvania, FQHCs are more cost effective than Medicaid if we invest all of the resources in just one policy. However, we find a better investment point balancing those two policies. This point is approximately where the additional expenses incurred from relaxing Medicaid eligibility equals the investment in FQHC expansion.

Deaf Adolescents’ Learning of Cardiovascular Health Information: Sources and Access Challenges

PubMed Central

Smith, Scott R.; Kushalnagar, Poorna; Hauser, Peter C.

2015-01-01

Deaf individuals have more cardiovascular risks than the general population that are believed to be related to their cardiovascular health knowledge disparities. This phenomenological study describes where 20 deaf sign language-using adolescents from Rochester, New York, many who possess many positive characteristics to support their health literacy, learn cardiovascular health information and their lived experiences accessing health information. The goal is to ultimately use this information to improve the delivery of cardiovascular health education to this population and other deaf adolescents at a higher risk for weak health literacy. Deaf bilingual researchers interviewed deaf adolescents, transcribed and coded the data, and described the findings. Five major sources of cardiovascular health information were identified including family, health education teachers, healthcare providers, printed materials, and informal sources. Despite possessing advantageous characteristics contributing to stronger health literacy, study participants described significant challenges with accessing health information from each source. They also demonstrated inconsistencies in their cardiovascular health knowledge, especially regarding heart attack, stroke, and cholesterol. These findings suggest a great need for additional public funding to research deaf adolescents’ informal health-related learning, develop accessible and culturally appropriate health surveys and health education programming, improve interpreter education, and disseminate information through social media. PMID:26048900

An Intelligent System Proposal for Improving the Safety and Accessibility of Public Transit by Highway

PubMed Central

García, Carmelo R.; Quesada-Arencibia, Alexis; Cristóbal, Teresa; Padrón, Gabino; Pérez, Ricardo; Alayón, Francisco

2015-01-01

The development of public transit systems that are accessible and safe for everyone, including people with special needs, is an objective that is justified from the civic and economic points of view. Unfortunately, public transit services are conceived for people who do not have reduced physical or cognitive abilities. In this paper, we present an intelligent public transit system by highway with the goal of facilitating access and improving the safety of public transit for persons with special needs. The system is deployed using components that are commonly available in transport infrastructure, e.g., sensors, mobile communications systems, and positioning systems. In addition, the system can operate in non-urban transport contexts, e.g., isolated rural areas, where the availability of basic infrastructure, such as electricity and communications infrastructures, is not always guaranteed. To construct the system, the principles and techniques of Ubiquitous Computing and Ambient Intelligence have been employed. To illustrate the utility of the system, two cases of services rendered by the system are described: the first case involves a surveillance system to guarantee accessibility at bus stops; the second case involves a route assistant for blind people. PMID:26295234

Maternity Leave Access and Health: A Systematic Narrative Review and Conceptual Framework Development.

PubMed

Andres, Ellie; Baird, Sarah; Bingenheimer, Jeffrey Bart; Markus, Anne Rossier

2016-06-01

Background Maternity leave is integral to postpartum maternal and child health, providing necessary time to heal and bond following birth. However, the relationship between maternity leave and health outcomes has not been formally and comprehensively assessed to guide public health research and policy in this area. This review aims to address this gap by investigating both the correlates of maternity leave utilization in the US and the related health benefits for mother and child. Methods We searched the peer-reviewed scholarly literature using six databases for the years 1990 to early 2015 and identified 37 studies to be included in the review. We extracted key data for each of the included studies and assessed study quality using the "Weight of the Evidence" approach. Results The literature generally confirms a positive, though limited correlation between maternity leave coverage and utilization. Likewise, longer maternity leaves are associated with improved breastfeeding intentions and rates of initiation, duration and predominance as well as improved maternal mental health and early childhood outcomes. However, the literature points to important disparities in access to maternity leave that carry over into health outcomes, such as breastfeeding. Synthesis We present a conceptual framework synthesizing what is known to date related to maternity leave access and health outcomes.

Patient navigation across the spectrum of women's health care in the United States.

PubMed

McKenney, Kathryn M; Martinez, Noelle G; Yee, Lynn M

2018-03-01

Patient navigation is a patient-centered intervention that uses trained personnel to identify patient-level barriers, including financial, cultural, logistical, and educational obstacles to health care and then mitigate these barriers to facilitate complete and timely access to health services. For example, to assist a woman with Medicaid who is seeking postpartum care, a patient navigator could help her schedule an appointment before her insurance benefits change, coordinate transportation and child care, give her informational pamphlets on contraception options, and accompany her to the appointment to ensure her questions are answered. Existing studies examining the efficacy of patient navigation interventions show particularly striking benefits in the realm of cancer care, including gynecological oncology; patient navigation has been demonstrated to increase access to screening, shorten time to diagnostic resolution, and improve cancer outcomes, particularly in health disparity populations, such as women of color, rural populations, and poor women. Because of the successes in cancer care at reducing disparities in health care access and health outcomes, patient navigation has the potential to improve care and reduce disparities in obstetric and benign gynecological care. We review the concept of patient navigation, offer potential roles for patient navigation in obstetrics and gynecology, and discuss areas for further investigation. Copyright © 2017 Elsevier Inc. All rights reserved.

The Impact of Road Construction on Subjective Well-Being in Communities in Madre de Dios, Peru.

PubMed

Riley-Powell, Amy R; Lee, Gwenyth O; Naik, Nehal S; Jensen, Kelly E; O'Neal, Christina; Salmón-Mulanovich, Gabriela; Hartinger, Stella M; Bausch, Daniel G; Paz-Soldan, Valerie A

2018-06-15

The interoceanic highway (IOH) in Madre de Dios, Peru has driven dramatic change in the Peruvian Amazon basin. We conducted a mixed methods study to examine the impact of these changes on the subjective well-being (SWB) of four communities on the IOH. Themes that emerged qualitatively included changing health threats, environmental degradation, and the impact of increased migration. To achieve a higher level of SWB, respondents emphasized the need for higher incomes, opportunities to learn new skills, and a better education for their children. Potential threats to SWB included marital problems and poorer health. Quantitative analyses suggested that social support and a sense of security impacted reported SWB scores based on life satisfaction, and the impact of income on life satisfaction was mediated by food security. Although long-term residents felt that specific determinants of SWB had both increased (food variety, transport and access to work) and decreased (access to natural resources and hunting), the majority reported that their lives had improved overall. Health had been affected by the IOH in both negative ways (increased dengue and road accidents) and positive ways (improved access to health services). Our results suggest that the rapidly-changing communities near the IOH link well-being to health, income, community, and the environment.

Using a Learning Collaborative Strategy With Office-based Practices to Increase Access and Improve Quality of Care for Patients With Opioid Use Disorders.

PubMed

Nordstrom, Benjamin R; Saunders, Elizabeth C; McLeman, Bethany; Meier, Andrea; Xie, Haiyi; Lambert-Harris, Chantal; Tanzman, Beth; Brooklyn, John; King, Gregory; Kloster, Nels; Lord, Clifton Frederick; Roberts, William; McGovern, Mark P

2016-01-01

Rapidly escalating rates of heroin and prescription opioid use have been widely observed in rural areas across the United States. Although US Food and Drug Administration-approved medications for opioid use disorders exist, they are not routinely accessible to patients. One medication, buprenorphine, can be prescribed by waivered physicians in office-based practice settings, but practice patterns vary widely. This study explored the use of a learning collaborative method to improve the provision of buprenorphine in the state of Vermont. We initiated a learning collaborative with 4 cohorts of physician practices (28 total practices). The learning collaborative consisted of a series of 4 face-to-face and 5 teleconference sessions over 9 months. Practices collected and reported on 8 quality-improvement data measures, which included the number of patients prescribed buprenorphine, and the percent of unstable patients seen weekly. Changes from baseline to 8 months were examined using a p-chart and logistic regression methodology. Physician engagement in the learning collaborative was favorable across all 4 cohorts (85.7%). On 6 of the 7 quality-improvement measures, there were improvements from baseline to 8 months. On 4 measures, these improvements were statistically significant (P < 0.001). Importantly, practice variation decreased over time on all measures. The number of patients receiving medication increased only slightly (3.4%). Results support the effectiveness of a learning collaborative approach to engage physicians, modestly improve patient access, and significantly reduce practice variation. The strategy is potentially generalizable to other systems and regions struggling with this important public health problem.

Women's experiences of participating in a prospective, longitudinal postpartum depression study: insights for perinatal mental health researchers.

PubMed

Andrighetti, Heather J; Semaka, Alicia; Austin, Jehannine C

2017-08-01

Barriers to recruitment for research on mental illness include participant distrust of researchers and social stigma. Though these issues may be acutely important in perinatal mental health research, they remain unexplored in this context. In order to inform strategies to more fully engage women in perinatal mental health research, we explored the motivations and experiences of women with a history of major depressive disorder who participated in a prospective longitudinal research study on postpartum depression (PPD). Sixteen women with a history of depression who had either completed or recently made a decision about participation in a longitudinal research study about PPD were interviewed by telephone. Qualitative, semi-structured interviews explored participants' decision-making about, and experiences of, participation. Interviews were audio-recorded, transcribed, and qualitatively analyzed using elements of grounded theory methodology. Follow-up interviews were conducted with four participants to refine and clarify preliminary results. Foundational elements necessary for women to consider participating in PPD research included personal acceptance of illness and trust in the research team/institution. Other main motivators included perceived personal relevance, anticipated benefits (including access to support/resources, learning opportunities, and improved self-worth), altruism, and accessible study procedures. Our data suggest that participating in perinatal mental health research may help women make meaning of their mental illness experience and is perceived as providing support. The findings-particularly around the importance of participant-researcher rapport and accessibility of study design-may inform strategies that improve participation rates, decrease attrition, and maximize participant benefits in perinatal mental health research.

Immigrant workers in the United States: recent trends, vulnerable populations, and challenges for occupational health.

PubMed

McCauley, Linda A

2005-07-01

Immigrant workers are a rapidly growing segment of the U.S. work force, and these increasing numbers have resulted in a different ethnic mix in the work force than in previous decades. Immigrant workers are not a homogenous group, but are over-represented in low-paying occupations. Their diversity and vulnerability present distinct challenges for occupational health nurses. High-risk occupations in which a large proportion of immigrant workers are hired include agriculture, sweatshops, day laborers, and construction. Initiatives needed to improve the working conditions of this vulnerable population include improved surveillance and research, culturally competent care providers, improved health care access, advocacy, and changes in immigration and health policy.

Specialist outreach clinics in primary care and rural hospital settings.

PubMed

Gruen, R L; Weeramanthri, T S; Knight, S E; Bailie, R S

2004-01-01

Specialist medical practitioners have conducted clinics in primary care and rural hospital settings for a variety of reasons in many different countries. Such clinics have been regarded as an important policy option for increasing the accessibility and effectiveness of specialist services and their integration with primary care services. To undertake a descriptive overview of studies of specialist outreach clinics and to assess the effectiveness of specialist outreach clinics on access, quality, health outcomes, patient satisfaction, use of services, and costs. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialised register (March 2002), the Cochrane Controlled Trials Register (CCTR) (Cochrane Library Issue 1, 2002), MEDLINE (including HealthStar) (1966 to May 2002), EMBASE (1988 to March 2002), CINAHL (1982 to March 2002), the Primary-Secondary Care Database previously maintained by the Centre for Primary Care Research in the Department of General Practice at the University of Manchester, a collection of studies from the UK collated in "Specialist Outreach Clinics in General Practice" (Roland 1998), and the reference lists of all retrieved articles. Randomised trials, controlled before and after studies and interrupted time series analyses of visiting specialist outreach clinics in primary care or rural hospital settings, either providing simple consultations or as part of complex multifaceted interventions. The participants were patients, specialists, and primary care providers. The outcomes included objective measures of access, quality, health outcomes, satisfaction, service use, and cost. Four reviewers working in pairs independently extracted data and assessed study quality. 73 outreach interventions were identified covering many specialties, countries and settings. Nine studies met the inclusion criteria. Most comparative studies came from urban non-disadvantaged populations in developed countries. Simple 'shifted outpatients' styles of specialist outreach were shown to improve access, but there was no evidence of impact on health outcomes. Specialist outreach as part of more complex multifaceted interventions involving collaboration with primary care, education or other services was associated with improved health outcomes, more efficient and guideline-consistent care, and less use of inpatient services. The additional costs of outreach may be balanced by improved health outcomes. This review supports the hypothesis that specialist outreach can improve access, outcomes and service use, especially when delivered as part of a multifaceted intervention. The benefits of simple outreach models in urban non-disadvantaged settings seem small. There is a need for good comparative studies of outreach in rural and disadvantaged settings where outreach may confer most benefit to access and health outcomes.

Improving vaccine registries through mobile technologies: a vision for mobile enhanced Immunization information systems.

PubMed

Wilson, Kumanan; Atkinson, Katherine M; Deeks, Shelley L; Crowcroft, Natasha S

2016-01-01

Immunization registries or information systems are critical to improving the quality and evaluating the ongoing success of immunization programs. However, the completeness of these systems is challenged by a myriad of factors including the fragmentation of vaccine administration, increasing mobility of individuals, new vaccine development, use of multiple products, and increasingly frequent changes in recommendations. Mobile technologies could offer a solution, which mitigates some of these challenges. Engaging individuals to have more control of their own immunization information using their mobile devices could improve the timeliness and accuracy of data in central immunization information systems. Other opportunities presented by mobile technologies that could be exploited to improve immunization information systems include mobile reporting of adverse events following immunization, the capacity to scan 2D barcodes, and enabling bidirectional communication between individuals and public health officials. Challenges to utilizing mobile solutions include ensuring privacy of data, access, and equity concerns, obtaining consent and ensuring adoption of technology at sufficiently high rates. By empowering individuals with their own health information, mobile technologies can also serve as a mechanism to transfer immunization information as individuals cross local, regional, and national borders. Ultimately, mobile enhanced immunization information systems can help realize the goal of the individual, the healthcare provider, and public health officials always having access to the same immunization information. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide.

PubMed

Liddy, Clare; Moroz, Isabella; Mihan, Ariana; Nawar, Nikhat; Keely, Erin

2018-06-21

Electronic consultation (eConsult) is an asynchronous electronic communication tool allowing primary care providers to obtain a specialist consultant's expert opinion in a timely manner, thereby offering a potential solution to excessive wait times for specialist care, which remain a serious concern in many countries. Our 2014 review of eConsult services demonstrated feasibility and high acceptability among patients and providers. However, gaps remain in knowledge regarding eConsult's impact on system costs and patient outcomes. Following the PRISMA guidelines, we conducted a systematic review in May 2017 of English and French literature on OVID Medline, EMBASE, ERIC, and CINAHL databases, examining all studies on eConsult services published since our previous review. The Quadruple Aim Framework was used to synthesize outcomes. Articles reporting on the impact of eConsult on access, patient safety and satisfaction, utilization rates, clinical workflow, and continuing medical education were analyzed using a narrative synthesis approach. The initial search yielded 1,021 results, 50 of which were included on abstract and received a quality assessment and full text review. Of these, 43 were included in our final analysis. Results demonstrated the worldwide presence of eConsult services in North America and countries beyond, including Brazil, Australia, Spain, and The Netherlands. The breadth of specialty services offered has greatly expanded beyond dermatology and includes cardiology, nephrology, and hematology among others. Overall impact on access measures, acceptability, cost, and provider satisfaction remain positive. There is limited research on population health outcomes of morbidity and mortality. The availability of eConsult services has spread both geographically and in terms of specialty services offered. By allowing for a greater population to be served, access to care is being improved; however, long-term impact should continue to be assessed with a focus on patient safety, morbidity, mortality, and cost effectiveness metrics.

Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

PubMed Central

Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E

2002-01-01

BACKGROUND: Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM: To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY: A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING: Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD: Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS: The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION: A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children. PMID:12528583

Evaluation of an educational website for parents of children with ADHD.

PubMed

Ryan, Gemma Sinead; Haroon, Munib; Melvin, Gail

2015-11-01

ADHD is a relatively common neuro-developmental condition characterized by hyperactivity, impulsivity and inattention. The provision of timely and accurate information about the condition and about strategies to manage it is vital especially because of widespread misconceptions about it. To see the effect of an educational website on (i) parental perceptions (ii) knowledge levels, and to obtain feedback to optimise user-experience. Parents whose children had ADHD (or were close to diagnosis) were recruited. Following a 30-item baseline knowledge test parents/carers were directed to an educational website on ADHD. After this they were re-contacted for follow up testing and feedback. n=172, 14 were lost to follow up. Ninety-one (59.4 %) participants were known to have accessed the website at follow up. The majority of carers accessed the website just once or twice (32.7%). Of those who did not access the website 65% cited a lack of time as the reason while 29% cited they were unable to access the internet at the time. The majority (74%) of those accessing the site were just browsing for general information. Parents showed increased knowledge post website use p=0.000. Of those accessing the website the majority (85.5%) felt it was relevant to them and would use it again (90.8%). Content analysis of open-ended feedback identified eight core themes including website appearance, content, functionality, perceptions, target audience, usability, usage patterns with areas for improvement noted in four areas. Websites can be used as an adjunct to information given at clinic. Although a majority of parents will access them, there are still barriers to access e.g. time. Websites do seem to improve parent/carer knowledge levels. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Evaluating the accessibility and utility of HIV-related point-of-care diagnostics for maternal health in rural South Africa: a study protocol

PubMed Central

Mashamba-Thompson, T P; Drain, P K; Sartorius, B

2016-01-01

Introduction Poor healthcare access is a major barrier to receiving antenatal care and a cause of high maternal mortality in South Africa (SA). ‘Point-of-care’ (POC) diagnostics is a powerful emerging healthcare approach to improve healthcare access. This study focuses on evaluating the accessibility and utility of POC diagnostics for maternal health in rural SA primary healthcare (PHC) clinics in order to generate a model framework of implementation of POC diagnostics in rural South African clinics. Method and analyses We will use several research methods, including a systematic review, quasi-experiments, survey, key informant interviews and audits. We will conduct a systematic review and experimental study to determine the impact of POC diagnostics on maternal health. We will perform a cross-sectional case study of 100 randomly selected rural primary healthcare clinics in KwaZulu-Natal to measure the context and patterns of POC diagnostics access and usage by maternal health providers and patients. We will conduct interviews with relevant key stakeholders to determine the reasons for POC deficiencies regarding accessibility and utility of HIV-related POC diagnostics for maternal health. We will also conduct a vertical audit to investigate all the quality aspects of POC diagnostic services including diagnostic accuracy in a select number of clinics. On the basis of information gathered, we will propose a model framework for improved implementation of POC diagnostics in rural South African public healthcare clinics. Statistical (Stata-13) and thematic (NVIVO) data analysis will be used in this study. Ethics and dissemination The study protocol was approved by the Ethics Committee of the University of KwaZulu-Natal (BE 484/14) and the KwaZulu-Natal Department of Health based on the Helsinki Declaration (HRKM 40/15). Findings of this study will be disseminated electronically and in print. They will be presented to conferences related to HIV/AIDS, diagnostics, maternal health and strengthening of health systems. PMID:27354074

Flexible ureterorenoscopy: Tips and tricks.

PubMed

Somani, Bhaskar Kumar; Aboumarzouk, Omar; Srivastava, Aneesh; Traxer, Olivier

2013-01-01

With advancement in technology, improvement in endoscope and ancillary equipment, more complex procedures can be performed using flexible ureterorenoscopy. In this review article we provide a summary of flexible ureterorenoscopic procedures with "tips and tricks" for success for each type of procedure. It looks at the disposables used with flexible ureterorenoscopic procedures, set up and patient positioning for gaining access, insertion and handling of scope and the use of urethral access sheath. We also provide techniques for various flexible ureterorenoscopic procedures including management of renal stones, calyceal diverticula and upper tract urothelial tumours.

Flexible ureterorenoscopy: Tips and tricks

PubMed Central

Somani, Bhaskar Kumar; Aboumarzouk, Omar; Srivastava, Aneesh; Traxer, Olivier

2013-01-01

With advancement in technology, improvement in endoscope and ancillary equipment, more complex procedures can be performed using flexible ureterorenoscopy. In this review article we provide a summary of flexible ureterorenoscopic procedures with “tips and tricks” for success for each type of procedure. It looks at the disposables used with flexible ureterorenoscopic procedures, set up and patient positioning for gaining access, insertion and handling of scope and the use of urethral access sheath. We also provide techniques for various flexible ureterorenoscopic procedures including management of renal stones, calyceal diverticula and upper tract urothelial tumours. PMID:23662000

AMORE; The Advanced Multimedia Organizer for Requirements Elicitation

DTIC Science & Technology

1993-06-01

terms of cinematic primitives, including: perspective, camera, sound, content, and context [Davenport 91]. Ambient sound can be used to provide...concept) [Dumais 88], [Salton 83]. Latent semantic indexing [Dumais 88] could improve the access to video shots described by cinematic primitives. As...into classes (includ- the cited articles) video source ing cinematic primi- tives) CMU/SEI-93-TR-12 33 A.6 Tree-Maps Retrieval Visualization

Improving patient access to an interventional US clinic.

PubMed

Steele, Joseph R; Clarke, Ryan K; Terrell, John A; Brightmon, Tonya R

2014-01-01

A continuous quality improvement project was conducted to increase patient access to a neurointerventional ultrasonography (US) clinic. The clinic was experiencing major scheduling delays because of an increasing patient volume. A multidisciplinary team was formed that included schedulers, medical assistants, nurses, technologists, and physicians. The team created an Ishikawa diagram of the possible causes of the long wait time to the next available appointment and developed a flowchart of the steps involved in scheduling and completing a diagnostic US examination and biopsy. The team then implemented a staged intervention that included adjustments to staffing and room use (stage 1); new procedures for scheduling same-day add-on appointments (stage 2); and a lead technician rotation to optimize patient flow, staffing, and workflow (stage 3). Six months after initiation of the intervention, the mean time to the next available appointment had decreased from 25 days at baseline to 1 day, and the number of available daily appointments had increased from 38 to 55. These improvements resulted from a coordinated provider effort and had a net present value of more than $275,000. This project demonstrates that structural changes in staffing, workflow, and room use can substantially reduce scheduling delays for critical imaging procedures. © RSNA, 2014.

A Conceptual Framework of Mapping Access to Health Care across EU Countries: The Patient Access Initiative.

PubMed

Souliotis, Kyriakos; Hasardzhiev, Stanimir; Agapidaki, Eirini

Research evidence suggests that access to health care is the key influential factor for improved population health outcomes and health care system sustainability. Although the importance of addressing barriers in access to health care across European countries is well documented, little has been done to improve the situation. This is due to different definitions, approaches and policies, and partly due to persisting disparities in access within and between European countries. To bridge this gap, the Patient Access Partnership (PACT) developed (a) the '5As' definition of access, which details the five critical elements (adequacy, accessibility, affordability, appropriateness, and availability) of access to health care, (b) a multi-stakeholders' approach for mapping access, and (c) a 13-item questionnaire based on the 5As definition in an effort to address these obstacles and to identify best practices. These tools are expected to contribute effectively to addressing access barriers in practice, by suggesting a common framework and facilitating the exchange of knowledge and expertise, in order to improve access to health care between and within European countries. © 2016 S. Karger AG, Basel.

Online access to doctors' notes: patient concerns about privacy.

PubMed

Vodicka, Elisabeth; Mejilla, Roanne; Leveille, Suzanne G; Ralston, James D; Darer, Jonathan D; Delbanco, Tom; Walker, Jan; Elmore, Joann G

2013-09-26

Offering patients online access to medical records, including doctors' visit notes, holds considerable potential to improve care. However, patients may worry about loss of privacy when accessing personal health information through Internet-based patient portals. The OpenNotes study provided patients at three US health care institutions with online access to their primary care doctors' notes and then collected survey data about their experiences, including their concerns about privacy before and after participation in the intervention. To identify patients' attitudes toward privacy when given electronic access to their medical records, including visit notes. The design used a nested cohort study of patients surveyed at baseline and after a 1-year period during which they were invited to read their visit notes through secure patient portals. Participants consisted of 3874 primary care patients from Beth Israel Deaconess Medical Center (Boston, MA), Geisinger Health System (Danville, PA), and Harborview Medical Center (Seattle, WA) who completed surveys before and after the OpenNotes intervention. The measures were patient-reported levels of concern regarding privacy associated with online access to visit notes. 32.91% of patients (1275/3874 respondents) reported concerns about privacy at baseline versus 36.63% (1419/3874 respondents) post-intervention. Baseline concerns were associated with non-white race/ethnicity and lower confidence in communicating with doctors, but were not associated with choosing to read notes or desire for continued online access post-intervention (nearly all patients with notes available chose to read them and wanted continued access). While the level of concern among most participants did not change during the intervention, 15.54% (602/3874 respondents, excluding participants who responded "don't know") reported more concern post-intervention, and 12.73% (493/3874 respondents, excluding participants who responded "don't know") reported less concern. When considering online access to visit notes, approximately one-third of patients had concerns about privacy at baseline and post-intervention. These perceptions did not deter participants from accessing their notes, suggesting that the benefits of online access to medical records may outweigh patients' perceived risks to privacy.

Online Access to Doctors' Notes: Patient Concerns About Privacy

PubMed Central

Mejilla, Roanne; Leveille, Suzanne G; Ralston, James D; Darer, Jonathan D; Delbanco, Tom; Walker, Jan; Elmore, Joann G

2013-01-01

Background Offering patients online access to medical records, including doctors’ visit notes, holds considerable potential to improve care. However, patients may worry about loss of privacy when accessing personal health information through Internet-based patient portals. The OpenNotes study provided patients at three US health care institutions with online access to their primary care doctors’ notes and then collected survey data about their experiences, including their concerns about privacy before and after participation in the intervention. Objective To identify patients’ attitudes toward privacy when given electronic access to their medical records, including visit notes. Methods The design used a nested cohort study of patients surveyed at baseline and after a 1-year period during which they were invited to read their visit notes through secure patient portals. Participants consisted of 3874 primary care patients from Beth Israel Deaconess Medical Center (Boston, MA), Geisinger Health System (Danville, PA), and Harborview Medical Center (Seattle, WA) who completed surveys before and after the OpenNotes intervention. The measures were patient-reported levels of concern regarding privacy associated with online access to visit notes. Results 32.91% of patients (1275/3874 respondents) reported concerns about privacy at baseline versus 36.63% (1419/3874 respondents) post-intervention. Baseline concerns were associated with non-white race/ethnicity and lower confidence in communicating with doctors, but were not associated with choosing to read notes or desire for continued online access post-intervention (nearly all patients with notes available chose to read them and wanted continued access). While the level of concern among most participants did not change during the intervention, 15.54% (602/3874 respondents, excluding participants who responded “don’t know”) reported more concern post-intervention, and 12.73% (493/3874 respondents, excluding participants who responded “don’t know”) reported less concern. Conclusions When considering online access to visit notes, approximately one-third of patients had concerns about privacy at baseline and post-intervention. These perceptions did not deter participants from accessing their notes, suggesting that the benefits of online access to medical records may outweigh patients’ perceived risks to privacy. PMID:24072335

Rising Expectations: Access to Biomedical Information

PubMed Central

Lindberg, D. A. B.; Humphreys, B. L.

2008-01-01

Summary Objective To provide an overview of the expansion in public access to electronic biomedical information over the past two decades, with an emphasis on developments to which the U.S. National Library of Medicine contributed. Methods Review of the increasingly broad spectrum of web-accessible genomic data, biomedical literature, consumer health information, clinical trials data, and images. Results The amount of publicly available electronic biomedical information has increased dramatically over the past twenty years. Rising expectations regarding access to biomedical information were stimulated by the spread of the Internet, the World Wide Web, advanced searching and linking techniques. These informatics advances simplified and improved access to electronic information and reduced costs, which enabled inter-organizational collaborations to build and maintain large international information resources and also aided outreach and education efforts The demonstrated benefits of free access to electronic biomedical information encouraged the development of public policies that further increase the amount of information available. Conclusions Continuing rapid growth of publicly accessible electronic biomedical information presents tremendous opportunities and challenges, including the need to ensure uninterrupted access during disasters or emergencies and to manage digital resources so they remain available for future generations. PMID:18587496

Biometrics: Accessibility challenge or opportunity?

PubMed

Blanco-Gonzalo, Ramon; Lunerti, Chiara; Sanchez-Reillo, Raul; Guest, Richard Michael

2018-01-01

Biometric recognition is currently implemented in several authentication contexts, most recently in mobile devices where it is expected to complement or even replace traditional authentication modalities such as PIN (Personal Identification Number) or passwords. The assumed convenience characteristics of biometrics are transparency, reliability and ease-of-use, however, the question of whether biometric recognition is as intuitive and straightforward to use is open to debate. Can biometric systems make some tasks easier for people with accessibility concerns? To investigate this question, an accessibility evaluation of a mobile app was conducted where test subjects withdraw money from a fictitious ATM (Automated Teller Machine) scenario. The biometric authentication mechanisms used include face, voice, and fingerprint. Furthermore, we employed traditional modalities of PIN and pattern in order to check if biometric recognition is indeed a real improvement. The trial test subjects within this work were people with real-life accessibility concerns. A group of people without accessibility concerns also participated, providing a baseline performance. Experimental results are presented concerning performance, HCI (Human-Computer Interaction) and accessibility, grouped according to category of accessibility concern. Our results reveal links between individual modalities and user category establishing guidelines for future accessible biometric products.

Barriers to health service access among female migrant Ugandan sex workers in Guangzhou, China.

PubMed

Davis, Alissa; Meyerson, Beth E; Aghaulor, Blessing; Brown, Katherine; Watson, Adisyn; Muessig, Kathryn E; Yang, Ligang; Tucker, Joseph D

2016-10-14

Increased trade between China and Uganda has fueled trafficking of female Ugandans into China. These women may face challenges accessing health services. This study focused on examining barriers to health care access among female Ugandan sex workers in China. In 2014, we undertook in-depth interviews with 19 female Ugandan sex workers in Guangzhou, China. Interviews focused on barriers to health service access and were analyzed using an a priori coding framework followed by open-coding to capture emergent themes. Out of 19 women, 12 women reported a history of being trafficked into China. None of the women had a valid Chinese visa. Fear of being arrested for lack of documentation discouraged women in this sample from accessing hospital services. Low pay, housing exploitation, and remittances contributed to participants' lack of financial resources, which further inhibited their ability to access health services. Participants expressed feeling social isolation from the local community and reported mistrust of local individuals and organizations, including hospitals. Ugandan sex workers in China faced substantial structural barriers that limited health service access. Policy changes and the development of new programs are urgently needed to ensure these women have improved access to health services.

Biometrics: Accessibility challenge or opportunity?

PubMed Central

Lunerti, Chiara; Sanchez-Reillo, Raul; Guest, Richard Michael

2018-01-01

Biometric recognition is currently implemented in several authentication contexts, most recently in mobile devices where it is expected to complement or even replace traditional authentication modalities such as PIN (Personal Identification Number) or passwords. The assumed convenience characteristics of biometrics are transparency, reliability and ease-of-use, however, the question of whether biometric recognition is as intuitive and straightforward to use is open to debate. Can biometric systems make some tasks easier for people with accessibility concerns? To investigate this question, an accessibility evaluation of a mobile app was conducted where test subjects withdraw money from a fictitious ATM (Automated Teller Machine) scenario. The biometric authentication mechanisms used include face, voice, and fingerprint. Furthermore, we employed traditional modalities of PIN and pattern in order to check if biometric recognition is indeed a real improvement. The trial test subjects within this work were people with real-life accessibility concerns. A group of people without accessibility concerns also participated, providing a baseline performance. Experimental results are presented concerning performance, HCI (Human-Computer Interaction) and accessibility, grouped according to category of accessibility concern. Our results reveal links between individual modalities and user category establishing guidelines for future accessible biometric products. PMID:29565989

A realist review of mobile phone-based health interventions for non-communicable disease management in sub-Saharan Africa.

PubMed

Opoku, Daniel; Stephani, Victor; Quentin, Wilm

2017-02-06

The prevalence of non-communicable diseases (NCDs) is increasing in sub-Saharan Africa. At the same time, the use of mobile phones is rising, expanding the opportunities for the implementation of mobile phone-based health (mHealth) interventions. This review aims to understand how, why, for whom, and in what circumstances mHealth interventions against NCDs improve treatment and care in sub-Saharan Africa. Four main databases (PubMed, Cochrane Library, Web of Science, and Google Scholar) and references of included articles were searched for studies reporting effects of mHealth interventions on patients with NCDs in sub-Saharan Africa. All studies published up until May 2015 were included in the review. Following a realist review approach, middle-range theories were identified and integrated into a Framework for Understanding the Contribution of mHealth Interventions to Improved Access to Care for patients with NCDs in sub-Saharan Africa. The main indicators of the framework consist of predisposing characteristics, needs, enabling resources, perceived usefulness, and perceived ease of use. Studies were analyzed in depth to populate the framework. The search identified 6137 titles for screening, of which 20 were retained for the realist synthesis. The contribution of mHealth interventions to improved treatment and care is that they facilitate (remote) access to previously unavailable (specialized) services. Three contextual factors (predisposing characteristics, needs, and enabling resources) influence if patients and providers believe that mHealth interventions are useful and easy to use. Only if they believe mHealth to be useful and easy to use, will mHealth ultimately contribute to improved access to care. The analysis of included studies showed that the most important predisposing characteristics are a positive attitude and a common language of communication. The most relevant needs are a high burden of disease and a lack of capacity of first-contact providers. Essential enabling resources are the availability of a stable communications network, accessible maintenance services, and regulatory policies. Policy makers and program managers should consider predisposing characteristics and needs of patients and providers as well as the necessary enabling resources prior to the introduction of an mHealth intervention. Researchers would benefit from placing greater attention on the context in which mHealth interventions are being implemented instead of focusing (too strongly) on the technical aspects of these interventions.

Ad Hoc Access Gateway Selection Algorithm

NASA Astrophysics Data System (ADS)

Jie, Liu

With the continuous development of mobile communication technology, Ad Hoc access network has become a hot research, Ad Hoc access network nodes can be used to expand capacity of multi-hop communication range of mobile communication system, even business adjacent to the community, improve edge data rates. For mobile nodes in Ad Hoc network to internet, internet communications in the peer nodes must be achieved through the gateway. Therefore, the key Ad Hoc Access Networks will focus on the discovery gateway, as well as gateway selection in the case of multi-gateway and handover problems between different gateways. This paper considers the mobile node and the gateway, based on the average number of hops from an average access time and the stability of routes, improved gateway selection algorithm were proposed. An improved gateway selection algorithm, which mainly considers the algorithm can improve the access time of Ad Hoc nodes and the continuity of communication between the gateways, were proposed. This can improve the quality of communication across the network.

Women and Development: Three Experimental Projects

ERIC Educational Resources Information Center

Clason, Carla

1975-01-01

A review of three experimental projects implemented by Unesco in the late 1960's to improve the status and equal educational opportunities of women includes: (1) Upper Volta, education for rural women; (2) Nepal, training primary school teachers; and (3) Chile, access of women to technical education. (LH)

Perspectives. Fall 2009

ERIC Educational Resources Information Center

PEPNet, 2009

2009-01-01

PEPNet's "Perspectives" is the collaborative newsletter of the four PEPNet regional centers. This newsletter combines each centers' individual strengths into a single resource that can be used on a national level. PEPNet's mission is to improve transition services and educational access for students who are deaf or hard of hearing, including those…

Rural Colleges as Catalysts for Community Change: The RCCI Experience.

ERIC Educational Resources Information Center

Rubin, Sarah

2001-01-01

The Rural Community College Initiative challenges colleges in economically distressed regions to become catalysts for economic and community development and improved access to education. Led by college-community teams, the 24 sites have experimented with strategic approaches that include leadership development, entrepreneurship education, small…

Developing Modern Information Systems and Services: Africa's Challenges for the Future.

ERIC Educational Resources Information Center

Chowdhury, G. G.

1996-01-01

Discusses the current state of information systems and services in Africa, examines future possibilities, and suggests areas for improvement. Topics include the lack of automation; CD-ROM databases for accessibility to information sources; developing low-cost electronic communication facilities; Internet connectivity; dependence on imported…

Automating Expertise in Collaborative Learning Environments

ERIC Educational Resources Information Center

LaVoie, Noelle; Streeter, Lynn; Lochbaum, Karen; Wroblewski, David; Boyce, Lisa; Krupnick, Charles; Psotka, Joseph

2010-01-01

We have developed a set of tools for improving online collaborative learning including an automated expert that monitors and moderates discussions, and additional tools to evaluate contributions, semantically search all posted comments, access a library of hundreds of digital books and provide reports to instructors. The technology behind these…

77 FR 13195 - Exempting In-Home Video Telehealth From Copayments

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-06

.... (This is not a toll-free number.) SUPPLEMENTARY INFORMATION: Many of our nation's veterans must travel... consultations, improved access to primary and ambulatory care, reduced waiting times, and decreased veteran travel. VA provides various telehealth services, including clinical video telehealth and in-home video...

The E-business Revolution and Human Performance.

ERIC Educational Resources Information Center

Harmon, Paul

2001-01-01

Provides an overview of the electronic business (e-business) revolution and suggests ways it will affect human performance improvement professionals. Highlights include customer reliance on the Web; use of the Internet and associated software to link employees, applications, and companies; information access and sharing; business-to-consumer and…

Application of a Telecolposcopy Program in Rural Settings.

PubMed

Hitt, Wilbur C; Low, Gordon M; Lynch, Christian E; Gauss, C Heath; Magann, Everett F; Lowery, Curtis L; Eswaran, Hari

2016-10-01

Individuals in rural areas are often restricted by the amount of physicians' availability, thus limiting access to healthcare in those settings. While Pap smear screening has increased across the United States, the rural South still reports high rates of cervical cancer and mortality. One solution to improve patient outcomes related to cervical cancer in rural settings is telecolposcopy. Women with abnormal Pap results or an abnormal visual examination needing an evaluation by colposcopy were referred to a hospital-based telecolposcopy program. Descriptive data are provided that include patients' access to care based on travel time and transportation costs. Over a 15-month time period, 940 unique patients were seen using telecolposcopy. Telecolposcopy was done at eight spoke sites across Arkansas representing patients from 72 of the 75 counties. Data for risk factors that include smoking, first sexual experience, and number of sexual partners in past 12 months and in a lifetime are discussed. Pap results and impression are provided. In addition, avoided transportation costs and travel time have been calculated and included. Cervical cancer is important public health concern especially for women residing in rural areas. We were able to demonstrate that our telecolposcopy program has provided sustainability statewide since its inception and that patients are willing to participate. In addition to providing increased access to care, the program also reduced travel time and costs associated with a face-to-face visit. Telecolposcopy should be further explored and utilized in rural settings as a way to reduce patient costs and improve cervical cancer outcomes.

Evaluating improvements in landside access for airports.

DOT National Transportation Integrated Search

1998-10-01

The purpose of this research was to describe the elements that comprise airport access and develop a methodology for identifying and evaluating existing landside access performance and proposed improvements from a passenger perspective. The scope was...

Adequacy and clarity of information on out-of-hours emergency dental services at Greater Manchester NHS dental practices: a cross-sectional study.

PubMed

Aldallal, S N; Aldallal, F N; Khajah, A S

2017-03-24

Objective To perform an evaluation of the information given to patients seeking emergency dental services during out-of-hours periods in Greater Manchester.Method This is a cross-sectional study. A list of all NHS dental practices in Greater Manchester was obtained from the NHS website. The investigators then accessed websites and voicemails of all practices to assess the information given to patients.Results The study shows that most practices have voicemail, which includes varying information on how to access emergency dental services during out-of-hours periods. Few of those included advice on the management of common dental emergencies. On the other hand, the majority of practices did not have websites. From those who included advice on how to access emergency dental services during out-of-hours periods on how to manage common dental emergencies on their websites, the information was easy to find.Conclusion The current information could be improved by ensuring the inclusion of essential details. Websites would help by including more details. In turn, this could help to reduce the number of inappropriate presentations to A&E departments.

78 FR 72860 - White River National Forest; Summit County, CO; 2013 Arapahoe Basin Improvements EIS

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-04

... experience that A-Basin provides; improve access to Montezuma Bowl; upgrade or remove existing lifts, as... Gullies and one in Beaver Bowl. Currently, The Beavers can be accessed legally through backcountry access... exit the controlled/patrolled portions of A-Basin's operational boundary to access adjacent backcountry...

Improving Web Accessibility in a University Setting

ERIC Educational Resources Information Center

Olive, Geoffrey C.

2010-01-01

Improving Web accessibility for disabled users visiting a university's Web site is explored following the World Wide Web Consortium (W3C) guidelines and Section 508 of the Rehabilitation Act rules for Web page designers to ensure accessibility. The literature supports the view that accessibility is sorely lacking, not only in the USA, but also…

42 CFR 480.111 - QIO access to records and information of institutions and practitioners.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Access to Information § 480.111 QIO access to records and... 42 Public Health 4 2011-10-01 2011-10-01 false QIO access to records and information of...

42 CFR 480.112 - QIO access to records and information of intermediaries and carriers.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Access to Information § 480.112 QIO access to records and... 42 Public Health 4 2011-10-01 2011-10-01 false QIO access to records and information of...

42 CFR 480.112 - QIO access to records and information of intermediaries and carriers.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Qio Access to Information § 480.112 QIO access to records and... 42 Public Health 4 2010-10-01 2010-10-01 false QIO access to records and information of...

Vascular Access Outcomes Reported in Maintenance Hemodialysis Trials: A Systematic Review.

PubMed

Viecelli, Andrea K; O'Lone, Emma; Sautenet, Benedicte; Craig, Jonathan C; Tong, Allison; Chemla, Eric; Hooi, Lai-Seong; Lee, Timmy; Lok, Charmaine; Polkinghorne, Kevan R; Quinn, Robert R; Vachharajani, Tushar; Vanholder, Raymond; Zuo, Li; Irish, Ashley B; Mori, Trevor A; Pascoe, Elaine M; Johnson, David W; Hawley, Carmel M

2018-03-01

Many randomized controlled trials have been performed with the goal of improving outcomes related to hemodialysis vascular access. If the reported outcomes are relevant and measured consistently to allow comparison of interventions across trials, such trials can inform decision making. This study aimed to assess the scope and consistency of vascular access outcomes reported in contemporary hemodialysis trials. Systematic review. Adults requiring maintenance hemodialysis. All randomized controlled trials and trial protocols reporting vascular access outcomes identified from ClinicalTrials.gov, Embase, MEDLINE, and the Cochrane Kidney and Transplant Specialized Register from January 2011 to June 2016. Any hemodialysis-related intervention. The frequency and characteristics of vascular access outcome measures were analyzed and classified. From 168 relevant trials, 1,426 access-related outcome measures were extracted and classified into 23 different outcomes. The 3 most common outcomes were function (136 [81%] trials), infection (63 [38%]), and maturation (31 [18%]). Function was measured in 489 different ways, but most frequently reported as "mean access blood flow (mL/min)" (37 [27%] trials) and "number of thromboses" (30 [22%]). Infection was assessed in 136 different ways, with "number of access-related infections" being the most common measure. Maturation was assessed in 44 different ways at 15 different time points and most commonly characterized by vein diameter and blood flow. Patient-reported outcomes, including pain (19 [11%]) and quality of life (5 [3%]), were reported infrequently. Only a minority of trials used previously standardized outcome definitions. Restricted sampling frame for feasibility and focus on contemporary trials. The reporting of access outcomes in hemodialysis trials is very heterogeneous, with limited patient-reported outcomes and infrequent use of standardized outcome measures. Efforts to standardize outcome reporting for vascular access are critical to optimizing the comparability, reliability, and value of trial evidence to improve outcomes for patients requiring hemodialysis. Copyright © 2017 National Kidney Foundation, Inc. All rights reserved.

Approaches to improving the contribution of the nursing and midwifery workforce to increasing universal access to primary health care for vulnerable populations: a systematic review.

PubMed

Dawson, A J; Nkowane, A M; Whelan, A

2015-12-18

Despite considerable evidence showing the importance of the nursing and midwifery workforce, there are no systematic reviews outlining how these cadres are best supported to provide universal access and reduce health care disparities at the primary health care (PHC) level. This review aims to identify nursing and midwifery policy, staffing, education and training interventions, collaborative efforts and strategies that have improved the quantity, quality and relevance of the nursing and midwifery workforce leading to health improvements for vulnerable populations. We undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The quality of retrieved papers was appraised using standard tools. The characteristics of screened papers were described, and a deductive qualitative content analysis methodology was applied to analyse the interventions and findings of included studies using a conceptual framework. Thirty-six papers were included in the review, the majority (25) from high-income countries and nursing settings (32). Eleven papers defined leadership and governance approaches that had impacted upon the health outcomes of disadvantaged groups including policies at the national and state level that had led to an increased supply and coverage of nursing and midwifery staff and scope of practice. Twenty-seven papers outlined human resource management strategies to support the expansion of nurse's and midwives' roles that often involved task shifting and task sharing. These included approaches to managing staffing supply, distribution and skills mix; workloads; supervision; performance management; and remuneration, financial incentives and staffing costs. Education and training activities were described in 14 papers to assist nurses and midwives to perform new or expanded roles and prepare nurses for inclusive practice. This review identified collaboration between nurses and midwives and other health providers and organizations, across sectors, and with communities and individuals that resulted in improved health care and outcomes. The findings of this review confirm the importance of a conceptual framework for understanding and planning leadership and governance approaches, management strategies and collaboration and education and training efforts to scale up and support nurses and midwives in existing or expanded roles to improve access to PHC for vulnerable populations.

Parallel In Situ Indexing for Data-intensive Computing

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

Kim, Jinoh; Abbasi, Hasan; Chacon, Luis

2011-09-09

As computing power increases exponentially, vast amount of data is created by many scientific re- search activities. However, the bandwidth for storing the data to disks and reading the data from disks has been improving at a much slower pace. These two trends produce an ever-widening data access gap. Our work brings together two distinct technologies to address this data access issue: indexing and in situ processing. From decades of database research literature, we know that indexing is an effective way to address the data access issue, particularly for accessing relatively small fraction of data records. As data sets increasemore » in sizes, more and more analysts need to use selective data access, which makes indexing an even more important for improving data access. The challenge is that most implementations of in- dexing technology are embedded in large database management systems (DBMS), but most scientific datasets are not managed by any DBMS. In this work, we choose to include indexes with the scientific data instead of requiring the data to be loaded into a DBMS. We use compressed bitmap indexes from the FastBit software which are known to be highly effective for query-intensive workloads common to scientific data analysis. To use the indexes, we need to build them first. The index building procedure needs to access the whole data set and may also require a significant amount of compute time. In this work, we adapt the in situ processing technology to generate the indexes, thus removing the need of read- ing data from disks and to build indexes in parallel. The in situ data processing system used is ADIOS, a middleware for high-performance I/O. Our experimental results show that the indexes can improve the data access time up to 200 times depending on the fraction of data selected, and using in situ data processing system can effectively reduce the time needed to create the indexes, up to 10 times with our in situ technique when using identical parallel settings.« less

Meckel's cave access: anatomic study comparing the endoscopic transantral and endonasal approaches.

PubMed

Van Rompaey, Jason; Suruliraj, Anand; Carrau, Ricardo; Panizza, Benedict; Solares, C Arturo

2014-04-01

Recent advances in endonasal endoscopy have facilitated the surgical access to the lateral skull base including areas such as Meckel's cave. This approach has been well documented, however, few studies have outlined transantral specific access to Meckel's. A transantral approach provides a direct pathway to this region obviating the need for extensive endonasal and transsphenoidal resection. Our aim in this study is to compare the anatomical perspectives obtained in endonasal and transantral approaches. We prepared 14 cadaveric specimens with intravascular injections of colored latex. Eight cadavers underwent endoscopic endonasal transpterygoid approaches to Meckel's cave. Six additional specimens underwent an endoscopic transantral approach to the same region. Photographic evidence was obtained for review. 30 CT scans were analyzed to measure comparative distances to Meckel's cave for both approaches. The endoscopic approaches provided a direct access to the anterior and inferior portions of Meckel's cave. However, the transantral approach required shorter instrumentation, and did not require clearing of the endonasal corridor. This approach gave an anterior view of Meckel's cave making posterior dissection more difficult. A transantral approach to Meckel's cave provides access similar to the endonasal approach with minimal invasiveness. Some of the morbidity associated with extensive endonasal resection could possibly be avoided. Better understanding of the complex skull base anatomy, from different perspectives, helps to improve current endoscopic skull base surgery and to develop new alternatives, consequently, leading to improvements in safety and efficacy.

Protein Solvent-Accessibility Prediction by a Stacked Deep Bidirectional Recurrent Neural Network.

PubMed

Zhang, Buzhong; Li, Linqing; Lü, Qiang

2018-05-25

Residue solvent accessibility is closely related to the spatial arrangement and packing of residues. Predicting the solvent accessibility of a protein is an important step to understand its structure and function. In this work, we present a deep learning method to predict residue solvent accessibility, which is based on a stacked deep bidirectional recurrent neural network applied to sequence profiles. To capture more long-range sequence information, a merging operator was proposed when bidirectional information from hidden nodes was merged for outputs. Three types of merging operators were used in our improved model, with a long short-term memory network performing as a hidden computing node. The trained database was constructed from 7361 proteins extracted from the PISCES server using a cut-off of 25% sequence identity. Sequence-derived features including position-specific scoring matrix, physical properties, physicochemical characteristics, conservation score and protein coding were used to represent a residue. Using this method, predictive values of continuous relative solvent-accessible area were obtained, and then, these values were transformed into binary states with predefined thresholds. Our experimental results showed that our deep learning method improved prediction quality relative to current methods, with mean absolute error and Pearson's correlation coefficient values of 8.8% and 74.8%, respectively, on the CB502 dataset and 8.2% and 78%, respectively, on the Manesh215 dataset.

Interventions to improve cultural competency in healthcare: a systematic review of reviews

PubMed Central

2014-01-01

Background Cultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health disparities. The aim of this systematic review of reviews is to gather and synthesize existing reviews of studies in the field to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area. Methods A systematic review of review articles published between January 2000 and June 2012 was conducted. Electronic databases (including Medline, Cinahl and PsycINFO), reference lists of articles, and key websites were searched. Reviews of cultural competency in health settings only were included. Each review was critically appraised by two authors using a study appraisal tool and were given a quality assessment rating of weak, moderate or strong. Results Nineteen published reviews were identified. Reviews consisted of between 5 and 38 studies, included a variety of health care settings/contexts and a range of study types. There were three main categories of study outcomes: patient-related outcomes, provider-related outcomes, and health service access and utilization outcomes. The majority of reviews found moderate evidence of improvement in provider outcomes and health care access and utilization outcomes but weaker evidence for improvements in patient/client outcomes. Conclusion This review of reviews indicates that there is some evidence that interventions to improve cultural competency can improve patient/client health outcomes. However, a lack of methodological rigor is common amongst the studies included in reviews and many of the studies rely on self-report, which is subject to a range of biases, while objective evidence of intervention effectiveness was rare. Future research should measure both healthcare provider and patient/client health outcomes, consider organizational factors, and utilize more rigorous study designs. PMID:24589335

Efficient implementation of real-time programs under the VAX/VMS operating system

NASA Technical Reports Server (NTRS)

Johnson, S. C.

1985-01-01

Techniques for writing efficient real-time programs under the VAX/VMS oprating system are presented. Basic operations are presented for executing at real-time priority and for avoiding needlless processing delays. A highly efficient technique for accessing physical devices by mapping to the input/output space and accessing the device registrs directly is described. To illustrate the application of the technique, examples are included of different uses of the technique on three devices in the Langley Avionics Integration Research Lab (AIRLAB): the KW11-K dual programmable real-time clock, the Parallel Communications Link (PCL11-B) communication system, and the Datacom Synchronization Network. Timing data are included to demonstrate the performance improvements realized with these applications of the technique.

Patient's access to healthcare and treatment in rheumatoid arthritis: the views of stakeholders in Portugal.

PubMed

Laires, Pedro A; Mesquita, Rui; Veloso, Luís; Martins, Ana Paula; Cernadas, Rui; Fonseca, João Eurico

2013-09-25

The access to healthcare and treatment by rheumatoid arthritis (RA) patients, particularly to biologics, differs significantly among European countries.We aimed to explore the views and experiences of Portuguese healthcare stakeholders on key barriers which limit the access to treatment, and ultimately to biologics, by RA patients and to find potential solutions (leverage points) to overcome the identified barriers. This was a qualitative research consisting of semi-structured face-to-face interviews with key stakeholders in RA framework. Thirty four individuals from eight groups of stakeholders were interviewed: rural and urban general practitioners (GPs), rheumatologists, hospital managers, hospital pharmacists, budget holders, representatives from the Portuguese Rheumatology Society and the RA Patient Association. Interviews were conducted between May and June 2011. Conventional content analysis with research triangulation was used. The key barriers identified were related to the accessibility to primary healthcare services, difficulties in RA diagnosis among GPs, inefficient referral to secondary healthcare and controlled process of biologics prescription in public hospitals. The leverage points identified included the improvement of epidemiological and clinical knowledge about RA in Portugal, a better understanding of the disease among patients and GPs, the clarification of biologics benefits among budget holders and a raised awareness of the current treatment guidelines. In order to further address the leverage points, the following key initiatives were proposed: optimization of RA national registry; dissemination of information on rheumatic symptoms in primary care facilities and among the general public; increase interaction between rheumatologists and GPs through clinical discussions of successfully treated patients or workshops; broader utilization of disease diagnosis and monitoring tools, such as DAS28, and implementation of hospital-based research to collect real-world data. Most of the key barriers limiting the access to treatment, including biologics, in RA in Portugal are upstream of rheumatology practice. Our findings suggest that future actions should be focused on the primary care level to improve referral to rheumatologists. In addition, the collection of real-world data seems essential to characterise the RA population, to improve disease management and to increase compliance with current treatment guidelines.

Use of handheld computers in clinical practice: a systematic review.

PubMed

Mickan, Sharon; Atherton, Helen; Roberts, Nia Wyn; Heneghan, Carl; Tilson, Julie K

2014-07-06

Many healthcare professionals use smartphones and tablets to inform patient care. Contemporary research suggests that handheld computers may support aspects of clinical diagnosis and management. This systematic review was designed to synthesise high quality evidence to answer the question; Does healthcare professionals' use of handheld computers improve their access to information and support clinical decision making at the point of care? A detailed search was conducted using Cochrane, MEDLINE, EMBASE, PsycINFO, Science and Social Science Citation Indices since 2001. Interventions promoting healthcare professionals seeking information or making clinical decisions using handheld computers were included. Classroom learning and the use of laptop computers were excluded. Two authors independently selected studies, assessed quality using the Cochrane Risk of Bias tool and extracted data. High levels of data heterogeneity negated statistical synthesis. Instead, evidence for effectiveness was summarised narratively, according to each study's aim for assessing the impact of handheld computer use. We included seven randomised trials investigating medical or nursing staffs' use of Personal Digital Assistants. Effectiveness was demonstrated across three distinct functions that emerged from the data: accessing information for clinical knowledge, adherence to guidelines and diagnostic decision making. When healthcare professionals used handheld computers to access clinical information, their knowledge improved significantly more than peers who used paper resources. When clinical guideline recommendations were presented on handheld computers, clinicians made significantly safer prescribing decisions and adhered more closely to recommendations than peers using paper resources. Finally, healthcare professionals made significantly more appropriate diagnostic decisions using clinical decision making tools on handheld computers compared to colleagues who did not have access to these tools. For these clinical decisions, the numbers need to test/screen were all less than 11. Healthcare professionals' use of handheld computers may improve their information seeking, adherence to guidelines and clinical decision making. Handheld computers can provide real time access to and analysis of clinical information. The integration of clinical decision support systems within handheld computers offers clinicians the highest level of synthesised evidence at the point of care. Future research is needed to replicate these early results and to identify beneficial clinical outcomes.

Use of handheld computers in clinical practice: a systematic review

PubMed Central

2014-01-01

Background Many healthcare professionals use smartphones and tablets to inform patient care. Contemporary research suggests that handheld computers may support aspects of clinical diagnosis and management. This systematic review was designed to synthesise high quality evidence to answer the question; Does healthcare professionals’ use of handheld computers improve their access to information and support clinical decision making at the point of care? Methods A detailed search was conducted using Cochrane, MEDLINE, EMBASE, PsycINFO, Science and Social Science Citation Indices since 2001. Interventions promoting healthcare professionals seeking information or making clinical decisions using handheld computers were included. Classroom learning and the use of laptop computers were excluded. Two authors independently selected studies, assessed quality using the Cochrane Risk of Bias tool and extracted data. High levels of data heterogeneity negated statistical synthesis. Instead, evidence for effectiveness was summarised narratively, according to each study’s aim for assessing the impact of handheld computer use. Results We included seven randomised trials investigating medical or nursing staffs’ use of Personal Digital Assistants. Effectiveness was demonstrated across three distinct functions that emerged from the data: accessing information for clinical knowledge, adherence to guidelines and diagnostic decision making. When healthcare professionals used handheld computers to access clinical information, their knowledge improved significantly more than peers who used paper resources. When clinical guideline recommendations were presented on handheld computers, clinicians made significantly safer prescribing decisions and adhered more closely to recommendations than peers using paper resources. Finally, healthcare professionals made significantly more appropriate diagnostic decisions using clinical decision making tools on handheld computers compared to colleagues who did not have access to these tools. For these clinical decisions, the numbers need to test/screen were all less than 11. Conclusion Healthcare professionals’ use of handheld computers may improve their information seeking, adherence to guidelines and clinical decision making. Handheld computers can provide real time access to and analysis of clinical information. The integration of clinical decision support systems within handheld computers offers clinicians the highest level of synthesised evidence at the point of care. Future research is needed to replicate these early results and to identify beneficial clinical outcomes. PMID:24998515

Gender and care: access to HIV testing, care, and treatment.

PubMed

Remien, Robert H; Chowdhury, Jenifar; Mokhbat, Jacques E; Soliman, Cherif; Adawy, Maha El; El-Sadr, Wafaa

2009-07-01

HIV transmission and occurrence of AIDS in the Middle East and North Africa region (MENA) is increasing, while access to ART in the region lags behind most low to middle-income countries. Like in other parts of the world, there is a growing feminization of the epidemic, and men and women each confront unique barriers to adequate HIV prevention and treatment services, while sharing some common obstacles as well. This paper focuses on important gender dimensions of access to HIV testing, care and treatment in the MENA region, including issues related to stigma, religion and morality, gender power imbalances, work status, and migration. Culturally specific policy and programmatic recommendations for improving HIV prevention and treatment in the MENA region are offered.

[Publicly funded programs of psychotherapy in Australia and England].

PubMed

Vasiliadis, Helen-Maria; Dezetter, Anne

Quebec's HealthCommissioner on the performance of the health system clearly highlighted gaps in the collaboration between primary care physicians and mental health specialists, decreased accessibility and inequity in access to effective mental health services such as psychotherapy.Objectives The aim of this article was to describe the implementation of two publicly funded programs of psychotherapy in Australia and England with similar gatekeeper systems to the one in Quebec.Findings Following the Access to Allied Psychological Services (ATAPS) program introduced in Australia in 2003, one of the most important initiatives from the Council of Australian Governments' National Action Plan on Mental Health 2006-2011 was the Better Access Initiative which commenced in 2006. The plan included AUD1.2 billion in funding for integrating and improving the mental health care system. The purpose of Better Access was to improve the treatment and management of mental illnesses and increasing community access to mental health professionals and providing more affordable mental health care. GPs were encouraged to work more closely with mental health professionals. Under this program, these professionals are able to provide mental health services on a fee-for-service basis subsidized through Medicare. Access to psychological therapies is provided through private providers, rather than through fund holding arrangements. As of 2009 in Australia, 2 million people (1 in 11) had received over 11.2 million subsidized mental health services. A recent study showed clinical improvements in patients with depression associated with Better Access, concluding that the program is meeting previously unmet mental health needs.In the case of England, the IAPT - Improving Access to psychological Therapies-program enabled primary care trusts (PCTs) to implement evidence-based psychological therapies as recommended by National Institute for Health and Clinical Excellence for people suffering from depression and anxiety. In October 2007, the Secretary of State for Health announced additional funds totalling £173 million between 2008 and 2011 that would be used to deliver a major training program that would build a skilled workforce of qualified psychological therapists in 4 therapy areas for adults and children: cognitive behaviour therapy; psychodynamic psychoanalytic therapy; systemic and family therapy; humanistic therapy. The main goals of the program were to have: (i) 3,600 newly trained therapists with an appropriate skill mix and supervision arrangements; (ii) 900,000 more people treated; (iii) 50% of people who leave treatment are recovered; (iv) 25,000 fewer people on sick pay and benefits.Conclusion To date, the results in both countries have shown clinical improvements in symptoms associated with depression and anxiety for people entering the programs and at a population level, decreasing the unmet mental health needs of the population by allowing self-referrals to the program, and therefore rendering access to services to populations otherwise not reached.

Health Care Experiences and Perceived Barriers to Health Care Access: A Qualitative Study Among African Migrants in Guangzhou, Guangdong Province, China

PubMed Central

Brown, Katherine B.; Yu, Fan; Yang, Jingqi; Wang, Jason; Schrock, Joshua M.; Bodomo, Adams B.; Yang, Ligang; Yang, Bin; Nehl, Eric J.; Tucker, Joseph D.; Wong, Frank Y.

2014-01-01

Guangzhou, one of China's largest cities and a main trading port in South China, has attracted many African businessmen and traders migrating to the city for financial gains. Previous research has explored the cultural and economic roles of this newly emerging population; however, little is known about their health care experiences while in China. Semi-structured interviews and focus groups were used to assess health care experiences and perceived barriers to health care access among African migrants in Guangzhou, China. Overall, African migrants experienced various barriers to accessing health care and were dissatisfied with local health services. The principal barriers to care reported included affordability, legal issues, language barriers, and cultural differences. Facing multiple barriers, African migrants have limited access to care in Guangzhou. Local health settings are not accustomed to the African migrant population, suggesting that providing linguistically and culturally appropriate services may improve access to care for the migrants. PMID:25294415

Equity in access to fortified maize flour and corn meal

PubMed Central

Zamora, Gerardo; De-Regil, Luz Maria

2014-01-01

Mass fortification of maize flour and corn meal with a single or multiple micronutrients is a public health intervention that aims to improve vitamin and mineral intake, micronutrient nutritional status, health, and development of the general population. Micronutrient malnutrition is unevenly distributed among population groups and is importantly determined by social factors, such as living conditions, socioeconomic position, gender, cultural norms, health systems, and the socioeconomic and political context in which people access food. Efforts trying to make fortified foods accessible to the population groups that most need them require acknowledgment of the role of these determinants. Using a perspective of social determinants of health, this article presents a conceptual framework to approach equity in access to fortified maize flour and corn meal, and provides nonexhaustive examples that illustrate the different levels included in the framework. Key monitoring areas and issues to consider in order to expand and guarantee a more equitable access to maize flour and corn meal are described. PMID:24329609

Health Care Access Among Deaf People.

PubMed

Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes

2016-01-01

Access to health care without barriers is a clearly defined right of people with disabilities as stated by the UN Convention on the Rights of People with Disabilities. The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in global health knowledge for deaf people including those with even higher risk of marginalization. Examples of approaches to improve access to health care, such as providing powerful and visually accessible communication through the use of sign language, the implementation of important communication technologies, and cultural awareness trainings for health professionals are discussed. Programs that raise health knowledge in Deaf communities and models of primary health care centers for deaf people are also presented. Published documents can empower deaf people to realize their right to enjoy the highest attainable standard of health. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

How improved access to healthcare was successfully spread across Sweden.

PubMed

Strindhall, Margareta; Henriks, Göran

2007-01-01

Swedish healthcare has an internationally high standard, but is often criticized from a patient perspective owing to access problems to primary and specialist care. The waiting time to get in touch or get an appointment with a doctor, nurse, or physiotherapist is often too long. Access problems also create stress for employees when there are too few appointments to offer. In addition, too much time gets spent on the administration of long waiting lists, which adds no value to patients. Jönköping County Council was not satisfied with this situation and decided to make an attempt to improve access in the whole system. To describe how access was improved in Jönköping County council and how the concept was spread nationally. A conceptual model for improved access and reduced queues in Jönköping County called Bra Mottagning (BM) ("Good Clinic" in Swedish) was developed in 1999. It was built on logistic principles and collaborative learning. The program consisted of 4 learning sessions over a period of 8 to 9 months. The process of learning, team development, leadership, and spread of a change concept for improved access in Sweden has evolved through repeated improvement cycles, from small tests to larger pilots and finally to a standardized concept. Since 1999, 2 new BM collaboratives have been started every year. The first 11 teams from the county council of Jönköping, which participated in BM1 to BM3, reduced their median waiting time from 90 to 7 days in 8 months, an improvement of 93% (83 days). The results have been sustainable over the last 7 years. In the county council as a system, advanced access was achieved in 40% of the 179 units in 2006. Since the national spread started, 2200 employees in 316 professional teams from 16 county councils in Sweden have participated in BM collaboratives. Of these, 80% improved access for their patients and 32% reached advanced access in 8 months. The described development and spread of a concept for improved access in Sweden has been successful. A general impression is that the spread was more successful in the counties where the top management was strongly committed to the mission and the concept. Important factors for the national spread have been the establishment of a broader planning group as a network, the education of access coaches, the standardization of methods, and scientific assessments of the concept. Our experience is that both leaders and employees need to share a holistic view and systems thinking and also develop a deep interest in learning about strategies for access improvement.

76 FR 40322 - Mt. Hood Meadows Ski Resort Parking Improvements

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-08

... additional 4.5 acres would be cleared for access roads, cut/fill slopes, storm water swales, snow storage, and an equipment maintenance yard. In addition, the proposed action includes the construction of the new Sunrise Vehicle Maintenance Shop on the north side of the Sunrise parking lot. DATES: Comments...

Elitism and Meritocracy in UK Universities: The UK Needs Investment in Its Labour Force

ERIC Educational Resources Information Center

Simister, John

2011-01-01

This article summarises previous academic research into university education, distinguishing between arguments for and against improving access. Several views are summarised, including structural-functionalism, which claims that powerful social groups maintain their status and income, and human capital theory, which focuses on employee…

Genomic characterization of a core set of the USDA-NPGS Ethiopian sorghum germplasm collection

USDA-ARS?s Scientific Manuscript database

The USDA Agriculture Research Service National Plant Germplasm System (NPGS) preserves the largest sorghum germplasm collection in the world, which includes 7,217 accessions from the center of diversity in Ethiopia. The characterization of this exotic germplasm at a genome-wide scale will improve co...

The Federal Pell Grant Program: Recent Growth and Policy Options

ERIC Educational Resources Information Center

Congressional Budget Office, 2013

2013-01-01

The Federal Pell Grant Program was created to improve the access of low-income students to postsecondary education. Grant recipients enroll at a variety of educational institutions, including four-year colleges and universities, for-profit schools, two-year community colleges, and institutions that specialize in occupational training. Grants are…

Federal Public Library Programs in Alabama, 1999.

ERIC Educational Resources Information Center

Alabama Public Library Service, Montgomery.

The Alabama Public Library Service (APLS) is charged with improving library services throughout the state to ensure that all citizens have access to quality library and information services. Part of this charge includes the responsibility for receiving and administering federal funds to the more than 200 public libraries in Alabama. Federal…

What Is the Problem to Which the Answer was Public Law 83-280: How is it Working Out and What Should We Do Next?

DTIC Science & Technology

2013-09-01

Improvement Program to rehabilitate senior’s homes to acceptable standards including; roofing, handicap accessibility, and septic systems. The...buildings, highways, hospitals, waste management sites, shelters, reservoirs/water tanks , historical sites, emergency operations centers, casinos

Perceptions and Resilience in Underrepresented Students' Pathways to College

ERIC Educational Resources Information Center

Perez-Felkner, Lara

2015-01-01

Background/Context: Schools have attempted to address stratification in black and Latino students' access to higher education through extensive reform initiatives, including those focused on social supports. A crucial focus has been missing from these efforts, essential to improving the effectiveness of support mechanisms and understanding why…

75 FR 70677 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-18

... research and through the promotion of improvements in clinical and health system practices, including the... publicly accessible Web-based database of evidence-based clinical practice guidelines meeting explicit... encouraging the use of evidence to make informed health care decisions. The NGC is a vehicle for such...

Affirmative Action, Gender Equity and University Admissions--Kenya, Uganda and Tanzania

ERIC Educational Resources Information Center

Onsongo, Jane

2009-01-01

The article examines the outcomes of affirmative action policies aimed at improving access for women students to university education in Kenya, Uganda and Tanzania. Different interpretations of affirmative action are found in the three countries. These include lower entry scores, remedial pre-university programmes and financial assistance. There…

75 FR 21645 - Secretary's Advisory Committee on Heritable Disorders in Newborns and Children

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-26

... with pre- and post-natal care about newborn screening and the potential use of residual dried blood... further access after newborn screening tests are completed. Multidisciplinary input, including from... quality check) or process improvement (e.g., non-commercial, internal program new test development or...

Effectiveness of Breakfast in the Classroom in Five Exemplary Districts

ERIC Educational Resources Information Center

Rainville, Alice Jo; King, Amber D.; Nettles, Mary Frances

2013-01-01

Purpose/Objectives: A national trend to improve school breakfast participation is the integration of breakfast within the school day. Breakfast in the classroom programs increase student access to school breakfast. Service models include "grab and go," distribution of breakfasts to each classroom, and mobile breakfast carts in hallways.…

The Medical Literature as a Resource for Health Care Practice.

ERIC Educational Resources Information Center

McKibbon, K. Ann; And Others

1995-01-01

Discussion of evidence-based medicine (EBM) focuses on information tools to facilitate the practice of EBM that were developed, evaluated, and made more accessible by the McMaster University (Canada) Faculty of Health Sciences. Highlights include users' guides to medical literature, strategies for improving MEDLINE searches, new journals, and…

A New Improving Quantum Secret Sharing Scheme

NASA Astrophysics Data System (ADS)

Xu, Ting-Ting; Li, Zhi-Hui; Bai, Chen-Ming; Ma, Min

2017-04-01

An improving quantum secret sharing scheme (IQSS scheme) was introduced by Nascimento et al. (Phys. Rev. A 64, 042311 (2001)), which was analyzed by the improved quantum access structure. In this paper, we propose a new improving quantum secret sharing scheme, and more quantum access structures can be realized by this scheme than the previous one. For example, we prove that any threshold and hypercycle quantum access structures can be realized by the new scheme.

Healthy firms: constraints to growth among private health sector facilities in Ghana and Kenya.

PubMed

Burger, Nicholas E; Kopf, Daniel; Spreng, Connor P; Yoong, Joanne; Sood, Neeraj

2012-01-01

Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have the business processes in place for operating a successful business and health facility.

Healthy Firms: Constraints to Growth among Private Health Sector Facilities in Ghana and Kenya

PubMed Central

Burger, Nicholas E.; Kopf, Daniel; Spreng, Connor P.; Yoong, Joanne; Sood, Neeraj

2012-01-01

Background Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. Methodology/Principal Findings We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. Conclusions/Significance The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have the business processes in place for operating a successful business and health facility. PMID:22383944

A cluster-randomized trial assessing the impact of school water, sanitation, and hygiene improvements on pupil enrollment and gender parity in enrollment.

PubMed

Garn, Joshua V; Greene, Leslie E; Dreibelbis, Robert; Saboori, Shadi; Rheingans, Richard D; Freeman, Matthew C

2013-10-01

We employed a cluster randomized trial design to measure the impact of a school based water, sanitation, and hygiene (WASH) improvement on pupil enrollment and on gender parity in enrollment, in primary schools in Nyanza Province, Kenya (2007-2009). Among schools with poor water access during the dry season, those that received a water supply, hygiene promotion and water treatment (HP&WT) and sanitation improvement, demonstrated increased enrollment (β=0.091 [0.009, 0.173] p=0.03), which translates to 26 additional pupils per school on average. The proportion of girls enrolled in school also increased by 4% (prevalence ratio (PR)=1.04 [1.00, 1.07] p=0.02). Among schools with better baseline water access during the dry season (schools that didn't receive a water source), we found no evidence of increased enrollment in schools that received a HP&WT intervention (β=0.016 [-0.039, 0.072] p=0.56) or the HP&WT and sanitation intervention (β=0.027 [-0.028, 0.082]p=0.34), and there was no evidence of improved gender parity (PR=0.99 [0.96, 1.02] p=0.59, PR=1.00 [0.97, 1.02] p=0.75, respectively). Our findings suggest that increased school enrollment and improved gender parity may be influenced by a comprehensive WASH program that includes an improved water source; schools with poor water access during the dry season may benefit most from these interventions.

Country Immunization Information System Assessments - Kenya, 2015 and Ghana, 2016.

PubMed

Scott, Colleen; Clarke, Kristie E N; Grevendonk, Jan; Dolan, Samantha B; Ahmed, Hussein Osman; Kamau, Peter; Ademba, Peter Aswani; Osadebe, Lynda; Bonsu, George; Opare, Joseph; Diamenu, Stanley; Amenuvegbe, Gregory; Quaye, Pamela; Osei-Sarpong, Fred; Abotsi, Francis; Ankrah, Joseph Dwomor; MacNeil, Adam

2017-11-10

The collection, analysis, and use of data to measure and improve immunization program performance are priorities for the World Health Organization (WHO), global partners, and national immunization programs (NIPs). High quality data are essential for evidence-based decision-making to support successful NIPs. Consistent recording and reporting practices, optimal access to and use of health information systems, and rigorous interpretation and use of data for decision-making are characteristics of high-quality immunization information systems. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment methodology designed to identify root causes of immunization data quality problems and facilitate development of plans for improvement. Data quality challenges common to both countries included low confidence in facility-level target population data (Kenya = 50%, Ghana = 53%) and poor data concordance between child registers and facility tally sheets (Kenya = 0%, Ghana = 3%). In Kenya, systemic challenges included limited supportive supervision and lack of resources to access electronic reporting systems; in Ghana, challenges included a poorly defined subdistrict administrative level. Data quality improvement plans (DQIPs) based on assessment findings are being implemented in both countries. IISAs can help countries identify and address root causes of poor immunization data to provide a stronger evidence base for future investments in immunization programs.

Report: EPA Could Improve Physical Access and Service Continuity/Contingency Controls for Financial and Mixed-Financial Systems Located at its Research Triangle Park Campus

EPA Pesticide Factsheets

Report #2006-P-00005, December 14, 2005. Controls needed to be improved in areas such as visitor access to facilities, use of contractor access badges, and general physical access to the NCC, computer rooms outside the NCC, and media storage rooms.

Can NGOs regulate medicines markets? Social enterprise in wholesaling, and access to essential medicines.

PubMed

Mackintosh, Maureen; Chaudhuri, Sudip; Mujinja, Phares Gm

2011-02-28

Citizens of high income countries rely on highly regulated medicines markets. However low income countries' impoverished populations generally struggle for access to essential medicines through out-of-pocket purchase on poorly regulated markets; results include ill health, drug resistance and further impoverishment. While the role of health facilities owned by non-governmental organisations (NGOs) in low income countries is well documented, national and international wholesaling of essential medicines by NGOs is largely unstudied. This article describes and assesses the activity of NGOs and social enterprise in essential medicines wholesaling. The article is based on a set of interviews conducted in 2006-8 with trading NGOs and social enterprises operating in Europe, India and Tanzania. The analysis applies socio-legal and economic perspectives on social enterprise and market regulation. Trading NGOs can resist the perverse incentives inherent in medicines wholesaling and improve access to essential medicines; they can also, in definable circumstances, exercise a broader regulatory influence over their markets by influencing the behaviour of competitors. We explore reasons for success and failure of social enterprise in essential medicines wholesaling, including commercial manufacturers' market response; social enterprise traders' own market strategies; and patterns of market advantage, market segmentation and subsidy generated by donors. We conclude that, in the absence of effective governmental activity and regulation, social enterprise wholesaling can improve access to good quality essential medicines. This role should be valued and where appropriate supported in international health policy design. NGO regulatory impact can complement but should not replace state action.

Can NGOs regulate medicines markets? Social enterprise in wholesaling, and access to essential medicines

PubMed Central

2011-01-01

Background Citizens of high income countries rely on highly regulated medicines markets. However low income countries' impoverished populations generally struggle for access to essential medicines through out-of-pocket purchase on poorly regulated markets; results include ill health, drug resistance and further impoverishment. While the role of health facilities owned by non-governmental organisations (NGOs) in low income countries is well documented, national and international wholesaling of essential medicines by NGOs is largely unstudied. This article describes and assesses the activity of NGOs and social enterprise in essential medicines wholesaling. Methods The article is based on a set of interviews conducted in 2006-8 with trading NGOs and social enterprises operating in Europe, India and Tanzania. The analysis applies socio-legal and economic perspectives on social enterprise and market regulation. Results Trading NGOs can resist the perverse incentives inherent in medicines wholesaling and improve access to essential medicines; they can also, in definable circumstances, exercise a broader regulatory influence over their markets by influencing the behaviour of competitors. We explore reasons for success and failure of social enterprise in essential medicines wholesaling, including commercial manufacturers' market response; social enterprise traders' own market strategies; and patterns of market advantage, market segmentation and subsidy generated by donors. Conclusions We conclude that, in the absence of effective governmental activity and regulation, social enterprise wholesaling can improve access to good quality essential medicines. This role should be valued and where appropriate supported in international health policy design. NGO regulatory impact can complement but should not replace state action. PMID:21356076

Partnering with community institutions to increase access to healthful foods across municipalities.

PubMed

Jaskiewicz, Lara; Dombrowski, Rachael D; Drummond, Heather M; Barnett, Gina Massuda; Mason, Maryann; Welter, Christina

2013-10-03

Low-income and minority communities have higher rates of nutrition-related chronic diseases than do high-income and nonminority communities and often have reduced availability to healthful foods. Corner store initiatives have been proposed as a strategy to improve access to healthful foods in these communities, yet few studies evaluating these initiatives have been published. Suburban Cook County, Illinois, encompasses 125 municipalities with a population of more than 2 million. From 2000 through 2009, the percentage of low-income suburban Cook County residents increased 41%; African-American populations increased 20%, and Hispanic populations increased 44%. A 2012 report found that access to stores selling healthful foods was low in several areas of the county. Beginning in March 2011, the Cook County Department of Public Health recruited community institutions (ie, local governments, nonprofit organizations, faith-based institutions) who recruited corner stores to participate in the initiative. Corner stores were asked to add new, healthful foods (May-June 2011) to become eligible to receive new equipment, marketing materials, and enhanced community outreach (July 2011-February 2012). Nine community institutions participated. Of the 53 corner stores approached, 25 (47%) participated in the trial phase, which included offering 6 healthful foods in their stores. Of those, 21 (84%) completed the conversion phase, which included expansion of healthful foods through additional equipment and marketing and promotional activities. Community institutions can play a key role in identifying and engaging corner stores across jurisdictions that are willing and able to implement a retail environment initiative to improve access to healthful foods in their communities.

A New UK 2006 National Kidney Allocation Scheme for deceased heart-beating donor kidneys.

PubMed

Johnson, Rachel J; Fuggle, Susan V; Mumford, Lisa; Bradley, J Andrew; Forsythe, John L R; Rudge, Chris J

2010-02-27

In 2004, it was agreed that a new allocation scheme for kidneys from deceased heart-beating donors was required in the United Kingdom to address observed inequities in access to transplant. The 2006 National Kidney Allocation Scheme (2006 NKAS) was developed to meet agreed objectives and preparatory work included a review of the criteria for human leukocyte antigen (HLA) matching and simulation evidence about the effectiveness of alternative schemes. ALGORITHM FOR 2006 NKAS: The 2006 NKAS gives absolute priority to all 000 HLA-A, -B, -DR-mismatched patients and well-matched pediatric patients (<18 years), and then a points score defines priorities for allocation with waiting time being most influential. Points for age and HLA mismatch are linked in a novel approach to ensure well-matched transplants for younger patients while recognizing that HLA matching is less important for older patients as retransplantation is less likely to be required. To improve equity for difficult to match patients, rare HLA specificities were defaulted to more common, related specificities. IMPACT OF 2006 NKAS: After 3 years, the scheme is already making good progress in achieving its objectives, with overall results similar to those observed in the simulations. There has been a significant benefit for patients waiting more than 5 years for transplant. A number of other advantages of the scheme are also apparent with equity of access improving in many respects, including the achievement of equity of access to transplant for HLA-DR homozygous patients, but geographical inequity of access will take a number of years to address fully.

Perceived impact and feasibility of strategies to improve access to healthy foods in Washington State, USA.

PubMed

Johnson, Donna B; Quinn, Emilee L; Podrabsky, Mary; Beckwith-Stanley, Nadia; Chan, Nadine; Ellings, Amy; Kovacs, Tricia; Lane, Claire

2013-12-01

The present study measured the perceived impact and political and implementation feasibility of state-level policy strategies related to increasing access to healthy foods and limiting unhealthy foods. Potential state-level policy strategies to improve access to healthy foods were identified through a review of evidence-based literature and policy recommendations. Respondents rated the perceived impact and political and implementation feasibility of each policy on a five-point scale using online surveys. Washington State policy process. Forty-nine content experts (national researchers and subject experts), forty policy experts (state elected officials or their staff, gubernatorial or legislative policy analysts) and forty-five other stakeholders (state-level advocates, programme administrators, food producers). In aggregate, respondents rated policy impact and implementation feasibility higher than political feasibility. Policy experts rated policy strategies as less politically feasible compared with content experts (P < 0·02) or other stakeholders (P < 0·001). Eight policy strategies were rated above the median for impact and political and implementation feasibility. These included policies related to nutrition standards in schools and child-care facilities, food distribution systems, urban planning projects, water availability, joint use agreements and breast-feeding supports. Although they may be perceived as potentially impactful, some policies will be more difficult to enact than others. Information about the potential feasibility of policies to improve access to healthy foods can be used to focus limited policy process resources on strategies with the highest potential for enactment, implementation and impact.

Disaster easily averted? Data confidentiality and the hospital desktop computer.

PubMed

Sethi, Neeraj; Lane, Gethin; Newton, Sophie; Egan, Philip; Ghosh, Samit

2014-05-01

We specifically identified the hospital desktop computer as a potential source of breaches in confidentiality. We aimed to evaluate if there was accessible, unprotected, confidential information stored on the desktop screen on computers in a district general hospital and if so, how a teaching intervention could improve this situation. An unannounced spot check of 59 ward computers was performed. Data were collected regarding how many had confidential information stored on the desktop screen without any password protection. An online learning module was mandated for healthcare staff and a second cycle of inspection performed. A district general hospital. Two doctors conducted the audit. Computers in clinical areas were assessed. All clinical staff with computer access underwent the online learning module. An online learning module regarding data protection and confidentiality. In the first cycle, 55% of ward computers had easily accessible patient or staff confidential information stored on their desktop screen. This included handovers, referral letters, staff sick leave lists, audits and nursing reports. The majority (85%) of computers accessed were logged in under a generic username and password. The intervention produced an improvement in the second cycle findings with only 26% of computers being found to have unprotected confidential information stored on them. The failure to comply with appropriate confidential data protection regulations is a persistent problem. Education produces some improvement but we also propose a systemic approach to solving this problem. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Racial Disparities In Geographic Access To Primary Care In Philadelphia.

PubMed

Brown, Elizabeth J; Polsky, Daniel; Barbu, Corentin M; Seymour, Jane W; Grande, David

2016-08-01

Primary care is often thought of as the gateway to improved health outcomes and can lead to more efficient use of health care resources. Because of primary care's cardinal importance, adequate access is an important health policy priority. In densely populated urban areas, spatial access to primary care providers across neighborhoods is poorly understood. We examined spatial variation in primary care access in Philadelphia, Pennsylvania. We calculated ratios of adults per primary care provider for each census tract and included buffer zones based on prespecified drive times around each tract. We found that the average ratio was 1,073; the supply of primary care providers varied widely across census tracts, ranging from 105 to 10,321. We identified six areas of Philadelphia that have much lower spatial accessibility to primary care relative to the rest of the city. After adjustment for sociodemographic and insurance characteristics, the odds of being in a low-access area were twenty-eight times greater for census tracts with a high proportion of African Americans than in tracts with a low proportion of African Americans. Project HOPE—The People-to-People Health Foundation, Inc.

The ASCENT (Allocation System Changes for Equity in Kidney Transplantation) Study: a Randomized Effectiveness-Implementation Study to Improve Kidney Transplant Waitlisting and Reduce Racial Disparity.

PubMed

Patzer, Rachel E; Smith, Kayla; Basu, Mohua; Gander, Jennifer; Mohan, Sumit; Escoffery, Cam; Plantinga, Laura; Melanson, Taylor; Kalloo, Sean; Green, Gary; Berlin, Alex; Renville, Gary; Browne, Teri; Turgeon, Nicole; Caponi, Susan; Zhang, Rebecca; Pastan, Stephen

2017-05-01

The United Network for Organ Sharing (UNOS) implemented a new Kidney Allocation System (KAS) in December 2014 that is expected to substantially reduce racial disparities in kidney transplantation among waitlisted patients. However, not all dialysis facility clinical providers and end stage renal disease (ESRD) patients are aware of how the policy change could improve access to transplant. We describe the ASCENT (Allocation System Changes for Equity in KidNey Transplantation) study, a randomized controlled effectiveness-implementation study designed to test the effectiveness of a multicomponent intervention to improve access to the early steps of kidney transplantation among dialysis facilities across the United States. The multicomponent intervention consists of an educational webinar for dialysis medical directors, an educational video for patients and an educational video for dialysis staff, and a dialysis-facility specific transplant performance feedback report. Materials will be developed by a multidisciplinary dissemination advisory board and will undergo formative testing in dialysis facilities across the United States. This study is estimated to enroll ~600 U.S. dialysis facilities with low waitlisting in all 18 ESRD Networks. The co-primary outcomes include change in waitlisting, and waitlist disparity at 1 year; secondary outcomes include changes in facility medical director knowledge about KAS, staff training regarding KAS, patient education regarding transplant, and a medical director's intent to refer patients for transplant evaluation. The results from the ASCENT study will demonstrate the feasibility and effectiveness of a multicomponent intervention designed to increase access to the deceased-donor kidney waitlist and reduce racial disparities in waitlisting.

Bringing the CMS distributed computing system into scalable operations

NASA Astrophysics Data System (ADS)

Belforte, S.; Fanfani, A.; Fisk, I.; Flix, J.; Hernández, J. M.; Kress, T.; Letts, J.; Magini, N.; Miccio, V.; Sciabà, A.

2010-04-01

Establishing efficient and scalable operations of the CMS distributed computing system critically relies on the proper integration, commissioning and scale testing of the data and workload management tools, the various computing workflows and the underlying computing infrastructure, located at more than 50 computing centres worldwide and interconnected by the Worldwide LHC Computing Grid. Computing challenges periodically undertaken by CMS in the past years with increasing scale and complexity have revealed the need for a sustained effort on computing integration and commissioning activities. The Processing and Data Access (PADA) Task Force was established at the beginning of 2008 within the CMS Computing Program with the mandate of validating the infrastructure for organized processing and user analysis including the sites and the workload and data management tools, validating the distributed production system by performing functionality, reliability and scale tests, helping sites to commission, configure and optimize the networking and storage through scale testing data transfers and data processing, and improving the efficiency of accessing data across the CMS computing system from global transfers to local access. This contribution reports on the tools and procedures developed by CMS for computing commissioning and scale testing as well as the improvements accomplished towards efficient, reliable and scalable computing operations. The activities include the development and operation of load generators for job submission and data transfers with the aim of stressing the experiment and Grid data management and workload management systems, site commissioning procedures and tools to monitor and improve site availability and reliability, as well as activities targeted to the commissioning of the distributed production, user analysis and monitoring systems.

Productivity and quality improvements in health care through airboss mobile messaging services.

PubMed

Shah, P J; Martinez, R; Cooney, E

1997-01-01

The US health care industry is in the midst of revolutionary changes. Under tremendous pressures from third-party payers and managed care programs to control costs while providing high quality medical services, health care entities are now looking at information technologies to help them achieve their goals. These goals typically include improved productivity, efficiency and decision-making capabilities among staff members. Moreover, hospitals and other health care facilities that provide a broad and integrated range of inpatient and outpatient care, wellness and home care services are in the best position to offer comprehensive packages to managed care and private insurers. Many health care providers and administrators are considered mobile employees. This mobility can range from intra-building and intra-campus to multi-site and metropolitan areas. This group often relies on a variety of information technologies such as personal computers, communicating laptops, pagers, cellular phones, wireline phones, cordless phones and fax machines to stay in touch and handle information needs. These health care professionals require mobile information access and messaging tools to improve communications, control accessibility and enhance decision-making capabilities. AirBoss mobile messaging services could address the health care industry's need for improved messaging capabilities for its mobile employees. The AirBoss family of services supports integrated voice services, data messaging, mobile facsimile and customized information delivery. This paper describes overview of the current mobile data networking capability, the AirBoss architecture, the health care-related applications it addresses and long-term benefits. In addition, a prototype application for mobile home health care workers is illustrated. This prototype application provides integrated e-mail, information services, web access, real-time access and update of patient records from wireline or wireless networks, and cross media delivery and notification. It provides seamless wide area access to patient data in a secure environment, thus providing a continuity of care from the hospital to home.

Exposing the Strategies that can Reduce the Obstacles: Improving the Science User Experience

NASA Astrophysics Data System (ADS)

Lindsay, F. E.; Brennan, J.; Behnke, J.; Lynnes, C.

2017-12-01

It is now well established that pursuing generic solutions to what seem are common problems in Earth science data access and use can often lead to disappointing results for both system developers and the intended users. This presentation focuses on real-world experience of managing a large and complex data system, NASA's Earth Science Data and Information Science System (EOSDIS), whose mission is to serve both broad user communities and those in smaller niche applications of Earth science data and services. In the talk, we focus on our experiences with known data user obstacles characterizing EOSDIS approaches, including various technological techniques, for engaging and bolstering, where possible, user experiences with EOSDIS. For improving how existing and prospective users discover and access NASA data from EOSDIS we introduce our cross-archive tool: Earthdata Search. This new search and order tool further empowers users to quickly access data sets using clever and intuitive features. The Worldview data visualization tool is also discussed highlighting how many users are now performing extensive data exploration without necessarily downloading data. Also, we explore our EOSDIS data discovery and access webinars, data recipes and short tutorials, targeted technical and data publications, user profiles and and social media as additional tools and methods used for improving our outreach and communications to a diverse user community. These efforts have paid substantial dividends for our user communities by allowing us to target discipline specific community needs. The desired take-away from this presentation will be an improved understanding of how EOSDIS has approached, and in several instances achieved, removing or lowering the barriers to data access and use. As we look ahead to more complex Earth science missions, EOSDIS will continue to focus on our user communities, both broad and specialized, so that our overall data system can continue to serve the needs of science and applications users.

Exposing the Strategies that Can Reduce the Obstacles: Improving the Science User Experience

NASA Technical Reports Server (NTRS)

Lindsay, Francis E.; Brennan, Jennifer; Behnke, Jeanne; Lynnes, Chris

2017-01-01

It is now well established that pursuing generic solutions to what seem are common problems in Earth science data access and use can often lead to disappointing results for both system developers and the intended users. This presentation focuses on real-world experience of managing a large and complex data system, NASAs Earth Science Data and Information Science System (EOSDIS), whose mission is to serve both broad user communities and those in smaller niche applications of Earth science data and services. In the talk, we focus on our experiences with known data user obstacles characterizing EOSDIS approaches, including various technological techniques, for engaging and bolstering, where possible, user experiences with EOSDIS. For improving how existing and prospective users discover and access NASA data from EOSDIS we introduce our cross-archive tool: Earthdata Search. This new search and order tool further empowers users to quickly access data sets using clever and intuitive features. The Worldview data visualization tool is also discussed highlighting how many users are now performing extensive data exploration without necessarily downloading data. Also, we explore our EOSDIS data discovery and access webinars, data recipes and short tutorials, targeted technical and data publications, user profiles and social media as additional tools and methods used for improving our outreach and communications to a diverse user community. These efforts have paid substantial dividends for our user communities by allowing us to target discipline specific community needs. The desired take-away from this presentation will be an improved understanding of how EOSDIS has approached, and in several instances achieved, removing or lowering the barriers to data access and use. As we look ahead to more complex Earth science missions, EOSDIS will continue to focus on our user communities, both broad and specialized, so that our overall data system can continue to serve the needs of science and applications users.

AVE-SESAME program for the REEDA System

NASA Technical Reports Server (NTRS)

Hickey, J. S.

1981-01-01

The REEDA system software was modified and improved to process the AVE-SESAME severe storm data. A random access file system for the AVE storm data was designed, tested, and implemented. The AVE/SESAME software was modified to incorporate the random access file input and to interface with new graphics hardware/software now available on the REEDA system. Software was developed to graphically display the AVE/SESAME data in the convention normally used by severe storm researchers. Software was converted to AVE/SESAME software systems and interfaced with existing graphics hardware/software available on the REEDA System. Software documentation was provided for existing AVE/SESAME programs underlining functional flow charts and interacting questions. All AVE/SESAME data sets in random access format was processed to allow developed software to access the entire AVE/SESAME data base. The existing software was modified to allow for processing of different AVE/SESAME data set types including satellite surface and radar data.

Vascular access in critical limb ischemia.

PubMed

Kang, Won Yu; Campia, Umberto; Ota, Hideaki; Didier, Romain J; Negi, Smita I; Kiramijyan, Sarkis; Koifman, Edward; Baker, Nevin C; Magalhaes, Marco A; Lipinski, Michael J; Escarcega, Ricardo O; Torguson, Rebecca; Waksman, Ron; Bernardo, Nelson L

2016-01-01

Currently, percutaneous endovascular intervention is considered a first line of therapy for treating patients with critical limb ischemia. As the result of remarkable development of techniques and technologies, percutaneous endovascular intervention has led to rates of limb salvage comparable to those achieved with bypass surgery, with fewer complications, even in the presence of lower rates of long-term patency. Currently, interventionalists have a multiplicity of access routes including smaller arteries, with both antegrade and retrograde approaches. Therefore, the choice of the optimal access site has become an integral part of the success of the percutaneous intervention. By understanding the technical aspects, as well as the advantages and limitations of each approach, the interventionalists can improve clinical outcomes in patients with severe peripheral arterial disease. This article reviews the access routes in critical limb ischemia, their advantages and disadvantages, and the clinical outcomes of each. Copyright © 2016 Elsevier Inc. All rights reserved.

Geobrowser Enhanced Access of Real-Time Antarctic Data

NASA Astrophysics Data System (ADS)

Breen, P.; Judge, D.; Cunningham, N.; Kirsch, P. J.

2007-12-01

A proof of principle project was initiated in the Fall of 2006 to develop a system enabling remote field station and ship borne data, collected in near real-time to be discovered, visualised and acquired through a web accessible framework. The two principal enabling drivers for this system were the recent improvements in communications with remote field stations and ships and the advent of low cost, easily accessible geobrowser technology providing the ability to visualise multiple, sometimes physically disparate datasets within a common interface. Strongly spatial in nature the oceanographic datasets suggested the incorporation of geobrowser (Google Earth) technology into this framework. A number of scientific benefits were identified by the project, these include the overall enhancing of the value of many of the datasets through their real-time contribution to forecasting models, satellite ground truthing and calibration of autonomous instrumentation. Improved efficacy of fieldwork led to rapid discovery of problems and the ability to deal with them promptly. The ability to correct or improve experiment parameters and increase capability of routine collection of high-quality data. In the past it may have been over a year before data arrived back at HQ potentially unusable, definitely unrepeatable and significantly reducing or delaying scientific output. The geobrowser interface provides the platform from which the spatial data is discovered, for example ship tracks and aspects of the physical oceanography such as sea surface temperature can be directly visualized. Importantly, ancillary and auxiliary information and metadata can be linked to the cruise data in a straightforward and accessible manner; scientists in Cambridge using a geobrowser were able to access and visualize cruise data from the Southern ocean 20 minutes after collection.

Improving access to mental health care in an Orthodox Jewish community: a critical reflection upon the accommodation of otherness.

PubMed

McEvoy, Phil; Williamson, Tracey; Kada, Raphael; Frazer, Debra; Dhliwayo, Chardworth; Gask, Linda

2017-08-14

The English National Health Service (NHS) has significantly extended the supply of evidence based psychological interventions in primary care for people experiencing common mental health problems. Yet despite the extra resources, the accessibility of services for 'under-served' ethnic and religious minority groups, is considerably short of the levels of access that may be necessary to offset the health inequalities created by their different exposure to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought to improve access to an NHS funded primary care mental health service to one 'under-served' population, an Orthodox Jewish community in the North West of England. A combination of qualitative and quantitative data were drawn upon including naturally occurring data, observational notes, e-mail correspondence, routinely collected demographic data and clinical outcomes measures, as well as written feedback and recorded discussions with 12 key informants. Improvements in access to mental health care for some people from the Orthodox Jewish community were achieved through the collaborative efforts of a distributed leadership team. The members of this leadership team were a self-selecting group of stakeholders which had a combination of local knowledge, cultural understanding, power to negotiate on behalf of their respective constituencies and expertise in mental health care. Through a process of dialogic engagement the team was able to work with the community to develop a bespoke service that accommodated its wish to maintain a distinct sense of cultural otherness. This critical reflection illustrates how dialogic engagement can further the mechanisms of candidacy, concordance and recursivity that are associated with improvements in access to care in under-served sections of the population, whilst simultaneously recognising the limits of constructive dialogue. Dialogue can change the dynamic of community engagement. However, the full alignment of the goals of differing constituencies may not always be possible, due the complex interaction between the multiple positions and understandings of stakeholders that are involved and the need to respect the other'-s' autonomy.