Integrated musculoskeletal service design by GP consortia

PubMed Central

2011-01-01

Background Musculoskeletal conditions are common in primary care and are associated with significant co-morbidity and impairment of quality of life. Traditional care pathways combined community-based physiotherapy with GP referral to hospital for a consultant opinion. Locally, this model led to only 30% of hospital consultant orthopaedic referrals being listed for surgery, with the majority being referred for physiotherapy. The NHS musculoskeletal framework proposed the use of interface services to provide expertise in diagnosis, triage and management of musculoskeletal problems not requiring surgery. The White Paper Equity and Excellence: Liberating the NHS has replaced PCT commissioning with GP consortia, who will lead future service development. Setting Primary and community care, integrated with secondary care, in the NHS in England. Question How can GP consortia lead the development of integrated musculoskeletal services? Review: The Ealing experience We explore here how Ealing implemented a ‘See and Treat’ interface clinic model to improve surgical conversion rates, reduce unnecessary hospital referrals and provide community treatment more efficiently than a triage model. A high-profile GP education programme enabled GPs to triage in their practices and manage patients without referral. Conclusion In Ealing, we demonstrated that most patients with musculoskeletal conditions can be managed in primary care and community settings. The integrated musculoskeletal service provides clear and fast routes to secondary care. This is both clinically effective and cost-effective, reserving hospital referral for patients most likely to need surgery. GP consortia, in conjunction with strong clinical leadership, inbuilt organisational and professional learning, and a GP champion, are well placed to deliver service redesign by co-ordinating primary care development, local commissioning of community services and the acute commissioning vehicles responsible for secondary

Integration of Family Planning Services into HIV Care and Treatment Services: A Systematic Review.

PubMed

Haberlen, Sabina A; Narasimhan, Manjulaa; Beres, Laura K; Kennedy, Caitlin E

2017-06-01

Evidence on the feasibility, effectiveness, and cost-effectiveness of integrating family planning (FP) and HIV services has grown significantly since the 2004 Glion Call to Action. This systematic review adds to the knowledge base by characterizing the range of models used to integrate FP into HIV care and treatment, and synthesizing the evidence on integration outcomes among women living with HIV. Fourteen studies met our inclusion criteria, eight of which were published after the last systematic review on the topic in 2013. Overall, integration was associated with higher modern method contraceptive prevalence and knowledge, although there was insufficient evidence to evaluate its effects on unintended pregnancy or achieving safe and healthy pregnancy. Evidence for change in unmet need for FP was limited, although two of the three evaluations that measured unmet need suggested possible improvements associated with integrated services. However, improving access to FP services through integration was not always sufficient to increase the use of more effective (noncondom) modern methods among women who wanted to prevent pregnancy. Integration efforts, particularly in contexts where contraceptive use is low, must address community-wide and HIV-specific barriers to using effective FP methods alongside improving access to information, commodities, and services within routine HIV care. © 2017 The Population Council, Inc.

Innovation in Evaluating the Impact of Integrated Service-Delivery: The Integra Indexes of HIV and Reproductive Health Integration.

PubMed

Mayhew, Susannah H; Ploubidis, George B; Sloggett, Andy; Church, Kathryn; Obure, Carol D; Birdthistle, Isolde; Sweeney, Sedona; Warren, Charlotte E; Watts, Charlotte; Vassall, Anna

2016-01-01

The body of knowledge on evaluating complex interventions for integrated healthcare lacks both common definitions of 'integrated service delivery' and standard measures of impact. Using multiple data sources in combination with statistical modelling the aim of this study is to develop a measure of HIV-reproductive health (HIV-RH) service integration that can be used to assess the degree of service integration, and the degree to which integration may have health benefits to clients, or reduce service costs. Data were drawn from the Integra Initiative's client flow (8,263 clients in Swaziland and 25,539 in Kenya) and costing tools implemented between 2008-2012 in 40 clinics providing RH services in Kenya and Swaziland. We used latent variable measurement models to derive dimensions of HIV-RH integration using these data, which quantified the extent and type of integration between HIV and RH services in Kenya and Swaziland. The modelling produced two clear and uncorrelated dimensions of integration at facility level leading to the development of two sub-indexes: a Structural Integration Index (integrated physical and human resource infrastructure) and a Functional Integration Index (integrated delivery of services to clients). The findings highlight the importance of multi-dimensional assessments of integration, suggesting that structural integration is not sufficient to achieve the integrated delivery of care to clients--i.e. "functional integration". These Indexes are an important methodological contribution for evaluating complex multi-service interventions. They help address the need to broaden traditional evaluations of integrated HIV-RH care through the incorporation of a functional integration measure, to avoid misleading conclusions on its 'impact' on health outcomes. This is particularly important for decision-makers seeking to promote integration in resource constrained environments.

Upstairs downstairs: vertical integration of a pediatric service.

PubMed

Racine, A D; Stein, R E; Belamarich, P F; Levine, E; Okun, A; Porder, K; Rosenfeld, J L; Schechter, M

1998-07-01

The combined effects of recent changes in health care financing and training priorities have compelled academic medical centers to develop innovative structures to maintain service commitments yet conform to health care marketplace demands. In 1992, a municipal hospital in the Bronx, New York, affiliated with a major academic medical center reorganized its pediatric service into a vertically integrated system of four interdependent practice teams that provided comprehensive care in the ambulatory as well as inpatient settings. One of the goals of the new system was to conserve inpatient resources. To describe the development of a new vertically integrated pediatric service at an inner-city municipal hospital and to test whether its adoption was associated with the use of fewer inpatient resources. A descriptive analysis of the rationale, goals, implementation strategies, and structure of the vertically integrated pediatric service combined with a before-and-after comparison of in-hospital resource consumption. A before-and-after comparison was conducted for two periods: the period before vertical integration, from January 1989 to December 1991, and the period after the adoption of vertical integration, from July 1992 to December 1994. Four measures of inpatient resource use were compared after adjustment for case mix index: mean certified length of stay per case, mean number of radiologic tests per case, mean number of ancillary tests per case, and mean number of laboratory tests per case. Difference-in-differences-in-differences estimators were used to control for institution-wide trends throughout the time period and regional trends in inpatient pediatric practice occurring across institutions. Results. In 1992, the Department of Pediatrics at the Albert Einstein College of Medicine reorganized the pediatric service at Jacobi Medical Center, one of its principal municipal hospital affiliates, into a vertically integrated pediatric service that combines ambulatory

Innovation in Evaluating the Impact of Integrated Service-Delivery: The Integra Indexes of HIV and Reproductive Health Integration

PubMed Central

Mayhew, Susannah H.; Ploubidis, George B.; Sloggett, Andy; Church, Kathryn; Obure, Carol D.; Birdthistle, Isolde; Sweeney, Sedona; Warren, Charlotte E.; Watts, Charlotte; Vassall, Anna

2016-01-01

Background The body of knowledge on evaluating complex interventions for integrated healthcare lacks both common definitions of ‘integrated service delivery’ and standard measures of impact. Using multiple data sources in combination with statistical modelling the aim of this study is to develop a measure of HIV-reproductive health (HIV-RH) service integration that can be used to assess the degree of service integration, and the degree to which integration may have health benefits to clients, or reduce service costs. Methods and Findings Data were drawn from the Integra Initiative’s client flow (8,263 clients in Swaziland and 25,539 in Kenya) and costing tools implemented between 2008–2012 in 40 clinics providing RH services in Kenya and Swaziland. We used latent variable measurement models to derive dimensions of HIV-RH integration using these data, which quantified the extent and type of integration between HIV and RH services in Kenya and Swaziland. The modelling produced two clear and uncorrelated dimensions of integration at facility level leading to the development of two sub-indexes: a Structural Integration Index (integrated physical and human resource infrastructure) and a Functional Integration Index (integrated delivery of services to clients). The findings highlight the importance of multi-dimensional assessments of integration, suggesting that structural integration is not sufficient to achieve the integrated delivery of care to clients—i.e. “functional integration”. Conclusions These Indexes are an important methodological contribution for evaluating complex multi-service interventions. They help address the need to broaden traditional evaluations of integrated HIV-RH care through the incorporation of a functional integration measure, to avoid misleading conclusions on its ‘impact’ on health outcomes. This is particularly important for decision-makers seeking to promote integration in resource constrained environments. PMID:26800517

jORCA: easily integrating bioinformatics Web Services.

PubMed

Martín-Requena, Victoria; Ríos, Javier; García, Maximiliano; Ramírez, Sergio; Trelles, Oswaldo

2010-02-15

Web services technology is becoming the option of choice to deploy bioinformatics tools that are universally available. One of the major strengths of this approach is that it supports machine-to-machine interoperability over a network. However, a weakness of this approach is that various Web Services differ in their definition and invocation protocols, as well as their communication and data formats-and this presents a barrier to service interoperability. jORCA is a desktop client aimed at facilitating seamless integration of Web Services. It does so by making a uniform representation of the different web resources, supporting scalable service discovery, and automatic composition of workflows. Usability is at the top of the jORCA agenda; thus it is a highly customizable and extensible application that accommodates a broad range of user skills featuring double-click invocation of services in conjunction with advanced execution-control, on the fly data standardization, extensibility of viewer plug-ins, drag-and-drop editing capabilities, plus a file-based browsing style and organization of favourite tools. The integration of bioinformatics Web Services is made easier to support a wider range of users. .

A service-based framework for pharmacogenomics data integration

NASA Astrophysics Data System (ADS)

Wang, Kun; Bai, Xiaoying; Li, Jing; Ding, Cong

2010-08-01

Data are central to scientific research and practices. The advance of experiment methods and information retrieval technologies leads to explosive growth of scientific data and databases. However, due to the heterogeneous problems in data formats, structures and semantics, it is hard to integrate the diversified data that grow explosively and analyse them comprehensively. As more and more public databases are accessible through standard protocols like programmable interfaces and Web portals, Web-based data integration becomes a major trend to manage and synthesise data that are stored in distributed locations. Mashup, a Web 2.0 technique, presents a new way to compose content and software from multiple resources. The paper proposes a layered framework for integrating pharmacogenomics data in a service-oriented approach using the mashup technology. The framework separates the integration concerns from three perspectives including data, process and Web-based user interface. Each layer encapsulates the heterogeneous issues of one aspect. To facilitate the mapping and convergence of data, the ontology mechanism is introduced to provide consistent conceptual models across different databases and experiment platforms. To support user-interactive and iterative service orchestration, a context model is defined to capture information of users, tasks and services, which can be used for service selection and recommendation during a dynamic service composition process. A prototype system is implemented and cases studies are presented to illustrate the promising capabilities of the proposed approach.

Integrating emergency services in an urban health system.

PubMed

Radloff, D; Blouin, A S; Larsen, L; Kripp, M E

2000-03-01

When planning for growth and management efficiency across urban health systems, economic and market factors present significant service line challenges and opportunities. This article describes the evolutionary integration of emergency services in St John Health System, a large, religious-sponsored health care system located in Detroit, Michigan. Critical business elements, including the System's vision, mission, and economic context, are defined as the framework for site-specific and System-wide planning. The impact of managed care and market changes prompted St John's clinicians and executives to explore how integrating emergency services could create a competitive market advantage.

Case Management and the Integration of Services: How Service Delivery Systems Shape Case Management.

ERIC Educational Resources Information Center

Moore, Stephen

1992-01-01

Notes that primary role that case management plays in coordination of services is determined by level of service integration and by level of resources in service delivery system. Describes conditions under which case management serves as mechanism for rationing services, marketing function, brokering function, or development role. Discusses…

Career Education for Mental Health Workers. Integrative Seminar in Human Service. Human Service Instructional Series. Module No. 5.

ERIC Educational Resources Information Center

Redcay, Shirley

This module on an integrative seminar in human service is one of a set of six developed to prepare human services workers for the changing mental health service delivery system. A total of eight objectives are included to help students integrate previously learned knowledge and skills into a process of assessing service need, developing treatment…

Supporting Theory Building in Integrated Services Research

ERIC Educational Resources Information Center

Robinson, Mark; Atkinson, Mary; Downing, Dick

2008-01-01

This literature review was commissioned by the National Foundation for Educational Research (NFER) to draw together current and recent studies of integrated working, in order to build an overview of the theories and models of such working. The review is important for current work on evaluating the early impact of integrated children's services and…

Collaborative Inquiry: Building Pre-Service Teachers' Capacity for ICT Pedagogical Integration

ERIC Educational Resources Information Center

Henderson, Michael; Cerovac, Milorad; Bellis, Natalie; Lancaster, Greg

2013-01-01

As part of the Teaching Teachers for the Future (TTF) project, Monash University initiated several strategies to assist pre-service teachers' integration of ICTs in their classroom practice. These included modelling of ICT pedagogical integration, assessment of ICT pedagogical integration, relocating pre-service teacher classes to a working…

Applying Semantic Web Services and Wireless Sensor Networks for System Integration

NASA Astrophysics Data System (ADS)

Berkenbrock, Gian Ricardo; Hirata, Celso Massaki; de Oliveira Júnior, Frederico Guilherme Álvares; de Oliveira, José Maria Parente

In environments like factories, buildings, and homes automation services tend to often change during their lifetime. Changes are concerned to business rules, process optimization, cost reduction, and so on. It is important to provide a smooth and straightforward way to deal with these changes so that could be handled in a faster and low cost manner. Some prominent solutions use the flexibility of Wireless Sensor Networks and the meaningful description of Semantic Web Services to provide service integration. In this work, we give an overview of current solutions for machinery integration that combine both technologies as well as a discussion about some perspectives and open issues when applying Wireless Sensor Networks and Semantic Web Services for automation services integration.

Elementary Education Pre-Service Teachers' Development of Mathematics Technology Integration Skills in a Technology Integration Course

ERIC Educational Resources Information Center

Polly, Drew

2015-01-01

Preparing pre-service teachers to effectively integrate technology in the classroom requires rich experiences that deepen their knowledge of technology, pedagogy, and content and the intersection of these aspects. This study examined elementary education pre-service teachers' development of skills and knowledge in a technology integration course…

Systematic review of youth mental health service integration research.

PubMed

Kinchin, Irina; Tsey, Komla; Heyeres, Marion; Cadet-James, Yvonne

2016-01-01

Quality mental health care is based on the integration of care across organisations and disciplines. The aims of this study were, first, to assess the extent, characteristics and reported outcomes of publications concerned with youth mental health service integration in Australia and internationally; and second, to investigate the study design quality of evaluative interventions and determine whether the studies report on the cost-effectiveness of the integration in order to inform the reform of youth mental health services by Queensland Health. A systematic search of the peer-reviewed literature and a narrative synthesis were undertaken of English language publications from 21 electronic databases. Inclusion criteria were: published 1998-2014 (inclusive); peer-reviewed research; focused on mental health services integration; reported data for youth aged 12-25 years. The methodological quality of evaluative interventions was assessed using the Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project (EPHPP). Twenty-five studies met the inclusion criteria: one (4%) was classified as a measurement research, 13 (52%) as descriptive, and 11 (44%) as interventions including five (45%) evaluative interventions. Four out of the five evaluative interventions reported positive effects of youth mental health service integration. Particular problems included ambiguity of definitions, absence of economic or cost analyses and insufficient consumer involvement. The methodological quality of the interventions was variable with, on average, a moderate level of selection bias and study design. Despite a slight increase in the number of studies in the last couple of years, there are important gaps in the evidence base for youth mental health service integration processes. The relatively small number of evaluative studies and lack of economic evaluations point to the need for additional research in this important area.

Developing and implementing a service charter for an integrated regional stroke service: an exploratory case study

PubMed Central

2014-01-01

Background Based on practices in commercial organizations and public services, healthcare organizations are using service charters to inform patients about the quality of service they can expect and to increase patient-centeredness. In the Netherlands, an integrated regional stroke service involving five organizations has developed and implemented a single service charter. The purpose of this study is to determine the organizational enablers for the effective development and implementation of this service charter. Methods We have conducted an exploratory qualitative study using Grounded Theory to determine the organizational enablers of charter development and implementation. Individual semi-structured interviews were held with all members of the steering committee and the taskforce responsible for the service charter. In these twelve interviews, participants were retrospectively asked for their opinions of the enablers. Interview transcripts have been analysed using Glaser’s approach of substantive coding consisting of open and selective coding in order to develop a framework of these enablers. A tabula rasa approach was used without any preconceived frameworks used in the coding process. Results We have determined seven categories of enablers formed of a total of 27 properties. The categories address a broad spectrum of enablers dealing with the basic foundations for cooperation, the way to manage the project’s organization and the way to implement the service charter. In addition to the enablers within each individual organization, enablers that reflect the whole chain seem to be important for the effective development and implementation of this service charter. Strategic alignment of goals within the chain, trust between organizations, willingness to cooperate and the extent of process integration are all important properties. Conclusions This first exploratory study into the enablers of the effective development and implementation was based on a single

MAPI: towards the integrated exploitation of bioinformatics Web Services.

PubMed

Ramirez, Sergio; Karlsson, Johan; Trelles, Oswaldo

2011-10-27

Bioinformatics is commonly featured as a well assorted list of available web resources. Although diversity of services is positive in general, the proliferation of tools, their dispersion and heterogeneity complicate the integrated exploitation of such data processing capacity. To facilitate the construction of software clients and make integrated use of this variety of tools, we present a modular programmatic application interface (MAPI) that provides the necessary functionality for uniform representation of Web Services metadata descriptors including their management and invocation protocols of the services which they represent. This document describes the main functionality of the framework and how it can be used to facilitate the deployment of new software under a unified structure of bioinformatics Web Services. A notable feature of MAPI is the modular organization of the functionality into different modules associated with specific tasks. This means that only the modules needed for the client have to be installed, and that the module functionality can be extended without the need for re-writing the software client. The potential utility and versatility of the software library has been demonstrated by the implementation of several currently available clients that cover different aspects of integrated data processing, ranging from service discovery to service invocation with advanced features such as workflows composition and asynchronous services calls to multiple types of Web Services including those registered in repositories (e.g. GRID-based, SOAP, BioMOBY, R-bioconductor, and others).

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

NASA Astrophysics Data System (ADS)

Lu, Xiaodong; Mori, Kinji

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

Integrating HIV testing and care into tuberculosis services in Benin: programmatic aspects.

PubMed

Ferroussier, O; Dlodlo, R A; Capo-Chichi, D; Boillot, F; Gninafon, M; Trébucq, A; Fujiwara, P I

2013-11-01

Between 2005 and 2008, the diagnosis and care of human immunodeficiency virus (HIV) infection and tuberculosis (TB) services were integrated in Benin. The appointment of a TB-HIV Coordinator by the National Tuberculosis Control Programme and quarterly supervisory visits to TB clinics have bolstered the implementation of integrated HIV-TB activities. HIV testing and cotrimoxazole preventive therapy were integrated smoothly into the TB services. The strategy chosen to facilitate access of HIV-positive TB patients to antiretroviral treatment contributed to greater integration over time, but perpetuated, for some, the burden of attending two facilities. The integration and decentralisation of TB and HIV care services at national level in Benin resulted in a high uptake of HIV services among TB patients.

Frail elderly patients. New model for integrated service delivery.

PubMed Central

Hébert, Rejean; Durand, Pierre J.; Dubuc, Nicole; Tourigny, André

2003-01-01

PROBLEM BEING ADDRESSED: Given the complex needs of frail older people and the multiplicity of care providers and services, care for this clientele lacks continuity. OBJECTIVE OF PROGRAM: Integrated service delivery (ISD) systems have been developed to improve continuity and increase the efficacy and efficiency of services. PROGRAM DESCRIPTION: The Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) is an innovative ISD model based on coordination. It includes coordination between decision makers and managers of different organizations and services; a single entry point; a case-management process; individualized service plans; a single assessment instrument based on clients' functional autonomy, coupled with a case-mix classification system; and a computerized clinical chart for communicating between institutions and professionals for client monitoring. CONCLUSION: Preliminary results on the efficacy of this model showed a decreased incidence of functional decline, a decreased burden for caregivers, and a smaller proportion of older people wishing to enter institutions. PMID:12943358

Integrating child welfare, juvenile justice, and other agencies in a continuum of services.

PubMed

Howell, James C; Kelly, Marion R; Palmer, James; Mangum, Ronald L

2004-01-01

This article presents a comprehensive strategy framework for integrating mental health, child welfare, education, substance abuse, and juvenile justice system services. It proposes an infrastructure of information exchange, cross-agency client referrals, a networking protocol, interagency councils, and service integration models. This infrastructure facilitates integrated service delivery.

Primary Care and Public Health Services Integration in Brazil’s Unified Health System

PubMed Central

Wall, Melanie; Yu, Gary; Penido, Cláudia; Schmidt, Clecy

2012-01-01

Objectives. We examined associations between transdisciplinary collaboration, evidence-based practice, and primary care and public health services integration in Brazil’s Family Health Strategy. We aimed to identify practices that facilitate service integration and evidence-based practice. Methods. We collected cross-sectional data from community health workers, nurses, and physicians (n = 262). We used structural equation modeling to assess providers’ service integration and evidence-based practice engagement operationalized as latent factors. Predictors included endorsement of team meetings, access to and consultations with colleagues, familiarity with community, and previous research experience. Results. Providers’ familiarity with community and team meetings positively influenced evidence-based practice engagement and service integration. More experienced providers reported more integration and engagement. Physicians reported less integration than did community health workers. Black providers reported less evidence-based practice engagement than did Pardo (mixed races) providers. After accounting for all variables, evidence-based practice engagement and service integration were moderately correlated. Conclusions. Age and race of providers, transdisciplinary collaboration, and familiarity with the community are significant variables that should inform design and implementation of provider training. Promising practices that facilitate service integration in Brazil may be used in other countries. PMID:22994254

Technology Integration Coursework and Finding Meaning in Pre-Service Teachers' Reflective Practice

ERIC Educational Resources Information Center

Kimmons, Royce; Miller, Brant G.; Amador, Julie; Desjardins, Christopher David; Hall, Cassidy

2015-01-01

This study seeks to inform teacher preparation programs regarding technology integration by understanding (1) relationships between tasks with specific technologies and pre-service teachers' critical thinking about technology integration and (2) relationships between how pre-service teachers are critically thinking about technology integration and…

Non-communicable diseases and HIV care and treatment: models of integrated service delivery.

PubMed

Duffy, Malia; Ojikutu, Bisola; Andrian, Soa; Sohng, Elaine; Minior, Thomas; Hirschhorn, Lisa R

2017-08-01

Non-communicable diseases (NCD) are a growing cause of morbidity in low-income countries including in people living with human immunodeficiency virus (HIV). Integration of NCD and HIV services can build upon experience with chronic care models from HIV programmes. We describe models of NCD and HIV integration, challenges and lessons learned. A literature review of published articles on integrated NCD and HIV programs in low-income countries and key informant interviews were conducted with leaders of identified integrated NCD and HIV programs. Information was synthesised to identify models of NCD and HIV service delivery integration. Three models of integration were identified as follows: NCD services integrated into centres originally providing HIV care; HIV care integrated into primary health care (PHC) already offering NCD services; and simultaneous introduction of integrated HIV and NCD services. Major challenges identified included NCD supply chain, human resources, referral systems, patient education, stigma, patient records and monitoring and evaluation. The range of HIV and NCD services varied widely within and across models. Regardless of model of integration, leveraging experience from HIV care models and adapting existing systems and tools is a feasible method to provide efficient care and treatment for the growing numbers of patients with NCDs. Operational research should be conducted to further study how successful models of HIV and NCD integration can be expanded in scope and scaled-up by managers and policymakers seeking to address all the chronic care needs of their patients. © 2017 John Wiley & Sons Ltd.

Integrating geo web services for a user driven exploratory analysis

NASA Astrophysics Data System (ADS)

Moncrieff, Simon; Turdukulov, Ulanbek; Gulland, Elizabeth-Kate

2016-04-01

In data exploration, several online data sources may need to be dynamically aggregated or summarised over spatial region, time interval, or set of attributes. With respect to thematic data, web services are mainly used to present results leading to a supplier driven service model limiting the exploration of the data. In this paper we propose a user need driven service model based on geo web processing services. The aim of the framework is to provide a method for the scalable and interactive access to various geographic data sources on the web. The architecture combines a data query, processing technique and visualisation methodology to rapidly integrate and visually summarise properties of a dataset. We illustrate the environment on a health related use case that derives Age Standardised Rate - a dynamic index that needs integration of the existing interoperable web services of demographic data in conjunction with standalone non-spatial secure database servers used in health research. Although the example is specific to the health field, the architecture and the proposed approach are relevant and applicable to other fields that require integration and visualisation of geo datasets from various web services and thus, we believe is generic in its approach.

Integrated Children's Services: Enablers, Challenges and Impact. Research Briefing

ERIC Educational Resources Information Center

Robinson, Mark; Atkinson, Mary; Downing, Dick

2008-01-01

This summary provides background information about the enablers, challenges and impact of integration, based on a thorough literature review of thirty-five sources. The review findings are presented under thematic headings that reflect the: (1) extent of integration: the "stage" or depth of the collaborative activity in integrated services; (2)…

A state policy framework for integrating health and social services.

PubMed

McGinnis, Tricia; Crawford, Maia; Somers, Stephen A

2014-07-01

Recognizing that health is determined by a variety of interrelated factors, states are looking to connect health care, public health, and social services to help achieve improved population health, better care, and reduced cost of care. This issue brief describes three essential components for integrating health, including physical and behavioral health services and public health, and social services: (1) a coordinating mechanism, (2) quality measurement and data-sharing tools, and (3) aligned financing and payment. It also presents a five-step policy framework to help states move beyond isolated pilot efforts and establish the infrastructure necessary to support ongoing integration of health and social services, particularly for Medicaid beneficiaries.

[Coordination between pharmaceutical services for integrated pharmacotherapy: the case of Catalonia].

PubMed

Costa, Karen Sarmento; Goldbaum, Moisés; Guayta-Escolies, Rafel; Modamio, Pilar; Mariño, Eduardo Luis; Tolsá, José Luis Segú

2017-08-01

Pharmaceutical policies have been considered strategies to contribute to the guarantee of care coordination and clinical integration. This study sought to describe the pharmaceutical services developed at different levels of care in the health network in Catalonia, as well as to identify and analyze the mechanisms and instruments that act as facilitators and/or barriers to the coordination of pharmacotherapy. This is a descriptive study of 12 cases of hospital pharmacy services, primary care and community pharmacies. Advances related to the perception, formalization and clinical and assistance coordination of the pharmaceutical services were identified. However, weaknesses and potential improvements in coordination were observed. The conclusion drawn was that the different tools and instruments implemented appear to facilitate a greater possibility of integration between pharmaceutical services and the latter with the health services network to contribute to integrated pharmacotherapy.

75 FR 20388 - International Business Machines Corporation, Global Technology Services Business Unit, Integrated...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-19

... Expense Team, Working From Various States in the United States, Including On-Site Leased Workers From... Technology Services Business Unit, Integrated Technology Services, Cost and Expense Team working from various... Technology Services Business Unit, Integrated Technology Services, Cost and Expense Team. The Department has...

Integrating Business Communication Instruction and Career Services: Activities and Assessment Tools

ERIC Educational Resources Information Center

Crews, Moody E.; Hemby, K. Virginia

2009-01-01

This paper is an extension of an earlier JARBI article, "Integrating University and College Career Services Programs into the Business Communication Curriculum" (Hemby & Crews, 2005). The original article provided business communication instructors with ideas for integrating career services' programs into the business communication curriculum,…

Integrating Health and Mental Health Services: A Past and Future History.

PubMed

Druss, Benjamin G; Goldman, Howard H

2018-04-25

The authors trace the modern history, current landscape, and future prospects for integration between mental health and general medical care in the United States. Research and new treatment models developed in the 1980s and early 1990s helped inform federal legislation, including the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act, which in turn are creating new opportunities to further integrate services. Future efforts should build on this foundation to develop clinical, service-level, and public health approaches that more fully integrate mental, medical, substance use, and social services.

Evolution of Women's Trauma-Integrated Services at the Substance Abuse and Mental Health Services Administration

ERIC Educational Resources Information Center

Salasin, Susan E.

2005-01-01

In this article a historical overview of the evolution of the Women's Trauma Integrated Services model at the Substance Abuse and Mental Health Services Administration (SAMHSA) is presented. Milestones in women's services policy development at SAMHSA (1992-1998) and in trauma treatment development for four different trauma populations (1960-1998)…

Building thematic and integrated services for solid Earth sciences: the EPOS integrated approach

NASA Astrophysics Data System (ADS)

Cocco, Massimo; Consortium, Epos

2016-04-01

EPOS has been designed with the vision of creating a pan-European infrastructure for solid Earth science to support a safe and sustainable society. In accordance with this scientific vision, the EPOS mission is to integrate the diverse and advanced European Research Infrastructures for solid Earth science relying on new e-science opportunities to monitor and unravel the dynamic and complex Earth System. EPOS will enable innovative multidisciplinary research for a better understanding of the Earth's physical and chemical processes that control earthquakes, volcanic eruptions, ground instability and tsunami as well as the processes driving tectonics and Earth's surface dynamics. To accomplish its mission, EPOS is engaging different stakeholders, not limited to scientists, to allow the Earth sciences to open new horizons in our understanding of the planet. EPOS also aims at contributing to prepare society for geo-hazards and to responsibly manage the exploitation of geo-resources. Through integration of data, models and facilities, EPOS will allow the Earth science community to make a step change in developing new concepts and tools for key answers to scientific and socio-economic questions concerning geo-hazards and geo-resources as well as Earth sciences applications to the environment and human welfare. A long-term integration plan is necessary to accomplish the EPOS mission. EPOS is presently in its implementation phase further extending its pan-European dimension. The EPOS Implementation Phase builds on the achievements of the successful EPOS Preparatory Phase project and consists of two key activities: the legal establishment of the EPOS-ERIC and the EPOS IP project. The EPOS implementation phase will last from 2015 to 2019. Key objectives of the project are: implementing Thematic Core Services (TCS), the domain-specific service hubs for coordinating and harmonizing national resources/plans with the European dimension of EPOS; building the Integrated Core

A Service Portal for the Integrated SCaN Network

NASA Technical Reports Server (NTRS)

Marx, Sarah R.

2012-01-01

The Space Communication and Navigation (SCaN) program office owns the assets and services provided by the Deep Space Network (DSN), Near Earth Network (NEN), and Space Network (SN). At present, these individual networks are operated by different NASA centers--JPL for DSN--and Goddard Space Flight Center (GSFC) for NEN and SN--with separate commitments offices for each center. In the near future, SCaN's program office would like to deploy an integrated service portal which would merge the two commitments offices with the goal of easing the task of user planning for space missions requiring services of two or more of these networks. Following interviews with subject matter experts in this field, use cases were created to include the services and functionality mission users would like to see in this new integrated service portal. These use cases provide a guideline for a mock-up of the design of the user interface for the portal. The benefit of this work will ease the time required and streamline/standardize the process for planning and scheduling SCAN's services for future space missions.

A novel virtual hub approach for multisource downstream service integration

NASA Astrophysics Data System (ADS)

Previtali, Mattia; Cuca, Branka; Barazzetti, Luigi

2016-08-01

A large development of downstream services is expected to be stimulated starting from earth observations (EO) datasets acquired by Copernicus satellites. An important challenge connected with the availability of downstream services is the possibility for their integration in order to create innovative applications with added values for users of different categories level. At the moment, the world of geo-information (GI) is extremely heterogeneous in terms of standards and formats used, thus preventing a facilitated access and integration of downstream services. Indeed, different users and data providers have also different requirements in terms of communication protocols and technology advancement. In recent years, many important programs and initiatives have tried to address this issue even on trans-regional and international level (e.g. INSPIRE Directive, GEOSS, Eye on Earth and SEIS). However, a lack of interoperability between systems and services still exists. In order to facilitate the interaction between different downstream services, a new architectural approach (developed within the European project ENERGIC OD) is proposed in this paper. The brokering-oriented architecture introduces a new mediation layer (the Virtual Hub) which works as an intermediary to bridge the gaps linked to interoperability issues. This intermediation layer de-couples the server and the client allowing a facilitated access to multiple downstream services and also Open Data provided by national and local SDIs. In particular, in this paper an application is presented integrating four services on the topic of agriculture: (i) the service given by Space4Agri (providing services based on MODIS and Landsat data); (ii) Gicarus Lab (providing sample services based on Landsat datasets) and (iii) FRESHMON (providing sample services for water quality) and services from a several regional SDIs.

Flexible Web services integration: a novel personalised social approach

NASA Astrophysics Data System (ADS)

Metrouh, Abdelmalek; Mokhati, Farid

2018-05-01

Dynamic composition or integration remains one of the key objectives of Web services technology. This paper aims to propose an innovative approach of dynamic Web services composition based on functional and non-functional attributes and individual preferences. In this approach, social networks of Web services are used to maintain interactions between Web services in order to select and compose Web services that are more tightly related to user's preferences. We use the concept of Web services community in a social network of Web services to reduce considerably their search space. These communities are created by the direct involvement of Web services providers.

Overcoming Barriers to Integrating Behavioral Health and Primary Care Services

PubMed Central

Grazier, Kyle L.; Smiley, Mary L.; Bondalapati, Kirsten S.

2016-01-01

Objective: Despite barriers, organizations with varying characteristics have achieved full integration of primary care services with providers and services that identify, treat, and manage those with mental health and substance use disorders. What are the key factors and common themes in stories of this success? Methods: A systematic literature review and snowball sampling technique was used to identify organizations. Site visits and key informant interviews were conducted with 6 organizations that had over time integrated behavioral health and primary care services. Case studies of each organization were independently coded to identify traits common to multiple organizations. Results: Common characteristics include prioritized vulnerable populations, extensive community collaboration, team approaches that included the patient and family, diversified funding streams, and data-driven approaches and practices. Conclusions: While significant barriers to integrating behavioral health and primary care services exist, case studies of organizations that have successfully overcome these barriers share certain common factors. PMID:27380923

Clinical service lines in integrated delivery systems: an initial framework and exploration.

PubMed

Parker, V A; Charns, M P; Young, G J

2001-01-01

The increasing pressures on integrated healthcare delivery systems (IDSs) to provide coordinated and cost-effective care focuses attention on the question of how to best integrate across multiple sites of care. One increasingly common approach to this issue is the development of clinical service lines that integrate specific bundles of services across the operating units of a system. This article presents a conceptual model of service lines and reports results from a descriptive investigation of service line development among members of the Industry Advisory Board--a research consortium comprising IDSs. The experiences of these IDSs (1) provide valuable insights into the range of organizational arrangements and implementation issues that are associated with service line management in healthcare systems and (2) suggest aspects of service line management worthy of further inquiry.

Integrating mental health services: the Finnish experience

PubMed Central

Lehtinen, Ville; Taipale, Vappu

2001-01-01

Abstract The aim of this paper is to give a short description of the most important developments of mental health services in Finland during the 1990s, examine their influences on the organisation and provision of services, and describe shortly some national efforts to handle the new situation. The Finnish mental health service system experienced profound changes in the beginning of the 1990s. These included the integration of mental health services, being earlier under own separate administration, with other specialised health services, decentralisation of the financing of health services, and de-institutionalisation of the services. The same time Finland underwent the deepest economic recession in Western Europe, which resulted in cut-offs especially in the mental health budgets. Conducting extensive national research and development programmes in the field of mental health has been one typically Finnish way of supporting the mental health service development. The first of these national programmes was the Schizophrenia Project 1981–97, whose main aims were to decrease the incidence of new long-term patients and the prevalence of old long-stay patients by developing an integrated treatment model. The Suicide Prevention Project 1986–96 aimed at raising awareness of this special problem and decreasing by 20% the proportionally high suicide rate in Finland. The National Depression Programme 1994–98 focused at this clearly increasing public health concern by several research and development project targeted both to the general population and specifically to children, primary care and specialised services. The latest, still on-going Meaningful Life Programme 1998–2003 which main aim is, by multi-sectoral co-operation, to improve the quality of life for people suffering from or living with the threat of mental disorders. Furthermore, the government launched in 1999 a new Goal and Action Programme for Social Welfare and Health Care 2000–2003, in which mental

Development and Integration of WWW-Based Services in an Existing University Environment.

ERIC Educational Resources Information Center

Garofalakis, John; Kappos, Panagiotis; Tsakalidis, Athanasios; Tsaknakis, John; Tzimas, Giannis; Vassiliadis, Vassilios

This paper describes the experience and the problems solved in the process of developing and integrating advanced World Wide Web-based services into the University of Patras (Greece) system. In addition to basic network services (e.g., e-mail, file transfer protocol), the final system will integrate the following set of advanced services: a…

Service Integration: Challenging Systems To Meet Families' Needs.

ERIC Educational Resources Information Center

Ward, Elie

This report offers an evaluation of services for families in New York State, finds that system is in chaos, and proposes a 5-year commitment to integrate programs and funding in six agencies. The report finds that billions of federal, state, local, and private dollars are committed annually to support separate service systems with no imperative…

Bioinformatics data distribution and integration via Web Services and XML.

PubMed

Li, Xiao; Zhang, Yizheng

2003-11-01

It is widely recognized that exchange, distribution, and integration of biological data are the keys to improve bioinformatics and genome biology in post-genomic era. However, the problem of exchanging and integrating biology data is not solved satisfactorily. The eXtensible Markup Language (XML) is rapidly spreading as an emerging standard for structuring documents to exchange and integrate data on the World Wide Web (WWW). Web service is the next generation of WWW and is founded upon the open standards of W3C (World Wide Web Consortium) and IETF (Internet Engineering Task Force). This paper presents XML and Web Services technologies and their use for an appropriate solution to the problem of bioinformatics data exchange and integration.

Cost, cost-efficiency and cost-effectiveness of integrated family planning and HIV services.

PubMed

Shade, Starley B; Kevany, Sebastian; Onono, Maricianah; Ochieng, George; Steinfeld, Rachel L; Grossman, Daniel; Newmann, Sara J; Blat, Cinthia; Bukusi, Elizabeth A; Cohen, Craig R

2013-10-01

To evaluate costs, cost-efficiency and cost-effectiveness of integration of family planning into HIV services. Integration of family planning services into HIV care and treatment clinics. A cluster-randomized trial. Twelve health facilities in Nyanza, Kenya were randomized to integrate family planning into HIV care and treatment; six health facilities were randomized to (nonintegrated) standard-of-care with separately delivered family planning and HIV services. We assessed costs, cost-efficiency (cost per additional use of more effective family planning), and cost-effectiveness (cost per pregnancy averted) associated with the first year of integration of family planning into HIV care. More effective family planning methods included oral and injectable contraceptives, subdermal implants, intrauterine device, and female and male sterilization. We collected cost data through interviews with study staff and review of financial records to determine costs of service integration. Integration of services was associated with an average marginal cost of $841 per site and $48 per female patient. Average overall and marginal costs of integration were associated with personnel costs [initial ($1003 vs. $872) and refresher ($498 vs. $330) training, mentoring ($1175 vs. $902) and supervision ($1694 vs. $1636)], with fewer resources required for other fixed ($18 vs. $0) and recurring expenses ($471 vs. $287). Integration was associated with a marginal cost of $65 for each additional use of more effective family planning and $1368 for each pregnancy averted. Integration of family planning and HIV services is feasible, inexpensive to implement, and cost-efficient in the Kenyan setting, and thus supports current Kenyan integration policy.

Measuring the degree of integrated tuberculosis and HIV service delivery in Cape Town, South Africa.

PubMed

Uyei, Jennifer; Coetzee, David; Macinko, James; Weinberg, Sharon L; Guttmacher, Sally

2014-01-01

To address the considerable tuberculosis (TB)/HIV co-infected population in Cape Town, a number of clinics have made an effort of varying degrees to integrate TB and HIV services. This article describes the development of a theory-based survey instrument designed to quantify the extent to which services were integrated in 33 clinics and presents the results of the survey. Using principal factor analysis, eight factors were extracted and used to make comparisons across three types of clinics: co-located TB and antiretroviral therapy (ART) services, clinics with TB services only and clinics with ART only. Clinics with co-located services scored highest on measures related to integrated TB/ART service delivery compared to clinics with single services, but within group variability was high indicating that co-location of TB and ART services is a necessary but insufficient condition for integrated service delivery. In addition, we found almost all clinics with only TB services in our sample had highly integrated pre-ART services, suggesting that integration of these services across a large number of clinics is feasible and acceptable to clinic staff. TB clinics with highly integrated pre-ART services appear to be efficient sites for introducing ART given that co-infected patients are already engaged in care, and may potentially facilitate earlier access to treatment and minimize loss to follow-up.

Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness.

PubMed

Rosenheck, R; Morrissey, J; Lam, J; Calloway, M; Johnsen, M; Goldman, H; Randolph, F; Blasinsky, M; Fontana, A; Calsyn, R; Teague, G

1998-11-01

This study evaluated the hypothesis that greater integration and coordination between agencies within service systems is associated with greater accessibility of services and improved client housing outcomes. As part of the Access to Community Care and Effective Services and Supports program, data were obtained on baseline client characteristics, service use, and 3-month and 12-month outcomes from 1832 clients seen at 18 sites during the first year of program operation. Data on interorganizational relationships were obtained from structured interviews with key informants from relevant organizations in each community (n = 32-82 at each site). Complete follow-up data were obtained from 1340 clients (73%). After control for baseline characteristics, service system integration was associated with superior housing outcomes at 12 months, and this relationship was mediated through greater access to housing agencies. Service system integration is related to improved access to housing services and better housing outcomes among homeless people with mental illness.

Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review.

PubMed

Haldane, Victoria; Legido-Quigley, Helena; Chuah, Fiona Leh Hoon; Sigfrid, Louise; Murphy, Georgina; Ong, Suan Ee; Cervero-Liceras, Francisco; Watt, Nicola; Balabanova, Dina; Hogarth, Sue; Maimaris, Will; Buse, Kent; McKee, Martin; Piot, Peter; Perel, Pablo

2018-01-01

Non-communicable diseases (NCDs), including cardiovascular diseases (CVD), hypertension and diabetes together with HIV infection are among the major public health concerns worldwide. Health services for HIV and NCDs require health systems that provide for people's chronic care needs, which present an opportunity to coordinate efforts and create synergies between programs to benefit people living with HIV and/or AIDS and NCDs. This review included studies that reported service integration for HIV and/or AIDS with coronary heart diseases, chronic CVD, cerebrovascular diseases (stroke), hypertension or diabetes. We searched multiple databases from inception until October 2015. Articles were screened independently by two reviewers and assessed for risk of bias. 11,057 records were identified with 7,616 after duplicate removal. After screening titles and abstracts, 14 papers addressing 17 distinct interventions met the inclusion criteria. We categorized integration models by diseases (HIV with diabetes, HIV with hypertension and diabetes, HIV with CVD and finally HIV with hypertension and CVD and diabetes). Models also looked at integration from micro (patient focused integration) to macro (system level integrations). Most reported integration of hypertension and diabetes with HIV and AIDS services and described multidisciplinary collaboration, shared protocols, and incorporating screening activities into community campaigns. Integration took place exclusively at the meso-level, with no micro- or macro-level integrations described. Most were descriptive studies, with one cohort study reporting evaluative outcomes. Several innovative initiatives were identified and studies showed that CVD and HIV service integration is feasible. Integration should build on existing protocols and use the community as a locus for advocacy and health services, while promoting multidisciplinary teams, including greater involvement of pharmacists. There is a need for robust and well

The influence of nursing care integration services on nurses' work satisfaction and quality of nursing care.

PubMed

Ryu, Jeong-Im; Kim, Kisook

2018-06-20

To investigate differences in work satisfaction and quality of nursing services between nurses from the nursing care integration service and general nursing units in Korea. The nursing care integration service was recently introduced in Korea to improve patient health outcomes through the provision of high quality nursing services and to relieve the caregiving burden of patients' families. In this cross-sectional study, data were collected from a convenience sample of 116 and 156 nurses working in nursing care integration service and general units, respectively. The data were analysed using descriptive statistics, t tests and one-way analysis of variance. Regarding work satisfaction, nursing care integration service nurses scored higher than general unit nurses on professional status, autonomy and task requirements, but the overall scores showed no significant differences. Scores on overall quality of nursing services, responsiveness and assurance were higher for nursing care integration service nurses than for general unit nurses. Nursing care integration service nurses scored higher than general unit nurses on some aspects of work satisfaction and quality of nursing services. Further studies with larger sample sizes will contribute to improving the quality of nursing care integration service units. These findings can help to establish strategies for the implementation and efficient operation of the nursing care integration service system, for the improvement of the quality of nursing services, and for successfully implementing and expanding nursing care integration service services in other countries. © 2018 John Wiley & Sons Ltd.

Integration of leprosy services into the General Health Service in Sri Lanka: overcoming challenges to implementation in a remote district.

PubMed

Wijesinghe, Thushanthi S; Wijesinghe, Pushpa Ranjan

2013-01-01

Sri Lanka took a policy decision to integrate leprosy services into the general health services (GHS) in 1999. This paper aims to summarize the emergence of new, specific challenges and how they were overcome during the integration of leprosy services to the GHS in a remote, leprosy endemic district in Sri Lanka. In this article, the regional epidemiologist as the team leader describes the principles used for transition to an effective integrated model of leprosy services from a centralized leprosy control model in the district. In addition, rationale for integration is viewed from the epidemiological and operational perspectives. National and district leprosy epidemiological data from secondary sources are also reviewed for corroborating the effectiveness of integration. Challenges surfaced were mainly related to the transfer of ownership of the programme, selection of appropriate service providing institutions easily accessible to clients, sustainability of leprosy services at the GHS, ensuring participation of all stakeholders in capacity building programmes and co-ordination of patient care in the absence of a dermatologist in the district. An empowered district team leader with specified roles and responsibilities, his sound technical and managerial know how and ability to translate 'team work' concept to practice were found to be essential for successful implementation of integration. Decision-making powers at the district level and flexibility to introduce new, area-specific changes to the centrally prepared core activities of integration were also vital to overcome locally surfaced challenges.

From NHS Choices to the integrated customer service platform.

PubMed

Gann, Bob; Grant, Maria J

2013-03-01

In 2013 the NHS Commissioning Board launches its new integrated customer service platform. The new service utilises the full range of channels (web, telephone, apps etc) to provide access to information to support transparency, participation and transactions. Digital health services have proven benefits in informed choice, shared decision making and patient participation. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

Integrated mental health services in England: a policy paradox

PubMed Central

England, Elizabeth; Lester, Helen

2005-01-01

Abstract Purpose The purpose of this paper is to examine the effects of health care policy on the development of integrated mental health services in England. Data sources Drawing largely from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors, we discuss three case studies of integrated care within primary care, secondary care and across the primary/secondary interface for people with serious mental illness. Conclusion We suggest that while the central thrust of a raft of recent Government policies in England has been towards integration of different parts of the health care system, policy waterfalls and implementation failures, the adoption of ideas before they have been thoroughly tried and tested, a lack of clarity over roles and responsibilities and poor communication have led to an integration rhetoric/reality gap in practice. This has particular implications for people with serious mental health problems. Discussion We conclude with suggestions for strategies that may facilitate more integrated working. PMID:16773165

Integrated modelling of ecosystem services and energy systems research

NASA Astrophysics Data System (ADS)

Agarwala, Matthew; Lovett, Andrew; Bateman, Ian; Day, Brett; Agnolucci, Paolo; Ziv, Guy

2016-04-01

The UK Government is formally committed to reducing carbon emissions and protecting and improving natural capital and the environment. However, actually delivering on these objectives requires an integrated approach to addressing two parallel challenges: de-carbonising future energy system pathways; and safeguarding natural capital to ensure the continued flow of ecosystem services. Although both emphasise benefiting from natural resources, efforts to connect natural capital and energy systems research have been limited, meaning opportunities to improve management of natural resources and meet society's energy needs could be missed. The ecosystem services paradigm provides a consistent conceptual framework that applies in multiple disciplines across the natural and economic sciences, and facilitates collaboration between them. At the forefront of the field, integrated ecosystem service - economy models have guided public- and private-sector decision making at all levels. Models vary in sophistication from simple spreadsheet tools to complex software packages integrating biophysical, GIS and economic models and draw upon many fields, including ecology, hydrology, geography, systems theory, economics and the social sciences. They also differ in their ability to value changes in natural capital and ecosystem services at various spatial and temporal scales. Despite these differences, current models share a common feature: their treatment of energy systems is superficial at best. In contrast, energy systems research has no widely adopted, unifying conceptual framework that organises thinking about key system components and interactions. Instead, the literature is organised around modelling approaches, including life cycle analyses, econometric investigations, linear programming and computable general equilibrium models. However, some consistencies do emerge. First, often contain a linear set of steps, from exploration to resource supply, fuel processing, conversion

Integration of hybrid wireless networks in cloud services oriented enterprise information systems

NASA Astrophysics Data System (ADS)

Li, Shancang; Xu, Lida; Wang, Xinheng; Wang, Jue

2012-05-01

This article presents a hybrid wireless network integration scheme in cloud services-based enterprise information systems (EISs). With the emerging hybrid wireless networks and cloud computing technologies, it is necessary to develop a scheme that can seamlessly integrate these new technologies into existing EISs. By combining the hybrid wireless networks and computing in EIS, a new framework is proposed, which includes frontend layer, middle layer and backend layers connected to IP EISs. Based on a collaborative architecture, cloud services management framework and process diagram are presented. As a key feature, the proposed approach integrates access control functionalities within the hybrid framework that provide users with filtered views on available cloud services based on cloud service access requirements and user security credentials. In future work, we will implement the proposed framework over SwanMesh platform by integrating the UPnP standard into an enterprise information system.

Successful outsourcing: improving quality of life through integrated support services.

PubMed

Bates, Jason; Sharratt, Martin; King, John

2014-01-01

This article examines the way that non-clinical support services are provided in healthcare settings through outsourcing partnerships. The integrated support services model and benefits to patient experience and safety as well as organizational efficiency and effectiveness are explored through an examination of services at a busy urban community hospital.

Colleges' Experiences: Integrating Support Services for Military Veterans

ERIC Educational Resources Information Center

Karp, Melinda Mechur; Klempin, Serena

2017-01-01

To improve the educational experiences and outcomes of student veterans, the Kisco Foundation developed the Kohlberg Prize in 2015. Two cohorts of colleges were awarded competitive grants to enhance their veterans services. This piece examines the process of creating integrated services for student veterans through the institutionalization of…

The tsunami service bus, an integration platform for heterogeneous sensor systems

NASA Astrophysics Data System (ADS)

Haener, R.; Waechter, J.; Kriegel, U.; Fleischer, J.; Mueller, S.

2009-04-01

1. INTRODUCTION Early warning systems are long living and evolving: New sensor-systems and -types may be developed and deployed, sensors will be replaced or redeployed on other locations and the functionality of analyzing software will be improved. To ensure a continuous operability of those systems their architecture must be evolution-enabled. From a computer science point of view an evolution-enabled architecture must fulfill following criteria: • Encapsulation of and functionality on data in standardized services. Access to proprietary sensor data is only possible via these services. • Loose coupling of system constituents which easily can be achieved by implementing standardized interfaces. • Location transparency of services what means that services can be provided everywhere. • Separation of concerns that means breaking a system into distinct features which overlap in functionality as little as possible. A Service Oriented Architecture (SOA) as e. g. realized in the German Indonesian Tsunami Early Warning System (GITEWS) and the advantages of functional integration on the basis of services described below adopt these criteria best. 2. SENSOR INTEGRATION Integration of data from (distributed) data sources is just a standard task in computer science. From few well known solution patterns, taking into account performance and security requirements of early warning systems only functional integration should be considered. Precondition for this is that systems are realized compliant to SOA patterns. Functionality is realized in form of dedicated components communicating via a service infrastructure. These components provide their functionality in form of services via standardized and published interfaces which could be used to access data maintained in - and functionality provided by dedicated components. Functional integration replaces the tight coupling at data level by a dependency on loosely coupled services. If the interfaces of the service providing

Improving Acceptance, Integration, and Health Among LGBT Service Members

DTIC Science & Technology

2017-10-01

physical and mental health needs of these communities. This project includes LGBT service members from all four services: Army, Air Force, Navy and Marine...within the military • Hazing • Bullying • Overall health • Healthcare utilization • Lost duty days • Sick call visits • Physical health symptoms...Award Numbers: W81XWH-15-1-0701 Title: Improving Acceptance, Integration, and Health Among LGBT Service Members Principal Investigators

Ecosystem services and economic theory: integration for policy-relevant research.

PubMed

Fisher, Brendan; Turner, Kerry; Zylstra, Matthew; Brouwer, Roy; de Groot, Rudolf; Farber, Stephen; Ferraro, Paul; Green, Rhys; Hadley, David; Harlow, Julian; Jefferiss, Paul; Kirkby, Chris; Morling, Paul; Mowatt, Shaun; Naidoo, Robin; Paavola, Jouni; Strassburg, Bernardo; Yu, Doug; Balmford, Andrew

2008-12-01

It has become essential in policy and decision-making circles to think about the economic benefits (in addition to moral and scientific motivations) humans derive from well-functioning ecosystems. The concept of ecosystem services has been developed to address this link between ecosystems and human welfare. Since policy decisions are often evaluated through cost-benefit assessments, an economic analysis can help make ecosystem service research operational. In this paper we provide some simple economic analyses to discuss key concepts involved in formalizing ecosystem service research. These include the distinction between services and benefits, understanding the importance of marginal ecosystem changes, formalizing the idea of a safe minimum standard for ecosystem service provision, and discussing how to capture the public benefits of ecosystem services. We discuss how the integration of economic concepts and ecosystem services can provide policy and decision makers with a fuller spectrum of information for making conservation-conversion trade-offs. We include the results from a survey of the literature and a questionnaire of researchers regarding how ecosystem service research can be integrated into the policy process. We feel this discussion of economic concepts will be a practical aid for ecosystem service research to become more immediately policy relevant.

Process-oriented integration and coordination of healthcare services across organizational boundaries.

PubMed

Tello-Leal, Edgar; Chiotti, Omar; Villarreal, Pablo David

2012-12-01

The paper presents a methodology that follows a top-down approach based on a Model-Driven Architecture for integrating and coordinating healthcare services through cross-organizational processes to enable organizations providing high quality healthcare services and continuous process improvements. The methodology provides a modeling language that enables organizations conceptualizing an integration agreement, and identifying and designing cross-organizational process models. These models are used for the automatic generation of: the private view of processes each organization should perform to fulfill its role in cross-organizational processes, and Colored Petri Net specifications to implement these processes. A multi-agent system platform provides agents able to interpret Colored Petri-Nets to enable the communication between the Healthcare Information Systems for executing the cross-organizational processes. Clinical documents are defined using the HL7 Clinical Document Architecture. This methodology guarantees that important requirements for healthcare services integration and coordination are fulfilled: interoperability between heterogeneous Healthcare Information Systems; ability to cope with changes in cross-organizational processes; guarantee of alignment between the integrated healthcare service solution defined at the organizational level and the solution defined at technological level; and the distributed execution of cross-organizational processes keeping the organizations autonomy.

Integrating Music Therapy Services and Speech-Language Therapy Services for Children with Severe Communication Impairments: A Co-Treatment Model

ERIC Educational Resources Information Center

Geist, Kamile; McCarthy, John; Rodgers-Smith, Amy; Porter, Jessica

2008-01-01

Documenting how music therapy can be integrated with speech-language therapy services for children with communication delay is not evident in the literature. In this article, a collaborative model with procedures, experiences, and communication outcomes of integrating music therapy with the existing speech-language services is given. Using…

Open pre-schools at integrated health services-A program theory.

PubMed

Abrahamsson, Agneta; Samarasinghe, Kerstin

2013-04-01

Family centres in Sweden are integrated services that reach all prospective parents and parents with children up to their sixth year, because of the co-location of the health service with the social service and the open pre-school. The personnel on the multi-professional site work together to meet the needs of the target group. The article explores a program theory focused on the open pre-schools at family centres. A multi-case design is used and the sample consists of open pre-schools at six family centres. The hypothesis is based on previous research and evaluation data. It guides the data collection which is collected and analysed stepwise. Both parents and personnel are interviewed individually and in groups at each centre. The hypothesis was expanded to a program theory. The compliance of the professionals was the most significant element that explained why the open access service facilitated positive parenting. The professionals act in a compliant manner to meet the needs of the children and parents as well as in creating good conditions for social networking and learning amongst the parents. The compliance of the professionals in this program theory of open pre-schools at family centres can be a standard in integrated and open access services, whereas the organisation form can vary. The best way of increasing the number of integrative services is to support and encourage professionals that prefer to work in a compliant manner.

The fundamentals of integrating service in a post-licensure RN to BSN program.

PubMed

Washington-Brown, Linda; Ritchie, Arlene

2014-01-01

Integrating service in a post-licensure registered nurse to bachelor of science in nursing (RN to BSN) program provides licensed registered nurse (RN) students the opportunity to learn, develop, and experience different cultures while serving the community and populations in need (McKinnon & Fitzpatrick, 2012). Service to the community, integrated with academic learning can be applied in a wide variety of settings, including schools, universities, and community faith-based organizations. Academic service-learning (ASL) can involve a group of students, a classroom, or an entire school. In the RN to BSN program, the authors use a student-directed service learning approach that integrates service-learning throughout the curriculum. RN students are introduced to service-learning at program orientation prior to the start of classes and receive reinforcement and active engagement throughout the curriculum. The students and volunteer agencies receive and give benefits from the services provided and the life lessons gained through mentorship, education, and hands-on experiences.

Single, Integrated, Service-Centric Model of Military Health System Governance

DTIC Science & Technology

and effectiveness of operational medical support. According to the Joint Concept for Health Services (JCHS), the need for integrated medical support...that keeps pace with the operational agility and organizational flexibility requirements to support globally integrated operations is clear. This

Integrated services plus drug treatment as a system alternative to crime control and parole.

PubMed

Danzer, Graham

2012-01-01

Integrated services have the potential to facilitate recovery in drug offenders as well as reduce criminal recidivism. This is significant given that prison overcrowding has led many drug offenders to be released from custody into society via the "reentry movement." Offenders incarcerated for many years often return to society with medical, mental health, behavioral, and drug abuse issues. These issues have been found in similar populations, including those with severe mental illness and the homeless, for which integrated services has shown to have a significant impact on improving functioning. Thus the argument of this article is that because integrated services have shown to be effective with somewhat similar populations, integrated services can be effective in treating paroled drug offenders. These benefits are expected to be to a greater degree than that achieved by current system policy regarding paroled drug offenders being supervised by parole officers rather than case managers facilitating integrated services.

A systematic review of integrated working between care homes and health care services

PubMed Central

2011-01-01

Background In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Results Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in

Zooming In on Copyright with Integrated Library Software Services

ERIC Educational Resources Information Center

Oye, Karen

2007-01-01

Over the last decade, many of Kelvin Smith Library's (KSL) content delivery services have gone digital, and some, such as enhanced course reserves products, are new to the market. The best digital library services have given KSL options and integrated solutions that allow it to do more than it thought possible just a few years ago. As with many…

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

PubMed

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

2016-05-10

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

Customer Decision Making in Web Services with an Integrated P6 Model

NASA Astrophysics Data System (ADS)

Sun, Zhaohao; Sun, Junqing; Meredith, Grant

Customer decision making (CDM) is an indispensable factor for web services. This article examines CDM in web services with a novel P6 model, which consists of the 6 Ps: privacy, perception, propensity, preference, personalization and promised experience. This model integrates the existing 6 P elements of marketing mix as the system environment of CDM in web services. The new integrated P6 model deals with the inner world of the customer and incorporates what the customer think during the DM process. The proposed approach will facilitate the research and development of web services and decision support systems.

Web services as applications' integration tool: QikProp case study.

PubMed

Laoui, Abdel; Polyakov, Valery R

2011-07-15

Web services are a new technology that enables to integrate applications running on different platforms by using primarily XML to enable communication among different computers over the Internet. Large number of applications was designed as stand alone systems before the concept of Web services was introduced and it is a challenge to integrate them into larger computational networks. A generally applicable method of wrapping stand alone applications into Web services was developed and is described. To test the technology, it was applied to the QikProp for DOS (Windows). Although performance of the application did not change when it was delivered as a Web service, this form of deployment had offered several advantages like simplified and centralized maintenance, smaller number of licenses, and practically no training for the end user. Because by using the described approach almost any legacy application can be wrapped as a Web service, this form of delivery may be recommended as a global alternative to traditional deployment solutions. Copyright © 2011 Wiley Periodicals, Inc.

The Allegheny initiative for mental health integration for the homeless: integrating heterogeneous health services for homeless persons.

PubMed

Gordon, Adam J; Montlack, Melissa L; Freyder, Paul; Johnson, Diane; Bui, Thuy; Williams, Jennifer

2007-03-01

The Allegheny Initiative for Mental Health Integration for the Homeless (AIM-HIGH) was a 3-year urban initiative in Pennsylvania that sought to enhance integration and coordination of medical and behavioral services for homeless persons through system-, provider-, and client-level interventions. On a system level, AIM-HIGH established partnerships between several key medical and behavioral health agencies. On a provider level, AIM-HIGH conducted 5 county-wide conferences regarding homeless integration, attended by 637 attendees from 72 agencies. On a client level, 5 colocated medical and behavioral health care clinics provided care to 1986 homeless patients in 4084 encounters, generating 1917 referrals for care. For a modest investment, AIM-HIGH demonstrated that integration of medical and behavioral health services for homeless persons can occur in a large urban environment.

The Allegheny Initiative for Mental Health Integration for the Homeless: Integrating Heterogeneous Health Services for Homeless Persons

PubMed Central

Gordon, Adam J.; Montlack, Melissa L.; Freyder, Paul; Johnson, Diane; Bui, Thuy; Williams, Jennifer

2007-01-01

The Allegheny Initiative for Mental Health Integration for the Homeless (AIM-HIGH) was a 3-year urban initiative in Pennsylvania that sought to enhance integration and coordination of medical and behavioral services for homeless persons through system-, provider-, and client-level interventions. On a system level, AIM-HIGH established partnerships between several key medical and behavioral health agencies. On a provider level, AIM-HIGH conducted 5 county-wide conferences regarding homeless integration, attended by 637 attendees from 72 agencies. On a client level, 5 colocated medical and behavioral health care clinics provided care to 1986 homeless patients in 4084 encounters, generating 1917 referrals for care. For a modest investment, AIM-HIGH demonstrated that integration of medical and behavioral health services for homeless persons can occur in a large urban environment. PMID:17267708

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

NASA Astrophysics Data System (ADS)

Xia, Weiwei; Shen, Lianfeng

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

Preservice and In-Service Teachers' Perceptions toward Technology Benefits and Integration

ERIC Educational Resources Information Center

Spaulding, Michael

2013-01-01

This study examined preservice teacher attitudes toward and expected technology integration practices as compared to in-service teachers' attitudes toward and actual (self-reported) practice of technology integration. The preservice teachers revealed a greater level of confidence in their ability to integrate technology and more positive beliefs…

Literacy Enrichment and Technology Integration in Pre-Service Teacher Education

ERIC Educational Resources Information Center

Keengwe, Jared, Ed.; Onchwari, Grace, Ed.; Hucks, Darrell, Ed.

2014-01-01

With the emergence of innovative technologies, the digital nature of learning environments has changed the face of education. The integration of these technologies into classroom instruction is essential for promoting student learning. "Literacy Enrichment and Technology Integration in Pre-Service Teacher Education" examines the various…

A service platform architecture design towards a light integration of heterogeneous systems in the wellbeing domain.

PubMed

Yang, Yaojin; Ahtinen, Aino; Lahteenmaki, Jaakko; Nyman, Petri; Paajanen, Henrik; Peltoniemi, Teijo; Quiroz, Carlos

2007-01-01

System integration is one of the major challenges for building wellbeing or healthcare related information systems. In this paper, we are going to share our experiences on how to design a service platform called Nuadu service platform, for providing integrated services in occupational health promotion and health risk management through two heterogeneous systems. Our design aims for a light integration covering the layers, from data through service up to presentation, while maintaining the integrity of the underlying systems.

Integrating family planning with other social services.

PubMed

Bernales, E H

1982-01-01

Family planning outreach workers in the 43 municipalities of Iloilo Province, Western Visayas, the Philippines, have provided their communities with health, nutrition, educational, and agricultural services since 1973, when the Provincial Development Staff (PDS) began attempting to integrate services. The early work of the PDS was aided by the launching of the National Population and Family Planning Outreach Project in rural areas in 1976 and the creation of the Provincial Population Office (PPO) in 1977. 43% of the Outreach Project cost is borne by the local government, with the Commission on Population covering the rest. It is anticipated that the local goverment will eventually absorb the full cost. The Outreach officers have become an integral part of the planning body of the provincial government, largely due to the creation of the Provincial Consultative Committee on Population (PCCP) in 1979. The PCCP, composed of 22 governmental and private agencies involved in population-related activities, is charged with implementing the national population program in order to utilize all possible resources for provincial development. Its Integrated Provincial Population Plan has become part of the total provincial development plan. The Municipal Population Planning Actions Teams, whose functions are patterned on those of the PCCPs, further strengthen local planning at the municipal level. Full-Time Outreach Workers participate as well in planning at the barangay level. The various community-based projects initiated by the Outreach staff in Iloilo demonstrate a concern with making the population program responsive to the immediate needs of the provincial population. Organizations which teach better farming methods and undertake community projects emphasize local initiative and solutions to problems, and demonstrate the committment of population workers to broader development efforts. Outreach workers are involved in primary health care, social service delivery, income

Home care: from adequate funding to integration of services.

PubMed

Hébert, Réjean

2009-01-01

With the aging of the population, the healthcare system needs to shift from the actual hospital-centred system developed in the past century for dealing with acute diseases and a young population toward a home-centred system, more appropriate for serving older people with chronic diseases. Funding of home care should not only be significantly increased but also be managed differently. We propose the introduction of an autonomy support benefit (ASB) to cover costs related to disabilities, irrespective of living environment, and to set up a public universal autonomy insurance program that will cover the ASB. This insurance should be at least partly capitalized to provide for the aging of the population and to ensure intergenerational equity. Also, since the home is a much more complicated service-delivery environment than the hospital, these services must be coordinated and integrated. The Program of Research to Integrate the Services for the Maintenance of Autonomy (PRISMA) is a coordination-type model of integration that was implemented and evaluated in three areas (one urban and two rural) in and around Sherbrooke, Quebec. A four-year longitudinal quasi-experimental study with over 1,500 participants demonstrated its efficiency in improving system effectiveness at no extra cost.

Teaching Service Modelling to a Mixed Class: An Integrated Approach

ERIC Educational Resources Information Center

Deng, Jeremiah D.; Purvis, Martin K.

2015-01-01

Service modelling has become an increasingly important area in today's telecommunications and information systems practice. We have adapted a Network Design course in order to teach service modelling to a mixed class of both the telecommunication engineering and information systems backgrounds. An integrated approach engaging mathematics teaching…

A four phase development model for integrated care services in the Netherlands

PubMed Central

Minkman, Mirella MN; Ahaus, Kees TB; Huijsman, Robbert

2009-01-01

Background Multidisciplinary and interorganizational arrangements for the delivery of coherent integrated care are being developed in a large number of countries. Although there are many integrated care programs worldwide, the process of developing these programs and interorganizational collaboration is described in the literature only to a limited extent. The purpose of this study is to explore how local integrated care services are developed in the Netherlands, and to conceptualize and operationalize a development model of integrated care. Methods The research is based on an expert panel study followed by a two-part questionnaire, designed to identify the development process of integrated care. Essential elements of integrated care, which were developed in a previous Delphi and Concept Mapping Study, were analyzed in relation to development process of integrated care. Results Integrated care development can be characterized by four developmental phases: the initiative and design phase; the experimental and execution phase; the expansion and monitoring phase; and the consolidation and transformation phase. Different elements of integrated care have been identified in the various developmental phases. Conclusion The findings provide a descriptive model of the development process that integrated care services can undergo in the Netherlands. The findings have important implications for integrated care services, which can use the model as an instrument to reflect on their current practices. The model can be used to help to identify improvement areas in practice. The model provides a framework for developing evaluation designs for integrated care arrangements. Further research is recommended to test the developed model in practice and to add international experiences. PMID:19261176

Integration of antenatal care services with health programmes in low- and middle-income countries: systematic review.

PubMed

de Jongh, Thyra E; Gurol-Urganci, Ipek; Allen, Elizabeth; Zhu, Nina Jiayue; Atun, Rifat

2016-06-01

Antenatal care (ANC) presents a potentially valuable platform for integrated delivery of additional health services for pregnant women-services that are vital to reduce the persistently high rates of maternal and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited evidence on the impact of integrating health services with ANC to guide policy. This review assesses the impact of integration of postnatal and other health services with ANC on health services uptake and utilisation, health outcomes and user experience of care in LMICs. Cochrane Library, MEDLINE, Embase, CINAHL Plus, POPLINE and Global Health were searched for studies that compared integrated models for delivery of postnatal and other health services with ANC to non-integrated models. Risk of bias of included studies was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC) criteria and the Newcastle-Ottawa Scale, depending on the study design. Due to high heterogeneity no meta-analysis could be conducted. Results are presented narratively. 12 studies were included in the review. Limited evidence, with moderate- to high-risk of bias, suggests that integrated service delivery results in improved uptake of essential health services for women, earlier initiation of treatment, and better health outcomes. Women also reported improved satisfaction with integrated services. The reported evidence is largely based on non-randomised studies with poor generalizability, and therefore offers very limited policy guidance. More rigorously conducted and geographically diverse studies are needed to better ascertain and quantify the health and economic benefits of integrating health services with ANC.

IRLT: Integrating Reputation and Local Trust for Trustworthy Service Recommendation in Service-Oriented Social Networks

PubMed Central

Liu, Zhiquan; Ma, Jianfeng; Jiang, Zhongyuan; Miao, Yinbin; Gao, Cong

2016-01-01

With the prevalence of Social Networks (SNs) and services, plenty of trust models for Trustworthy Service Recommendation (TSR) in Service-oriented SNs (S-SNs) have been proposed. The reputation-based schemes usually do not contain user preferences and are vulnerable to unfair rating attacks. Meanwhile, the local trust-based schemes generally have low reliability or even fail to work when the trust path is too long or does not exist. Thus it is beneficial to integrate them for TSR in S-SNs. This work improves the state-of-the-art Combining Global and Local Trust (CGLT) scheme and proposes a novel Integrating Reputation and Local Trust (IRLT) model which mainly includes four modules, namely Service Recommendation Interface (SRI) module, Local Trust-based Trust Evaluation (LTTE) module, Reputation-based Trust Evaluation (RTE) module and Aggregation Trust Evaluation (ATE) module. Besides, a synthetic S-SN based on the famous Advogato dataset is deployed and the well-known Discount Cumulative Gain (DCG) metric is employed to measure the service recommendation performance of our IRLT model with comparing to that of the excellent CGLT model. The results illustrate that our IRLT model is slightly superior to the CGLT model in honest environment and significantly outperforms the CGLT model in terms of the robustness against unfair rating attacks. PMID:26963089

IRLT: Integrating Reputation and Local Trust for Trustworthy Service Recommendation in Service-Oriented Social Networks.

PubMed

Liu, Zhiquan; Ma, Jianfeng; Jiang, Zhongyuan; Miao, Yinbin; Gao, Cong

2016-01-01

With the prevalence of Social Networks (SNs) and services, plenty of trust models for Trustworthy Service Recommendation (TSR) in Service-oriented SNs (S-SNs) have been proposed. The reputation-based schemes usually do not contain user preferences and are vulnerable to unfair rating attacks. Meanwhile, the local trust-based schemes generally have low reliability or even fail to work when the trust path is too long or does not exist. Thus it is beneficial to integrate them for TSR in S-SNs. This work improves the state-of-the-art Combining Global and Local Trust (CGLT) scheme and proposes a novel Integrating Reputation and Local Trust (IRLT) model which mainly includes four modules, namely Service Recommendation Interface (SRI) module, Local Trust-based Trust Evaluation (LTTE) module, Reputation-based Trust Evaluation (RTE) module and Aggregation Trust Evaluation (ATE) module. Besides, a synthetic S-SN based on the famous Advogato dataset is deployed and the well-known Discount Cumulative Gain (DCG) metric is employed to measure the service recommendation performance of our IRLT model with comparing to that of the excellent CGLT model. The results illustrate that our IRLT model is slightly superior to the CGLT model in honest environment and significantly outperforms the CGLT model in terms of the robustness against unfair rating attacks.

How to Integrate HIV and Sexual and Reproductive Health Services in Namibia, the Epako Clinic Case Study

PubMed Central

Forster, Norbert; Campuzano, Pedro; Kambapani, Rejoice; Brahmbhatt, Heena; Hidinua, Grace; Turay, Mohamed; Ikandi, Simon Kimathi; Kabongo, Leonard; Zariro, Farai

2017-01-01

Introduction: During the past two decades, HIV and Sexual and Reproductive Health services in Namibia have been provided in silos, with high fragmentation. As a consequence of this, quality and efficiency of services in Primary Health Care has been compromised. Methods: We conducted an operational research (observational pre-post study) in a public health facility in Namibia. A health facility assessment was conducted before and after the integration of health services. A person-centred integrated model was implemented to integrate all health services provided at the health facility in addition to HIV and Sexual and Reproductive Health services. Comprehensive services are provided by each health worker to the same patients over time (longitudinality), on a daily basis (accessibility) and with a good external referral system (coordination). Prevalence rates of time flows and productivity were done. Results: Integrated services improved accessibility, stigma and quality of antenatal care services by improving the provider-patient communication, reducing the time that patients stay in the clinic in 16% and reducing the waiting times in 14%. In addition, nurse productivity improved 85% and the expected time in the health facility was reduced 24% without compromising the uptake of TB, HIV, outpatient, antenatal care or first visit family planning services. Given the success on many indicators resulting from integration of services, the goal of this paper was to describe “how” health services have been integrated, the “process” followed and presenting some “results” from the integrated clinic. Conclusions: Our study shows that HIV and SRH services can be effectively integrated by following the person-centred integrated model. Based on the Namibian experience on “how” to integrate health services and the “process” to achieve it, other African countries can replicate the model to move away from the silo approach and contribute to the achievement of

Work in progress. Integrating physicians' services in the home.

PubMed Central

McWilliam, C. L.; Stewart, M.; Sangster, J.; Cohen, I.; Mitchell, J.; Sutherland, C.; Ryan, B.

2001-01-01

OBJECTIVE: While increasing acuity levels and the concomitant complexity of service demand that physicians be involved in in-home care, conflicting evidence and opinions do not show how this can best be achieved. DESIGN: A phenomenologic research design was used to obtain insights into the challenges and opportunities of integrating physicians' services into the usual in-home services in London, Ont. SETTING: Home care in London, Ont. PARTICIPANTS: Twelve participants included three patients, two family caregivers, two family physicians, the program's nurse practitioner, two case managers, and two community nurses. METHOD: In-depth interviews with a maximally varied purposeful sample of patients, caregivers, and providers were analyzed using immersion and crystallization techniques. MAIN FINDINGS: Findings revealed the potential for enhanced continuity of care and interdisciplinary team functioning. Having a nurse practitioner, interdisciplinary team-building exercises and meetings, regular face-to-face contact among all providers, support for family caregivers, and 24-hour coverage for physicians were found to be essential for success. CONCLUSION: Integration of services takes time, money, and sustained commitment, particularly when undertaken in geographically isolated communities. Informed choice and a fair remuneration system remain important considerations for family physicians. PMID:11785281

A Smart Modeling Framework for Integrating BMI-enabled Models as Web Services

NASA Astrophysics Data System (ADS)

Jiang, P.; Elag, M.; Kumar, P.; Peckham, S. D.; Liu, R.; Marini, L.; Hsu, L.

2015-12-01

Serviced-oriented computing provides an opportunity to couple web service models using semantic web technology. Through this approach, models that are exposed as web services can be conserved in their own local environment, thus making it easy for modelers to maintain and update the models. In integrated modeling, the serviced-oriented loose-coupling approach requires (1) a set of models as web services, (2) the model metadata describing the external features of a model (e.g., variable name, unit, computational grid, etc.) and (3) a model integration framework. We present the architecture of coupling web service models that are self-describing by utilizing a smart modeling framework. We expose models that are encapsulated with CSDMS (Community Surface Dynamics Modeling System) Basic Model Interfaces (BMI) as web services. The BMI-enabled models are self-describing by uncovering models' metadata through BMI functions. After a BMI-enabled model is serviced, a client can initialize, execute and retrieve the meta-information of the model by calling its BMI functions over the web. Furthermore, a revised version of EMELI (Peckham, 2015), an Experimental Modeling Environment for Linking and Interoperability, is chosen as the framework for coupling BMI-enabled web service models. EMELI allows users to combine a set of component models into a complex model by standardizing model interface using BMI as well as providing a set of utilities smoothing the integration process (e.g., temporal interpolation). We modify the original EMELI so that the revised modeling framework is able to initialize, execute and find the dependencies of the BMI-enabled web service models. By using the revised EMELI, an example will be presented on integrating a set of topoflow model components that are BMI-enabled and exposed as web services. Reference: Peckham, S.D. (2014) EMELI 1.0: An experimental smart modeling framework for automatic coupling of self-describing models, Proceedings of HIC 2014

Impact of integration of sexual and reproductive health services on consultation duration times: results from the Integra Initiative

PubMed Central

Siapka, Mariana; Obure, Carol Dayo; Mayhew, Susannah H; Fenty, Justin; Initiative, Integra; Vassall, Anna

2017-01-01

Abstract The lack of human resources is a key challenge in scaling up of HIV services in Africa’s health care system. Integrating HIV services could potentially increase their effectiveness and optimize the use of limited resources and clinical staff time. We examined the impact of integration of provider initiated HIV counselling and testing (PITC) and family planning (FP counselling and FP provision) services on duration of consultation to assess the impact of PITC and FP integration on staff workload. This study was conducted in 24 health facilities in Kenya under the Integra Initiative, a non-randomized, pre/post intervention trial to evaluate the impact of integrated HIV and sexual and reproductive health services on health and service outcomes. We compared the time spent providing PITC-only services, FP-only services and integrated PITC/FP services. We used log-linear regression to assess the impact of plausible determinants on the duration of clients’ consultation times. Median consultation duration times were highest for PITC-only services (30 min), followed by integrated services (10 min) and FP-only services (8 min). Times for PITC-only and FP-only services were 69.7% higher (95% Confidence Intervals (CIs) 35.8–112.0) and 43.9% lower (95% CIs −55.4 to − 29.6) than times spent on these services when delivered as an integrated service, respectively. The reduction in consultation times with integration suggests a potential reduction in workload. The higher consultation time for PITC-only could be because more pre- and post-counselling is provided at these stand-alone services. In integrated PITC/FP services, the duration of the visit fell below that required by HIV testing guidelines, and service mix between counselling and testing substantially changed. Integration of HIV with FP services may compromise the quality of services delivered and care must be taken to clearly specify and monitor appropriate consultation duration times and

Implementing and measuring the level of laboratory service integration in a program setting in Nigeria.

PubMed

Mbah, Henry; Negedu-Momoh, Olubunmi Ruth; Adedokun, Oluwasanmi; Ikani, Patrick Anibbe; Balogun, Oluseyi; Sanwo, Olusola; Ochei, Kingsley; Ekanem, Maurice; Torpey, Kwasi

2014-01-01

The surge of donor funds to fight HIV&AIDS epidemic inadvertently resulted in the setup of laboratories as parallel structures to rapidly respond to the identified need. However these parallel structures are a threat to the existing fragile laboratory systems. Laboratory service integration is critical to remedy this situation. This paper describes an approach to quantitatively measure and track integration of HIV-related laboratory services into the mainstream laboratory services and highlight some key intervention steps taken, to enhance service integration. A quantitative before-and-after study conducted in 122 Family Health International (FHI360) supported health facilities across Nigeria. A minimum service package was identified including management structure; trainings; equipment utilization and maintenance; information, commodity and quality management for laboratory integration. A check list was used to assess facilities at baseline and 3 months follow-up. Level of integration was assessed on an ordinal scale (0 = no integration, 1 = partial integration, 2 = full integration) for each service package. A composite score grading expressed as a percentage of total obtainable score of 14 was defined and used to classify facilities (≤ 80% FULL, 25% to 79% PARTIAL and <25% NO integration). Weaknesses were noted and addressed. We analyzed 9 (7.4%) primary, 104 (85.2%) secondary and 9 (7.4%) tertiary level facilities. There were statistically significant differences in integration levels between baseline and 3 months follow-up period (p<0.01). Baseline median total integration score was 4 (IQR 3 to 5) compared to 7 (IQR 4 to 9) at 3 months follow-up (p = 0.000). Partial and fully integrated laboratory systems were 64 (52.5%) and 0 (0.0%) at baseline, compared to 100 (82.0%) and 3 (2.4%) respectively at 3 months follow-up (p = 0.000). This project showcases our novel approach to measure the status of each laboratory on the integration continuum.

Improving Acceptance, Integration and Health among LGBT Service Members

DTIC Science & Technology

2017-10-01

very little data available on the unique physical and mental health needs of these communities. This project includes LGBT service members from...Sick call visits • Physical health symptoms • Sexual/gender identity disclosure • Depressive symptoms • Suicidality • PTSD symptoms • Sexual...Award Numbers: W81XWH-15-1-0700 Title: Improving Acceptance, Integration, and Health Among LGBT Service Members Principal Investigators

Development and integration of pharmacist clinical services into the patient-centered medical home.

PubMed

Berdine, Hildegarde J; Skomo, Monica L

2012-01-01

To describe the development of pharmacist clinical services within a primary care physician practice using a standardized business plan, the extent of clinical pharmacy service integration into the patient-centered medical home (PCMH), and the clinical changes in the pharmacist's patient cohort. A two-physician primary care/occupational care practice in Pittsburgh, PA, from May 2007 to December 2011. Pharmacist-led clinic receives physician referrals for medication management, adherence, and disease management services. Pharmacist practice in a primary care setting with emphasis on integration of clinical services into the medical home model designed by the American Academy of Family Physicians. Characterization of the patient's pharmacist and services provided by the pharmacist. Glycosylated hemoglobin (A1C), body mass index (BMI), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, triglycerides, and blood pressure. The top five primary referral reasons were diabetes self-management, weight management, medication adherence, hypertension, and dyslipidemia management. Improvements in clinical parameters were demonstrated for lipids and A1C at 1 and 2 years after baseline. Statistically significant improvements in BMI also were observed. The pharmacist developed and integrated clinical services into a primary care practice, became an integral member of the clinical team in the two-physician PCMH, and improved patient outcomes.

Interventions and approaches to integrating HIV and mental health services: a systematic review.

PubMed

Chuah, Fiona Leh Hoon; Haldane, Victoria Elizabeth; Cervero-Liceras, Francisco; Ong, Suan Ee; Sigfrid, Louise A; Murphy, Georgina; Watt, Nicola; Balabanova, Dina; Hogarth, Sue; Maimaris, Will; Otero, Laura; Buse, Kent; McKee, Martin; Piot, Peter; Perel, Pablo; Legido-Quigley, Helena

2017-11-01

The frequency in which HIV and AIDS and mental health problems co-exist, and the complex bi-directional relationship between them, highlights the need for effective care models combining services for HIV and mental health. Here, we present a systematic review that synthesizes the literature on interventions and approaches integrating these services. This review was part of a larger systematic review on integration of services for HIV and non-communicable diseases. Eligible studies included those that described or evaluated an intervention or approach aimed at integrating HIV and mental health care. We searched multiple databases from inception until October 2015, independently screened articles identified for inclusion, conducted data extraction, and assessed evaluative papers for risk of bias. Forty-five articles were eligible for this review. We identified three models of integration at the meso and micro levels: single-facility integration, multi-facility integration, and integrated care coordinated by a non-physician case manager. Single-site integration enhances multidisciplinary coordination and reduces access barriers for patients. However, the practicality and cost-effectiveness of providing a full continuum of specialized care on-site for patients with complex needs is arguable. Integration based on a collaborative network of specialized agencies may serve those with multiple co-morbidities but fragmented and poorly coordinated care can pose barriers. Integrated care coordinated by a single case manager can enable continuity of care for patients but requires appropriate training and support for case managers. Involving patients as key actors in facilitating integration within their own treatment plan is a promising approach. This review identified much diversity in integration models combining HIV and mental health services, which are shown to have potential in yielding positive patient and service delivery outcomes when implemented within appropriate

Interventions and approaches to integrating HIV and mental health services: a systematic review

PubMed Central

Chuah, Fiona Leh Hoon; Haldane, Victoria Elizabeth; Cervero-Liceras, Francisco; Ong, Suan Ee; Sigfrid, Louise A; Murphy, Georgina; Watt, Nicola; Balabanova, Dina; Hogarth, Sue; Maimaris, Will; Otero, Laura; Buse, Kent; McKee, Martin; Piot, Peter; Perel, Pablo; Legido-Quigley, Helena

2017-01-01

Abstract Background The frequency in which HIV and AIDS and mental health problems co-exist, and the complex bi-directional relationship between them, highlights the need for effective care models combining services for HIV and mental health. Here, we present a systematic review that synthesizes the literature on interventions and approaches integrating these services. Methods This review was part of a larger systematic review on integration of services for HIV and non-communicable diseases. Eligible studies included those that described or evaluated an intervention or approach aimed at integrating HIV and mental health care. We searched multiple databases from inception until October 2015, independently screened articles identified for inclusion, conducted data extraction, and assessed evaluative papers for risk of bias. Results Forty-five articles were eligible for this review. We identified three models of integration at the meso and micro levels: single-facility integration, multi-facility integration, and integrated care coordinated by a non-physician case manager. Single-site integration enhances multidisciplinary coordination and reduces access barriers for patients. However, the practicality and cost-effectiveness of providing a full continuum of specialized care on-site for patients with complex needs is arguable. Integration based on a collaborative network of specialized agencies may serve those with multiple co-morbidities but fragmented and poorly coordinated care can pose barriers. Integrated care coordinated by a single case manager can enable continuity of care for patients but requires appropriate training and support for case managers. Involving patients as key actors in facilitating integration within their own treatment plan is a promising approach. Conclusion This review identified much diversity in integration models combining HIV and mental health services, which are shown to have potential in yielding positive patient and service delivery

Integrating Diversity Education and Service Learning: A 15+ Year Journey Continues

ERIC Educational Resources Information Center

Womble, Myra N.; Adams, Elaine

2016-01-01

This paper reports the 15+ year journey undertaken by university faculty to integrate service learning with diversity education. It has taken the faculty from its initial integration of academic community learning and diversity education in 1999 to its current course offering in 2015. The purpose of this integration has remained the same, to…

Progress of Geomagnetism towards integration of data and services in EPOS

NASA Astrophysics Data System (ADS)

Flower, Simon; Hejda, Pavel; Chambodut, Aude; Curto, Juan-Jose; Matzka, Jürgen; Thomson, Alan; Korja, Toivo; Rasmussen, Thorkild; Smirnov, Maxim; Viljanen, Ari; Kauristie, Kirsti

2017-04-01

The geomagnetism community is involved in the European Plate Observing System (EPOS), a European Research Infrastructure through which science communities will offer a number of services that will integrate to simplify cross-disciplinary research. The Geomagnetism community will provide data from geomagnetic observatories, from producers of geomagnetic indices and events, from geomagnetic models and from magneto-telluric observations. A number of these services (data from the INTERMAGNET network and the World Data Centre, indices and events from the International Service of Geomagnetic Indices and the access to the International Geomagnetic Reference Field and World Magnetic Model) will be integrated into EPOS systems in the first wave of services to be connected. This poster will describe the contribution from geomagnetism to EPOS. It will include a description of the data and services that the geomagnetic community will provide and also discuss how metadata will be made available from the community to the EPOS core IT systems. Finally it will describe how the provision of geomagnetic services in EPOS will be guided and governed by members of the community .

Implementation of Integrated Services--The Example of Family Centres in North Rhine-Westphalia

ERIC Educational Resources Information Center

Stöbe-Blossey, Sybille

2013-01-01

This paper deals with the implementation of integrated services providing early support for young children and their families. The integration of services is considered to have highly positive effects on the development of children and on the prevention of child neglect and maltreatment. Therefore, childcare centres have been developed into family…

Impact of integration of sexual and reproductive health services on consultation duration times: results from the Integra Initiative.

PubMed

Siapka, Mariana; Obure, Carol Dayo; Mayhew, Susannah H; Sweeney, Sedona; Fenty, Justin; Vassall, Anna

2017-11-01

The lack of human resources is a key challenge in scaling up of HIV services in Africa's health care system. Integrating HIV services could potentially increase their effectiveness and optimize the use of limited resources and clinical staff time. We examined the impact of integration of provider initiated HIV counselling and testing (PITC) and family planning (FP counselling and FP provision) services on duration of consultation to assess the impact of PITC and FP integration on staff workload. This study was conducted in 24 health facilities in Kenya under the Integra Initiative, a non-randomized, pre/post intervention trial to evaluate the impact of integrated HIV and sexual and reproductive health services on health and service outcomes. We compared the time spent providing PITC-only services, FP-only services and integrated PITC/FP services. We used log-linear regression to assess the impact of plausible determinants on the duration of clients' consultation times. Median consultation duration times were highest for PITC-only services (30 min), followed by integrated services (10 min) and FP-only services (8 min). Times for PITC-only and FP-only services were 69.7% higher (95% Confidence Intervals (CIs) 35.8-112.0) and 43.9% lower (95% CIs -55.4 to - 29.6) than times spent on these services when delivered as an integrated service, respectively. The reduction in consultation times with integration suggests a potential reduction in workload. The higher consultation time for PITC-only could be because more pre- and post-counselling is provided at these stand-alone services. In integrated PITC/FP services, the duration of the visit fell below that required by HIV testing guidelines, and service mix between counselling and testing substantially changed. Integration of HIV with FP services may compromise the quality of services delivered and care must be taken to clearly specify and monitor appropriate consultation duration times and procedures during the

Improving Acceptance, Integration and Health among LGBT Service Members

DTIC Science & Technology

2017-10-01

these stressors on LGBT service members is poorly understood, with very little data available on the unique physical and mental health needs of these...Bullying • Overall health • Healthcare utilization • Lost duty days • Sick call visits • Physical health symptoms • Sexual/gender identity disclosure...Award Numbers: W81XWH-15-1-0699 Title: Improving Acceptance, Integration and Health among LGBT Service Members Principal Investigators: Jeremy

Enhancing Mobility: Integrating New Services into Your Library's Mobile Platform to Increase Traffic

ERIC Educational Resources Information Center

Felts, John W., Jr.

2014-01-01

Kimbel Library launched its mobile environment and ran it in full production for several months yet usage patterns were quite low and flat. The library only saw a substantial increase in usage when new, value-added services were integrated into this platform. Upon implementing and integrating discovery services, chat and SMS capabilities, and…

Considerations for Integration of Counseling and Health Services on College and University Campuses

ERIC Educational Resources Information Center

Journal of American College Health, 2010

2010-01-01

While the majority of college and university campuses have discrete mental health and medical services, the integration of the two areas has been subject of increased discussion among student health and counseling professionals. The push to integrate counseling and health services is motivated by a variety of reasons: a philosophical desire to…

Improving antiretroviral therapy scale-up and effectiveness through service integration and decentralization.

PubMed

Suthar, Amitabh B; Rutherford, George W; Horvath, Tara; Doherty, Meg C; Negussie, Eyerusalem K

2014-03-01

Current service delivery systems do not reach all people in need of antiretroviral therapy (ART). In order to inform the operational and service delivery section of the WHO 2013 consolidated antiretroviral guidelines, our objective was to summarize systematic reviews on integrating ART delivery into maternal, newborn, and child health (MNCH) care settings in countries with generalized epidemics, tuberculosis (TB) treatment settings in which the burden of HIV and TB is high, and settings providing opiate substitution therapy (OST); and decentralizing ART into primary health facilities and communities. A summary of systematic reviews. The reviewers searched PubMed, Embase, PsycINFO, Web of Science, CENTRAL, and the WHO Index Medicus databases. Randomized controlled trials and observational cohort studies were included if they compared ART coverage, retention in HIV care, and/or mortality in MNCH, TB, or OST facilities providing ART with MNCH, TB, or OST facilities providing ART services separately; or primary health facilities or communities providing ART with hospitals providing ART. The reviewers identified 28 studies on integration and decentralization. Antiretroviral therapy integration into MNCH facilities improved ART coverage (relative risk [RR] 1.37, 95% confidence interval [CI] 1.05-1.79) and led to comparable retention in care. ART integration into TB treatment settings improved ART coverage (RR 1.83, 95% CI 1.48-2.23) and led to a nonsignificant reduction in mortality (RR 0.55, 95% CI 0.29-1.05). The limited data on ART integration into OST services indicated comparable rates of ART coverage, retention, and mortality. Partial decentralization into primary health facilities improved retention (RR 1.05, 95% CI 1.01-1.09) and reduced mortality (RR 0.34, 95% CI 0.13-0.87). Full decentralization improved retention (RR 1.12, 95% CI 1.08-1.17) and led to comparable mortality. Community-based ART led to comparable rates of retention and mortality. Integrating ART

Integrating Social Services and Home-Based Primary Care for High-Risk Patients.

PubMed

Feinglass, Joe; Norman, Greg; Golden, Robyn L; Muramatsu, Naoko; Gelder, Michael; Cornwell, Thomas

2018-04-01

There is a consensus that our current hospital-intensive approach to care is deeply flawed. This review article describes the research evidence for developing a better system of care for high-cost, high-risk patients. It reviews the evidence that home-centered care and integration of health care with social services are the cornerstones of a more humane and efficient system. The article describes the strengths and weaknesses of research evaluating the effects of social services in addressing social determinants of health, and how social support is critical to successful acute care transition programs. It reviews the history of incorporating social services into care management, and the prospects that recent payment reforms and regulatory initiatives can succeed in stimulating the financial integration of social services into new care coordination initiatives. The article reviews the literature on home-based primary care for the chronically ill and disabled, and suggests that it is the emergence of this care modality that holds the greatest promise for delivery system reform. In the hope of stimulating further discussion and debate, the authors summarize existing viewpoints on how a home-centered system, which integrates social and medical services, might emerge in the next few years.

The influence of integrated tuberculosis and human immunodeficiency virus service delivery on patient outcomes.

PubMed

Uyei, J; Coetzee, D; Macinko, J; Weinberg, S L; Guttmacher, S

2014-03-01

Public health clinics in Cape Town, South Africa. To examine the influence of integrated tuberculosis (TB) and human immunodeficiency virus (HIV) service delivery on mortality, TB cure and successful treatment completion and loss to follow-up of TB-HIV co-infected patients on concurrent anti-tuberculosis and antiretroviral treatment (ART). A survey instrument was used to measure the degree to which TB and HIV services were jointly delivered, and patient data were collected retrospectively from clinic sites and the Department of Health. Six domains measuring integrated TB and HIV service delivery were modelled to assess their relationship with patient outcomes. Two domains, integrated TB and ART service delivery and the delivery of TB and HIV care by one clinical team, were associated with lowered odds of death. Care by the same clinical team was also associated with reduced loss to follow-up. Overall, these findings show that the organization and delivery of health services are important factors that influence health outcomes. These findings strongly support efforts by local governments to integrate TB and ART services, and may help to alleviate concerns that restructuring of TB programs could have a negative impact on long-standing gains.

A Framework for Sharing and Integrating Remote Sensing and GIS Models Based on Web Service

PubMed Central

Chen, Zeqiang; Lin, Hui; Chen, Min; Liu, Deer; Bao, Ying; Ding, Yulin

2014-01-01

Sharing and integrating Remote Sensing (RS) and Geographic Information System/Science (GIS) models are critical for developing practical application systems. Facilitating model sharing and model integration is a problem for model publishers and model users, respectively. To address this problem, a framework based on a Web service for sharing and integrating RS and GIS models is proposed in this paper. The fundamental idea of the framework is to publish heterogeneous RS and GIS models into standard Web services for sharing and interoperation and then to integrate the RS and GIS models using Web services. For the former, a “black box” and a visual method are employed to facilitate the publishing of the models as Web services. For the latter, model integration based on the geospatial workflow and semantic supported marching method is introduced. Under this framework, model sharing and integration is applied for developing the Pearl River Delta water environment monitoring system. The results show that the framework can facilitate model sharing and model integration for model publishers and model users. PMID:24901016

A framework for sharing and integrating remote sensing and GIS models based on Web service.

PubMed

Chen, Zeqiang; Lin, Hui; Chen, Min; Liu, Deer; Bao, Ying; Ding, Yulin

2014-01-01

Sharing and integrating Remote Sensing (RS) and Geographic Information System/Science (GIS) models are critical for developing practical application systems. Facilitating model sharing and model integration is a problem for model publishers and model users, respectively. To address this problem, a framework based on a Web service for sharing and integrating RS and GIS models is proposed in this paper. The fundamental idea of the framework is to publish heterogeneous RS and GIS models into standard Web services for sharing and interoperation and then to integrate the RS and GIS models using Web services. For the former, a "black box" and a visual method are employed to facilitate the publishing of the models as Web services. For the latter, model integration based on the geospatial workflow and semantic supported marching method is introduced. Under this framework, model sharing and integration is applied for developing the Pearl River Delta water environment monitoring system. The results show that the framework can facilitate model sharing and model integration for model publishers and model users.

One stop shop versus collaborative integration: what is the best way of delivering sexual health services?

PubMed

French, R S; Coope, C M; Graham, A; Gerressu, M; Salisbury, C; Stephenson, J M

2006-06-01

To examine various models of integrated and/or one stop shop (OSS) sexual health services (including general practice, mainstream specialist services, and designated young people's services) and explore their relative strengths and weaknesses. Literature review and interviews with key informants involved in developing the National Strategy for Sexual Health and HIV (n = 11). The paper focuses on five broad perspectives (logistics, public health, users, staff, and cost). Contraceptive and genitourinary medicine issues are closely related. However, there is no agreement about what is meant by having "integrated" services, about which services should be integrated, or where integration should happen. There are concerns that OSSs will result in over-centralisation, to the disadvantage of stand alone and satellite services. OSS models are potentially more user focused, but the stigma that surrounds sexual health services may create an access barrier. From staff perspectives, the advantages are greater career opportunities and increased responsibility, while the disadvantages are concern that OSSs will result in loss of expertise and professional status. Cost effectiveness data are contradictory. Although there is a policy commitment to look at how integrated services can be better developed, more evidence is required on the impact and appropriateness of this approach.

Health Systems Integration of Sexual and Reproductive Health and HIV Services in Sub-Saharan Africa: A Scoping Study

PubMed Central

Kendall, Tamil; Langer, Ana; Bärnighausen, Till

2014-01-01

Objective: Both sexual and reproductive health (SRH) services and HIV programs in sub-Saharan Africa are typically delivered vertically, operating parallel to national health systems. The objective of this study was to map the evidence on national and international strategies for integration of SRH and HIV services in sub-Saharan Africa and to develop a research agenda for future health systems integration. Methods: We examined the literature on national and international strategies to integrate SRH and HIV services using a scoping study methodology. Current policy frameworks, national HIV strategies and research, and gray literature on integration were mapped. Five countries in sub-Saharan Africa with experience of integrating SRH and HIV services were purposively sampled for detailed thematic analysis, according to the health systems functions of governance, policy and planning, financing, health workforce organization, service organization, and monitoring and evaluation. Results: The major international health policies and donor guidance now support integration. Most integration research has focused on linkages of SRH and HIV front-line services. Yet, the common problems with implementation are related to delayed or incomplete integration of higher level health systems functions: lack of coordinated leadership and unified national integration policies; separate financing streams for SRH and HIV services and inadequate health worker training, supervision and retention. Conclusions: Rigorous health systems research on the integration of SRH and HIV services is urgently needed. Priority research areas include integration impact, performance, and economic evaluation to inform the planning, financing, and coordination of integrated service delivery. PMID:25436826

Measuring Integration of Cancer Services to Support Performance Improvement: The CSI Survey

PubMed Central

Dobrow, Mark J.; Paszat, Lawrence; Golden, Brian; Brown, Adalsteinn D.; Holowaty, Eric; Orchard, Margo C.; Monga, Neerav; Sullivan, Terrence

2009-01-01

Objective: To develop a measure of cancer services integration (CSI) that can inform clinical and administrative decision-makers in their efforts to monitor and improve cancer system performance. Methods: We employed a systematic approach to measurement development, including review of existing cancer/health services integration measures, key-informant interviews and focus groups with cancer system leaders. The research team constructed a Web-based survey that was field- and pilot-tested, refined and then formally conducted on a sample of cancer care providers and administrators in Ontario, Canada. We then conducted exploratory factor analysis to identify key dimensions of CSI. Results: A total of 1,769 physicians, other clinicians and administrators participated in the survey, responding to a 67-item questionnaire. The exploratory factor analysis identified 12 factors that were linked to three broader dimensions: clinical, functional and vertical system integration. Conclusions: The CSI Survey provides important insights on a range of typically unmeasured aspects of the coordination and integration of cancer services, representing a new tool to inform performance improvement efforts. PMID:20676250

Needs Assessments: An Integrated Assignment in Civic Service

ERIC Educational Resources Information Center

Norris, Debra S.; Schwartz, Charles L.

2009-01-01

An undergraduate social work program developed a service-learning experience in partnership with a local United Way organization to complete a community needs assessment project. The experience integrated the curricula of a social work research methods course and a generalist-macro practice course with the principles and actions of experiential…

Analyzing Morton's Typology of Service Paradigms and Integrity

ERIC Educational Resources Information Center

Bringle, Robert G.; Hatcher, Julie A.; McIntosh, Rachel E.

2006-01-01

Research on college students found limited support for Morton's (1995) hypothesis that students have a preference for one distinct type of service orientation (i.e., charity, project, social change). The findings did replicate previous findings that college students prefer the charity paradigm. A measure of integrity was developed and two…

Mutual benefits in academic-service partnership: An integrative review.

PubMed

Sadeghnezhad, Maliheh; Heshmati Nabavi, Fatemeh; Najafi, Fereshteh; Kareshki, Hossein; Esmaily, Habibollah

2018-05-30

Academic and service institutions involve with many challenges. Partnership programs are a golden opportunity to achieve mutual benefits to overcome these challenges. Identifying mutual benefits is the cornerstone of forming a successful partnership and guarantee to its continuity. There are definitions and instances of mutual benefits in the literature related to partnership programs, but there is no coherent evidence and clear picture of these benefits. This study is conducted to identify mutual benefits in academic-service partnership by analyzing the definitions and instances of it in the literature. An integrative review of key papers regarding mutual benefits in academic-service partnership was undertaken. This review was guided by the framework described by Whittemore and Knafl. Search of the following databases was conducted: MEDLINE, ERIC, Google Scholar, Emerald Insight and Science Direct. The search terms were mutual benefits, mutual gains, mutual interest, mutual expectations, mutual goals, mutual demand, partnership, collaboration, academic-service partnership and academic service collaboration. Cooper's five-stage integrative review method was used. Quality evaluation of articles was conducted. Data were abstracted from included articles. The analysis was conducted based on the qualitative content analysis of the literature suggested by Zhang and Wildemuth. 28 articles were included in this review. Mutual benefits are described in four categories include: synergy in training and empowerment of human resources, education improvement, access to shared resources, facilitate production and application of beneficial knowledge into practice. Mutual benefits in the academic-service partnership include a range of goals, interests, expectations, and needs of partner organizations that is achievable and measurable through joint planning and collaboration. We suggest academic and service policymakers to consider these benefits in the planning and evaluating

Graph-Based Semantic Web Service Composition for Healthcare Data Integration.

PubMed

Arch-Int, Ngamnij; Arch-Int, Somjit; Sonsilphong, Suphachoke; Wanchai, Paweena

2017-01-01

Within the numerous and heterogeneous web services offered through different sources, automatic web services composition is the most convenient method for building complex business processes that permit invocation of multiple existing atomic services. The current solutions in functional web services composition lack autonomous queries of semantic matches within the parameters of web services, which are necessary in the composition of large-scale related services. In this paper, we propose a graph-based Semantic Web Services composition system consisting of two subsystems: management time and run time. The management-time subsystem is responsible for dependency graph preparation in which a dependency graph of related services is generated automatically according to the proposed semantic matchmaking rules. The run-time subsystem is responsible for discovering the potential web services and nonredundant web services composition of a user's query using a graph-based searching algorithm. The proposed approach was applied to healthcare data integration in different health organizations and was evaluated according to two aspects: execution time measurement and correctness measurement.

Integrating Service and Experience: When Education Meets Admissions

ERIC Educational Resources Information Center

Stafne, Marcos

2010-01-01

In the past five years the Rubin Museum of Art has had significant shifts in the organizational structure and interrelation of visitor services and education due to various financial and administrative changes. Though varying levels of integration have existed in the institution's history, due to budget constraints in early 2009, the two separate…

Models for Integrating Human Services into the School.

ERIC Educational Resources Information Center

Dolan, Lawrence J.

This report examines five models of school-based integrated human service programs to evaluate the effects of the programs in light of the growing support for and implementation of these programs. The study examined the following programs: (1) school-based health clinics in Baltimore (Maryland); (2) Success for All (an elementary school-level…

Qualitative Assessment of the Integration of HIV Services With Infant Routine Immunization Visits in Tanzania

PubMed Central

Wallace, Aaron; Kimambo, Sajida; Dafrossa, Lyimo; Rusibamayila, Neema; Rwebembera, Anath; Songoro, Juma; Arthur, Gilly; Luman, Elizabeth; Finkbeiner, Thomas; Goodson, James L.

2015-01-01

Background In 2009, a project was implemented in 8 primary health clinics throughout Tanzania to explore the feasibility of integrating pediatric HIV prevention services with routine infant immunization visits. Methods We conducted interviews with 64 conveniently sampled mothers of infants who had received integrated HIV and immunization services and 16 providers who delivered the integrated services to qualitatively identify benefits and challenges of the intervention midway through project implementation. Findings Mothers’ perceived benefits of the integrated services included time savings, opportunity to learn their child's HIV status and receive HIV treatment, if necessary. Providers’ perceived benefits included reaching mothers who usually would not come for only HIV testing. Mothers and providers reported similar challenges, including mothers’ fear of HIV testing, poor spousal support, perceived mandatory HIV testing, poor patient flow affecting confidentiality of service delivery, heavier provider workloads, and community stigma against HIV-infected persons; the latter a more frequent theme in rural compared with urban locations. Interpretation Future scale-up should ensure privacy of these integrated services received at clinics and community outreach to address stigma and perceived mandatory testing. Increasing human resources for health to address higher workloads and longer waiting times for proper patient flow is necessary in the long term. PMID:24326602

Cloud Applications in Language Teaching: Examining Pre-Service Teachers' Expertise, Perceptions and Integration

ERIC Educational Resources Information Center

Aburezeq, Ibtehal Mahmoud; Dweikat, Fawzi Fayez Ishtaiwa

2017-01-01

This study examined pre-service teachers' expertise, perceptions and integration of cloud applications in teaching of Arabic and English. Questionnaires and semi-structured interviews were used as data collection methods. The findings of the study specified that pre-service teachers did not own sufficient expertise for effective integration of…

Interconnected operations services in a vertically integrated utility

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

Hoffman, S.P.

1999-11-01

The North American electric industry has historically been composed of regulated Vertically Integrated Utilities (VIU). Vertical integration means that the same company owns generation, transmission, and distribution facilities. Regulated utilities were ensured cost recovery for all justifiable expenses. The entire industry is in the process of deregulation. The industry-wide trend is to competitive generation, while transmission and distribution remain regulated. Many variations, in both timing and structure, exist in states that have enacted deregulation and retail choice legislation. Some have combined retail choice with an ISO and power exchange; others have opted for retail choice without either. In the past,more » Interconnected Operations Services (IOS) were obtained by informal means within the same company. Generation is now being actively bought and sold as companies align their strategic direction with different sectors of the emerging electric industry. In the future, these IOS will have to be obtained by formal arrangements. The formal arrangements will need to encompass parameters including service definitions, compensation, performance measurement, and performance incentives. These formal arrangements are presently taking different forms in the industry depending on the stage of deregulation in each area, and on the particular agreements made by each Control Area. This paper describes how VIUs obtained and dispatched the IOS needed for reliability, and what challenges will be faced with respect to these services.« less

Integration of High-Performance Computing into Cloud Computing Services

NASA Astrophysics Data System (ADS)

Vouk, Mladen A.; Sills, Eric; Dreher, Patrick

High-Performance Computing (HPC) projects span a spectrum of computer hardware implementations ranging from peta-flop supercomputers, high-end tera-flop facilities running a variety of operating systems and applications, to mid-range and smaller computational clusters used for HPC application development, pilot runs and prototype staging clusters. What they all have in common is that they operate as a stand-alone system rather than a scalable and shared user re-configurable resource. The advent of cloud computing has changed the traditional HPC implementation. In this article, we will discuss a very successful production-level architecture and policy framework for supporting HPC services within a more general cloud computing infrastructure. This integrated environment, called Virtual Computing Lab (VCL), has been operating at NC State since fall 2004. Nearly 8,500,000 HPC CPU-Hrs were delivered by this environment to NC State faculty and students during 2009. In addition, we present and discuss operational data that show that integration of HPC and non-HPC (or general VCL) services in a cloud can substantially reduce the cost of delivering cloud services (down to cents per CPU hour).

California Integrated Service Delivery Evaluation Report. Phase I

ERIC Educational Resources Information Center

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

2010-01-01

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

Sharing Service Resource Information for Application Integration in a Virtual Enterprise - Modeling the Communication Protocol for Exchanging Service Resource Information

NASA Astrophysics Data System (ADS)

Yamada, Hiroshi; Kawaguchi, Akira

Grid computing and web service technologies enable us to use networked resources in a coordinated manner. An integrated service is made of individual services running on coordinated resources. In order to achieve such coordinated services autonomously, the initiator of a coordinated service needs to know detailed service resource information. This information ranges from static attributes like the IP address of the application server to highly dynamic ones like the CPU load. The most famous wide-area service discovery mechanism based on names is DNS. Its hierarchical tree organization and caching methods take advantage of the static information managed. However, in order to integrate business applications in a virtual enterprise, we need a discovery mechanism to search for the optimal resources based on the given a set of criteria (search keys). In this paper, we propose a communication protocol for exchanging service resource information among wide-area systems. We introduce the concept of the service domain that consists of service providers managed under the same management policy. This concept of the service domain is similar to that for autonomous systems (ASs). In each service domain, the service information provider manages the service resource information of service providers that exist in this service domain. The service resource information provider exchanges this information with other service resource information providers that belong to the different service domains. We also verified the protocol's behavior and effectiveness using a simulation model developed for proposed protocol.

Organizing integrated health-care services to meet older people's needs.

PubMed

Araujo de Carvalho, Islene; Epping-Jordan, JoAnne; Pot, Anne Margriet; Kelley, Edward; Toro, Nuria; Thiyagarajan, Jotheeswaran A; Beard, John R

2017-11-01

In most countries, a fundamental shift in the focus of clinical care for older people is needed. Instead of trying to manage numerous diseases and symptoms in a disjointed fashion, the emphasis should be on interventions that optimize older people's physical and mental capacities over their life course and that enable them to do the things they value. This, in turn, requires a change in the way services are organized: there should be more integration within the health system and between health and social services. Existing organizational structures do not have to merge; rather, a wide array of service providers must work together in a more coordinated fashion. The evidence suggests that integrated health and social care for older people contributes to better health outcomes at a cost equivalent to usual care, thereby giving a better return on investment than more familiar ways of working. Moreover, older people can participate in, and contribute to, society for longer. Integration at the level of clinical care is especially important: older people should undergo comprehensive assessments with the goal of optimizing functional ability and care plans should be shared among all providers. At the health system level, integrated care requires: (i) supportive policy, plans and regulatory frameworks; (ii) workforce development; (iii) investment in information and communication technologies; and (iv) the use of pooled budgets, bundled payments and contractual incentives. However, action can be taken at all levels of health care from front-line providers through to senior leaders - everyone has a role to play.

Patients’ Preference for Integrating Homoeopathy Services within the Secondary Health Care Settings in India

PubMed Central

Manchanda, Rajkumar; Koley, Munmun; Saha, Subhranil; Sarkar, Debabrata; Mondal, Ramkumar; Thakur, Prosenjit; Biswas, Debjyoti; Rawat, Birendra Singh; Rajachandrasekar, Bhuvaneswari; Mittal, Renu

2016-01-01

Indian patients’ preference for integrated homoeopathy services remains underresearched. Two earlier surveys revealed favorable attitude toward and satisfaction from integrated services. The objectives of this study were to examine knowledge, attitudes, and practice of homoeopathy and to evaluate preference toward its integration into secondary-level health care. A cross-sectional survey was conducted during May to October 2015 among 659 adult patients visiting randomly selected secondary-level conventional health care setups in Kolkata, Mumbai, Kottayam, and New Delhi (India) using a self-administered 24-item questionnaire in 4 local vernaculars (Bengali, Marathi, Malayalam, and Hindi). Knowledge and practice scores were compromised; attitude scores toward integration and legal regulation were high. Respondents were uncertain regarding side effects of homoeopathy and concurrent use and interactions with conventional medicines. A total of 82.40% (95% confidence interval = 79.23, 85.19) of the participants were in favor of integrating homoeopathy services. Preference was significantly higher in Delhi and lower in Kottayam. Probable strategic measures for further development of integrated models are discussed. PMID:27215693

On Line Service Composition in the Integrated Clinical Environment for eHealth and Medical Systems

PubMed Central

García-Valls, Marisol; Touahria, Imad Eddine

2017-01-01

Medical and eHealth systems are progressively realized in the context of standardized architectures that support safety and ease the integration of the heterogeneous (and often proprietary) medical devices and sensors. The Integrated Clinical Environment (ICE) architecture appeared recently with the goal of becoming a common framework for defining the structure of the medical applications as concerns the safe integration of medical devices and sensors. ICE is simply a high level architecture that defines the functional blocks that should be part of a medical system to support interoperability. As a result, the underlying communication backbone is broadly undefined as concerns the enabling software technology (including the middleware) and associated algorithms that meet the ICE requirements of the flexible integration of medical devices and services. Supporting the on line composition of services in a medical system is also not part of ICE; however, supporting this behavior would enable flexible orchestration of functions (e.g., addition and/or removal of services and medical equipment) on the fly. iLandis one of the few software technologies that supports on line service composition and reconfiguration, ensuring time-bounded transitions across different service orchestrations; it supports the design, deployment and on line reconfiguration of applications, which this paper applies to service-based eHealth domains. This paper designs the integration between ICE architecture and iLand middleware to enhance the capabilities of ICE with on line service composition and the time-bounded reconfiguration of medical systems based on distributed services. A prototype implementation of a service-based eHealth system for the remote monitoring of patients is described; it validates the enhanced capacity of ICE to support dynamic reconfiguration of the application services. Results show that the temporal cost of the on line reconfiguration of the eHealth application is bounded

On Line Service Composition in the Integrated Clinical Environment for eHealth and Medical Systems.

PubMed

García-Valls, Marisol; Touahria, Imad Eddine

2017-06-08

Medical and eHealth systems are progressively realized in the context of standardized architectures that support safety and ease the integration of the heterogeneous (and often proprietary) medical devices and sensors. The Integrated Clinical Environment (ICE) architecture appeared recently with the goal of becoming a common framework for defining the structure of the medical applications as concerns the safe integration of medical devices and sensors. ICE is simply a high level architecture that defines the functional blocks that should be part of a medical system to support interoperability. As a result, the underlying communication backbone is broadly undefined as concerns the enabling software technology (including the middleware) and associated algorithms that meet the ICE requirements of the flexible integration of medical devices and services. Supporting the on line composition of services in a medical system is also not part of ICE; however, supporting this behavior would enable flexible orchestration of functions (e.g., addition and/or removal of services and medical equipment) on the fly. iLandis one of the few software technologies that supports on line service composition and reconfiguration, ensuring time-bounded transitions across different service orchestrations; it supports the design, deployment and on line reconfiguration of applications, which this paper applies to service-based eHealth domains. This paper designs the integration between ICE architecture and iLand middleware to enhance the capabilities of ICE with on line service composition and the time-bounded reconfiguration of medical systems based on distributed services. A prototype implementation of a service-based eHealth system for the remote monitoring of patients is described; it validates the enhanced capacity of ICE to support dynamic reconfiguration of the application services. Results show that the temporal cost of the on line reconfiguration of the eHealth application is bounded

The politics of tuberculosis and HIV service integration in Ghana.

PubMed

Amo-Adjei, Joshua; Kumi-Kyereme, Akwasi; Fosuah Amo, Hannah; Awusabo-Asare, Kofi

2014-09-01

The need to integrate TB/HIV control programmes has become critical due to the comorbidity regarding these diseases and the need to optimise the use of resources. In developing countries such as Ghana, where public health interventions depend on donor funds, the integration of the two programmes has become more urgent. This paper explores stakeholders' views on the integration of TB/HIV control programmes in Ghana within the remits of contingency theory. With 31 purposively selected informants from four regions, semi-structured interviews and observations were conducted between March and May 2012, and the data collected were analysed using the inductive approach. The results showed both support for and opposition to integration, as well as some of the avoidable challenges inherent in combining TB/HIV control. While those who supported integration based their arguments on clinical synergies and the need to promote the efficient use of resources, those who opposed integration cited the potential increase in workload, the clinical complications associated with joint management, the potential for a leadership crisis, and the "smaller the better" propositions to support their stance. Although a policy on TB/HIV integration exists, inadequate 'political will' from the top management of both programmes has trickled down to lower levels, which has stifled progress towards the comprehensive management of TB/HIV and particularly leading to weak data collection and management structures and unsatisfactory administration of co-trimoxazole for co-infected patients. It is our view that the leadership of both programmes show an increased commitment to protocols involving the integration of TB/HIV, followed by a commitment to addressing the 'fears' of frontline service providers to encourage confidence in the process of service integration. Copyright © 2014 Elsevier Ltd. All rights reserved.

'Drug adherence levels are falling down again': health worker perceptions of women's service utilization before and after integration of HIV/AIDS services into general care in India.

PubMed

Shukla, Shrivridhi; Muchomba, Felix M; McCoyd, Judith L M

2018-06-01

Integrated models of HIV/AIDS service delivery are believed to have advantages over stand-alone models of care from health planners' and providers' perspectives. Integration models differ, yet there is little information about the influence of differing models on workers' beliefs about models' efficacy. Here, we examine the effect of integration of HIV care into the general health system in India. In 2014, India replaced its stand-alone model of HIV service delivery-Community Care Centers (CCCs)-with a purported integrated model that delivers HIV medical services at general hospitals and HIV psychosocial services at nearby Care and Support Centers (CSCs). We examine 15 health workers' perceptions of how change from the earlier stand-alone model to the current model impacted women's care in a district in Uttar Pradesh, India. Results indicate that (1) Women's antiretroviral (ART) adherence and utilization of psychosocial support service for HIV/AIDS suffered when services were not provided at one site; (2) Provision of inpatient care in the CCC model offered women living in poverty personal safety in accessing HIV health services and promoted chances of competent ART usage and repeat service utilization; and (3) Although integration of HIV services with the general health system was perceived to improve patient anonymity and decrease chances of HIV-related stigma and discrimination, resource shortages continued to plague the integrated system while shifting costs of time and money to the patients. Findings suggest that integration efforts need to consider the context of service provision and the gendered nature of access to HIV care.

Factors influencing the successful integration of ambulance volunteers and first responders into ambulance services.

PubMed

O'Meara, Peter; Tourle, Vianne; Rae, John

2012-09-01

This study identifies the factors associated with the successful integration of ambulance volunteers and first responders into major ambulance services in Australia and New Zealand and then proposes a model of volunteer management for ambulance services. All ten members of the Australasian Council of Ambulance Authorities completed a questionnaire describing their volunteer and first-responder staff, their numbers and deployment, and the management and integration of volunteers within their respective organisations. Eight senior managers responsible for ambulance volunteers and first responders from six States of Australia and one region of New Zealand subsequently participated in semistructured interviews. Analysis of interview transcripts and publicly available data revealed facilitative factors associated with strong, vibrant ambulance volunteer systems. These facilitative factors are commitment to volunteer models of service delivery; a degree of management decentralisation and volunteer input into decision-making; commitment of resources towards the volunteer model; and the organisational integration of volunteers into the ambulance service. The proposed facilitative model of volunteer management developed aims to encourage the adoption of positive and innovative strategies to improve the integration of ambulance volunteers and first responders in ambulance services. The model consists of four components: leadership; integrative processes; resource commitment; and relative autonomy. The first three of these relate directly to the organisation, while the fourth concerns the volunteers themselves. If these approaches were replicated more widely, a viable and effective volunteer emergency health response system could be established in those areas where it is uneconomic or impractical to provide a salaried ambulance service staffed with professionally qualified paramedics. © 2012 Blackwell Publishing Ltd.

Integrated Educational and Mental Health Services within a Day Treatment Setting.

ERIC Educational Resources Information Center

Francis, Greta; Radka, Dale F.

This paper discusses the integration of educational and mental health services for children and adolescents within a psychiatric day treatment setting at the Bradley School housed in a private psychiatric hospital affiliated with Brown University in Rhode Island. A full range of mental health services are used, and therapies are delivered in the…

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

PubMed

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

2018-07-01

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

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

PubMed

2005-03-01

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

Graph-Based Semantic Web Service Composition for Healthcare Data Integration

PubMed Central

2017-01-01

Within the numerous and heterogeneous web services offered through different sources, automatic web services composition is the most convenient method for building complex business processes that permit invocation of multiple existing atomic services. The current solutions in functional web services composition lack autonomous queries of semantic matches within the parameters of web services, which are necessary in the composition of large-scale related services. In this paper, we propose a graph-based Semantic Web Services composition system consisting of two subsystems: management time and run time. The management-time subsystem is responsible for dependency graph preparation in which a dependency graph of related services is generated automatically according to the proposed semantic matchmaking rules. The run-time subsystem is responsible for discovering the potential web services and nonredundant web services composition of a user's query using a graph-based searching algorithm. The proposed approach was applied to healthcare data integration in different health organizations and was evaluated according to two aspects: execution time measurement and correctness measurement. PMID:29065602

A systematic approach to the planning, implementation, monitoring, and evaluation of integrated health services.

PubMed

Reynolds, Heidi W; Sutherland, Elizabeth G

2013-05-06

Because of the current emphasis and enthusiasm focused on integration of health systems, there is a risk of piling resources into integrated strategies without the necessary systems in place to monitor their progress adequately or to measure impact, and to learn from these efforts. The rush to intervene without adequate monitoring and evaluation will continue to result in a weak evidence base for decision making and resource allocation. Program planning and implementation are inextricability linked to monitoring and evaluation. Country level guidance is needed to identify country-specific integrated strategies, thereby increasing country ownership. This paper focuses on integrated health services but takes into account how health services are influenced by the health system, managed by programs, and made up of interventions. We apply the principles in existing comprehensive monitoring and evaluation (M&E) frameworks in order to outline a systematic approach to the M&E of integration for the country level. The approach is grounded by first defining the country-specific health challenges that integration is intended to affect. Priority points of contact for care can directly influence health, and essential packages of integration for all major client presentations need to be defined. Logic models are necessary to outline the plausible causal pathways and define the inputs, roles and responsibilities, indicators, and data sources across the health system. Finally, we recommend improvements to the health information system and in data use to ensure that data are available to inform decisions, because changes in the M&E function to make it more integrated will also facilitate integration in the service delivery, planning, and governance components. This approach described in the paper is the ideal, but its application at the country level can help reveal gaps and guide decisions related to what health services to prioritize for integration, help plan for how to

Integration of HIV Care with Primary Health Care Services: Effect on Patient Satisfaction and Stigma in Rural Kenya

PubMed Central

Odeny, Thomas A.; Penner, Jeremy; Lewis-Kulzer, Jayne; Leslie, Hannah H.; Shade, Starley B.; Adero, Walter; Kioko, Jackson; Cohen, Craig R.; Bukusi, Elizabeth A.

2013-01-01

HIV departments within Kenyan health facilities are usually better staffed and equipped than departments offering non-HIV services. Integration of HIV services into primary care may address this issue of skewed resource allocation. Between 2008 and 2010, we piloted a system of integrating HIV services into primary care in rural Kenya. Before integration, we conducted a survey among returning adults ≥18-year old attending the HIV clinic. We then integrated HIV and primary care services. Three and twelve months after integration, we administered the same questionnaires to a sample of returning adults attending the integrated clinic. Changes in patient responses were assessed using truncated linear regression and logistic regression. At 12 months after integration, respondents were more likely to be satisfied with reception services (adjusted odds ratio, aOR 2.71, 95% CI 1.32–5.56), HIV education (aOR 3.28, 95% CI 1.92–6.83), and wait time (aOR 1.97 95% CI 1.03–3.76). Men's comfort with receiving care at an integrated clinic did not change (aOR = 0.46 95% CI 0.06–3.86). Women were more likely to express discomfort after integration (aOR 3.37 95% CI 1.33–8.52). Integration of HIV services into primary care services was associated with significant increases in patient satisfaction in certain domains, with no negative effect on satisfaction. PMID:23738055

76 FR 5834 - International Business Machines Corporation, Global Technology Services Business Unit, Integrated...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-02

... Expense Team, Payroll, Travel and Mobility Services Team, Working From Various States In the United States... Unit, Integrated Technology Services, Cost and Expense Team, working from various states in the United... reports that workers of the Payroll, Travel, and Mobility Services Team were part of the International...

Integrated Services Digital Networks: Concepts, Policies, and Emerging Issues.

ERIC Educational Resources Information Center

Wigand, Rolf T.

1988-01-01

Describes the nature and operations of Integrated Services Digital Networks (ISDN). Argues that while Western European nations have advanced centralized planning for the introduction of ISDN, the United States is proceeding slowly because of a lack of universal standards and the state of deregulatory policy. (MM)

Integrating service development with evaluation in telehealthcare: an ethnographic study.

PubMed

Finch, Tracy; May, Carl; Mair, Frances; Mort, Maggie; Gask, Linda

2003-11-22

To identify issues that facilitate the successful integration of evaluation and development of telehealthcare services. Ethnographic study using various qualitative research techniques to obtain data from several sources, including in-depth semistructured interviews, project steering group meetings, and public telehealthcare meetings. Seven telehealthcare evaluation projects (four randomised controlled trials and three pragmatic service evaluations) in the United Kingdom, studied over two years. Projects spanned a range of specialties-dermatology, psychiatry, respiratory medicine, cardiology, and oncology. Clinicians, managers, technical experts, and researchers involved in the projects. Key problems in successfully integrating evaluation and service development in telehealthcare are, firstly, defining existing clinical practices (and anticipating changes) in ways that permit measurement; secondly, managing additional workload and conflicting responsibilities brought about by combining clinical and research responsibilities (including managing risk); and, thirdly, understanding various perspectives on effectiveness and the limitations of evaluation results beyond the context of the research study. Combined implementation and evaluation of telehealthcare systems is complex, and is often underestimated. The distinction between quantitative outcomes and the workability of the system is important for producing evaluative knowledge that is of practical value. More pragmatic approaches to evaluation, that permit both quantitative and qualitative methods, are required to improve the quality of such research and its relevance for service provision in the NHS.

Nurses' Needs for Care Robots in Integrated Nursing Care Services.

PubMed

Lee, Jai-Yon; Song, Young Ae; Jung, Ji Young; Kim, Hyun Jeong; Kim, Bo Ram; Do, Hyun-Kyung; Lim, Jae-Young

2018-05-13

To determine the need for care robots among nurses and to suggest how robotic care should be prioritized in an integrated nursing care services. Korea is expected to be a super-aged society by 2030. To solve care issues with elderly inpatient caused by informal caregivers, the government introduced 'integrated nursing care services'; these are comprehensive care systems staffed by professionally trained nurses. To assist them, a care robot development project has been launched. The study applied a cross-sectional survey. In 2016, we conducted a multi-center survey involving 302 registered nurses in five hospitals including three tertiary and two secondary hospitals in Korea. The questionnaire consisted of general characteristics of nurses and their views on and extents of agreement about issues associated with robotic care. Trial center nurses and those with ≥10 years of experience reported positively on the prospects for robotic care. The top three desired primary roles for care robots were 'measuring/monitoring', 'mobility/activity' and 'safety care'. 'Reduction in workload', especially in terms of 'other nursing services' which were categorized as non-value-added nursing activities, was the most valued feature. The nurses approved of the aid by care robots but were concerned about device malfunction and interruption of rapport with patients. Care robots are expected to be effective in integrated nursing care services, particularly in 'measuring/monitoring'. Such robots should decrease nurses' workload and minimize non-value-added nursing activities efficiently. No matter how excellent care robots are, they must co-operate with and be controlled by nurses. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

PRISMA: Program of Research to Integrate the Services for the Maintenance of Autonomy. A system-level integration model in Quebec

PubMed Central

MacAdam, Margaret

2015-01-01

The Program of Research to Integrate the Services for the Maintenance of Autonomy (PRISMA) began in Quebec in 1999. Evaluation results indicated that the PRISMA Project improved the system of care for the frail elderly at no additional cost. In 2001, the Quebec Ministry of Health and Social Services made implementing the six features of the PRISMA approach a province-wide goal in the programme now known as RSIPA (French acronym). Extensive Province-wide progress has been made since then, but ongoing challenges include reducing unmet need for case management and home care services, creating incentives for increased physician participation in care planning and improving the computerized client chart, among others. PRISMA is the only evaluated international model of a coordination approach to integration and one of the few, if not the only, integration model to have been adopted at the system level by policy-makers. PMID:26417212

Pre-Service Physics and Chemistry Teachers' Conceptual Integration of Physics and Chemistry Concepts

ERIC Educational Resources Information Center

Tuysuz, Mustafa; Bektas, Oktay; Geban, Omer; Ozturk, Gokhan; Yalvac, Bugrahan

2016-01-01

This study examines the pre-service teachers' opinions about conceptual integration (CI) and their understanding of it. A qualitative phenomenology design was used in the study. Data was collected through in-depth semi-structured interviews comprising ten guiding questions. Three pre-service physics and three pre-service chemistry teachers…

Pre-Service Teachers' Use of a Technology Integration Planning Cycle: A Case Study

ERIC Educational Resources Information Center

Beschorner, Beth; Kruse, Jerrid

2016-01-01

This study explored pre-service teachers' use of Hutchison and Woodward's (2014) Technology Integration Planning Cycle for instructional lesson planning in literacy. Ten pre-service teachers enrolled in a course entitled Literacy Assessment and Instruction II participated. As part of the course, each pre-service teacher developed and delivered…

Integrating technology readiness into the expectation-confirmation model: an empirical study of mobile services.

PubMed

Chen, Shih-Chih; Liu, Ming-Ling; Lin, Chieh-Peng

2013-08-01

The aim of this study was to integrate technology readiness into the expectation-confirmation model (ECM) for explaining individuals' continuance of mobile data service usage. After reviewing the ECM and technology readiness, an integrated model was demonstrated via empirical data. Compared with the original ECM, the findings of this study show that the integrated model may offer an ameliorated way to clarify what factors and how they influence the continuous intention toward mobile services. Finally, the major findings are summarized, and future research directions are suggested.

Integrating adaptive management and ecosystem services concepts to improve natural resource management: Challenges and opportunities

USGS Publications Warehouse

Epanchin-Niell, Rebecca S.; Boyd, James W.; Macauley, Molly K.; Scarlett, Lynn; Shapiro, Carl D.; Williams, Byron K.

2018-05-07

Executive Summary—OverviewNatural resource managers must make decisions that affect broad-scale ecosystem processes involving large spatial areas, complex biophysical interactions, numerous competing stakeholder interests, and highly uncertain outcomes. Natural and social science information and analyses are widely recognized as important for informing effective management. Chief among the systematic approaches for improving the integration of science into natural resource management are two emergent science concepts, adaptive management and ecosystem services. Adaptive management (also referred to as “adaptive decision making”) is a deliberate process of learning by doing that focuses on reducing uncertainties about management outcomes and system responses to improve management over time. Ecosystem services is a conceptual framework that refers to the attributes and outputs of ecosystems (and their components and functions) that have value for humans.This report explores how ecosystem services can be moved from concept into practice through connection to a decision framework—adaptive management—that accounts for inherent uncertainties. Simultaneously, the report examines the value of incorporating ecosystem services framing and concepts into adaptive management efforts.Adaptive management and ecosystem services analyses have not typically been used jointly in decision making. However, as frameworks, they have a natural—but to date underexplored—affinity. Both are policy and decision oriented in that they attempt to represent the consequences of resource management choices on outcomes of interest to stakeholders. Both adaptive management and ecosystem services analysis take an empirical approach to the analysis of ecological systems. This systems orientation is a byproduct of the fact that natural resource actions affect ecosystems—and corresponding societal outcomes—often across large geographic scales. Moreover, because both frameworks focus on

Orion European Service Module (ESM) Development, Integration and Qualification Status

NASA Technical Reports Server (NTRS)

Berthe, Philippe; Over, Ann P.; Picardo, Michelle; Byers, Anthony W.

2017-01-01

ESA and the European Industry are supplying the European Service Module for Orion. An overview of the system and subsystem configuration of the Orion European Service Module (ESM) as designed and built for the EM-1 mission is provided as well as an outline of its development, assembly, integration and verification process performed by ESA and NASA in coordination with their respective Industrial prime contractors, Airbus Defence and Space and Lockheed Martin.

'Trust and teamwork matter': community health workers' experiences in integrated service delivery in India.

PubMed

Mishra, Arima

2014-01-01

A comprehensive and integrated approach to strengthen primary health care has been the major thrust of the National Rural Health Mission (NRHM) that was launched in 2005 to revamp India's rural public health system. Though the logic of horizontal and integrated health care to strengthen health systems has long been acknowledged at policy level, empirical evidence on how such integration operates is rare. Based on recent (2011-2012) ethnographic fieldwork in Odisha, India, this article discusses community health workers' experiences in integrated service delivery through village-level outreach sessions within the NRHM. It shows that for health workers, the notion of integration goes well beyond a technical lens of mixing different health services. Crucially, they perceive 'teamwork' and 'building trust with the community' (beyond trust in health services) to be critical components of their practice. However, the comprehensive NRHM primary health care ideology - which the health workers espouse - is in constant tension with the exigencies of narrow indicators of health system performance. Our ethnography shows how monitoring mechanisms, the institutionalised privileging of statistical evidence over field-based knowledge and the highly hierarchical health bureaucratic structure that rests on top-down communications mitigate efforts towards sustainable health system integration.

One stop shop versus collaborative integration: what is the best way of delivering sexual health services?

PubMed Central

French, R S; Coope, C M; Graham, A; Gerressu, M; Salisbury, C; Stephenson, J M; Team, and the One‐Stop Shop Evaluation

2006-01-01

Objectives To examine various models of integrated and/or one stop shop (OSS) sexual health services (including general practice, mainstream specialist services, and designated young people's services) and explore their relative strengths and weaknesses. Methods Literature review and interviews with key informants involved in developing the National Strategy for Sexual Health and HIV (n = 11). Results The paper focuses on five broad perspectives (logistics, public health, users, staff, and cost). Contraceptive and genitourinary medicine issues are closely related. However, there is no agreement about what is meant by having “integrated” services, about which services should be integrated, or where integration should happen. There are concerns that OSSs will result in over‐centralisation, to the disadvantage of stand alone and satellite services. OSS models are potentially more user focused, but the stigma that surrounds sexual health services may create an access barrier. From staff perspectives, the advantages are greater career opportunities and increased responsibility, while the disadvantages are concern that OSSs will result in loss of expertise and professional status. Cost effectiveness data are contradictory. Conclusion Although there is a policy commitment to look at how integrated services can be better developed, more evidence is required on the impact and appropriateness of this approach. PMID:16731668

Integrated Semantics Service Platform for the Internet of Things: A Case Study of a Smart Office

PubMed Central

Ryu, Minwoo; Kim, Jaeho; Yun, Jaeseok

2015-01-01

The Internet of Things (IoT) allows machines and devices in the world to connect with each other and generate a huge amount of data, which has a great potential to provide useful knowledge across service domains. Combining the context of IoT with semantic technologies, we can build integrated semantic systems to support semantic interoperability. In this paper, we propose an integrated semantic service platform (ISSP) to support ontological models in various IoT-based service domains of a smart city. In particular, we address three main problems for providing integrated semantic services together with IoT systems: semantic discovery, dynamic semantic representation, and semantic data repository for IoT resources. To show the feasibility of the ISSP, we develop a prototype service for a smart office using the ISSP, which can provide a preset, personalized office environment by interpreting user text input via a smartphone. We also discuss a scenario to show how the ISSP-based method would help build a smart city, where services in each service domain can discover and exploit IoT resources that are wanted across domains. We expect that our method could eventually contribute to providing people in a smart city with more integrated, comprehensive services based on semantic interoperability. PMID:25608216

Integrated semantics service platform for the Internet of Things: a case study of a smart office.

PubMed

Ryu, Minwoo; Kim, Jaeho; Yun, Jaeseok

2015-01-19

The Internet of Things (IoT) allows machines and devices in the world to connect with each other and generate a huge amount of data, which has a great potential to provide useful knowledge across service domains. Combining the context of IoT with semantic technologies, we can build integrated semantic systems to support semantic interoperability. In this paper, we propose an integrated semantic service platform (ISSP) to support ontological models in various IoT-based service domains of a smart city. In particular, we address three main problems for providing integrated semantic services together with IoT systems: semantic discovery, dynamic semantic representation, and semantic data repository for IoT resources. To show the feasibility of the ISSP, we develop a prototype service for a smart office using the ISSP, which can provide a preset, personalized office environment by interpreting user text input via a smartphone. We also discuss a scenario to show how the ISSP-based method would help build a smart city, where services in each service domain can discover and exploit IoT resources that are wanted across domains. We expect that our method could eventually contribute to providing people in a smart city with more integrated, comprehensive services based on semantic interoperability.

Maternal and child health and family planning service utilization in Guatemala: implications for service integration.

PubMed

Seiber, Eric E; Hotchkiss, David R; Rous, Jeffrey J; Berruti, Andrés A

2005-07-01

Does the utilization of modern maternal and child health (MCH) services influence subsequent contraceptive use? The answer to this question holds important implications for proposals which advocate MCH and family planning service integration. This study uses data from the 1995/6 Guatemalan Demographic Health Survey and its 1997 Providers Census to test the influence of MCH service utilization on individual contraceptive use decisions. We use a full-information maximum likelihood regression model to control for unobserved heterogeneity. This model produces estimates of the MCH effect, independent of individual women's underlying receptiveness to MCH and contraceptive messages. The results of the analysis indicate that the intensity of MCH service use is indeed positively associated with subsequent contraceptive use among Guatemalan women, even after controlling for observed and unobserved individual- , household- , and community-level factors. Importantly, this finding holds even after controlling for the unobserved factors that 'predispose' some women to use both types of services. Simulations reveal that, for these Guatemalan women, key determinants such as age and primary schooling work indirectly through MCH service use to increase contraceptive utilization.

The impact of HIV/SRH service integration on workload: analysis from the Integra Initiative in two African settings

PubMed Central

2014-01-01

Background There is growing interest in integration of HIV and sexual and reproductive health (SRH) services as a way to improve the efficiency of human resources (HR) for health in low- and middle-income countries. Although this is supported by a wealth of evidence on the acceptability and clinical effectiveness of service integration, there is little evidence on whether staff in general health services can easily absorb HIV services. Methods We conducted a descriptive analysis of HR integration through task shifting/sharing and staff workload in the context of the Integra Initiative - a large-scale five-year evaluation of HIV/SRH integration. We describe the level, characteristics and changes in HR integration in the context of wider efforts to integrate HIV/SRH, and explore the impact of HR integration on staff workload. Results Improvements in the range of services provided by staff (HR integration) were more likely to be achieved in facilities which also improved other elements of integration. While there was no overall relationship between integration and workload at the facility level, HIV/SRH integration may be most influential on staff workload for provider-initiated HIV testing and counselling (PITC) and postnatal care (PNC) services, particularly where HIV care and treatment services are being supported with extra SRH/HIV staffing. Our findings therefore suggest that there may be potential for further efficiency gains through integration, but overall the pace of improvement is slow. Conclusions This descriptive analysis explores the effect of HIV/SRH integration on staff workload through economies of scale and scope in high- and medium-HIV prevalence settings. We find some evidence to suggest that there is potential to improve productivity through integration, but, at the same time, significant challenges are being faced, with the pace of productivity gain slow. We recommend that efforts to implement integration are assessed in the broader context of HR

The impact of HIV/SRH service integration on workload: analysis from the Integra Initiative in two African settings.

PubMed

Sweeney, Sedona; Obure, Carol Dayo; Terris-Prestholt, Fern; Darsamo, Vanessa; Michaels-Igbokwe, Christine; Muketo, Esther; Nhlabatsi, Zelda; Warren, Charlotte; Mayhew, Susannah; Watts, Charlotte; Vassall, Anna

2014-08-07

There is growing interest in integration of HIV and sexual and reproductive health (SRH) services as a way to improve the efficiency of human resources (HR) for health in low- and middle-income countries. Although this is supported by a wealth of evidence on the acceptability and clinical effectiveness of service integration, there is little evidence on whether staff in general health services can easily absorb HIV services. We conducted a descriptive analysis of HR integration through task shifting/sharing and staff workload in the context of the Integra Initiative - a large-scale five-year evaluation of HIV/SRH integration. We describe the level, characteristics and changes in HR integration in the context of wider efforts to integrate HIV/SRH, and explore the impact of HR integration on staff workload. Improvements in the range of services provided by staff (HR integration) were more likely to be achieved in facilities which also improved other elements of integration. While there was no overall relationship between integration and workload at the facility level, HIV/SRH integration may be most influential on staff workload for provider-initiated HIV testing and counselling (PITC) and postnatal care (PNC) services, particularly where HIV care and treatment services are being supported with extra SRH/HIV staffing. Our findings therefore suggest that there may be potential for further efficiency gains through integration, but overall the pace of improvement is slow. This descriptive analysis explores the effect of HIV/SRH integration on staff workload through economies of scale and scope in high- and medium-HIV prevalence settings. We find some evidence to suggest that there is potential to improve productivity through integration, but, at the same time, significant challenges are being faced, with the pace of productivity gain slow. We recommend that efforts to implement integration are assessed in the broader context of HR planning to ensure that neither staff

TPACK Competencies and Technology Integration Self-Efficacy Perceptions of Pre-Service Teachers

ERIC Educational Resources Information Center

Keser, Hafize; Karaoglan Yilmaz, Fatma Gizem; Yilmaz, Ramazan

2015-01-01

This study compared the technological pedagogical content knowledge (TPACK) competency of pre-service teachers with their self-efficacy perception towards technology integration, based on various variables; and the correlation between their TPACK competencies and self-efficacy perceptions towards technology integration were examined. The study…

Assessing Patients' Preference for Integrating Herbal Medicine Within Primary Care Services in Saudi Arabia.

PubMed

Allam, Safaa; Moharam, Maha; Alarfaj, Gada

2014-07-01

Family physician advice and follow-up may be important to reduce the negative aspects of locally marketed herbal remedies and improve the patient outcome. There is a lack of studies assessing the preference of Saudi patients for the integration of herbal medicine into primary care services. To examine the knowledge, attitudes, and practice of Saudi patients toward herbal medicine and its integration into primary care services. A cross-sectional study was conducted between February and March 2013 among adult patients attending the family medicine clinics at a primary care center in Riyadh, Saudi Arabia. A self-administered questionnaire (27 items) was developed and administered to all patients. A total of 240 patients were included in the current analysis. The average age was 33.5 ± 9.9 years, and 61% of the patients were women. Approximately 60% of the patients were aware of herbal medicine use and its possible side effects. More than 85% of the patients believed that herbal containers should be labeled with safety information. Approximately 71% of the patients had a favorable attitude toward integrated services. Approximately 65% of the patients used herbal remedies for themselves, and 42% used them for their children. Preference for integrated services was significantly associated with female sex, better knowledge, positive attitudes toward safety and regulations, and higher level of practice. A good knowledge and a very favorable attitude toward integrating herbal medicine into primary care services were found among a group of patients attending a primary care center in Saudi Arabia. © The Author(s) 2014.

Technical and economic feasibility of integrated video service by satellite

NASA Technical Reports Server (NTRS)

Price, K. M.; Kwan, R. K.; White, L. W.; Garlow, R. K.; Henderson, T. R.

1992-01-01

A feasibility study is presented of utilizing modern satellite technology, or more advanced technology, to create a cost-effective, user-friendly, integrated video service, which can provide videophone, video conference, or other equivalent wideband service on demand. A system is described that permits a user to select a desired audience and establish the required links similar to arranging a teleconference by phone. Attention is given to video standards, video traffic scenarios, satellite system architecture, and user costs.

Pre-Service Teachers' Self-Efficacy Beliefs towards Educational Technologies Integration in Tanzania

ERIC Educational Resources Information Center

Raphael, Christina; Mtebe, Joel S.

2017-01-01

This study examines pre-service teachers' (N = 386) self-efficacy beliefs towards educational technologies integration in the classroom at the two colleges in Tanzania that prepare secondary education teachers. Using regression analysis, the study found out that the determinants of self-efficacy beliefs among pre-service teachers towards…

First, keep it safe: Integration of a complementary medicine service within a hospital.

PubMed

Schiff, Elad; Levy, Ilana; Arnon, Zahi; Ben-Arye, Eran; Attias, Samuel

2018-05-01

This paper sought to explore risk/safety considerations associated with the integration of a complementary medicine (CM) service within a public academic medical centre in Israel. We reviewed various sources pertaining to the CM service (interviews with CM staff, patients' electronic charts, service guidelines, correspondence with hospital administration) and conducted a thematic analysis to evaluate safety-related incidents during the 7 years of operation. In addition, we systematically assessed the charts for reports of treatment-associated adverse effects, which were documented in an obligatory field on treatment reports. After reviewing transcripts of interviews with 12 CM practitioners and with the director and vice-director of the CM service as well as transcripts of 8560 consultations that included 7383 treatments, we categorised 3 major domains of CM safety management: (i) prevention of safety-related incidents by appropriate selection of CM practitioners and modalities, (ii) actual adverse incidents and (iii) prevention of their recurrence using both hospital and CM service safety protocols. CM staff reported 5 categories of adverse incidents, most of which were minor. Twenty-nine adverse incidents were documented in the 7383 treatment sessions (0.4%). Safety management needs to be addressed both before introducing CM services in hospitals and throughout their integration. Important considerations for the safe integration of CM practices in the hospital include communication between CM and conventional practitioners, adherence to hospital safety rules, implementing a systematic approach for detecting and reporting safety-related incidents and continuous adaptation of the CM service safety protocols. © 2018 John Wiley & Sons Ltd.

Academic-Service Partnerships in Nursing: An Integrative Review

PubMed Central

Beal, Judy A.

2012-01-01

This integrative review summarizes currently available evidence on academic-service partnerships in the profession of nursing. More than 300 articles, published primarily in refereed journals, were accessed. Articles (110) were included in this review as they presented detailed and substantive information about any aspect of a nursing academic-service partnership. The majority were anecdotal in nature. Topics clustered around the following categories: pre-requisites for successful partnerships, benefits of partnerships, types of partnerships, and workforce development with its themes of academic-practice progression and educational re-design. Many examples of partnerships between academic and service settings were thoroughly described and best practices suggested, most often, however, without formal evaluation of outcomes. Nursing leaders in both settings have a long tradition of partnering with very little replicable evidence to support their efforts. It is critical that future initiatives evaluate the effectiveness of these partnerships, not only to ensure quality of patient outcomes but also to maximize efforts at building capacity for tomorrow's workforce. PMID:22548160

An Architecture for Standardized Terminology Services by Wrapping and Integration of Existing Applications

PubMed Central

Cornet, Ronald; Prins, Antoon K.

2003-01-01

Research on terminology services has resulted in development of applications and definition of standards, but has not yet led to widespread use of (standardized) terminology services in practice. Current terminology services offer functionality both for concept representation and lexical knowledge representation, hampering the possibility of combining the strengths of dedicated (concept and lexical) services. We therefore propose an extensible architecture in which concept-related and lexicon-related components are integrated and made available through a uniform interface. This interface can be extended in order to conform to existing standards, making it possible to use dedicated (third-party) components in a standardized way. As a proof of concept and a reference implementation, a SOAP-based Java implementation of the terminology service is being developed, providing wrappers for Protégé and UMLS Knowledge Source Server. Other systems, such as the Description Logic-based reasoner RACER can be easily integrated by implementation of an appropriate wrapper. PMID:14728158

Integrating service development with evaluation in telehealthcare: an ethnographic study

PubMed Central

Finch, Tracy; May, Carl; Mair, Frances; Mort, Maggie; Gask, Linda

2003-01-01

Objectives To identify issues that facilitate the successful integration of evaluation and development of telehealthcare services. Design Ethnographic study using various qualitative research techniques to obtain data from several sources, including in-depth semistructured interviews, project steering group meetings, and public telehealthcare meetings. Setting Seven telehealthcare evaluation projects (four randomised controlled trials and three pragmatic service evaluations) in the United Kingdom, studied over two years. Projects spanned a range of specialties—dermatology, psychiatry, respiratory medicine, cardiology, and oncology. Participants Clinicians, managers, technical experts, and researchers involved in the projects. Results and discussion Key problems in successfully integrating evaluation and service development in telehealthcare are, firstly, defining existing clinical practices (and anticipating changes) in ways that permit measurement; secondly, managing additional workload and conflicting responsibilities brought about by combining clinical and research responsibilities (including managing risk); and, thirdly, understanding various perspectives on effectiveness and the limitations of evaluation results beyond the context of the research study. Conclusions Combined implementation and evaluation of telehealthcare systems is complex, and is often underestimated. The distinction between quantitative outcomes and the workability of the system is important for producing evaluative knowledge that is of practical value. More pragmatic approaches to evaluation, that permit both quantitative and qualitative methods, are required to improve the quality of such research and its relevance for service provision in the NHS. PMID:14630758

HIV Education and Welfare Services in Primary Care: An Empirical Model of Integration in Brazil's Unified Health System.

PubMed

Rahman, Rahbel; Pinto, Rogério M; Wall, Melanie M

2017-03-14

Integration of health education and welfare services in primary care systems is a key strategy to solve the multiple determinants of chronic diseases, such as Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS). However, there is a scarcity of conceptual models from which to build integration strategies. We provide a model based on cross-sectional data from 168 Community Health Agents, 62 nurses, and 32 physicians in two municipalities in Brazil's Unified Health System (UHS). The outcome, service integration, comprised HIV education, community activities (e.g., health walks and workshops), and documentation services (e.g., obtainment of working papers and birth certificates). Predictors included individual factors (provider confidence, knowledge/skills, perseverance, efficacy); job characteristics (interprofessional collaboration, work-autonomy, decision-making autonomy, skill variety); and organizational factors (work conditions and work resources). Structural equation modeling was used to identify factors associated with service integration. Knowledge and skills, skill variety, confidence, and perseverance predicted greater integration of HIV education alongside community activities and documentation services. Job characteristics and organizational factors did not predict integration. Our study offers an explanatory model that can be adapted to examine other variables that may influence integration of different services in global primary healthcare systems. Findings suggest that practitioner trainings to improve integration should focus on cognitive constructs-confidence, perseverance, knowledge, and skills.

Improving the Work-Integrated Learning Experience through a Third-Party Advisory Service

ERIC Educational Resources Information Center

Jackson, Denise; Ferns, Sonia; Rowbottom, David; Mclaren, Diane

2017-01-01

This study trialled a Work-Integrated Learning (WIL) Advisory Service, provided by the Chamber of Commerce and Industry of Western Australia (CCIWA) in collaboration with four WA universities. The service was established to broker relationships between industry and universities, support employers engaged in WIL and enhance the WIL experience for…

Child welfare organizations: Do specialization and service integration impact placement decisions?

PubMed

Smith, Carrie; Fluke, John; Fallon, Barbara; Mishna, Faye; Decker Pierce, Barbara

2018-02-01

The objective of this study was to contribute to the understanding of the child welfare organization by testing the hypothesis that the characteristics of organizations influence decisions made by child protection staff for vulnerable children. The influence of two aspects of organizational structure on the decision to place a child in out-of-home care were examined: service integration and worker specialization. A theoretical framework that integrated the Decision-Making Ecology Framework (Baumann et al., 2011) and Yoo et al. (2007) conceptual framework of organizational constructs as predictors of service effectiveness was tested. Secondary data analysis of the Ontario Incidence Study of Reported Child Abuse and Neglect - 2013 (OIS-2013) was conducted. A subsample of 4949 investigations from 16 agencies was included in this study. Given the nested structure of the data, multi-level modelling was used to test the relative contribution of case and organizational factors to the decision to place. Despite the reported differences among child welfare organizations and research that has demonstrated variance in the placement decision as a result of organizational factors, the structure of the organization (i.e., worker specialization and service integration) showed no predictive power in the final models. The lack of variance may be explained by the relatively low frequency of placements during the investigation phase of service, the hierarchical impact of the factors of the DME and the limited information available regarding the structure of child welfare organizations in Ontario. Suggestions for future research are provided. Copyright © 2017 Elsevier Ltd. All rights reserved.

Semantic Repositories for eGovernment Initiatives: Integrating Knowledge and Services

NASA Astrophysics Data System (ADS)

Palmonari, Matteo; Viscusi, Gianluigi

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

Integration of prevention of mother-to-child HIV transmission into maternal health services in Senegal.

PubMed

Cisse, C

2017-06-01

The objective of this study was to assess the level of integration of prevention of mother-to-child HIV transmission (PMTCT) in facilities providing services for maternal, newborn, and child health (MNCH) and reproductive health (RH) in Senegal. The survey, conducted from August through November, 2014, comprised five parts : a literature review to assess the place of this integration in the health policies, standards, and protocols in effect in Senegal; an analysis by direct observation of attitudes and practices of 25 healthcare providers at 5 randomly-selected obstetrics and gynecology departments representative of different levels of the health pyramid; a questionnaire evaluating knowledge and attitudes of 10 providers about the integration of PMTCT services into MNCH/RH facilities; interviews to collect the opinions of 70 clients, including 16 HIV-positive, about the quality of PMTCT services they received; and a questionnaire evaluating knowledge and opinions of 14 policy-makers/managers of health programs focusing on mothers and children about this integration. The literature review revealed several constraints impeding this integration : the policy documents, standards, and protocols of each of the programs involved do not clearly indicate the modalities of this integration; the programs are housed in two different divisions while the national Program against the Human Immunodeficiency Virus reports directly to the Prime Minister; program operations remains generally vertical; the resources for the different programs are not sufficiently shared; there is no integrated training module covering integrated management of pregnancy and delivery; and supervision for each of the different programs is organized separately.The observation of the providers supporting women during pregnancy, during childbirth, and in the postpartum period, showed an effort to integrate PMTCT into the MNCH/RH services delivered daily to clients. But this desire is hampered by many

Development of Integrated Public Administration Custom Services in Hungary.

PubMed

Laki, Tamas

2015-01-01

The paper is a case-study introducing a national project in Hungary establishing a countrywide public administration customer service system where accessibility was a key issue. Starting from the concept the paper describes the methods and organisational background how accessible design was integrated in the planning method and gives a feedback of site experiences.

The EPOS Implementation Phase: building thematic and integrated services for solid Earth sciences

NASA Astrophysics Data System (ADS)

Cocco, Massimo; Epos Consortium, the

2015-04-01

integrating RI elements. This integration requires a significant coordination between, among others, disciplinary (thematic) communities, national RIs policies and initiatives, as well as geo- and IT-scientists. The RIs that EPOS is coordinating include: i) regionally-distributed geophysical observing systems (seismological and geodetic networks); ii) local observatories (including geomagnetic, near-fault and volcano observatories); iii) analytical and experimental laboratories; iv) integrated satellite data and geological information services v) new services for natural and anthropogenic hazards. Here we present the successful story of the EPOS Preparatory Phase and the progress towards the implementation of both integrated core services (ICS) and thematic core services (TCS) for the different communities participating to the integration plan. We aim to discuss the achieved results and the approach followed to design the implementation phase. The goal is to present and discuss the strategies adopted to foster the implementation of TCS, clarifying their crucial role as domain-specific service hubs for coordinating and harmonizing national resources/plans with the European dimension of EPOS, and their integration to develop the new ICS. We will present the prototype of the ICS central hub as a key contribution for providing multidisciplinary services for solid Earth sciences as well as the glue to keep ICT aspects integrated and rationalized across EPOS. Finally, we will discuss the well-defined role of the EPOS-ERIC Headquarter to coordinate and harmonize national RIs and EPOS services (through ICS and TCS) looking for an effective commitment by national governments. It will be an important and timely opportunity to discuss the EPOS roadmap toward the operation of the novel multidisciplinary platform for discoveries to foster scientific excellence in solid Earth sciences.

Organizational change for services integration in public human service organizations: experiences in seven counties.

PubMed

Packard, Thomas; Patti, Rino; Daly, Donna; Tucker-Tatlow, Jennifer

2012-01-01

This is a study of organizational change strategies employed in seven county human service agencies to improve the coordination of services through the structural integration of previously free standing organizations or the development of voluntary interagency collaborative service delivery systems. The central question involves the identification of organizational change tactics which contributed to the success of the organizational change initiatives. The literature on organizational change is reviewed, with particular attention to a framework developed by Fernandez and Rainey based on their extensive review and synthesis of the research on successful change strategies in the public and business sectors. Qualitative and quantitative data were gathered from over 250 individuals and from agency documents. Findings are compared with the success factors identified by Fernandez and Rainey, and refinements to their propositions are suggested. More precise methods for measuring successful and unsuccessful change initiatives are suggested. Implications for practice and research are presented.

Jordanian Pre-Service Teachers' and Technology Integration: A Human Resource Development Approach

ERIC Educational Resources Information Center

Al-Ruz, Jamal Abu; Khasawneh, Samer

2011-01-01

The purpose of this study was to test a model in which technology integration of pre-service teachers was predicted by a number of university-based and school-based factors. Initially, factors affecting technology integration were identified, and a research-based path model was developed to explain causal relationships between these factors. The…

Research into the influence of internal interdepartmental integration on service innovation and customer loyalty

NASA Astrophysics Data System (ADS)

Huang, Jui-Chan; Wu, Tzu-Jung; Wen, Hao-Ming; Hsin-Fei, Wu; Hairui, Ji

2017-06-01

It is the most important for the company to improve customer value and customer loyalty through service innovation. However, at present, only researches related to organizations or consumer behaviors are conducted, there is rare research into the combination between organization level and consumer behavior, and this research tries to explore this aspect, which is the motivation and contribution of this research. This research aims to explore the relationship between "Interdepartmental Integration", "Service Innovation" and "Customer Loyalty", according to the analysis results, the relationship between "interdepartmental integration and service innovation" and "service innovation and customer loyalty" has a low positive correlation and it reaches significant level; it shows the relationship between "interdepartmental interaction and progressive innovation" and "interdepartmental collaboration and fundamental innovation" is significant.

General practice integration in Australia. Primary health services provider and consumer perceptions of barriers and solutions.

PubMed

Appleby, N J; Dunt, D; Southern, D M; Young, D

1999-08-01

To identify practical examples of barriers and possible solutions to improve general practice integration with other health service providers. Twelve focus groups, including one conducted by teleconference, were held across Australia with GPs and non GP primary health service providers between May and September, 1996. Focus groups were embedded within concept mapping sessions, which were used to conceptually explore the meaning of integration in general practice. Data coding, organising and analysis were based on the techniques documented by Huberman and Miles. Barriers to integration were perceived to be principally due to the role and territory disputes between the different levels of government and their services, the manner in which the GP's role is currently defined, and the system of GP remuneration. Suggestions on ways to improve integration involved two types of strategies. The first involves initiatives implemented 'top down' through major government reform to service structures, including the expansion of the role of divisions of general practice, and structural changes to the GP remuneration systems. The second type of strategy suggested involves initiatives implemented from the 'bottom up' involving services such as hospitals (e.g. additional GP liaison positions) and the use of information technology to link services and share appropriate patient data. The findings support the need for further research and evaluation of initiatives aimed at achieving general practice integration at a systems level. There is little evidence to suggest which types of initiatives improve integration. However, general practice has been placed in the centre of the health care debate and is likely to remain central to the success of such initiatives. Clarification of the future role and authority of general practice will therefore be required if such integrative strategies are to be successful at a wider health system level.

Preference of methadone maintenance patients for the integrative and decentralized service delivery models in Vietnam.

PubMed

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

2015-09-17

Integrating and decentralizing services are essential to increase the accessibility and provide comprehensive care for methadone patients. Moreover, they assure the sustainability of a HIV/AIDS prevention program by reducing the implementation cost. This study aimed to measure the preference of patients enrolling in a MMT program for integrated and decentralized MMT clinics and then further examine related factors. A cross-sectional study was conducted among 510 patients receiving methadone at 3 clinics in Hanoi. Structured questionnaires were used to collect data about the preference for integrated and decentralized MMT services. Covariates including socio-economic status; health-related quality of life (using EQ-5D-5 L instrument) and HIV status; history of drug use along with MMT treatment; and exposure to the discrimination within family and community were also investigated. Multivariate logistic regression with polynomial fractions was used to identify the determinants of preference for integrative and decentralized models. Of 510 patients enrolled, 66.7 and 60.8 % preferred integrated and decentralized models, respectively. The main reason for preferring the integrative model was the convenience of use of various services (53.2 %), while more privacy (43.5 %) was the primary reason to select stand-alone model. People preferred the decentralized model primarily because of travel cost reduction (95.0 %), while the main reason for not selecting the model was increased privacy (7.7 %). After adjusting for covariates, factors influencing the preference for integrative model were poor socioeconomic status, anxiety/depression, history of drug rehabilitation, and ever disclosed health status; while exposure to community discrimination inversely associated with this preference. In addition, people who were self-employed, had a longer duration of MMT, and use current MMT with comprehensive HIV services were less likely to select decentralized model. In conclusion

Factors influencing integration of TB services in general hospitals in two regions of China: a qualitative study

PubMed Central

2012-01-01

Background In the majority of China, the Centre for Disease Control (CDC) at the county level provides both clinical and public health care for TB cases, with hospitals and other health facilities referring suspected TB cases to the CDC. In recent years, an integrated model has emerged, where the CDC remains the basic management unit for TB control, while a general hospital is designated to provide clinical care for TB patients. This study aims to explore the factors that influence the integration of TB services in general hospitals and generate knowledge to aid the scale-up of integration of TB services in China. Methods This study adopted a qualitative approach using interviews from sites in East and West China. Analysis was conducted using a thematic framework approach. Results The more prosperous site in East China was more coordinated and thus had a better method of resource allocation and more patient-orientated service, compared with the poorer site in the West. The development of public health organizations appeared to influence how effectively integration occurred. An understanding from staff that hospitals had better capacity to treat TB patients than CDCs was a strong rationale for integration. However, the economic and political interests might act as a barrier to effective integration. Both sites shared the same challenges of attracting and retaining a skilled workforce for the TB services. The role of the health bureau was more directive in the Western site, while a more participatory and collaborative approach was adopted in the Eastern site. Conclusion The process of integration identifies similarities and differences between sites in more affluent East China and poorer West China. Integration of TB services in the hospitals needs to address the challenges of stakeholder motivations and resource allocation. Effective inter-organizational collaboration could help to improve the efficiency and quality of TB service. Key words: TB control, service

The European Plate Observing System (EPOS): Integrating Thematic Services for Solid Earth Science

NASA Astrophysics Data System (ADS)

Atakan, Kuvvet; Bailo, Daniele; Consortium, Epos

2016-04-01

The mission of EPOS is to monitor and understand the dynamic and complex Earth system by relying on new e-science opportunities and integrating diverse and advanced Research Infrastructures in Europe for solid Earth Science. EPOS will enable innovative multidisciplinary research for a better understanding of the Earth's physical and chemical processes that control earthquakes, volcanic eruptions, ground instability and tsunami as well as the processes driving tectonics and Earth's surface dynamics. Through integration of data, models and facilities EPOS will allow the Earth Science community to make a step change in developing new concepts and tools for key answers to scientific and socio-economic questions concerning geo-hazards and geo-resources as well as Earth sciences applications to the environment and to human welfare. EPOS, during its Implementation Phase (EPOS-IP), will integrate multidisciplinary data into a single e-infrastructure. Multidisciplinary data are organized and governed by the Thematic Core Services (TCS) and are driven by various scientific communities encompassing a wide spectrum of Earth science disciplines. These include Data, Data-products, Services and Software (DDSS), from seismology, near fault observatories, geodetic observations, volcano observations, satellite observations, geomagnetic observations, as well as data from various anthropogenic hazard episodes, geological information and modelling. In addition, transnational access to multi-scale laboratories and geo-energy test-beds for low-carbon energy will be provided. TCS DDSS will be integrated into Integrated Core Services (ICS), a platform that will ensure their interoperability and access to these services by the scientific community as well as other users within the society. This requires dedicated tasks for interactions with the various TCS-WPs, as well as the various distributed ICS (ICS-Ds), such as High Performance Computing (HPC) facilities, large scale data storage

Effect of organizational and environmental factors on service differentiation strategy of integrated healthcare networks.

PubMed

Lin, Y J; Wan, T T

2001-02-01

During the past decade, the missions/goals of medical providers of healthcare services in the United States have shifted--from emphasizing individual, independent illness treatments to focusing on the continuum of care, population-based wellness, and providing the appropriate care in the most efficient way. Integrated healthcare networks (IHNs)--or integrated healthcare delivery systems--have been focusing heavily on their level of various partnership integration (i.e. service differentiation strategy) in order to offer a full continuum of care. The aim of this study, using the individual IHN as the unit of analysis, was to identify organizational and environmental factors that influence IHN administrators to focus on their service differentiation of market lines, including the establishment of third-party payers' contracts, the affiliation of managed-care organizations, and the alliances of various nonhospital medical providers, to provide a continuum of care. The study findings show that tax status of an IHN, its age, and market competition affect its service differentiation strategy in the provision of a full continuum of care.

Implementing PEHR: Design and Integration of a Consent Creator Service.

PubMed

Weiss, Nicolas; Aguduri, Lakshmi S; Yüksekogul, Nilay; Schreiweis, Björn; Brandner, Antje; Bronsch, Tobias; Pensold, Peter; Stein, Katharina E; Bergh, Björn; Heinze, Oliver

2016-01-01

Giving the patient full control over his medical data electronically remains one of the most discussed topics in healthcare today. The INFOPAT project in the Rhine-Neckar region focuses on a personal cross-enterprise electronic health record (PEHR) in which the patient plays a major role. Thus, he should be provided with the possibility of granting access to his medical data which could be realized using a consent creator service. This paper presents a user interface concept for such a service as well as aspects for the technical implementation. In addition, a pattern for integrating the service into an existing IHE based infrastructure is shown. These concepts could be further adapted for improving patient empowerment in health care projects.

Optimation of Operation System Integration between Main and Feeder Public Transport (Case Study: Trans Jakarta-Kopaja Bus Services)

NASA Astrophysics Data System (ADS)

Miharja, M.; Priadi, Y. N.

2018-05-01

Promoting a better public transport is a key strategy to cope with urban transport problems which are mostly caused by a huge private vehicle usage. A better public transport service quality not only focuses on one type of public transport mode, but also concerns on inter modes service integration. Fragmented inter mode public transport service leads to a longer trip chain as well as average travel time which would result in its failure to compete with a private vehicle. This paper examines the optimation process of operation system integration between Trans Jakarta Bus as the main public transport mode and Kopaja Bus as feeder public transport service in Jakarta. Using scoring-interview method combined with standard parameters in operation system integration, this paper identifies the key factors that determine the success of the two public transport operation system integrations. The study found that some key integration parameters, such as the cancellation of “system setoran”, passenger get in-get out at official stop points, and systematic payment, positively contribute to a better service integration. However, some parameters such as fine system, time and changing point reliability, and information system reliability are among those which need improvement. These findings are very useful for the authority to set the right strategy to improve operation system integration between Trans Jakarta and Kopaja Bus services.

Glycyrrhizic acid ameliorates myocardial ischemic injury by the regulation of inflammation and oxidative state.

PubMed

Xu, Chongli; Liang, Caihong; Sun, Weixin; Chen, Jiandong; Chen, Xiaohu

2018-01-01

Glycyrrhizic acid (GA), a bioactive triterpenoid saponin isolated from the roots of licorice plants ( Glycyrrhiza glabra ), has been shown to exert a variety of pharmacological activities and is considered to have potential therapeutic applications. The purpose of the present study was to investigate the cardioprotective effect of GA on myocardial ischemia (MI) injury rats induced by isoproterenol (ISO), and explore the potential mechanisms underlying these effects. The rats were randomized into five groups: control, ISO, ISO+diltiazem (10 mg/kg), ISO+GA (10 mg/kg), and ISO+GA (20 mg/kg). Electrocardiogram and histopathological examination were performed. Markers of cardiac marker enzymes (creatine kinase-MB, lactate dehydrogenase), oxidative stress (superoxide dismutase, malondialdehyde [MDA]), and inflammation (TNF-α, IL-1β, and IL-6) were also measured in each group. Proteins involved in NF-κB and Nrf-2/HO-1 pathway were detected by Western blot. GA decreased the ST elevation induced by MI, decreased serum levels of creatine kinase, lactate dehydrogenase, malondialdehyde, IL-6, IL-1β, and TNF-α, and increased serum superoxide dismutase and malondialdehyde activities. Furthermore, GA increased the protein levels of Nrf-2 and HO-1 and downregulated the phosphorylation of IκB, and NF-κB p65 in ISO-induced MI. These observations indicated that GA has cardioprotective effects against MI, and these effects might be related to the activation of Nrf-2/HO-1 and inhibition of NF-κB signaling pathway in the myocardium.

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

ERIC Educational Resources Information Center

Center for Rural Pennsylvania, Harrisburg.

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

Evaluating the Early Impact of Integrated Children's Services. Round 1 Summary Report

ERIC Educational Resources Information Center

Lord, Pippa; Kinder, Kay; Wilkin, Anne; Atkinson, Mary; Harland, Jennie

2008-01-01

In early 2007, at the start of the Local Authorities Research Consortium's (LARC's) first year of work, local authorities (LAs) wanted to know if integration of services was having an impact on outcomes. One year on, the question has become--how can we make integrated working deliver better outcomes faster and more consistently? The shift in…

"We are all in this together": integrated health service plans in Ontario.

PubMed

Eliasoph, Hy; Monaghan, Barry; Beaudoin, Rémy; Cushman, Robert; DuBois-Wing, Gwen; Emery, Marilyn J; Fenn, W Michael; Hanmer, Sandra J; Huras, Paul; Lowi-Young, Mimi; Mandy, Pat; Trimnell, Jean; Switzer, Garry; Woolgar, Tony; Butler, John

2007-01-01

Ontario's 14 Local Health Integration Networks (LHINs) produced their first major deliverable when they issued their integrated health service plans in October 2006. This article reviews the experience of LHINs in meeting this challenge, outlines the process and outcome dimensions of the plans and discusses eight opportunities for LHINs as they act on the basis of their plans.

Social Cognitive Predictors of Pre-Service Teachers' Technology Integration Performance

ERIC Educational Resources Information Center

Perkmen, Serkan; Pamuk, Sonmez

2011-01-01

The main objective of the study was to examine interrelationships among social cognitive variables (self-efficacy, outcome expectations, and performance goals) and their role in predicting pre-service teachers' technology integration performance. Although researchers have examined the role of these variables in the teacher-education context, the…

Insights from a pilot program to integrate medical and social services.

PubMed

Meiners, Mark R; Mokler, Pamela M; Kasunic, Mary Lynn; Hawthornthwaite, Scott; Foster, Susan; Scheer, David; Maldonado, Anna Maria

2014-01-01

This study examines lessons learned from the design, implementation, and early results of an integrated managed care pilot program linking member benefits of a Medicare-Medicaid health care plan with community services and supports. The health plan's average monthly costs for members receiving an assessment and services declined by an economically meaningful, statistically significant amount in the postintervention period relative to the preintervention period compared with those who did not accept an assessment or services. The results along with the lesson learned from the pilot are viewed by the parties as supportive of further program development.

Building Thematic and Integrated Services for European Solid Earth Sciences: the EPOS Integrated Approach

NASA Astrophysics Data System (ADS)

Harrison, M.; Cocco, M.

2017-12-01

EPOS (European Plate Observing System) has been designed with the vision of creating a pan-European infrastructure for solid Earth science to support a safe and sustainable society. In accordance with this scientific vision, the EPOS mission is to integrate the diverse and advanced European Research Infrastructures for solid Earth science relying on new e-science opportunities to monitor and unravel the dynamic and complex Earth System. EPOS will enable innovative multidisciplinary research for a better understanding of the Earth's physical and chemical processes that control earthquakes, volcanic eruptions, ground instability and tsunami as well as the processes driving tectonics and Earth's surface dynamics. To accomplish its mission, EPOS is engaging different stakeholders, to allow the Earth sciences to open new horizons in our understanding of the planet. EPOS also aims at contributing to prepare society for geo-hazards and to responsibly manage the exploitation of geo-resources. Through integration of data, models and facilities, EPOS will allow the Earth science community to make a step change in developing new concepts and tools for key answers to scientific and socio-economic questions concerning geo-hazards and geo-resources as well as Earth sciences applications to the environment and human welfare. The research infrastructures (RIs) that EPOS is coordinating include: i) distributed geophysical observing systems (seismological and geodetic networks); ii) local observatories (including geomagnetic, near-fault and volcano observatories); iii) analytical and experimental laboratories; iv) integrated satellite data and geological information services; v) new services for natural and anthropogenic hazards; vi) access to geo-energy test beds. Here we present the activities planned for the implementation phase focusing on the TCS, the ICS and on their interoperability. We will discuss the data, data-products, software and services (DDSS) presently under

Proposal of a service delivery integration index of home care for older persons: application in several European cities

PubMed Central

Henrard, Jean-Claude; Ankri, Joël; Frijters, Dinnus; Carpenter, Iain; Topinkova, Eva; Garms-Homolova, Vjenka; Finne-Soveri, Harriett; Sørbye, Liv Wergeland; Jónsson, Palmi V.; Ljunggren, Gunnar; Schroll, Marianne; Wagner, Cordula; Bernabei, Roberto

2006-01-01

Abstract Purpose To propose an integration index of home care delivery to older persons, to study its validity and to apply it to home care services of European cities. Theory Home care delivery integration was based on two dimensions referring to process-centred integration and organisational structure approach. Method Items considered as part of both dimensions according to an expert consensus (face validity) were extracted from a standardised questionnaire used in “Aged in Home care” (AdHoc) study to capture basic characteristics of home care services. Their summation leads to a services' delivery integration index. This index was applied to AdHoc services. A factor analysis was computed in order to empirically test the validity of the theoretical constructs. The plot of the settings was performed. Results Application of the index ranks home care services in four groups according to their score. Factor analysis identifies a first factor which opposes working arrangement within service to organisational structure bringing together provisions for social care. A second factor corresponds to basic nursing care and therapies. Internal consistency for those three domains ranges from 0.78 to 0.93. When plotting the different settings different models of service delivery appear. Conclusion The proposed index shows that behind a total score several models of care delivery are hidden. Comparison of service delivery integration should take into account this heterogeneity. PMID:17006549

Hybrid High-Impact Pedagogies: Integrating Service-Learning with Three Other High-Impact Pedagogies

ERIC Educational Resources Information Center

Bringle, Robert G.

2017-01-01

This article proposes enhancing student learning through civic engagement by considering the advantages of integrating service-learning with study away, research, and internships and pre-professional courses into first-order, second-order, and third-order hybrid high-impact pedagogies. Service-learning contributes numerous attributes to the other…

Service-Learning Integrated throughout a College of Engineering (SLICE)

ERIC Educational Resources Information Center

Duffy, John; Barrington, Linda; West, Cheryl; Heredia, Manuel; Barry, Carol

2011-01-01

In the fall of 2004 a college began a program to integrate service-learning (S-L) projects into required engineering courses throughout the curriculum, so that students would be exposed to S-L in at least one course in each of eight semesters. The ultimate goal is to graduate better engineers and more engaged citizens and to improve communities,…

Implementation of Integrated Service Networks under the Quebec Mental Health Reform: Facilitators and Barriers associated with Different Territorial Profiles.

PubMed

Fleury, Marie-Josée; Grenier, Guy; Vallée, Catherine; Aubé, Denise; Farand, Lambert

2017-03-10

This study evaluates implementation of the Quebec Mental Health Reform (2005-2015), which promoted the development of integrated service networks, in 11 local service networks organized into four territorial groups according to socio-demographic characteristics and mental health services offered. Data were collected from documents concerning networks; structured questionnaires completed by 90 managers and by 16 respondent-psychiatrists; and semi-structured interviews with 102 network stakeholders. Factors associated with implementation and integration were organized according to: 1) reform characteristics; 2) implementation context; 3) organizational characteristics; and 4) integration strategies. While local networks were in a process of development and expansion, none were fully integrated at the time of the study. Facilitators and barriers to implementation and integration were primarily associated with organizational characteristics. Integration was best achieved in larger networks including a general hospital with a psychiatric department, followed by networks with a psychiatric hospital. Formalized integration strategies such as service agreements, liaison officers, and joint training reduced some barriers to implementation in networks experiencing less favourable conditions. Strategies for the implementation of healthcare reform and integrated service networks should include sustained support and training in best-practices, adequate performance indicators and resources, formalized integration strategies to improve network coordination and suitable initiatives to promote staff retention.

HIV Education and Welfare Services in Primary Care: An Empirical Model of Integration in Brazil’s Unified Health System

PubMed Central

Rahman, Rahbel; Pinto, Rogério M.; Wall, Melanie M.

2017-01-01

Integration of health education and welfare services in primary care systems is a key strategy to solve the multiple determinants of chronic diseases, such as Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS). However, there is a scarcity of conceptual models from which to build integration strategies. We provide a model based on cross-sectional data from 168 Community Health Agents, 62 nurses, and 32 physicians in two municipalities in Brazil’s Unified Health System (UHS). The outcome, service integration, comprised HIV education, community activities (e.g., health walks and workshops), and documentation services (e.g., obtainment of working papers and birth certificates). Predictors included individual factors (provider confidence, knowledge/skills, perseverance, efficacy); job characteristics (interprofessional collaboration, work-autonomy, decision-making autonomy, skill variety); and organizational factors (work conditions and work resources). Structural equation modeling was used to identify factors associated with service integration. Knowledge and skills, skill variety, confidence, and perseverance predicted greater integration of HIV education alongside community activities and documentation services. Job characteristics and organizational factors did not predict integration. Our study offers an explanatory model that can be adapted to examine other variables that may influence integration of different services in global primary healthcare systems. Findings suggest that practitioner trainings to improve integration should focus on cognitive constructs—confidence, perseverance, knowledge, and skills. PMID:28335444

Reinforcing integrated psychiatric service attendance in an opioid-agonist program: a randomized and controlled trial.

PubMed

Kidorf, Michael; Brooner, Robert K; Gandotra, Neeraj; Antoine, Denis; King, Van L; Peirce, Jessica; Ghazarian, Sharon

2013-11-01

The benefits of integrating substance abuse and psychiatric care may be limited by poor service utilization. This randomized clinical trial evaluated the efficacy of using contingency management to improve utilization of psychiatric services co-located and integrated within a community-based methadone maintenance treatment program. Opioid-dependent outpatients (n=125) with any current psychiatric disorder were randomly assigned to: (1) reinforced on-site integrated care (ROIC), with vouchers (worth $25.00) contingent on full adherence to each week of scheduled psychiatric services; or (2) standard on-site integrated care (SOIC). All participants received access to the same schedule of psychiatrist and mental health counseling sessions for 12-weeks. ROIC participants attended more overall psychiatric sessions at month 1 (M=7.53 vs. 3.97, p<.001), month 2 (M=6.31 vs. 2.81, p<.001), and month 3 (M=5.71 vs. 2.44, p<.001). Both conditions evidenced reductions in psychiatric distress (p<.001) and similar rates of drug-positive urine samples. No differences in study retention were observed. These findings suggest that contingency management can improve utilization of psychiatric services scheduled within an on-site and integrated treatment model. Delivering evidenced-based mental health counseling, or modifying the contingency plan to include illicit drug use, may be required to facilitate greater changes in psychiatric and substance abuse outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Integration initiatives for forensic services

PubMed Central

ARBOLEDA-FLÓREZ, JULIO

2003-01-01

Poorly implemented mental health reform policies are often given as reasons for the growth in demands for forensic psychiatric services and the steady increase of mental patients in prison systems. However, in this paper, additional reasons are advanced to explain the growth of forensic psychiatry, such as an expansion in the types of "psychiatric defences" in courts of law; public concerns about violent behaviour attributed to the mentally ill; the community management of paraphilias, especially pedophilia; the development of risk assessment methodologies and the halo of super-specialization. The net result of these developments is that patients who receive a label of "forensic" enter into a mental health ghetto with little connectivity or integration with the general mental health system. The forensic label increases the stigma and decreases opportunities for reintegration and full social recovery. The paper provides guidelines to reverse these trends. PMID:16946932

Integrated sexual healthcare: the development and review of one model of service delivery.

PubMed

Dawson, S G; Callander, N; Roche, C; Kingsland, T; Desmond, N

2000-07-01

Sexual health is topical with many factors impacting upon its concept and hence provision. In 1995 the Sexual Health Service in East Berkshire was formed by the integration of the clinical services of Family Planning, Genitourinary and HIV Medicine with Sexual Health Promotion. The philosophy of the service is to provide holistic sexual healthcare in one visit, on one site by one clinical team. This article outlines the practical developments and the strengths and weaknesses of this model of service.

A Model for Integrating Low Vision Services into Educational Programs.

ERIC Educational Resources Information Center

Jose, Randall T.; And Others

1988-01-01

A project integrating low-vision services into children's educational programs comprised four components: teacher training, functional vision evaluations for each child, a clinical examination by an optometrist, and follow-up visits with the optometrist to evaluate the prescribed low-vision aids. Educational implications of the project and project…

Immunization coverage in India for areas served by the Integrated Child Development Services programme. The Integrated Child Development Services Consultants.

PubMed

Tandon, B N; Gandhi, N

1992-01-01

The Integrated Child Development Services (ICDS) programme was launched by the Indian government in October 1975 to provide a package of health, nutrition and informal educational services to mothers and children. In 1988 we studied the impact of ICDS on the immunization coverage of children aged 12-24 months and of mothers of infants in 19 rural, 8 tribal, and 9 urban ICDS projects that had been operational for more than 5 years. Complete coverage with BCG, diphtheria-pertussis-tetanus (DPT) and poliomyelitis vaccines was recorded for 65%, 63%, and 64% of children, respectively, in the ICDS population. By comparison, the coverage in the non-ICDS group was only 22% for BCG, 28% for DPT, and 27% for poliomyelitis. Complete immunization with tetanus toxoid was recorded for 68% of the mothers in the ICDS group and for 40% in the non-ICDS group. Coverage was greater in the urban and lower in the tribal projects. Scheduled castes, scheduled tribes, backward communities, and minorities (groups that have a high priority for social services) had immunization coverages in ICDS projects that were similar to those of higher castes.

Developing integrated health and social care services for older persons in Europe

PubMed Central

Leichsenring, Kai

2004-01-01

Abstract Purpose This paper is to distribute first results of the EU Fifth Framework Project ‘Providing integrated health and social care for older persons—issues, problems and solutions’ (PROCARE—http://www.euro.centre.org/procare/). The project's first phase was to identify different approaches to integration as well as structural, organisational, economic and social-cultural factors and actors that constitute integrated and sustainable care systems. It also served to retrieve a number of experiences, model ways of working and demonstration projects in the participating countries which are currently being analysed in order to learn from success—or failure—and to develop policy recommendations for the local, national and European level. Theory The paper draws on existing definitions of integrated care in various countries and by various scholars. Given the context of an international comparative study it tries to avoid providing a single, ready-made definition but underlines the role of social care as part and parcel of this type of integrated care in the participating countries. Methods The paper is based on national reports from researchers representing ten organisations (university institutes, consultancy firms, research institutes, the public and the NGO sector) from 9 European countries: Austria, Denmark, Finland, France, Germany, Greece, Italy, the Netherlands, and the UK. Literature reviews made intensive use of grey literature and evaluation studies in the context of at least five model ways of working in each country. Results As a result of the cross-national overview an attempt to classify different approaches and definitions is made and indicators of relative importance of the different instruments used in integrating health and social care services are provided. Conclusions The cross-national overview shows that issues concerning co-ordination and integration of services are high on the agenda in most countries. Depending on the state of

Profile of Metacognition of Mathematics Pre-Service Teachers in Understanding the Concept of Integral Calculus with Regard Gender Differences

NASA Astrophysics Data System (ADS)

Misu, L.; Budayasa, I. K.; Lukito, A.

2018-01-01

This research is to describe metacognition profile of female and male mathematics’ pre-service teachers in understanding the concept of integral calculus. The subjects of this study are one female and 1 male mathematics’ pre-service teachers who have studied integral calculus. This research type is an explorative study with the qualitative approach. The main data collection of this research was obtained by using Interview technique. In addition, there are supporting data which is the result of the written work of research subjects (SP) in understanding the question of integral calculus. The results of this study are as follows: There is a difference in metacognition profiles between male and female mathematics’ pre-service teachers in the understanding concept of integral calculus in the interpreting category, especially the definite integral concept. While in the category of exemplifying, there is no difference in metacognition profile between male and female mathematics’ pre-service teachers either the definite integral concept and the indefinite integral concept.

Multi-actor involvement for integrating ecosystem services in strategic environmental assessment of spatial plans

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

Rozas-Vásquez, Daniel, E-mail: danielrozas@gmail.com; Laboratorio de Planificación Territorial, Universidad Católica de Temuco, Rudecindo ortega, 02950 Temuco; Fürst, Christine

Integrating an ecosystem services (ES) approach into Strategic Environmental Assessment (SEA) of spatial plans potentially enhances the consideration of the value of nature in decision making and policy processes. However, there is increasing concern about the institutional context and a lack of a common understanding of SEA and ecosystem services for adopting them as an integrated framework. This paper addresses this concern by analysing the current understanding and network relations in a multi-actor arrangement as a first step towards a successful integration of ES in SEA and spatial planning. Our analysis focuses on a case study in Chile, where wemore » administered a questionnaire survey to some of the main actors involved in the spatial planning process. The questionnaire focused on issues such as network relations among actors and on conceptual understanding, perceptions and challenges for integrating ES in SEA and spatial planning, knowledge on methodological approaches, and the connections and gaps in the science-policy interface. Our findings suggest that a common understanding of SEA and especially of ES in a context of multiple actors is still at an initial stage in Chile. Additionally, the lack of institutional guidelines and methodological support is considered the main challenge for integration. We conclude that preconditions exist in Chile for integrating ES in SEA for spatial planning, but they strongly depend on appropriate governance schemes that promote a close science-policy interaction, as well as collaborative work and learning. - Highlights: • Linking ecosystem services in SEA is an effective framework for sustainability. • Multi-actor understanding and networks in ecosystem services and SEA were analyzed. • Understanding of SEA and especially of ES is still in an initial stage in Chile. • A lack of institutional guidelines is one of the key challenges for this link.« less

Closing service system gaps for homeless clients with a dual diagnosis: integrated teams and interagency cooperation.

PubMed

Rosenheck, Robert A; Resnick, Sandra G; Morrissey, Joseph P

2003-06-01

There is great concern about fragmentation of mental health service delivery, especially for dually diagnosed homeless people, and apprehension that such fragmentation adversely affects service access and outcomes. This study first seeks to articulate two alternative approaches to the integration of psychiatric and substance abuse services, one involving an integrated team model and the other a collaborative relationship between agencies. It then applies this conceptualization to a sample of dually diagnosed homeless people who participated in the ACCESS demonstration. Longitudinal outcome data were obtained through interviews at baseline, 3 months, and 12 months with homeless clients with a dual diagnosis (N = 1074) who received ACT-like case management services through the ACCESS demonstration. A survey of ACCESS case managers was conducted to obtain information on: (i) the proportion of clients who received substance abuse services directly from ACCESS case management teams, and the proportion who received services from other agencies; and (ii) the perceived quality of the relationship (i.e. communication, cooperation and trust) between providers--both within the same teams and between agencies. Hierarchical linear modeling was then used to examine the relationship of these two factors to service use and outcome with mixed-model regression analysis. Significant (p<.05) and positive relationships were observed in 4 of the 20 analyses of the association of service use and measures of communication, cooperation, and trust (either intrateam or inter-agency) while none were significant and negative. At 12 months, receipt of a higher proportion of services from agencies other than the ACCESS team was associated with fewer days homeless, and greater reduction of psychiatric symptoms, contradicting the hypothesis that integrated team care is more effective than interagency collaborations. This study broadens the conceptual framework for addressing service system

Investigating Variables Predicting Turkish Pre-service Teachers' Integration of ICT into Teaching Practices

ERIC Educational Resources Information Center

Aslan, Aydin; Zhu, Chang

2017-01-01

Pre-service teachers need to acquire information and communications technology (ICT) competency in order to integrate ICT into their teaching practices. This research was conducted to investigate to what extent ICT-related variables--such as perceived ICT competence, perceived competence in ICT integration, attitudes toward ICT, anxiety around ICT…

‘Trust and teamwork matter’: Community health workers' experiences in integrated service delivery in India

PubMed Central

Mishra, Arima

2014-01-01

A comprehensive and integrated approach to strengthen primary health care has been the major thrust of the National Rural Health Mission (NRHM) that was launched in 2005 to revamp India's rural public health system. Though the logic of horizontal and integrated health care to strengthen health systems has long been acknowledged at policy level, empirical evidence on how such integration operates is rare. Based on recent (2011–2012) ethnographic fieldwork in Odisha, India, this article discusses community health workers' experiences in integrated service delivery through village-level outreach sessions within the NRHM. It shows that for health workers, the notion of integration goes well beyond a technical lens of mixing different health services. Crucially, they perceive ‘teamwork’ and ‘building trust with the community’ (beyond trust in health services) to be critical components of their practice. However, the comprehensive NRHM primary health care ideology – which the health workers espouse – is in constant tension with the exigencies of narrow indicators of health system performance. Our ethnography shows how monitoring mechanisms, the institutionalised privileging of statistical evidence over field-based knowledge and the highly hierarchical health bureaucratic structure that rests on top-down communications mitigate efforts towards sustainable health system integration. PMID:25025872

The development of integrated service centre system for professional teachers empowerment in North Sumatera

NASA Astrophysics Data System (ADS)

Gultom, S.; Simanjorang, M. M.; Muchtar, Z.; Mansyur, A.

2018-03-01

Based on Act number 12 in year 2012 the function of higher education is related to individual, social community, knowledge and technology development. Hence, higher education providers need to think and develop policies in order to improve their service and fulfil the higher education function. As part of the effort to fulfil its function Universitas Negeri Medan (Unimed), which historically was a pre-service teacher training institute, should has a special interest on improving teachers’ professionalism. The Act number 14 in year 2005 described requirements for professional teacher, including academic qualification and set of competencies possessed by the teacher. The Act also guaranties teachers’ right to have opportunities for improving their competencies and academic qualification through training and other professionalism development programme. The question is how this guarantee can be implemented. In order to answer this question a developmental study has been done which aimed on developing an integrated service centre system for professional teachers empowerment. As the name implies, this integrated service centre system is expected to be a real manifestation of Unimed’s support towards the improvement of professional teachers quality, which in the end will boils down to the improvement of national education services quality. The result of this study is an integrated service centre system for professional teachers empowerment that fulfils the professionalism principles described in the Act number 14 in year 2005, which has been developed by considering problems faced by and also supports needed by teachers post certification programme.

Integration of Specialized Pain Control Services in Palliative Care: A Nationwide Web-based Survey.

PubMed

Page, Nivedita Dilip

2017-01-01

Pain control is an important part of palliative care (PC), and conventional analgesics do not provide adequate pain relief to all patients. Many patients present with complex pain syndromes that require interventional pain control measures usually deployed by pain specialists. There is adequate integration of specialized pain control services with PC elsewhere, but information about the same in our country is lacking. An internet survey was conducted among palliative specialists regarding the need and availability of pain specialists for their patients suffering from complex pain syndromes. Their attitude toward integrating specialized pain control services in their practice was also explored. Majority of palliative physicians came across situations where specialists in pain would control the patients' pain better. There was a poor availability of such services, and when available, the cost was significant. It is heartening to note that though there is poor integration of specialized pain control services with palliation, palliative physicians acknowledge the need for pain specialists and their techniques for providing pain relief for their patients. Effective pain control is needed in palliation, barriers however exist, and there is a need to make pain specialists and interventional techniques more freely available.

Integrating complementary medicine and health care services into practice.

PubMed Central

LaValley, J W; Verhoef, M J

1995-01-01

Complementary medicine and health care services constitute a significant proportion of the use of health care services in Canada, despite a history of limited acceptance of these therapies by the medical profession. However, physician attitudes appear to be changing. A survey of a random sample of general practitioners in Quebec (see page 29 of this issue) shows that four out of five general practitioners perceive at least one of three complementary health care services to be useful. Similar surveys of samples in Alberta and Ontario suggest that physicians there, although somewhat less enthusiastic than their counterparts in Quebec, have also begun to be more open-minded about these types of therapies. However, physicians have reported little understanding of complementary health care services, which suggests the need for more research on and education about these services. The Medical Society of Nova Scotia has responded to this need by establishing a Section of Complementary Medicine. The authors believe that fair, accountable, scientific and rigorous research on complementary therapies will benefit physicians and patients. The problems inherent in applying reductionist analysis to a holistic approach to care can be largely circumvented by focusing on outcomes research. In light of the popularity of these therapies, inquiry into patient use of complementary health care services should become a part of a complete patient history. This measure would promote greater patient-physician communication and integration of complementary health care services into patient care. PMID:7796375

The Potential Role of the School as a Site for Integrating Social Services. A Report.

ERIC Educational Resources Information Center

Baillie, Susan; And Others

Physically integrating social services with schools might be a feasible way of providing social services at a lower cost and/or might lead to improved social services. Examination of 10 school/social service complexes reveals an attempt to redefine the neighborhood at the same time enlarging and rendering it less parochial. The rapidly expanding…

Do Integrated Children's Services Improve Children's Outcomes?: Evidence from England's Children's Trust Pathfinders

ERIC Educational Resources Information Center

O'Brien, Margaret; Bachmann, Max O.; Jones, Natalia R.; Reading, Richard; Thoburn, June; Husbands, Chris; Shreeve, Ann; Watson, Jacqueline

2009-01-01

Thirty-five children's trust pathfinders, local cross-sector partnerships, were introduced across England in 2003 to promote greater integration in children's services. Using administrative performance data, this paper tracks yearly trends in child service outputs and child well-being outcomes from 1997 to 2004 in these local areas, including the…

Space Mission Operations Ground Systems Integration Customer Service

NASA Technical Reports Server (NTRS)

Roth, Karl

2014-01-01

, and cultural differences, to ensure an efficient response to customer issues using a small Customer Service Team (CST) and adaptability, constant communication with customers, technical expertise and knowledge of services, and dedication to customer service. The HOSC Customer Support Team has implemented a variety of processes, and procedures that help to mitigate the potential problems that arise when integrating ground system services for a variety of complex missions and the lessons learned from this experience will lead the future of customer service in the space operations industry.

Inquiry of Pre-Service Teachers' Concern about Integrating Web 2.0 into Instruction

ERIC Educational Resources Information Center

Hao, Yungwei; Lee, Kathryn S.

2017-01-01

To promote technology integration, it is essential to address pre-service teacher (PST) concerns about facilitating technology-enhanced learning environments. This study adopted the Concerns-Based Adoption Model to investigate PST concern on Web 2.0 integration. Four hundred and eighty-nine PSTs in a teacher education university in north Taiwan…

Experiences of health care providers with integrated HIV and reproductive health services in Kenya: a qualitative study.

PubMed

Mutemwa, Richard; Mayhew, Susannah; Colombini, Manuela; Busza, Joanna; Kivunaga, Jackline; Ndwiga, Charity

2013-01-11

There is broad consensus on the value of integration of HIV services and reproductive health services in regions of the world with generalised HIV/AIDS epidemics and high reproductive morbidity. Integration is thought to increase access to and uptake of health services; and improves their efficiency and cost-effectiveness through better use of available resources. However, there is still very limited empirical literature on health service providers and how they experience and operationalize integration. This qualitative study was conducted among frontline health workers to explore provider experiences with integration in order to ascertain their significance to the performance of integrated health facilities. Semi-structured in-depth interviews were conducted with 32 frontline clinical officers, registered nurses, and enrolled nurses in Kitui district (Eastern province) and Thika and Nyeri districts (Central province) in Kenya. The study was conducted in health facilities providing integrated HIV and reproductive health services (post-natal care and family planning). All interviews were conducted in English, transcribed and analysed using Nvivo 8 qualitative data analysis software. Providers reported delivering services in provider-level and unit-level integration, as well as a combination of both. Provider experiences of actual integration were mixed. At personal level, providers valued skills enhancement, more variety and challenge in their work, better job satisfaction through increased client-satisfaction. However, they also felt that their salaries were poor, they faced increased occupational stress from: increased workload, treating very sick/poor clients, and less quality time with clients. At operational level, providers reported increased service uptake, increased willingness among clients to take an HIV test, and reduced loss of clients. But the majority also reported infrastructural and logistic deficiencies (insufficient physical room space, equipment

Preparing the sexual health workforce to deliver integrated services: is education the answer? A qualitative study exploring the impact of sexual health education on developing integrated policy and practice.

PubMed

Brook, Judy; Salmon, Debra; Knight, Rachael-Anne

2017-05-01

Aim This study aimed to explore the ability of sexual health nurses working in the South West of England, to implement new learning within existing sexual health service delivery models. Drawing on Lipsky's account of street-level bureaucracy to conceptualise policy implementation, the impact of workforce learning on the development of integrated services across this region of the United Kingdom was assessed. In order to achieve the United Nations' goal of universal access to sexual health, it is essential for reproductive and sexual health, including HIV provision, to integrate into a single service. This integration requires a commitment to collaboration by service commissioners and an alignment of principles and values across sexual health and contraceptive services. UK health policy has embraced this holistic agenda but moves towards integrating historically separate clinical services, has presented significant workforce development challenges and influenced policy success. Employing a qualitative approach, the study included data from semi-structured telephone interviews and focus groups, and longitudinal data from pre- and post-intervention surveys, collected between September 2013 and September 2015. Data were collected from 88 nurses undertaking a workforce development programme and six of their service managers. Data were analysed using thematic analysis to identify consistent themes. Findings Nurses confirmed the role of new learning in enabling them to negotiate the political landscape but expressed frustration at their lack of agency in the integration agenda, exposing a clear dichotomy between the intentions of policy and the reality of practice. Nevertheless, using high levels of professional judgement and discretion practitioners managed the incongruence between policy and practice in order to deliver integrated services in the interests of patients. Workforce education, while essential for the transition to the delivery of integrated services, was

Toward Integrated Family Services in Rural Settings: A Summary of Research and Practice. Program Report.

ERIC Educational Resources Information Center

Stoops, Jack W.; Hull, Janis L.

This report synthesizes research findings with observations of three Pacific Northwest sites attempting service integration in rural settings. At case-study sites in Washington and Oregon, rural schools, communities, and service providers collaborate to deliver services to students and community members suffering from high unemployment, alcohol…

Evaluation of the Integrated Services Pilot Program from Western Australia

ERIC Educational Resources Information Center

Hancock, Peter; Cooper, Trudi; Bahn, Susanne

2009-01-01

Independent evaluation of refugee-focused programs in developed nations is increasingly a mandatory requirement of funding bodies and government agencies. This paper presents an evaluation of the Integrated Services Centre (ISC) Pilot Project that was conducted in Australia in 2007 and early 2008. The purpose of the ISC program was to provide…

Evaluation of the integrated clinic model for HIV/AIDS services in Ho Chi Minh City, Viet Nam, 2013-2014.

PubMed

Hung, V; Nguyen, S T; Tieu, V T T; Nguyen, T T T; Duong, T H; Lyss, S; Oeltmann, J E

2016-12-21

Setting: Ho Chi Minh City (HCMC), Viet Nam. Objective: To evaluate a new integrated service model for human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) care. Design: In HCMC, co-located services, including voluntary HIV counseling and testing (VCT), HIV treatment at out-patient clinics (OPC), and methadone maintenance therapy (MMT) for persons who inject drugs, have operated under different administrative structures. In the context of decreasing international financial support, integration of these services into one administrative structure with reduced staff occurred in seven districts in HCMC between October 2013 and June 2014. We used a pre-post study design to compare service-related outcomes from routinely collected data at health facilities 6 months before and 6 months after integration. Results: The proportion of HIV-infected persons linked from VCT to OPCs was unchanged or increased following integration. A higher percentage of patients eligible for antiretroviral therapy (ART) were started on ART. The proportion of ART patients lost to follow-up remained unchanged. The proportions of MMT patients who tested positive for heroin or other substances decreased or were unchanged. Conclusions: VCT, OPC and MMT service delivery quality remained the same or improved during the 6 months following the integration. Expansion of the integrated model should be considered for HIV-related services.

[The Promotion of Resources Integration in Long-Term Care Service: The Experience of Taipei City Hospital].

PubMed

Wu, Meng-Ping; Huang, Chao-Ming; Sun, Wen-Jung; Shih, Chih-Yuan; Hsu, Su-Hsuan; Huang, Sheng-Jean

2018-02-01

The home-based medical care integrated plan under Taiwan National Health Insurance has changed from paying for home-based medical care, home-based nursing, home-based respiratory treatment, and palliative care to paying for a single, continuous home-based care service package. Formerly, physician-visit regulations limited home visits for home-based nursing to providing medical related assessments only. This limitation not only did not provide practical assistance to the public but also caused additional problems for those with mobility problems or who faced difficulties in making visits hospital. This 2016 change in regulations opens the door for doctors to step out their 'ivory tower', while offering the public more options to seek medical assistance in the hope that patients may change their health-seeking behavior. The home-based concept that underlies the medical service system is rooted deeply in the community in order to set up a sound, integrated model of community medical care. It is a critical issue to proceed with timely job handover confirmation with the connecting team and to provide patients with continuous-care services prior to discharge through the discharge-planning service and the connection with the connecting team. This is currently believed to be the only continuous home-based medical care integrated service model in the world. This model not only connects services such as health literacy, rehabilitation, home-based medical care, home-based nursing, community palliative care, and death but also integrates community resources, builds community resources networks, and provides high quality community care services.

Developing a framework for gathering and using service user experiences to improve integrated health and social care: the SUFFICE framework.

PubMed

Ward, Vicky; Pinkney, Lisa; Fry, Gary

2016-09-08

More people than ever receive care and support from health and social care services. Initiatives to integrate the work of health and social care staff have increased rapidly across the UK but relatively little has been done to chart and improve their impact on service users. Our aim was to develop a framework for gathering and using service user feedback to improve integrated health and social care in one locality in the North of England. We used published literature and interviews with health and social care managers to determine the expected service user experiences of local community-based integrated teams and the ways in which team members were expected to work together. We used the results to devise qualitative data collection and analysis tools for gathering and analyzing service user feedback. We used developmental evaluation and service improvement methodologies to devise a procedure for developing service improvement plans. We identified six expected service user experiences of integrated care and 15 activities that health and social care teams were expected to undertake. We used these to develop logic models and tools for collecting and analysing service user experiences. These include a narrative interview schedule, a plan for analyzing data, and a method for synthesizing the results into a composite 'story'. We devised a structured service improvement procedure which involves teams of health and social care staff listening to a composite service user story, identifying how their actions as a team may have contributed to the story and developing a service improvement plan. This framework aims to put service user experiences at the heart of efforts to improve integration. It has been developed in collaboration with National Health Service (NHS) and Social Care managers. We expect it to be useful for evaluating and improving integrated care initiatives elsewhere.

The effect of for-profit laboratories on the accountability, integration, and cost of Canadian health care services.

PubMed

Sutherland, Ross

2012-01-01

Canadian public health care systems pay for-profit corporations to provide essential medical laboratory services. This practice is a useful window on the effects of using for-profit corporations to provide publicly funded services. Because private corporations are substantially protected by law from the public disclosure of "confidential business information," increased for-profit delivery has led to decreased transparency, thus impeding informed debate on how laboratory services are delivered. Using for-profit laboratories increases the cost of diagnostic testing and hinders the integration of health care services more generally. Two useful steps toward ending the for-profit provision of laboratory services would be to stop fee-for-service funding and to integrate all laboratory work within public administrative structures.

PNAUM: integrated approach to Pharmaceutical Services, Science, Technology and Innovation

PubMed Central

Gadelha, Carlos Augusto Grabois; Costa, Karen Sarmento; do Nascimento, José Miguel; Soeiro, Orlando Mário; Mengue, Sotero Serrate; da Motta, Márcia Luz; de Carvalho, Antônio Carlos Campos

2016-01-01

ABSTRACT This paper describes the development process of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines) based on an integrated approach to pharmaceutical services, science, technology and innovation. It starts by contextualizing health and development in Brazil and features elements of the National Policy for Science, Technology and Innovation in Health in Brazil and the National Policy for Pharmaceutical Services. On presenting pharmaceutical policy guidelines, it stresses the lack of nationwide data. This survey, commissioned by the Brazilian Ministry of Health, has two components: household survey and evaluation of pharmaceutical services in primary care. The findings point to perspectives that represent, besides the enhancement of public policy for pharmaceutical services and public health, results of government action aimed at developing the economic and industrial health care complex to improve the health conditions of the Brazilian population. PMID:27982379

Integration of outpatient infectious diseases clinic pharmacy services and specialty pharmacy services for patients with HIV infection.

PubMed

Gilbert, Elise M; Gerzenshtein, Lana

2016-06-01

The integration of specialty pharmacy services and existing outpatient clinical pharmacy services within an infectious diseases (ID) clinic to optimize the care of patients with human immunodeficiency virus (HIV) infection is described. The management of HIV-infected patients is a highly specialized area of practice, often requiring use of complex medication regimens for reduction of HIV-associated morbidity and mortality prophylaxis and treatment of opportunistic infections, and prevention of HIV transmission. To maximize the effectiveness and safety of treatment with antiretroviral agents and associated pharmacotherapies, an interdisciplinary team is often involved in patient care. At Chicago-based Northwestern Medicine (NM), the outpatient ID clinic has long worked with an interdisciplinary care team including physicians, clinical pharmacists, nurses, and social workers to care for patients with HIV infection. In April 2014, specialty pharmacy services for patients with HIV infection were added to the NM ID clinic's care model to help maintain continuity of care and enhance patient follow-up. The care model includes well-defined roles for clinical pharmacists, pharmacy residents and students on rotation, and licensed pharmacy technicians. Specialty pharmacy services, including medication education, prescription fulfillment, assistance with medication access (e.g., navigation of financial assistance programs, completion of prior-authorization requests), and treatment monitoring, allow for closed-loop medication management of the HIV-infected patient population. Integration of specialty pharmacy services with the interdisciplinary care provided in the outpatient NM ID clinic has enhanced continuity of care for patients with HIV infection in terms of prescription filling, medication counseling, and adherence monitoring. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

The EPOS Architecture: Integrated Services for solid Earth Science

NASA Astrophysics Data System (ADS)

Cocco, Massimo; Consortium, Epos

2013-04-01

The European Plate Observing System (EPOS) represents a scientific vision and an IT approach in which innovative multidisciplinary research is made possible for a better understanding of the physical processes controlling earthquakes, volcanic eruptions, unrest episodes and tsunamis as well as those driving tectonics and Earth surface dynamics. EPOS has a long-term plan to facilitate integrated use of data, models and facilities from existing (but also new) distributed research infrastructures, for solid Earth science. One primary purpose of EPOS is to take full advantage of the new e-science opportunities coming available. The aim is to obtain an efficient and comprehensive multidisciplinary research platform for the Earth sciences in Europe. The EPOS preparatory phase (EPOS PP), funded by the European Commission within the Capacities program, started on November 1st 2010 and it has completed its first two years of activity. EPOS is presently mid-way through its preparatory phase and to date it has achieved all the objectives, milestones and deliverables planned in its roadmap towards construction. The EPOS mission is to integrate the existing research infrastructures (RIs) in solid Earth science warranting increased accessibility and usability of multidisciplinary data from monitoring networks, laboratory experiments and computational simulations. This is expected to enhance worldwide interoperability in the Earth Sciences and establish a leading, integrated European infrastructure offering services to researchers and other stakeholders. The Preparatory Phase aims at leveraging the project to the level of maturity required to implement the EPOS construction phase, with a defined legal structure, detailed technical planning and financial plan. We will present the EPOS architecture, which relies on the integration of the main outcomes from legal, governance and financial work following the strategic EPOS roadmap and according to the technical work done during the

Barriers and enablers to integrating maternal and child health services to antenatal care in low and middle income countries.

PubMed

de Jongh, T E; Gurol-Urganci, I; Allen, E; Jiayue Zhu, N; Atun, R

2016-03-01

Antenatal care (ANC) represents a delivery platform for a broad range of health services; however, these opportunities are insufficiently utilised. This review explores key barriers and enablers for successful integration of health s"ervices with ANC in different contexts. Data from peer-reviewed and grey literature were organised using the SURE checklist. We identified 46 reports focusing on integration of HIV, tuberculosis, malaria, syphilis or nutrition services with ANC from Asia, Africa and the Pacific. Perspectives of service users and providers, social and political factors, and health system characteristics (such as resource availability and organisational structures) affected ease of integration. Health system factors, context and stakeholders must be considered for integrated antenatal care services. © 2016 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

Optimizing the interventional cardiology facility: services integration in routine workflow.

PubMed

Gortzis, Lefteris; Kalogeropoulos, A; Alexopoulos, D; Nikiforidis, G

2007-01-01

Integration of administrative and clinical data, imaging, and expert services, although challenging,is a key requirement in contemporary interventional cardiology facilities (ICF). We propose a workflow-oriented hybrid system to support the ICF and investigate its feasibility and effectiveness ina referral medical center. We have developed a Java-powered hybrid system (NetCARDIO), able to support over web synchronous and asynchronous data management, realtime multimedia data telemonitoring and continuous telementoring. Data regarding procedural rates, treatment planning and radiation exposure were collected over a two-year period of routine NetCARDIO implementation(July 2002 to June 2004) and compared with data from an immediately preceding period of equal duration (January 2000 to December 2001). During the NetCARDIO period, 163 +/- 17 coronary procedures per month were performed vs.77 +/- 15 during the control period (p <0.001). Percutaneous coronary intervention was delivered 'ad hoc' in 88% of eligible patients vs. 45% (p <0.001). Mean fluoroscopy time per coronary lesion treated decreased from 594 +/- 82 s to 540 +/- 94 s(p < 0.001). Annual radiation exposure of expert interventionists was decreased by 22%. Electronic storage significantly reduced archiving costs. Real-time multimodal services sharing combined with powerful database capabilities is feasible through a web-based structure, significantly enhancing performance and cost-effectiveness of ICF. Further research is needed to promote integration of additional data sources and services.

Integrity Analysis of Real-Time Ppp Technique with Igs-Rts Service for Maritime Navigation

NASA Astrophysics Data System (ADS)

El-Diasty, M.

2017-10-01

Open sea and inland waterways are the most widely used mode for transporting goods worldwide. It is the International Maritime Organization (IMO) that defines the requirements for position fixing equipment for a worldwide radio-navigation system, in terms of accuracy, integrity, continuity, availability and coverage for the various phases of navigation. Satellite positioning systems can contribute to meet these requirements, as well as optimize marine transportation. Marine navigation usually consists of three major phases identified as Ocean/Coastal/Port approach/Inland waterway, in port navigation and automatic docking with alert limit ranges from 25 m to 0.25 m. GPS positioning is widely used for many applications and is currently recognized by IMO for a future maritime navigation. With the advancement in autonomous GPS positioning techniques such as Precise Point Positioning (PPP) and with the advent of new real-time GNSS correction services such as IGS-Real-Time-Service (RTS), it is necessary to investigate the integrity of the PPP-based positioning technique along with IGS-RTS service in terms of availability and reliability for safe navigation in maritime application. This paper monitors the integrity of an autonomous real-time PPP-based GPS positioning system using the IGS real-time service (RTS) for maritime applications that require minimum availability of integrity of 99.8 % to fulfil the IMO integrity standards. To examine the integrity of the real-time IGS-RTS PPP-based technique for maritime applications, kinematic data from a dual frequency GPS receiver is collected onboard a vessel and investigated with the real-time IGS-RTS PPP-based GPS positioning technique. It is shown that the availability of integrity of the real-time IGS-RTS PPP-based GPS solution is 100 % for all navigation phases and therefore fulfil the IMO integrity standards (99.8 % availability) immediately (after 1 second), after 2 minutes and after

Teaching Diversity through Service-Learning: An Integrative Praxis Pedagogical Approach

ERIC Educational Resources Information Center

Rice, Julie Steinkopf; Horn, Terri

2014-01-01

Service-learning has been shown to be an effective technique for teaching diversity; however, the literature is scant concerning theoretically informed approaches. This study fills that void by drawing upon the work of Freire, Rendón, and others. After describing how an integrative praxis approach is applied in a sociology course, the authors…

Constructing an Integrated and Evidenced-Based Model for Residential Services

ERIC Educational Resources Information Center

Metzger, Jed

2006-01-01

There is paucity in both the literature and in the practice of integrated, evidence-based models of residential care for youth. This article describes the assessment and the process that led to the redesign of services at a residential center. The article describes how evidence-based models for each of the four major disciplines (residential…

How to assess and prepare health systems in low- and middle-income countries for integration of services-a systematic review.

PubMed

Topp, Stephanie M; Abimbola, Seye; Joshi, Rohina; Negin, Joel

2018-03-01

Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle-income countries (LMICs). We adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for and capacity to implement integrated services. We searched Medline via Ovid, Web of Science and the Cochrane library using terms adapted from Dudley and Garner's systematic review on integration in LMICs. From an initial list of 10 550 articles, 206 were selected for full-text review by two reviewers who independently reviewed articles and inductively extracted and synthesized themes related to health system preparedness. We identified five 'context' related categories and four health system 'capability' themes. The contextual enabling and constraining factors for frontline service integration were: (1) the organizational framework of frontline services, (2) health care worker preparedness, (3) community and client preparedness, (4) upstream logistics and (5) policy and governance issues. The intersecting health system capabilities identified were the need for: (1) sufficiently functional frontline health services, (2) sufficiently trained and motivated health care workers, (3) availability of technical tools and equipment suitable to facilitate integrated frontline services and (4) appropriately devolved authority and decision-making processes to enable frontline managers and staff to adapt integration to local circumstances. Moving beyond claims that integration is defined differently by different programs and thus unsuitable for comparison, this review demonstrates that synthesis is possible. It presents a common set of contextual factors and health system capabilities

Moving towards Universal Health Coverage through the Development of Integrated Service Delivery Packages for Primary Health Care in the Solomon Islands

PubMed Central

Whiting, Stephen; Postma, Sjoerd; Jamshaid de Lorenzo, Ayesha; Aumua, Audrey

2016-01-01

The Solomon Islands Government is pursuing integrated care with the goal of improving the quality of health service delivery to rural populations. Under the auspices of Universal Health Coverage, integrated service delivery packages were developed which defined the clinical and public health services that should be provided at different levels of the health system. The process of developing integrated service delivery packages helped to identify key policy decisions the government needed to make in order to improve service quality and efficiency. The integrated service delivery packages have instigated the revision of job descriptions and are feeding into the development of a human resource plan for health. They are also being used to guide infrastructure development and health system planning and should lead to better management of resources. The integrated service delivery packages have become a key tool to operationalise the government’s policy to move towards a more efficient, equitable, quality and sustainable health system. PMID:28321177

Engineering management consideration for an integrated aeronautical mobile satellite service

NASA Astrophysics Data System (ADS)

Belcher, John M.

In order to meet local air traffic control terminal requirements as well as national and transborder requirements, countries have developed communications, navigation, and surveillance (CNS) systems having little systems integration and a solely ground-based solution to air traffic control problems. It is believed that the application of satellite technology is the only currently viable solution that will enable international civil aviation to overcome the shortcomings of the presently available CNS systems. If properly implemented, available satellite system technology integrated with avionics and ground based capabilities, can be used to meet new global aviation demands. A clear transition plan has to be implemented so as to ensure continuity of service, recognize user-borne costs, and satisfy institutional and national objectives in the progress toward a universal air traffic management (ATM) system. ATM systems design should rely on a modular approach for flexibility and upgrading. An aeronautical mobile satellite service is intended to provide a worldwide satellite data link and direct air/ground voice communication. Institutional and financial roadblocks for implemetation of a global based approach will likely be far greater than technical constraints.

[Vertical integration and contracting-out in generic hospital services in Spain].

PubMed

Puig-Junoy, J; Pérez-Sust, P

2002-01-01

This study examines the factors that influence make or buy decisions corresponding to four generic services (housekeeping, laundry, food services, and maintenance and security) in Spanish hospitals (3,160 transactions in 790 hospitals). The empirical estimation of a logistic model based on hospital utility maximization is presented. Factors included in the model are not only those related to transaction costs, but also those related to public intervention and the political dimension. A total of 55.7% of hospitals contracted-out at least one of the generic services. The services most frequently contracted-out were housekeeping and maintenance and security(45.1 and 32.5%, respectively). In contrast, the services (94.3% and 80.1%, respectively). Hospital size (economies of scale), measured by the number of beds, was one of the most important factors influencing make or buy decisions. We find evidence that economies of scale are related to a higher level of vertical integration, while specialization and for-profit objectives favor the decision to contract-out. The choice of organizational model for laundry services presents a different pattern from that of the other three services. Empirical results show that some asset specificity could be present in laundry services.

Integrating medical devices in the operating room using service-oriented architectures.

PubMed

Ibach, Bastian; Benzko, Julia; Schlichting, Stefan; Zimolong, Andreas; Radermacher, Klaus

2012-08-01

Abstract With the increasing documentation requirements and communication capabilities of medical devices in the operating room, the integration and modular networking of these devices have become more and more important. Commercial integrated operating room systems are mainly proprietary developments using usually proprietary communication standards and interfaces, which reduce the possibility of integrating devices from different vendors. To overcome these limitations, there is a need for an open standardized architecture that is based on standard protocols and interfaces enabling the integration of devices from different vendors based on heterogeneous software and hardware components. Starting with an analysis of the requirements for device integration in the operating room and the techniques used for integrating devices in other industrial domains, a new concept for an integration architecture for the operating room based on the paradigm of a service-oriented architecture is developed. Standardized communication protocols and interface descriptions are used. As risk management is an important factor in the field of medical engineering, a risk analysis of the developed concept has been carried out and the first prototypes have been implemented.

Integrating Grid Services into the Cray XT4 Environment

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

NERSC; Cholia, Shreyas; Lin, Hwa-Chun Wendy

2009-05-01

The 38640 core Cray XT4"Franklin" system at the National Energy Research Scientific Computing Center (NERSC) is a massively parallel resource available to Department of Energy researchers that also provides on-demand grid computing to the Open Science Grid. The integration of grid services on Franklin presented various challenges, including fundamental differences between the interactive and compute nodes, a stripped down compute-node operating system without dynamic library support, a shared-root environment and idiosyncratic application launching. Inour work, we describe how we resolved these challenges on a running, general-purpose production system to provide on-demand compute, storage, accounting and monitoring services through generic gridmore » interfaces that mask the underlying system-specific details for the end user.« less

Collaboration, integration and change in children's services: critical issues and key ingredients.

PubMed

Horwath, Jan; Morrison, Tony

2007-01-01

Government and state policy, irrespective of jurisdiction, increasingly require and indeed specify the nature of collaboration with regard to the delivery of child welfare services for maltreated children. The rationale for collaboration appears obvious in as much as it is aimed at promoting multidisciplinary practice in order to meet the needs of the vulnerable child. However, collaboration, whilst a useful and motivating concept, is in reality far from straightforward and contains complexities and ambiguities. The aim of this paper is to explore these complexities and ambiguities to provide an overview of key developmental frameworks relevant to the creation and maintenance of strategic high-level multiagency partnerships. The authors begin by exploring the characteristic features of different levels of multiagency collaboration that is communication, co-operation, co-ordination, coalition, and integration. As the emphasis in a variety of jurisdictions in the Western world is on the highest levels of collaboration namely coalition and service integration this is the focus of the paper. The authors synthesize the main literature in the field to consider the critical elements for effective collaborative endeavors at this level including predisposing factors, mandate, leadership, machinery, process, and outcomes. The paper concludes by recognizing that the drive towards integrated services is occurring in a climate of continuing change. The need to identify the impact of such an environment when managing multiagency partnerships is explored using five steps to change.

A cloud-based production system for information and service integration: an internet of things case study on waste electronics

NASA Astrophysics Data System (ADS)

Wang, Xi Vincent; Wang, Lihui

2017-08-01

Cloud computing is the new enabling technology that offers centralised computing, flexible data storage and scalable services. In the manufacturing context, it is possible to utilise the Cloud technology to integrate and provide industrial resources and capabilities in terms of Cloud services. In this paper, a function block-based integration mechanism is developed to connect various types of production resources. A Cloud-based architecture is also deployed to offer a service pool which maintains these resources as production services. The proposed system provides a flexible and integrated information environment for the Cloud-based production system. As a specific type of manufacturing, Waste Electrical and Electronic Equipment (WEEE) remanufacturing experiences difficulties in system integration, information exchange and resource management. In this research, WEEE is selected as the example of Internet of Things to demonstrate how the obstacles and bottlenecks are overcome with the help of Cloud-based informatics approach. In the case studies, the WEEE recycle/recovery capabilities are also integrated and deployed as flexible Cloud services. Supporting mechanisms and technologies are presented and evaluated towards the end of the paper.

Providing primary health care through integrated microfinance and health services in Latin America.

PubMed

Geissler, Kimberley H; Leatherman, Sheila

2015-05-01

The simultaneous burdens of communicable and chronic non-communicable diseases cause significant morbidity and mortality in middle-income countries. The poor are at particular risk, with lower access to health care and higher rates of avoidable mortality. Integrating health-related services with microfinance has been shown to improve health knowledge, behaviors, and access to appropriate health care. However, limited evidence is available on effects of fully integrating clinical health service delivery alongside microfinance services through large scale and sustained long-term programs. Using a conceptual model of health services access, we examine supply- and demand-side factors in a microfinance client population receiving integrated services. We conduct a case study using data from 2010 to 2012 of the design of a universal screening program and primary care services provided in conjunction with microfinance loans by Pro Mujer, a women's development organization in Latin America. The program operates in Argentina, Bolivia, Mexico, Nicaragua, and Peru. We analyze descriptive reports and administrative data for measures related to improving access to primary health services and management of chronic diseases. We find provision of preventive care is substantial, with an average of 13% of Pro Mujer clients being screened for cervical cancer each year, 21% receiving breast exams, 16% having a blood glucose measurement, 39% receiving a blood pressure measurement, and 46% having their body mass index calculated. This population, with more than half of those screened being overweight or obese and 9% of those screened having elevated glucose measures, has major risk factors for diabetes, high blood pressure, and cardiovascular disease without intervention. The components of the Pro Mujer health program address four dimensions of healthcare access: geographic accessibility, availability, affordability, and acceptability. Significant progress has been made to meet basic

Postpartum family planning integration with maternal, newborn and child health services: a cross-sectional analysis of client flow patterns in India and Kenya.

PubMed

Mackenzie, Devon; Pfitzer, Anne; Maly, Christina; Waka, Charles; Singh, Gajendra; Sanyal, Abanti

2018-04-03

Maternal, newborn and child health (MNCH) services represent opportunities to integrate postpartum family planning (PPFP). Objectives were to determine levels of MNCH-family planning (FP) integration and associations between integration, client characteristics and service delivery factors in facilities that received programmatic PPFP support. Cross-sectional client flow assessment conducted during May-July 2014, over 5 days at 10 purposively selected public sector facilities in India (4 hospitals) and Kenya (2 hospitals and 4 health centres). 2158 client visits tracked (1294 India; 864 Kenya). Women aged 18 or older accessing services while pregnant and/or with a child under 2 years. PPFP/postpartum intrauterine device-Bihar, India (2012-2013); Jharkhand, India (2009-2014); Embu, Kenya (2006-2010). Maternal, infant and young child nutrition/FP integration-Bondo, Kenya (2011-2014). Proportion of visits where clients received integrated MNCH-FP services, client characteristics as predictors of MNCH-FP integration and MNCH-FP integration as predictor of length of time spent at facility. Levels of MNCH-FP integration varied widely across facilities (5.3% to 63.0%), as did proportion of clients receiving MNCH-FP integrated services by service area. Clients travelling 30-59 min were half as likely to receive integrated services versus those travelling under 30 min (OR 0.5, 95% CI 0.4 to 0.7, P<0.001). Clients receiving MNCH-FP services (vs MNCH services only) spent an average of 10.5 min longer at the facility (95% CI -0.1 to 21.9, not statistically significant). Findings suggest importance of focused programmatic support for integration by MNCH service area. FP integration was highest in areas receiving specific support. Integration does not seem to impose an undue burden on clients in terms of time spent at the facility. Clients living furthest from facilities are least likely to receive integrated services. © Article author(s) (or their employer(s) unless

Using HIV&AIDS statistics in pre-service Mathematics Education to integrate HIV&AIDS education.

PubMed

van Laren, Linda

2012-12-01

In South Africa, the HIV&AIDS education policy documents indicate opportunities for integration across disciplines/subjects. There are different interpretations of integration/inclusion and mainstreaming HIV&AIDS education, and numerous levels of integration. Integration ensures that learners experience the disciplines/subjects as being linked and related, and integration is required to support and expand the learners' opportunities to attain skills, acquire knowledge and develop attitudes and values across the curriculum. This study makes use of self-study methodology where I, a teacher educator, aim to improve my practice through including HIV&AIDS statistics in Mathematics Education. This article focuses on how I used HIV&AIDS statistics to facilitate pre-service teacher reflection and introduce them to integration of HIV&AIDS education across the curriculum. After pre-service teachers were provided with HIV statistics, they drew a pie chart which graphically illustrated the situation and reflected on issues relating to HIV&AIDS. Three themes emerged from the analysis of their reflections. The themes relate to the need for further HIV&AIDS education, the changing pastoral role of teachers and the changing context of teaching. This information indicates that the use of statistics is an appropriate means of initiating the integration of HIV&AIDS education into the academic curriculum.

Integrating primary care with occupational health services: a success story.

PubMed

Griffith, Karen; Strasser, Patricia B

2010-12-01

This article describes the process used by a large U.S. manufacturing company to successfully integrate full-service primary care centers at two locations. The company believed that by providing employees with health promotion and disease prevention services, including screening, early diagnosis, and uncomplicated illness treatment, its health care costs could be significantly reduced while saving employees money. To accurately demonstrate the cost-effectiveness of adding primary care to existing occupational health services, a thorough financial analysis projected the return on investment (ROI) of the program. Decisions were made about center size, the scope of services, and staffing. A critical part of the ROI analysis involved evaluating employee health claim data to identify the actual cost of health care services for each center and the projected costs if the services were provided on-site. The pilot initiative included constructing two on-site health center facilities staffed with primary care physicians, nurse practitioners, physical therapists, and other health care professionals. Key outcome metrics from the pilot clinics exceeded goals in three of four categories. In addition, clinic use after 12 months far exceeded benchmarks for similar clinics. Most importantly, the pilot clinics were operating with a positive cash flow within the first year and demonstrated an increasingly positive ROI. Copyright 2010, SLACK Incorporated.

Integrating Community Services for Young Children and Their Families. Policy Briefs, Report 3, 1993.

ERIC Educational Resources Information Center

Kunesh, Linda G.; Farley, Joanne

This policy brief reports on the status of state policies and programs that relate to integrating community services for children and families. Problems with the current service delivery system are discussed, and guidelines for creating a profamily system through effective collaboration are outlined. Information from a questionnaire on early…

Measuring and Supporting Pre-Service Teachers' Self-Efficacy towards Computers, Teaching, and Technology Integration

ERIC Educational Resources Information Center

Killi, Carita; Kauppinen, Merja; Coiro, Julie; Utriainen, Jukka

2016-01-01

This paper reports on two studies designed to examine pre-service teachers' self-efficacy beliefs. Study I investigated the measurement properties of a self-efficacy beliefs questionnaire comprising scales for computer self-efficacy, teacher self-efficacy, and self-efficacy towards technology integration. In Study I, 200 pre-service teachers…

Challenges encountered in providing integrated HIV, antenatal and postnatal care services: a case study of Katakwi and Mubende districts in Uganda.

PubMed

Ahumuza, Sharon Eva; Rujumba, Joseph; Nkoyooyo, Abdallah; Byaruhanga, Raymond; Wanyenze, Rhoda K

2016-04-18

Integration of sexual and reproductive health (SRH), HIV/AIDS and maternal health (MH) services is a critical strategy to confront the HIV/AIDS epidemic, high maternal mortality and the unmet need for contraception. In 2011 the AIDS Information Centre (AIC) in partnership with the Ministry of Health implemented SRH, HIV/AIDS and MH integration services in the districts of Katakwi and Mubende in Uganda. This paper documents challenges encountered in providing these integrated services in the two districts. This was a cross-sectional qualitative study conducted in Mubende and Katakwi districts in Uganda. Data were collected using 10 focus group discussions with 89 women attending ANC and postnatal care and 21 key informant interviews with district managers and health workers who were involved in the integrated service delivery. Content thematic approach was used for data analysis. The study findings indicate that various challenges were encountered in integrating HIV, ANC and PNC services. Major challenges included inadequate staff, gaps in knowledge of service providers especially with regard to provision of long-term family planning, limited space, shortage of critical supplies such as HIV test kits, drugs and gloves. These findings indicate that the delivery of integrated HIV, SRH and MH services is hampered greatly by health system challenges and depict the need for additional staffing in health facilities, capacity building of health workers and health managers as well as ensuring sufficient supplies to health facilities for smooth implementation of integrated SRH, HIV and MH services.

Cargo Commercial Orbital Transportation Services Environmental Control and Life Support Integration

NASA Technical Reports Server (NTRS)

Duchesne, Stephanie; Thacker, Karen; Williams, Dave

2012-01-01

The International Space Station s (ISS) largest crew and cargo resupply vehicle, the Space Shuttle, retired in 2011. To help augment ISS resupply and return capability, NASA announced a project to promote the development of Commercial Orbital Transportation Services (COTS) for the ISS in January of 2006. By December of 2008, NASA entered into space act agreements with SpaceX and Orbital Sciences Corporation for COTS development and ISS Commercial Resupply Services (CRS). The intent of CRS is to fly multiple resupply missions each year to ISS with SpaceX s Dragon vehicle providing resupply and return capabilities and Orbital Science Corporation s Cygnus vehicle providing resupply capability to ISS. The ISS program launched an integration effort to ensure that these new commercial vehicles met the requirements of the ISS vehicle and ISS program needs. The Environmental Control and Life Support System (ECLSS) requirements cover basic cargo vehicle needs including maintaining atmosphere, providing atmosphere circulation, and fire detection and suppression. The ISS-COTS integration effort brought unique challenges combining NASA s established processes and design knowledge with the commercial companies new initiatives and limited experience with human space flight. This paper will discuss the ISS ECLS COTS integration effort including challenges, successes, and lessons learned.

Commercial Orbital Transportation Cargo Services Environmental Control and Life Support Integration

NASA Technical Reports Server (NTRS)

Duchesne, Stephanie; Williams, Dave; Orozco, Nicole; Philistine, Cynthia

2010-01-01

The International Space Station s (ISS) largest crew and cargo resupply vehicle, the Space Shuttle, will retire in 2011. To help augment ISS resupply and return capability, NASA announced a project to promote the development of Commercial Orbital Transportation Services (COTS) for the ISS in January of 2006. By December of 2008, NASA entered into space act agreements with SpaceX and Orbital Sciences Corporation for COTS development and ISS Commercial Resupply Services (CRS). The intent of CRS is to fly multiple resupply missions each year to ISS with SpaceX s Dragon vehicle providing resupply and return capabilities and Orbital Science Corporation s Cygnus vehicle providing resupply capability to ISS. The ISS program launched an integration effort to ensure that these new commercial vehicles met the requirements of the ISS vehicle and ISS program needs. The Environmental Control and Life Support System (ECLSS) requirements cover basic cargo vehicle needs including maintaining atmosphere, providing atmosphere circulation, and fire detection and suppression. The ISS-COTS integration effort brought unique challenges combining NASA s established processes and design knowledge with the commercial companies new initiatives and limited experience with human space flight. This paper will discuss the ISS ECLS COTS integration effort including challenges, successes, and lessons learned.

The Semantic Automated Discovery and Integration (SADI) Web service Design-Pattern, API and Reference Implementation

PubMed Central

2011-01-01

Background The complexity and inter-related nature of biological data poses a difficult challenge for data and tool integration. There has been a proliferation of interoperability standards and projects over the past decade, none of which has been widely adopted by the bioinformatics community. Recent attempts have focused on the use of semantics to assist integration, and Semantic Web technologies are being welcomed by this community. Description SADI - Semantic Automated Discovery and Integration - is a lightweight set of fully standards-compliant Semantic Web service design patterns that simplify the publication of services of the type commonly found in bioinformatics and other scientific domains. Using Semantic Web technologies at every level of the Web services "stack", SADI services consume and produce instances of OWL Classes following a small number of very straightforward best-practices. In addition, we provide codebases that support these best-practices, and plug-in tools to popular developer and client software that dramatically simplify deployment of services by providers, and the discovery and utilization of those services by their consumers. Conclusions SADI Services are fully compliant with, and utilize only foundational Web standards; are simple to create and maintain for service providers; and can be discovered and utilized in a very intuitive way by biologist end-users. In addition, the SADI design patterns significantly improve the ability of software to automatically discover appropriate services based on user-needs, and automatically chain these into complex analytical workflows. We show that, when resources are exposed through SADI, data compliant with a given ontological model can be automatically gathered, or generated, from these distributed, non-coordinating resources - a behaviour we have not observed in any other Semantic system. Finally, we show that, using SADI, data dynamically generated from Web services can be explored in a manner

The Semantic Automated Discovery and Integration (SADI) Web service Design-Pattern, API and Reference Implementation.

PubMed

Wilkinson, Mark D; Vandervalk, Benjamin; McCarthy, Luke

2011-10-24

The complexity and inter-related nature of biological data poses a difficult challenge for data and tool integration. There has been a proliferation of interoperability standards and projects over the past decade, none of which has been widely adopted by the bioinformatics community. Recent attempts have focused on the use of semantics to assist integration, and Semantic Web technologies are being welcomed by this community. SADI - Semantic Automated Discovery and Integration - is a lightweight set of fully standards-compliant Semantic Web service design patterns that simplify the publication of services of the type commonly found in bioinformatics and other scientific domains. Using Semantic Web technologies at every level of the Web services "stack", SADI services consume and produce instances of OWL Classes following a small number of very straightforward best-practices. In addition, we provide codebases that support these best-practices, and plug-in tools to popular developer and client software that dramatically simplify deployment of services by providers, and the discovery and utilization of those services by their consumers. SADI Services are fully compliant with, and utilize only foundational Web standards; are simple to create and maintain for service providers; and can be discovered and utilized in a very intuitive way by biologist end-users. In addition, the SADI design patterns significantly improve the ability of software to automatically discover appropriate services based on user-needs, and automatically chain these into complex analytical workflows. We show that, when resources are exposed through SADI, data compliant with a given ontological model can be automatically gathered, or generated, from these distributed, non-coordinating resources - a behaviour we have not observed in any other Semantic system. Finally, we show that, using SADI, data dynamically generated from Web services can be explored in a manner very similar to data housed in

Beyond "One-Stop" Shopping: An Integrated Service Delivery System for Job Seekers and Employers.

ERIC Educational Resources Information Center

Anderson, Richard T.

The Workforce Development Center (WDC), in Waukesha County, Wisconsin, is a cooperative effort of nine public and private agencies, including the Wisconsin Job Service, the Private Industry Council, and Waukesha County Technical College (WCTC), to provide integrated employment services to area citizens and employers. Located on the WCTC campus,…

Integrating Human and Ecosystem Health Through Ecosystem Services Frameworks.

PubMed

Ford, Adriana E S; Graham, Hilary; White, Piran C L

2015-12-01

The pace and scale of environmental change is undermining the conditions for human health. Yet the environment and human health remain poorly integrated within research, policy and practice. The ecosystem services (ES) approach provides a way of promoting integration via the frameworks used to represent relationships between environment and society in simple visual forms. To assess this potential, we undertook a scoping review of ES frameworks and assessed how each represented seven key dimensions, including ecosystem and human health. Of the 84 ES frameworks identified, the majority did not include human health (62%) or include feedback mechanisms between ecosystems and human health (75%). While ecosystem drivers of human health are included in some ES frameworks, more comprehensive frameworks are required to drive forward research and policy on environmental change and human health.

Integration services to enable regional shared electronic health records.

PubMed

Oliveira, Ilídio C; Cunha, João P S

2011-01-01

eHealth is expected to integrate a comprehensive set of patient data sources into a coherent continuum, but implementations vary and Portugal is still lacking on electronic patient data sharing. In this work, we present a clinical information hub to aggregate multi-institution patient data and bridge the information silos. This integration platform enables a coherent object model, services-oriented applications development and a trust framework. It has been instantiated in the Rede Telemática de Saúde (www.RTSaude.org) to support a regional Electronic Health Record approach, fed dynamically from production systems at eight partner institutions, providing access to more than 11,000,000 care episodes, relating to over 350,000 citizens. The network has obtained the necessary clearance from the Portuguese data protection agency.

Preferred Instructional Design Strategies for Preparation of Pre-Service Teachers of Integrated STEM Education

ERIC Educational Resources Information Center

Roberts, Amanda Shackleford

2013-01-01

The purpose of this study was to identify the preferred instructional design strategies for the preparation of pre-service teachers who will deliver integrated STEM lessons. The research objectives were threefold and included identifying a preferred definition of integrated STEM education, developing its purpose statement, and creating a list of…

Generic Service Integration in Adaptive Learning Experiences Using IMS Learning Design

ERIC Educational Resources Information Center

de-la-Fuente-Valentin, Luis; Pardo, Abelardo; Kloos, Carlos Delgado

2011-01-01

IMS Learning Design is a specification to capture the orchestration taking place in a learning scenario. This paper presents an extension called Generic Service Integration. This paradigm allows a bidirectional communication between the course engine in charge of the orchestration and conventional Web 2.0 tools. This communication allows the…

Research on Disaster Early Warning and Disaster Relief Integrated Service System Based on Block Data Theory

NASA Astrophysics Data System (ADS)

Yang, J.; Zhang, H.; Wang, C.; Tang, D.

2018-04-01

With the continuous development of social economy, the interaction between mankind and nature has become increasingly evident. Disastrous global catastrophes have occurred from time to time, causing huge losses to people's lives and property. All governments recognize the importance of the establishment of disaster early warning and release mechanisms, and it is also an urgent issue to improve the comprehensive service level of emergency response and disaster relief. However, disaster early warning and emergency relief information is usually generated by different departments, and the diverse data sources, difficult integration, and limited release speed have always been difficult issues to be solved. Block data is the aggregation of various distributed (point data) and segmentation (data) big data on a specific platform and make them happen continuous polymerization effect, block data theory is a good solution to cross-sectoral, cross-platform Disaster information data sharing and integration problems. This paper attempts to discuss the integrated service mechanism of disaster information aggregation and disaster relief based on block data theory and introduces a location-based integrated service system for disaster early warning and disaster relief.

Numbers, systems, people: how interactions influence integration. Insights from case studies of HIV and reproductive health services delivery in Kenya

PubMed Central

Mayhew, Susannah H; Warren, Charlotte E; Collumbien, Martine; Ndwiga, Charity; Mutemwa, Richard; Lut, Irina; Colombini, Manuela; Vassall, Anna

2017-01-01

Abstract Drawing on rich data from the Integra evaluation of integrated HIV and reproductive-health services, we explored the interaction of systems hardware and software factors to explain why some facilities were able to implement and sustain integrated service delivery while others were not. This article draws on detailed mixed-methods data for four case-study facilities offering reproductive-health and HIV services between 2009 and 2013 in Kenya: (i) time-series client flow, tracking service uptake for 8841 clients; (ii) structured questionnaires with 24 providers; (iii) in-depth interviews with 17 providers; (iv) workload and facility data using a periodic activity review and cost-instruments; and (v) contextual data on external activities related to integration in study sites. Overall, our findings suggested that although structural factors like stock-outs, distribution of staffing and workload, rotation of staff can affect how integrated care is provided, all these factors can be influenced by staff themselves: both frontline and management. Facilities where staff displayed agency of decision making, worked as a team to share workload and had management that supported this, showed better integration delivery and staff were able to overcome some structural deficiencies to enable integrated care. Poor-performing facilities had good structural integration, but staff were unable to utilize this because they were poorly organized, unsupported or teams were dysfunctional. Conscientious objection and moralistic attitudes were also barriers. Integra has demonstrated that structural integration is not sufficient for integrated service delivery. Rather, our case studies show that in some cases excellent leadership and peer-teamwork enabled facilities to perform well despite resource shortages. The ability to provide support for staff to work flexibly to deliver integrated services and build resilient health systems to meet changing needs is particularly relevant as

Positioning for capitation in long-term care: a profile of vertical integration strategies in health and social service organizations.

PubMed

Walsh, A M

1998-01-01

During the next decade, the population over age 65 is expected to increase by 11% while the population over age 85 is expected to increase by 42%. These projections suggest that many organizations which currently provide services to the aged will be required to design a range of new products and services for this diverse population. Vertically integrated services provide a viable opportunity to competitively position an organization to respond to the diverse needs of an aged market. Since vertical integration will be essential in negotiating capitate contracts for the aged in the future, this study examined the extent of vertical integration in 116 health and social service organizations in an urban market with an expanding geriatric population.

THE TSUNAMI SERVICE BUS, AN INTEGRATION PLATFORM FOR HETEROGENEOUS SENSOR SYSTEMS

NASA Astrophysics Data System (ADS)

Fleischer, J.; Häner, R.; Herrnkind, S.; Kriegel, U.; Schwarting, H.; Wächter, J.

2009-12-01

The Tsunami Service Bus (TSB) is the sensor integration platform of the German Indonesian Tsunami Early Warning System (GITEWS) [1]. The primary goal of GITEWS is to deliver reliable tsunami warnings as fast as possible. This is achieved on basis of various sensor systems like seismometers, ocean instrumentation, and GPS stations, all providing fundamental data to support prediction of tsunami wave propagation by the GITEWS warning center. However, all these sensors come with their own proprietary data formats and specific behavior. Also new sensor types might be added, old sensors will be replaced. To keep GITEWS flexible the TSB was developed in order to access and control sensors in a uniform way. To meet these requirements the TSB follows the architectural blueprint of a Service Oriented Architecture (SOA). The integration platform implements dedicated services communicating via a service infrastructure. The functionality required for early warnings is provided by loosely coupled services replacing the "hard-wired" coupling at data level. Changes in the sensor specification are confined to the data level without affecting the warning center. Great emphasis was laid on following the Sensor Web Enablement (SWE) standard [2], specified by the Open Geospatial Consortium (OGC) [3]. As a result the full functionality needed in GITEWS could be achieved by implementing the four SWE services: The Sensor Observation Service for retrieving sensor measurements, the Sensor Alert Service in order to deliver sensor alerts, the Sensor Planning Service for tasking sensors, and the Web Notification Service for conduction messages to various media channels. Beyond these services the TSB also follows SWE Observation & Measurements specifications (O&M) for data encoding and Sensor Model Language (SensorML) for meta information. Moreover, accessing sensors via the TSB is not restricted to GITEWS. Multiple instances of the TSB can be composed to realize federate warning system

Integrated services to support detection, prevention and planning of the agricultural-forest-rural land against fires

NASA Astrophysics Data System (ADS)

Scipioni, A.; Tagliaferri, F.

2009-04-01

Objective of the document is to define lines of development and distribution of the services to support detection, prevention and planning of the agricultural-forest-rural land against fire. The services will be a valid support on hand of the Regional and National Administrations involved in the agricultural-forest-rural activities (Ministry of Agricultural and Forestry Policies, National Forest Police, ecc..), through the employment of the SIAN "National Agricultural Informative System", that is the integrated national information system for the entire agriculture, forestry and fisheries Administration. The services proposals would be distributed through the GIS (Geographic Information Systems) of the SIAN: the GIS database is a single nation-wide digital graphic database consisting of: - Ortophotos: Aerial images of approz. 45 km2 each with ground resolution of 50 cm; - Cadastral maps: Land maps; - Thematic layers: Land use and crops identification The GIS services can take full advantage of the benefits of SIAN architectural model designed for best integration and interoperability with other Central and Local P.A. bodies whose main items are: - Integration of information from different sources; - Maintainance of the internal coeherence of any integrated information; - Flexibility with respect to technical or organizational changes The "innovative "services described below could be useful to support the development of institutional tasks of public Agencies and Administrations (es. Regions or Civil Protection agencies) according to than previewed from the D.Lgs. 173/98. Services of support to the management of the phenomenon of wildland fires The activities outlined in below figure, don't have a linear and defined temporal sequence, but a dynamic and time integration. It guarantees not only the integrated use of the various information, but also the value of every product, for level of accuracy, coherence and timeliness of the information. Description of four main

Integrated Specialized Early-Course Psychosis Treatment Services - University Psychiatric Hospital Vrapce Model.

PubMed

Ostojić, DraŽenka; Čulo, Ilaria; Silić, Ante; Kos, Suzana; Savić, Aleksandar

2018-06-01

First episode of psychosis presents a critical period in terms of numerous associated risks, but also possibilities for effective therapeutic interventions. There is a continued focus on early interventions in prodromal states and early course of frank psychosis, aimed at ensuring faster remission, reducing relapses, achieving better long-term functioning, and preventing adverse outcomes linked to untreated psychosis and chronic psychotic disorders. A number of different specialized treatment models and services exist trying to close knowledge gaps and provide clinical interventions to first-episode psychosis (FEP) patients, but there is still no generally accepted standard of care informing our every-day practice. FEP and early-course psychosis specialized treatment model developed in 2004 in University Psychiatric Hospital Vrapce rests on integration of care across different organization units and clinical presentation acuity levels and patient needs (intensive care, FEP inpatient unit, FEP outpatient services including day hospital). Such integration of FEP services allows for flexible entry point on multiple levels, earlier structuring of therapeutic alliance for those requiring inpatient care, reduction of risks associated with FEP, quicker formation of long-term treatment plans, reduction of delay in accessing specialized services, and a more coordinated diagnostic process and recruitment of FEP patient population. Detailed evaluations of outcomes and comparisons with different treatment models are necessary in order to assess strengths and weaknesses of each specific model and inform modifications to current practice models.

Service-Learning and Integrated Course Redesign: Principles of Management and the Campus Kitchen Metaproject

ERIC Educational Resources Information Center

Flannery, Brenda L.; Pragman, Claudia H.

2010-01-01

This article describes the process of redesigning a Principles of Management course to integrate a service-learning metaproject. The metaproject was Campus Kitchen, a food recovery and delivery program operated on a handful of university campuses across the United States. We used L. Dee Fink's integrated course design approach as well as systems…

Overview of Integrated Child Development Services Programme in India: Some Policy Implications for Nepal.

ERIC Educational Resources Information Center

Shrestha, Kishor

This paper presents an overview of the Integrated Child Development Services (ICDS) program in India, discusses the context of Early Childhood Education (ECE) in Nepal, analyzes the best practices of the ICDS, and draws some policy implications for improving ECE in Nepal. The ICDS program is an integrated child development program with the…

Obstacles to the coordination of delivering integrated prenatal HIV, syphilis and hepatitis B testing services in Guangdong: using a needs assessment approach.

PubMed

Xia, Jianhong; Rutherford, Shannon; Ma, Yuanzhu; Wu, Li; Gao, Shuang; Chen, Tingting; Lu, Xiao; Zhang, Xiaozhuang; Chu, Cordia

2015-03-24

Integration of services for Prevention of Mother-To-Child Transmission of HIV (PMTCT) into routine maternal and child health care is promoted as a priority strategy by the WHO to facilitate the implementation of PMTCT. Integration of services emphasizes inter-sectoral coordination in the health systems to provide convenient services for clients. China has been integrating prenatal HIV, syphilis and hepatitis B testing services since 2009. However, as the individual health systems are complex, effective coordination among different health agencies is challenging. Few studies have examined the factors that affect the coordination of such complex systems. The aim of this study is to assess the effectiveness of and examine challenges for integrated service delivery. Findings will provide the basis for strategy development to enhance the effective delivery of integrated services. The research was conducted in Guangdong province in 2013 using a needs assessment approach that includes qualitative and quantitative methods. Quantitative data was collected through a survey and from routine monitoring for PMTCT and qualitative data was collected through stakeholder interviews. Routine monitoring data used to assess key indicators of coordination suggested numerous coordination problems. The rates of prenatal HIV (95%), syphilis (47%) and hepatitis B (47%) test were inconsistent. An average of only 20% of the HIV positive mothers was referred in the health systems. There were no regular meetings among different health agencies and the clients indicated complicated service processes. The major obstacles to the coordination of delivering these integrated services are lack of service resource integration; and lack of a mechanism for coordination of the health systems, with no uniform guidelines, clear roles or consistent evaluation. The key obstacles that have been identified in this study hinder the coordination of the delivery of integrated services. Our recommendations include

Integrated care services: lessons learned from the deployment of the NEXES project.

PubMed

Hernández, Carme; Alonso, Albert; Garcia-Aymerich, Judith; Grimsmo, Anders; Vontetsianos, Theodore; García Cuyàs, Francesc; Altes, Anna Garcia; Vogiatzis, Ioannis; Garåsen, Helge; Pellise, Laura; Wienhofen, Leendert; Cano, Isaac; Meya, Montserrat; Moharra, Montserrat; Martinez, Joan Ignasi; Escarrabill, Juan; Roca, Josep

2015-01-01

To identify barriers to deployment of four articulated Integrated Care Services supported by Information Technologies in three European sites. The four services covered the entire spectrum of severity of illness. The project targeted chronic patients with obstructive pulmonary disease, cardiac failure and/or type II diabetes mellitus. One health care sector in Spain (Barcelona) (n = 11.382); six municipalities in Norway (Trondheim) (n = 450); and one hospital in Greece (Athens) (n = 388). The four services were: (i) Home-based long-term maintenance of rehabilitation effects (n = 337); (ii) Enhanced Care for frail patients, n = 1340); (iii) Home Hospitalization and Early Discharge (n = 2404); and Support for remote diagnosis (forced spirometry testing) in primary care (Support) (n = 8139). Both randomized controlled trials and pragmatic study designs were combined. Two technological approaches were compared. The Model for Assessment of Telemedicine applications was adopted. The project demonstrated: (i) Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (p < 0.01); (ii) Enhanced care and fewer hospitalizations in chronic respiratory patients (p < 0.05); (iii) Reduced in-hospital days for all types of patients (p < 0.001) in Home Hospitalization/Early Discharge; and (iv) Increased quality of testing (p < 0.01) for patients with respiratory symptoms in Support, with marked differences among sites. The four integrated care services showed high potential to enhance health outcomes with cost-containment. Change management, technological approach and legal issues were major factors modulating the success of the deployment. The project generated a business plan to foster service sustainability and health innovation. Deployment strategies require site-specific adaptations.

Achieving End-to-End QoS in the Next Generation Internet: Integrated Services Over Differentiated Service Networks

NASA Technical Reports Server (NTRS)

Bai, Haowei; Atiquzzaman, Mohammed; Ivancic, William

2001-01-01

Currently there are two approaches to provide Quality of Service (QoS) in the next generation Internet: An early one is the Integrated Services (IntServ) with the goal of allowing end-to-end QoS to be provided to applications; the other one is the Differentiated Services (DiffServ) architecture providing QoS in the backbone. In this context, a DiffServ network may be viewed as a network element in the total end-to-end path. The objective of this paper is to investigate the possibility of providing end-to-end QoS when IntServ runs over DiffServ backbone in the next generation Internet. Our results show that the QoS requirements of IntServ applications can be successfully achieved when IntServ traffic is mapped to the DiffServ domain in next generation Internet.

Achieving End-to-End QoS in the Next Generation Internet: Integrated Services over Differentiated Service Networks

NASA Technical Reports Server (NTRS)

Bai, Haowei; Atiquzzaman, Mohammed; Ivancic, William

2001-01-01

Currently there are two approaches to provide Quality of Service (QoS) in the next generation Internet: An early one is the Integrated Services (IntServ) with the goal of allowing end-to-end QoS to be provided to applications; the other one is the Differentiated Services (DiffServ) architecture providing QoS in the backbone. In this context, a DiffServ network may be viewed as a network element in the total end-to-end path. The objective of this paper is to investigate the possibility of providing end-to-end QoS when IntServ runs over DiffServ backbone in the next generation Internet. Our results show that the QoS requirements of IntServ applications can be successfully achieved when IntServ traffic is mapped to the DiffServ domain in next generation Internet.

Changes in contraceptive use following integration of family planning into ART Services in Cross River State, Nigeria.

PubMed

McCarraher, Donna R; Vance, Gwyneth; Gwarzo, Usman; Taylor, Douglas; Chabikuli, Otto Nzapfurundi

2011-12-01

One strategy for meeting the contraceptive needs of HIV-positive women is to integrate family planning into HIV services. In 2008 in Cross River State, Nigeria,family planning was integrated into antiretroviral (ART) services in five local government areas. A basic family planning/HIV integration model was implemented in three of these areas, and an enhanced model in the other two. We conducted baseline interviews in 2008 and follow-up interviews 12-14 months later with 274 female ART clients aged 18-45 in 2009 across the five areas. Unmet need for contraception was high at baseline (28-35 percent). We found that modern contraceptive use rose in the enhanced and basic groups; most of the increase was in consistent condom use. Despite an increase in family planning counseling by ART providers, referrals to family planning services for noncondom methods were low. We conclude by presenting alternative strategies for family planning/HIV integration in settings where large families and low contraceptive use are normative.

Perceiving integration of a complementary medicine service within a general surgery department through documentation of consultations: a thematic analysis.

PubMed

Schiff, Elad; Ben-Arye, Eran; Attias, Samuel; Sroka, Gideon; Matter, Ibrahim; Keshet, Yael

2012-12-01

This study aims to examine the meaning and practical implications of integration of a complementary medicine-based surgery service in a hospital setting (CISS--Complementary/Integrative Surgery Service) through analysis of consultation reports associated with this service. Thematic analysis was used to evaluate CISS consultation reports in a hospital electronic consultant charting system during the first half year of the service's activity. 304 consultation reports were analyzed. Nurses initiated significantly more consultations than physicians (55% vs 7%). Consultation requests were gradually more focused on specific symptoms, possibly manifesting a better understanding of the scope of complementary medicine in the surgery setting. CISS practitioners responded in more biomedical language over time, albeit offering a more holistic perspective regarding patients' needs as well as clarifications regarding the nature of the treatment they provided. Diverse communication patterns in consultations evolved over time representing dynamics in multiple levels of integration of the CISS. Documented communication through consultations can provide a window to the process of integration of complementary medicine-based services in health systems. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Integrated care management: aligning medical call centers and nurse triage services.

PubMed

Kastens, J M

1998-01-01

Successful integrated delivery systems must aggressively design new approaches to managing patient care. Implementing a comprehensive care management model to coordinate patient care across the continuum is essential to improving patient care and reducing costs. The practice of telephone nursing and the need for experienced registered nurses to staff medical call centers, nurse triage centers, and outbound telemanagement is expanding as the penetration of full-risk capitated managed care contracts are signed. As health systems design their new care delivery approaches and care management models, medical call centers will be an integral approach to managing demand for services, chronic illnesses, and prevention strategies.

Health systems facilitators and barriers to the integration of HIV and chronic disease services: a systematic review

PubMed Central

Watt, Nicola; Sigfrid, Louise; Legido-Quigley, Helena; Hogarth, Sue; Maimaris, Will; Otero-García, Laura; Perel, Pablo; Buse, Kent; McKee, Martin; Piot, Peter; Balabanova, Dina

2017-01-01

Abstract Integration of services for patients with more than one diagnosed condition has intuitive appeal but it has been argued that the empirical evidence to support it is limited. We report the findings of a systematic review that sought to identify health system factors, extrinsic to the integration process, which either facilitated or hindered the integration of services for two common disorders, HIV and chronic non-communicable diseases. Findings were initially extracted and organized around a health system framework, followed by a thematic cross-cutting analysis and validation steps. Of the 150 articles included, 67% (n = 102) were from high-income countries. The articles explored integration with services for one or several chronic disorders, the most studied being alcohol or substance use disorders (47.7%), and mental health issues (29.5%). Four cross-cutting themes related to the health system were identified. The first and most common theme was the requirement for effective collaboration and coordination: formal and informal productive relationships throughout the system between providers and within teams, and between staff and patients. The second was the need for adequate and appropriately skilled and incentivized health workers—with the right expertise, training and operational support for the programme. The third was the need for supportive institutional structures and dedicated resources. The fourth was leadership in terms of political will, effective managerial oversight and organizational culture, indicating that actual implementation is as important as programme design. A fifth theme, outside the health system, but underpinning all aspects of the system operation, was that placing the patient at the centre of service delivery and responding holistically to their diverse needs. This was an important facilitator of integration. These findings confirm that integration processes in service delivery depend substantially for their success on

Integrating postabortion care, menstrual regulation and family planning services in Bangladesh: a pre-post evaluation.

PubMed

Biswas, Kamal K; Pearson, Erin; Shahidullah, S M; Sultana, Sharmin; Chowdhury, Rezwana; Andersen, Kathryn L

2017-03-11

In Bangladesh, abortion is restricted except to save the life of a woman, but menstrual regulation is allowed to induce menstruation and return to non-pregnancy after a missed period. MR services are typically provided through the Directorate General of Family Planning, while postabortion care services for incomplete abortion are provided by facilities under the Directorate General of Health Services. The bifurcated health system results in reduced quality of care, particularly for postabortion care patients whose procedures are often performed using sub-optimal uterine evacuation technology and typically do not receive postabortion contraceptive services. This study evaluated the success of a pilot project that aimed to integrate menstrual regulation, postabortion care and family planning services across six Directorate General of Health Services and Directorate General of Family Planning facilities by training providers on woman-centered abortion care and adding family planning services at sites offering postabortion care. A pre-post evaluation was conducted in the six large intervention facilities. Structured client exit interviews were administered to all uterine evacuation clients presenting in the 2-week data collection period for each facility at baseline (n = 105; December 2011-January 2012) and endline (n = 107; February-March 2013). Primary outcomes included service integration indicators such as provision of menstrual regulation, postabortion care and family planning services in both facility types, and quality of care indicators such as provision of pain management, provider communication and women's satisfaction with the services received. Outcomes were compared between baseline and endline for Directorate General of Family Planning and Directorate General of Health Services facilities, and chi-square tests and t-tests were used to test for differences between baseline and endline. At the end of the project there was an increase in menstrual

The EBM-DPSER Conceptual Model: Integrating Ecosystem Services into the DPSIR Framework

PubMed Central

Kelble, Christopher R.; Loomis, Dave K.; Lovelace, Susan; Nuttle, William K.; Ortner, Peter B.; Fletcher, Pamela; Cook, Geoffrey S.; Lorenz, Jerry J.; Boyer, Joseph N.

2013-01-01

There is a pressing need to integrate biophysical and human dimensions science to better inform holistic ecosystem management supporting the transition from single species or single-sector management to multi-sector ecosystem-based management. Ecosystem-based management should focus upon ecosystem services, since they reflect societal goals, values, desires, and benefits. The inclusion of ecosystem services into holistic management strategies improves management by better capturing the diversity of positive and negative human-natural interactions and making explicit the benefits to society. To facilitate this inclusion, we propose a conceptual model that merges the broadly applied Driver, Pressure, State, Impact, and Response (DPSIR) conceptual model with ecosystem services yielding a Driver, Pressure, State, Ecosystem service, and Response (EBM-DPSER) conceptual model. The impact module in traditional DPSIR models focuses attention upon negative anthropomorphic impacts on the ecosystem; by replacing impacts with ecosystem services the EBM-DPSER model incorporates not only negative, but also positive changes in the ecosystem. Responses occur as a result of changes in ecosystem services and include inter alia management actions directed at proactively altering human population or individual behavior and infrastructure to meet societal goals. The EBM-DPSER conceptual model was applied to the Florida Keys and Dry Tortugas marine ecosystem as a case study to illustrate how it can inform management decisions. This case study captures our system-level understanding and results in a more holistic representation of ecosystem and human society interactions, thus improving our ability to identify trade-offs. The EBM-DPSER model should be a useful operational tool for implementing EBM, in that it fully integrates our knowledge of all ecosystem components while focusing management attention upon those aspects of the ecosystem most important to human society and does so within

The EBM-DPSER conceptual model: integrating ecosystem services into the DPSIR framework.

PubMed

Kelble, Christopher R; Loomis, Dave K; Lovelace, Susan; Nuttle, William K; Ortner, Peter B; Fletcher, Pamela; Cook, Geoffrey S; Lorenz, Jerry J; Boyer, Joseph N

2013-01-01

There is a pressing need to integrate biophysical and human dimensions science to better inform holistic ecosystem management supporting the transition from single species or single-sector management to multi-sector ecosystem-based management. Ecosystem-based management should focus upon ecosystem services, since they reflect societal goals, values, desires, and benefits. The inclusion of ecosystem services into holistic management strategies improves management by better capturing the diversity of positive and negative human-natural interactions and making explicit the benefits to society. To facilitate this inclusion, we propose a conceptual model that merges the broadly applied Driver, Pressure, State, Impact, and Response (DPSIR) conceptual model with ecosystem services yielding a Driver, Pressure, State, Ecosystem service, and Response (EBM-DPSER) conceptual model. The impact module in traditional DPSIR models focuses attention upon negative anthropomorphic impacts on the ecosystem; by replacing impacts with ecosystem services the EBM-DPSER model incorporates not only negative, but also positive changes in the ecosystem. Responses occur as a result of changes in ecosystem services and include inter alia management actions directed at proactively altering human population or individual behavior and infrastructure to meet societal goals. The EBM-DPSER conceptual model was applied to the Florida Keys and Dry Tortugas marine ecosystem as a case study to illustrate how it can inform management decisions. This case study captures our system-level understanding and results in a more holistic representation of ecosystem and human society interactions, thus improving our ability to identify trade-offs. The EBM-DPSER model should be a useful operational tool for implementing EBM, in that it fully integrates our knowledge of all ecosystem components while focusing management attention upon those aspects of the ecosystem most important to human society and does so within

A stakeholder visioning exercise to enhance chronic care and the integration of community pharmacy services.

PubMed

Franco-Trigo, L; Tudball, J; Fam, D; Benrimoj, S I; Sabater-Hernández, D

2018-02-21

Collaboration between relevant stakeholders in health service planning enables service contextualization and facilitates its success and integration into practice. Although community pharmacy services (CPSs) aim to improve patients' health and quality of life, their integration in primary care is far from ideal. Key stakeholders for the development of a CPS intended at preventing cardiovascular disease were identified in a previous stakeholder analysis. Engaging these stakeholders to create a shared vision is the subsequent step to focus planning directions and lay sound foundations for future work. This study aims to develop a stakeholder-shared vision of a cardiovascular care model which integrates community pharmacists and to identify initiatives to achieve this vision. A participatory visioning exercise involving 13 stakeholders across the healthcare system was performed. A facilitated workshop, structured in three parts (i.e., introduction; developing the vision; defining the initiatives towards the vision), was designed. The Chronic Care Model inspired the questions that guided the development of the vision. Workshop transcripts, researchers' notes and materials produced by participants were analyzed using qualitative content analysis. Stakeholders broadened the objective of the vision to focus on the management of chronic diseases. Their vision yielded 7 principles for advanced chronic care: patient-centered care; multidisciplinary team approach; shared goals; long-term care relationships; evidence-based practice; ease of access to healthcare settings and services by patients; and good communication and coordination. Stakeholders also delineated six environmental factors that can influence their implementation. Twenty-four initiatives to achieve the developed vision were defined. The principles and factors identified as part of the stakeholder shared-vision were combined in a preliminary model for chronic care. This model and initiatives can guide policy

Establishing an integrated gastroenterology service between a medical center and the community.

PubMed

Niv, Yaron; Dickman, Ram; Levi, Zohar; Neumann, Gadi; Ehrlich, Dorit; Bitterman, Haim; Dreiher, Jacob; Cohen, Arnon; Comaneshter, Doron; Halpern, Eyran

2015-02-21

To combine community and hospital services in order to enable improvements in patient management, an integrated gastroenterology service (IGS) was established. Referral patterns to specialist clinics were optimized; open access route for endoscopic procedures (including esophago-gastro-duodenoscopy, sigmoidoscopy and colonoscopy) was established; family physicians' knowledge and confidence were enhanced; direct communication lines between experts and primary care physicians were opened. Continuing education, guidelines and agreed instructions for referral were promoted by the IGS. Six quality indicators were developed by the Delphi method, rigorously designed and regularly monitored. Improvement was assessed by comparing 2010, 2011 and 2012 indicators. An integrated delivery system in a specific medical field may provide a solution to a fragmented healthcare system impaired by a lack of coordination. In this paper we describe a new integrated gastroenterology service established in April 2010. Waiting time for procedures decreased: 3 mo in April 30th 2010 to 3 wk in April 30th 2011 and stayed between 1-3 wk till December 30th 2012. Average cost for patient's visit decreased from 691 to 638 NIS (a decrease of 7.6%). Six health indicators were improved significantly comparing 2010 to 2012, 2.5% to 67.5%: Bone densitometry for patients with inflammatory bowel disease, preventive medications for high risk patients on aspirin/NSAIDs, colonoscopy following positive fecal occult blood test, gastroscopy in Barrett's esophagus, documentation of family history of colorectal cancer, and colonoscopy in patients with a family history of colorectal cancer. Establishment of an IGS was found to effectively improve quality of care, while being cost-effective.

Design of a terminal solution for integration of in-home health care devices and services towards the Internet-of-Things

NASA Astrophysics Data System (ADS)

Pang, Zhibo; Zheng, Lirong; Tian, Junzhe; Kao-Walter, Sharon; Dubrova, Elena; Chen, Qiang

2015-01-01

In-home health care services based on the Internet-of-Things are promising to resolve the challenges caused by the ageing of population. But the existing research is rather scattered and shows lack of interoperability. In this article, a business-technology co-design methodology is proposed for cross-boundary integration of in-home health care devices and services. In this framework, three key elements of a solution (business model, device and service integration architecture and information system integration architecture) are organically integrated and aligned. In particular, a cooperative Health-IoT ecosystem is formulated, and information systems of all stakeholders are integrated in a cooperative health cloud as well as extended to patients' home through the in-home health care station (IHHS). Design principles of the IHHS includes the reuse of 3C platform, certification of the Health Extension, interoperability and extendibility, convenient and trusted software distribution, standardised and secured electrical health care record handling, effective service composition and efficient data fusion. These principles are applied to the design of an IHHS solution called iMedBox. Detailed device and service integration architecture and hardware and software architecture are presented and verified by an implemented prototype. The quantitative performance analysis and field trials have confirmed the feasibility of the proposed design methodology and solution.

LEOPACK The integrated services communications system based on LEO satellites

NASA Astrophysics Data System (ADS)

Negoda, A.; Bunin, S.; Bushuev, E.; Dranovsky, V.

LEOPACK is yet another LEO satellite project which provides global integrated services for 'business' communications. It utilizes packet rather then circuit switching in both terrestrial and satellite chains as well as cellular approach for frequencies use. Original multiple access protocols and decentralized network control make it possible to organize regionally or logically independent and world-wide networks. Relatively small number of satellites (28) provides virtually global network coverage.

A Model for Integrating New Technologies into Pre-Service Teacher Training Programs Ajman University (A Case Study)

ERIC Educational Resources Information Center

Shaqour, Ali Zuhdi H.

2005-01-01

This study introduces a "Technology Integration Model" for a learning environment utilizing constructivist learning principles and integrating new technologies namely computers and the Internet into pre-service teacher training programs. The technology integrated programs and learning environments may assist learners to gain experiences…

Integrated Services Digital Networks: How It Can Be Used for Distance Education.

ERIC Educational Resources Information Center

Saba, Farhad; Twitchell, David

1989-01-01

Describes Integrated Services Digital Networks (ISDN), which, combined with desktop workstations, will provide access to voice, text, and video telecommunications. Telecommunications technology is discussed, the use of desktop workstations to facilitate ISDN is described, and possible future uses of ISDN technology in distance education are…

Integrative Pre-Service Elementary Teacher Training: The Role of Interdisciplinary Collaborative Mathematics

ERIC Educational Resources Information Center

Chiatula, Victoria Oliaku

2015-01-01

This primer summarizes interdisciplinary collaborative mathematics as an integrative approach to train pre-service elementary teachers to teach math utilizing Junior Achievement USA (JA) educational programs within an elementary Math Methods course. The primer provides a JA historical background/program overview, summarizes the interdisciplinary…

Bio-jETI: a service integration, design, and provisioning platform for orchestrated bioinformatics processes.

PubMed

Margaria, Tiziana; Kubczak, Christian; Steffen, Bernhard

2008-04-25

With Bio-jETI, we introduce a service platform for interdisciplinary work on biological application domains and illustrate its use in a concrete application concerning statistical data processing in R and xcms for an LC/MS analysis of FAAH gene knockout. Bio-jETI uses the jABC environment for service-oriented modeling and design as a graphical process modeling tool and the jETI service integration technology for remote tool execution. As a service definition and provisioning platform, Bio-jETI has the potential to become a core technology in interdisciplinary service orchestration and technology transfer. Domain experts, like biologists not trained in computer science, directly define complex service orchestrations as process models and use efficient and complex bioinformatics tools in a simple and intuitive way.

Numbers, systems, people: how interactions influence integration. Insights from case studies of HIV and reproductive health services delivery in Kenya.

PubMed

Mayhew, Susannah H; Sweeney, Sedona; Warren, Charlotte E; Collumbien, Martine; Ndwiga, Charity; Mutemwa, Richard; Lut, Irina; Colombini, Manuela; Vassall, Anna

2017-11-01

Drawing on rich data from the Integra evaluation of integrated HIV and reproductive-health services, we explored the interaction of systems hardware and software factors to explain why some facilities were able to implement and sustain integrated service delivery while others were not. This article draws on detailed mixed-methods data for four case-study facilities offering reproductive-health and HIV services between 2009 and 2013 in Kenya: (i) time-series client flow, tracking service uptake for 8841 clients; (ii) structured questionnaires with 24 providers; (iii) in-depth interviews with 17 providers; (iv) workload and facility data using a periodic activity review and cost-instruments; and (v) contextual data on external activities related to integration in study sites. Overall, our findings suggested that although structural factors like stock-outs, distribution of staffing and workload, rotation of staff can affect how integrated care is provided, all these factors can be influenced by staff themselves: both frontline and management. Facilities where staff displayed agency of decision making, worked as a team to share workload and had management that supported this, showed better integration delivery and staff were able to overcome some structural deficiencies to enable integrated care. Poor-performing facilities had good structural integration, but staff were unable to utilize this because they were poorly organized, unsupported or teams were dysfunctional. Conscientious objection and moralistic attitudes were also barriers.Integra has demonstrated that structural integration is not sufficient for integrated service delivery. Rather, our case studies show that in some cases excellent leadership and peer-teamwork enabled facilities to perform well despite resource shortages. The ability to provide support for staff to work flexibly to deliver integrated services and build resilient health systems to meet changing needs is particularly relevant as health

Influencing Factors and Integration of ICT into Teaching Practices of Pre- Service and Starting Teachers

ERIC Educational Resources Information Center

Aslan, Aydin; Zhu, Chang

2016-01-01

Teachers need to be competent in integrating ICT into education to support teaching and learning process. This study aims to investigate both the pre-service and starting teachers' perceptions for ICT-related variables--perceived ICT competence, perceived competence in ICT integration, attitudes towards ICT, anxiety around ICT usage, external…

Integrated care services: lessons learned from the deployment of the NEXES project

PubMed Central

Hernández, Carme; Alonso, Albert; Garcia-Aymerich, Judith; Grimsmo, Anders; Vontetsianos, Theodore; García Cuyàs, Francesc; Altes, Anna Garcia; Vogiatzis, Ioannis; Garåsen, Helge; Pellise, Laura; Wienhofen, Leendert; Cano, Isaac; Meya, Montserrat; Moharra, Montserrat; Martinez, Joan Ignasi; Escarrabill, Juan; Roca, Josep

2015-01-01

Objectives To identify barriers to deployment of four articulated Integrated Care Services supported by Information Technologies in three European sites. The four services covered the entire spectrum of severity of illness. The project targeted chronic patients with obstructive pulmonary disease, cardiac failure and/or type II diabetes mellitus. Setting One health care sector in Spain (Barcelona) (n = 11.382); six municipalities in Norway (Trondheim) (n = 450); and one hospital in Greece (Athens) (n = 388). Method The four services were: (i) Home-based long-term maintenance of rehabilitation effects (n = 337); (ii) Enhanced Care for frail patients, n = 1340); (iii) Home Hospitalization and Early Discharge (n = 2404); and Support for remote diagnosis (forced spirometry testing) in primary care (Support) (n = 8139). Both randomized controlled trials and pragmatic study designs were combined. Two technological approaches were compared. The Model for Assessment of Telemedicine applications was adopted. Results The project demonstrated: (i) Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (p < 0.01); (ii) Enhanced care and fewer hospitalizations in chronic respiratory patients (p < 0.05); (iii) Reduced in-hospital days for all types of patients (p < 0.001) in Home Hospitalization/Early Discharge; and (iv) Increased quality of testing (p < 0.01) for patients with respiratory symptoms in Support, with marked differences among sites. Conclusions The four integrated care services showed high potential to enhance health outcomes with cost-containment. Change management, technological approach and legal issues were major factors modulating the success of the deployment. The project generated a business plan to foster service sustainability and health innovation. Deployment strategies require site-specific adaptations. PMID:26034465

Learning To Serve, Serving To Learn: A View from Higher Education. Integrating Service-Learning into Curriculum: Lessons Learned. Teacher Education Consortium in Service-Learning.

ERIC Educational Resources Information Center

2003

This collection of papers includes lessons learned from a 3-year collaboration among faculty who had pursued a scholarly inquiry of service-learning, integrated service-learning into their curricula, altered their teaching, forged partnerships with community based organizations, and developed measures and methodologies for assessing results. The…

The Bilingual Academic Services and Integrated Career Systems Program: Project BASICS, 1987-1988. OREA Report.

ERIC Educational Resources Information Center

Berney, Tomi D.; Carey, Cecilia

The Bilingual Academic Services and Integrated Career Systems Program (Project BASICS) is a federally-funded program of instructional and support services provided to 122 students at a Queens high school. The program's aim was to develop English literacy skills and appreciation of cultural diversity, and to prepare students for the psychosocial…

Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider.

PubMed

Douglas, Heather E; Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

2017-04-10

There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients.

"It was the whole picture" a mixed methods study of successful components in an integrated wellness service in North East England.

PubMed

Cheetham, M; Van der Graaf, P; Khazaeli, B; Gibson, E; Wiseman, A; Rushmer, R

2018-03-22

A growing number of Local Authorities (LAs) have introduced integrated wellness services as part of efforts to deliver cost effective, preventive services that address the social determinants of health. This study examined which elements of an integrated wellness service in the north east of England were effective in improving health and wellbeing (HWB). The study used a mixed-methods approach. In-depth semi-structured interviews (IVs) were conducted with integrated wellness service users (n = 25) and focus groups (FGs) with group based service users (n = 14) and non-service users (n = 23) to gather the views of stakeholders. Findings are presented here alongside analysis of routine monitoring data. The different data were compared to examine what each data source revealed about the effectiveness of the service. Findings suggest that integrated wellness services work by addressing the social determinants of health and respond to multiple complex health and social concerns rather than single issues. The paper identifies examples of 'active ingredients' at the heart of the programme, such as sustained relationships, peer support and confidence building, as well as the activities through which changes take place, such as sports and leisure opportunities which in turn encourage social interaction. Wider wellbeing outcomes, including reduced social isolation and increased self-efficacy are also reported. Practical and motivational support helped build community capacity by encouraging community groups to access funding, helped navigate bureaucratic systems, and promoted understanding of marginalised communities. Fully integrated wellness services could support progression opportunities through volunteering and mentoring. An integrated wellness service that offers a holistic approach was valued by service users and allowed them to address complex issues simultaneously. Few of the reported health gains were captured in routine data. Quantitative and

An analysis of the economic and patient outcome impact of an integrated COPD service in east London.

PubMed

Garner, Anna; Hodson, Matthew; Ketsetzis, Georgios; Pulle, Laurence; Yorke, Janelle; Bhowmik, Angshu

2017-01-01

Exacerbations of COPD carry a huge burden of morbidity and a significant economic impact. It has been shown that home care may be useful for exacerbations of COPD. This article presents a review of an integrated COPD service in east London. Hospital Episode Statistics, Public Health Mortality Files and clinical data were used to analyze differences in health care usage and COPD patient outcomes, including COPD assessment test (CAT) scores for a subsample, before and after the introduction of the integrated service. There was a significant (30%) reduction in the number of hospital bed days for COPD patients ( P <0.05), alongside a significant increase in patients with only a short stay (0-1 days) in hospital ( P <0.0001). There was a significant increase in the number of patients dying outside of hospital (a proxy for quality of end-of-life care) following introduction of the service ( P =0.00015). Patients also reported a clinically significant improvement in CAT scores. A locally developed economic model shows that the economic benefits of the service (via impact on place of death and reduction in length of hospital stay) were almost equal to the cost of the service. The increase in proportion of short-stay admissions and the reduction in bed days suggest an impact of the service on early supported discharge and that this along with an improvement in patient clinical outcomes and in quality of end-of-life care shows that an exemplar integrated COPD service can provide benefits that equate to a nearly cost-neutral service.

GAUSS Market Analysis for Integrated Satellite Communication and Navigation Location Based services

NASA Astrophysics Data System (ADS)

Di Fazio, Antonella; Dricot, Fabienne; Tata, Francesco

2003-07-01

The demand for mobile information services coupled with positioning technologies for delivering value- added services that depend on a user's location has rapidly increased during last years. In particular, services and applications related with improved mobility safety and transport efficiency look very attractive.Solutions for location services vary in respect of positioning accuracy and the technical infrastructure required, and the associated investment in terminals and networks. From the analysis of the state-of-the art, it comes that various technologies are currently available on the European market, while mobile industry is gearing up to launch a wide variety of location services like tracking, alarming and locating.Nevertheless, when addressing safety of life as well as security applications, severe hurdles have to be posed in the light of existing technologies. Existing navigation (e.g. GPS) and communication systems are not able to completely satisfy the needs and requirements of safety-of-life-critical applications. As a matter of fact, the GPS system's main weaknesses today is its lack of integrity, which means its inability to warn users of a malfunction in a reasonable time, while the other positioning techniques do not provide satisfactory accuracy as well, and terrestrial communication networks are not capable to cope with stringent requirement in terms of service reliability and coverage.In this context, GAUSS proposes an innovative satellite-based solution using novel technology and effective tools for addressing mobility challenges in a cost efficient manner, improving safety and effectiveness.GAUSS (Galileo And UMTS Synergetic System) is a Research and Technological Development project co- funded by European Commission, within the frame of the 5th IST Programme. The project lasted two years, and it was successfully completed in November 2002. GAUSS key concept is the integration of Satellite Navigation GNSS and UMTS communication technology, to

Special Medicare reimbursement and fraud and abuse considerations for management services organizations, medical foundations, and integrated delivery systems.

PubMed

DeMuro, P R; Owens, J F

1994-01-01

This chapter discusses certain Medicare reimbursement and fraud and abuse considerations for management services organizations (MSOs), medical foundations, and integrated delivery systems. It stresses the necessity of a business plan, the sources of capitalization that might be used in creating an integrated delivery system, and their effect on Medicare reimbursement. It also discusses related party principles and considerations and the Medicare "incident to" regulations. Furthermore, it discusses the application of certain Medicare safe harbor regulations on MSOs' structures and services, and those of medical foundations and integrated delivery systems.

Exotic plant species receive adequate pollinator service despite variable integration into plant-pollinator networks.

PubMed

Thompson, Amibeth H; Knight, Tiffany M

2018-05-01

Both exotic and native plant species rely on insect pollinators for reproductive success, and yet few studies have evaluated whether and how exotic plant species receive services from native pollinators for successful reproduction in their introduced range. Plant species are expected to successfully reproduce in their exotic range if they have low reliance on animal pollinators or if they successfully integrate themselves into resident plant-pollinator networks. Here, we quantify the breeding system, network integration, and pollen limitation for ten focal exotic plant species in North America. Most exotic plant species relied on animal pollinators for reproduction, and these species varied in their network integration. However, plant reproduction was limited by pollen receipt for only one plant species. Our results demonstrate that even poorly integrated exotic plant species can still have high pollination service and high reproductive success. The comprehensive framework considered here provides a method to consider the contribution of plant breeding systems and the pollinator community to pollen limitation, and can be applied to future studies to provide a more synthetic understanding of the factors that determine reproductive success of exotic plant species.

Bio-jETI: a service integration, design, and provisioning platform for orchestrated bioinformatics processes

PubMed Central

Margaria, Tiziana; Kubczak, Christian; Steffen, Bernhard

2008-01-01

Background With Bio-jETI, we introduce a service platform for interdisciplinary work on biological application domains and illustrate its use in a concrete application concerning statistical data processing in R and xcms for an LC/MS analysis of FAAH gene knockout. Methods Bio-jETI uses the jABC environment for service-oriented modeling and design as a graphical process modeling tool and the jETI service integration technology for remote tool execution. Conclusions As a service definition and provisioning platform, Bio-jETI has the potential to become a core technology in interdisciplinary service orchestration and technology transfer. Domain experts, like biologists not trained in computer science, directly define complex service orchestrations as process models and use efficient and complex bioinformatics tools in a simple and intuitive way. PMID:18460173

Integrating traditional nursing service orientation content with electronic medical record orientation.

PubMed

Harton, Brenda B; Borrelli, Larry; Knupp, Ann; Rogers, Necolen; West, Vickie R

2009-01-01

Traditional nursing service orientation classes at an acute care hospital were integrated with orientation to the electronic medical record to blend the two components in a user-friendly format so that the learner is introduced to the culture, processes, and documentation methods of the organization, with an opportunity to document online in a practice domain while lecture and discussion information is fresh.

Establishing an integrated gastroenterology service between a medical center and the community

PubMed Central

Niv, Yaron; Dickman, Ram; Levi, Zohar; Neumann, Gadi; Ehrlich, Dorit; Bitterman, Haim; Dreiher, Jacob; Cohen, Arnon; Comaneshter, Doron; Halpern, Eyran

2015-01-01

AIM: To combine community and hospital services in order to enable improvements in patient management, an integrated gastroenterology service (IGS) was established. METHODS: Referral patterns to specialist clinics were optimized; open access route for endoscopic procedures (including esophago-gastro-duodenoscopy, sigmoidoscopy and colonoscopy) was established; family physicians’ knowledge and confidence were enhanced; direct communication lines between experts and primary care physicians were opened. Continuing education, guidelines and agreed instructions for referral were promoted by the IGS. Six quality indicators were developed by the Delphi method, rigorously designed and regularly monitored. Improvement was assessed by comparing 2010, 2011 and 2012 indicators. RESULTS: An integrated delivery system in a specific medical field may provide a solution to a fragmented healthcare system impaired by a lack of coordination. In this paper we describe a new integrated gastroenterology service established in April 2010. Waiting time for procedures decreased: 3 mo in April 30th 2010 to 3 wk in April 30th 2011 and stayed between 1-3 wk till December 30th 2012. Average cost for patient’s visit decreased from 691 to 638 NIS (a decrease of 7.6%). Six health indicators were improved significantly comparing 2010 to 2012, 2.5% to 67.5%: Bone densitometry for patients with inflammatory bowel disease, preventive medications for high risk patients on aspirin/NSAIDs, colonoscopy following positive fecal occult blood test, gastroscopy in Barrett’s esophagus, documentation of family history of colorectal cancer, and colonoscopy in patients with a family history of colorectal cancer. CONCLUSION: Establishment of an IGS was found to effectively improve quality of care, while being cost-effective. PMID:25717251

Opportunities for and constraints to integration of health services in Poland*

PubMed Central

Sobczak, Alicja

2002-01-01

Abstract At the beginning of the article the typologies, expected outcomes and forces aiming at health care integration are discussed. Integration is recognised as a multidimensional concept. The suggested typologies of integration are based on structural configurations, co-ordination mechanisms (including clinical co-ordination), and driving forces. A review of the Polish experience in integration/disintegration of health care systems is the main part of the article. Creation of integrated health care management units (ZOZs) in the beginning of the 1970s serves as an example of structural vertical integration missing co-ordination mechanisms. ZOZs as huge, costly and inflexible organisations became subjects of public criticism and discredited the idea of health care integration. At the end of the 1980s and in the decade of the 1990s, management of public health care was decentralised, the majority of ZOZs dismantled, and many health care public providers got the status of independent entities. The private sector developed rapidly. Sickness funds, which in 1999 replaced the previous state system, introduced “quasi-market” conditions where health providers have to compete for contracts. Some providers developed strategies of vertical and horizontal integration to get a competitive advantage. Consolidation of private ambulatory clinics, the idea of “integrated care” as a “contracting package”, development of primary health care and ambulatory specialist clinics in hospitals are the examples of such strategies. The new health policy declared in 2002 has recognised integration as a priority. It stresses the development of payment mechanisms and information base (Register of Health Services – RUM) that promote integration. The Ministry of Health is involved directly in integrated emergency system designing. It seems that after years of disintegration and deregulation the need for effective integration has become obvious. PMID:16896398

Closed-Loop Lifecycle Management of Service and Product in the Internet of Things: Semantic Framework for Knowledge Integration.

PubMed

Yoo, Min-Jung; Grozel, Clément; Kiritsis, Dimitris

2016-07-08

This paper describes our conceptual framework of closed-loop lifecycle information sharing for product-service in the Internet of Things (IoT). The framework is based on the ontology model of product-service and a type of IoT message standard, Open Messaging Interface (O-MI) and Open Data Format (O-DF), which ensures data communication. (1) BACKGROUND: Based on an existing product lifecycle management (PLM) methodology, we enhanced the ontology model for the purpose of integrating efficiently the product-service ontology model that was newly developed; (2) METHODS: The IoT message transfer layer is vertically integrated into a semantic knowledge framework inside which a Semantic Info-Node Agent (SINA) uses the message format as a common protocol of product-service lifecycle data transfer; (3) RESULTS: The product-service ontology model facilitates information retrieval and knowledge extraction during the product lifecycle, while making more information available for the sake of service business creation. The vertical integration of IoT message transfer, encompassing all semantic layers, helps achieve a more flexible and modular approach to knowledge sharing in an IoT environment; (4) Contribution: A semantic data annotation applied to IoT can contribute to enhancing collected data types, which entails a richer knowledge extraction. The ontology-based PLM model enables as well the horizontal integration of heterogeneous PLM data while breaking traditional vertical information silos; (5) CONCLUSION: The framework was applied to a fictive case study with an electric car service for the purpose of demonstration. For the purpose of demonstrating the feasibility of the approach, the semantic model is implemented in Sesame APIs, which play the role of an Internet-connected Resource Description Framework (RDF) database.

Health systems facilitators and barriers to the integration of HIV and chronic disease services: a systematic review.

PubMed

Watt, Nicola; Sigfrid, Louise; Legido-Quigley, Helena; Hogarth, Sue; Maimaris, Will; Otero-García, Laura; Perel, Pablo; Buse, Kent; McKee, Martin; Piot, Peter; Balabanova, Dina

2017-11-01

Integration of services for patients with more than one diagnosed condition has intuitive appeal but it has been argued that the empirical evidence to support it is limited. We report the findings of a systematic review that sought to identify health system factors, extrinsic to the integration process, which either facilitated or hindered the integration of services for two common disorders, HIV and chronic non-communicable diseases. Findings were initially extracted and organized around a health system framework, followed by a thematic cross-cutting analysis and validation steps. Of the 150 articles included, 67% (n = 102) were from high-income countries. The articles explored integration with services for one or several chronic disorders, the most studied being alcohol or substance use disorders (47.7%), and mental health issues (29.5%). Four cross-cutting themes related to the health system were identified. The first and most common theme was the requirement for effective collaboration and coordination: formal and informal productive relationships throughout the system between providers and within teams, and between staff and patients. The second was the need for adequate and appropriately skilled and incentivized health workers-with the right expertise, training and operational support for the programme. The third was the need for supportive institutional structures and dedicated resources. The fourth was leadership in terms of political will, effective managerial oversight and organizational culture, indicating that actual implementation is as important as programme design. A fifth theme, outside the health system, but underpinning all aspects of the system operation, was that placing the patient at the centre of service delivery and responding holistically to their diverse needs. This was an important facilitator of integration. These findings confirm that integration processes in service delivery depend substantially for their success on characteristics of

Service user integration into social work education: lessons learned from nordic participatory action projects.

PubMed

Angelin, Anna

2015-01-01

Service users have lacked substantial influence, access, and participation in social work education in Norway and Sweden. In this article the author presents comparative analyses of two participatory projects that have developed and implemented practices that integrate service users into academic social work education and empower service users. The Norwegian HUSK project and the Social Work as Mobilization and Entrepreneurship course, also known as the "Mobilization course," at Lund University in Sweden demonstrate collaboration between research, social work education, and service users. The conclusions focus on the importance of the empowering processes by including recognition and dialogue, co-learning in practice, and the use of neutral venues to ensure effective user participation. The inclusion of service users in social work education can improve both practice and education.

The Investigation of Pre-Service Teachers' Concerns about Integrating Web 2.0 Technologies into Instruction

ERIC Educational Resources Information Center

Hao, Yungwei; Wang, Shiou-ling; Chang, Su-jen; Hsu, Yin-hung; Tang, Ren-yen

2013-01-01

Studies indicated Web 2.0 technologies can support learning. Then, integration of innovation may create concerns among teachers because of the innovative features. In this study, the innovation refers to Web 2.0 technology integration into instruction. To help pre-service teachers make the best use of the innovation in their future instruction, it…

Integrating Personalized and Community Services for Mobile Travel Planning and Management

NASA Astrophysics Data System (ADS)

Yu, Chien-Chih

Personalized and community services have been noted as keys to enhance and facilitate e-tourism as well as mobile applications. This paper aims at proposing an integrated service framework for combining personalized and community functions to support mobile travel planning and management. Major mobile tourism related planning and decision support functions specified include personalized profile management, information search and notification, evaluation and recommendation, do-it-yourself planning and design, community and collaboration management, auction and negotiation, transaction and payment, as well as trip tracking and quality control. A system implementation process with an example prototype is also presented for illustrating the feasibility and effectiveness of the proposed system framework, process model, and development methodology.

DIY-style GIS service in mobile navigation system integrated with web and wireless GIS

NASA Astrophysics Data System (ADS)

Yan, Yongbin; Wu, Jianping; Fan, Caiyou; Wang, Minqi; Dai, Sheng

2007-06-01

Mobile navigation system based on handheld device can not only provide basic GIS services, but also enable these GIS services to be provided without location limit, to be more instantly interacted between users and devices. However, we still see that most navigation systems have common defects on user experience like limited map format, few map resources, and unable location share. To overcome the above defects, we propose DIY-style GIS service which provide users a more free software environment and allow uses to customize their GIS services. These services include defining geographical coordinate system of maps which helps to hugely enlarge the map source, editing vector feature, related property information and hotlink images, customizing covered area of download map via General Packet Radio Service (GPRS), and sharing users' location information via SMS (Short Message Service) which establishes the communication between users who needs GIS services. The paper introduces the integration of web and wireless GIS service in a mobile navigation system and presents an implementation sample of a DIY-Style GIS service in a mobile navigation system.

Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider

PubMed Central

Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

2017-01-01

Introduction: There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Methods: Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Results: Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. Conclusions: There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients. PMID:29042851

Facilitating Middle Level Pre-Service Teachers' Literacy Integration in Early Field Experiences

ERIC Educational Resources Information Center

Leckie, Alisa; Wall, Amanda

2016-01-01

This study explored how pre-service teachers integrated literacy in middle level social studies. This study was conducted in the context of the Common Core State Standards (CCSS) and their focus on disciplinary literacy, the Council for the Accreditation of Educator Preparation (CAEP) Standards and their focus on rich clinical experiences, and…

Evaluating the Early Impact of Integrated Children's Services. Round 1 Final Report

ERIC Educational Resources Information Center

Lord, Pippa; Kinder, Kay; Wilkin, Anne; Atkinson, Mary; Harland, Jennie

2008-01-01

The focus of the Local Authorities Research Consortium's (LARC's) first year was to identify the early impact of integrated children's services and the features that promote or hinder success in improving outcomes for children and young people. The research operated in varied localities within the 14 participating Local Authorities (LAs), with one…

Eradicating Barriers to Mental Health Care Through Integrated Service Models: Contemporary Perspectives for Psychiatric-Mental Health Nurses.

PubMed

Ellis, Horace; Alexander, Vinette

2016-06-01

There has been renewed, global interest in developing new and transformative models of facilitating access to high-quality, cost-effective, and individually-centered health care for severe mentally-ill (SMI) persons of diverse racial/ethnic, cultural and socioeconomic backgrounds. However, in our present-day health-service delivery systems, scholars have identified layers of barriers to widespread dispersal of well-needed mental health care both nationally and internationally. It is crucial that contemporary models directed at eradicating barriers to mental health services are interdisciplinary in context, design, scope, sequence, and best-practice standards. Contextually, nurses are well-positioned to influence the incorporation and integration of new concepts into operationally interdisciplinary, evidence-based care models with measurable outcomes. The aim of this concept paper is to use the available evidence to contextually explicate how the blended roles of psychiatric mental health (PMH) nursing can be influential in eradicating barriers to care and services for SMI persons through the integrated principles of collaboration, integration and service expansion across health, socioeconomic, and community systems. A large body of literature proposes that any best-practice standards aimed at eliminating barriers to the health care needs of SMI persons require systematic, well-coordinated interdisciplinary partnerships through evidence-based, high-quality, person-centered, and outcome-driven processes. Transforming the conceptual models of collaboration, integration and service expansion could be revolutionary in how care and services are coordinated and dispersed to populations across disadvantaged communities. Building on their longstanding commitment to individual and community care approaches, and their pivotal roles in research, education, leadership, practice, and legislative processes; PMH nurses are well-positioned to be both influential and instrumental in

Occupational Health Services Integrated in Primary Health Care in Iran.

PubMed

Rafiei, Masoud; Ezzatian, Reza; Farshad, Asghar; Sokooti, Maryam; Tabibi, Ramin; Colosio, Claudio

2015-01-01

A healthy workforce is vital for maintaining social and economic development on a global, national and local level. Around half of the world's people are economically active and spend at least one third of their time in their place of work while only 15% of workers have access to basic occupational health services. According to WHO report, since the early 1980s, health indicators in Iran have consistently improved, to the extent that it is comparable with those in developed countries. In this paper it was tried to briefly describe about Health care system and occupational Health Services as part of Primary Health care in Iran. To describe the health care system in the country and the status of occupational health services to the workers and employers, its integration into Primary Health Care (PHC) and outlining the challenges in provision of occupational health services to the all working population. Iran has fairly good health indicators. More than 85 percent of the population in rural and deprived regions, for instance, have access to primary healthcare services. The PHC centers provide essential healthcare and public-health services for the community. Providing, maintaining and improving of the workers' health are the main goals of occupational health services in Iran that are presented by different approaches and mostly through Workers' Houses in the PHC system. Iran has developed an extensive network of PHC facilities with good coverage in most rural areas, but there are still few remote areas that might suffer from inadequate services. It seems that there is still no transparent policy to collaborate with the private sector, train managers or provide a sustainable mechanism for improving the quality of services. Finally, strengthening national policies for health at work, promotion of healthy work and work environment, sharing healthy work practices, developing updated training curricula to improve human resource knowledge including occupational health

How In-Service Science Teachers Integrate History and Nature of Science in Elementary Science Courses

ERIC Educational Resources Information Center

Hacieminoglu, Esme

2014-01-01

The purpose of this study is to investigate how the in-service science teachers' (IST) perceptions and practices about curriculum and integration of the history of science (HOS) and the nature of science (NOS) affect their science courses. For this aim, how ISTs integrated the NOS and HOS in their elementary science courses for understanding of…

Modeling and Detecting Feature Interactions among Integrated Services of Home Network Systems

NASA Astrophysics Data System (ADS)

Igaki, Hiroshi; Nakamura, Masahide

This paper presents a framework for formalizing and detecting feature interactions (FIs) in the emerging smart home domain. We first establish a model of home network system (HNS), where every networked appliance (or the HNS environment) is characterized as an object consisting of properties and methods. Then, every HNS service is defined as a sequence of method invocations of the appliances. Within the model, we next formalize two kinds of FIs: (a) appliance interactions and (b) environment interactions. An appliance interaction occurs when two method invocations conflict on the same appliance, whereas an environment interaction arises when two method invocations conflict indirectly via the environment. Finally, we propose offline and online methods that detect FIs before service deployment and during execution, respectively. Through a case study with seven practical services, it is shown that the proposed framework is generic enough to capture feature interactions in HNS integrated services. We also discuss several FI resolution schemes within the proposed framework.

Outcomes and Cost-Effectiveness of Integrating HIV and Nutrition Service Delivery: Pilots in Malawi and Mozambique.

PubMed

Bergmann, Julie N; Legins, Kenneth; Sint, Tin Tin; Snidal, Sarah; Amor, Yanis Ben; McCord, Gordon C

2017-03-01

This paper provides the first estimates of impact and cost-effectiveness for integrated HIV and nutrition service delivery in sub-Saharan Africa. HIV and undernutrition are synergistic co-epidemics impacting millions of children throughout the region. To alleviate this co-epidemic, UNICEF supported small-scale pilot programs in Malawi and Mozambique that integrated HIV and nutrition service delivery. We use trends from integration sites and comparison sites to estimate the number of lives saved, infections averted and/or undernutrition cases cured due to programmatic activities, and to estimate cost-effectiveness. Results suggest that Malawi's program had a cost-effectiveness of $11-29/DALY, while Mozambique's was $16-59/DALY. Some components were more effective than others ($1-4/DALY for Malawi's Male motivators vs. $179/DALY for Mozambique's One stop shops). These results suggest that integrating HIV and nutrition programming leads to a positive impact on health outcomes and should motivate additional work to evaluate impact and determine cost-effectiveness using an appropriate research design.

Pre-Service Teachers' TPACK Competencies for Spreadsheet Integration: Insights from a Mathematics-Specific Instructional Technology Course

ERIC Educational Resources Information Center

Agyei, Douglas D.; Voogt, Joke M.

2015-01-01

This article explored the impact of strategies applied in a mathematics instructional technology course for developing technology integration competencies, in particular in the use of spreadsheets, in pre-service teachers. In this respect, 104 pre-service mathematics teachers from a teacher training programme in Ghana enrolled in the mathematics…

Closed-Loop Lifecycle Management of Service and Product in the Internet of Things: Semantic Framework for Knowledge Integration

PubMed Central

Yoo, Min-Jung; Grozel, Clément; Kiritsis, Dimitris

2016-01-01

This paper describes our conceptual framework of closed-loop lifecycle information sharing for product-service in the Internet of Things (IoT). The framework is based on the ontology model of product-service and a type of IoT message standard, Open Messaging Interface (O-MI) and Open Data Format (O-DF), which ensures data communication. (1) Background: Based on an existing product lifecycle management (PLM) methodology, we enhanced the ontology model for the purpose of integrating efficiently the product-service ontology model that was newly developed; (2) Methods: The IoT message transfer layer is vertically integrated into a semantic knowledge framework inside which a Semantic Info-Node Agent (SINA) uses the message format as a common protocol of product-service lifecycle data transfer; (3) Results: The product-service ontology model facilitates information retrieval and knowledge extraction during the product lifecycle, while making more information available for the sake of service business creation. The vertical integration of IoT message transfer, encompassing all semantic layers, helps achieve a more flexible and modular approach to knowledge sharing in an IoT environment; (4) Contribution: A semantic data annotation applied to IoT can contribute to enhancing collected data types, which entails a richer knowledge extraction. The ontology-based PLM model enables as well the horizontal integration of heterogeneous PLM data while breaking traditional vertical information silos; (5) Conclusion: The framework was applied to a fictive case study with an electric car service for the purpose of demonstration. For the purpose of demonstrating the feasibility of the approach, the semantic model is implemented in Sesame APIs, which play the role of an Internet-connected Resource Description Framework (RDF) database. PMID:27399717

Integrated specialty service readiness in health reform: connections in haemophilia comprehensive care.

PubMed

Pritchard, A M; Page, D

2008-05-01

The World Health Organization (WHO) has identified primary healthcare reform as a global priority whereby innovative practice changes are directed at improving health. This transformation to health reform in haemophilia service requires clarification of comprehensive care to reflect the WHO definition of health and key elements of primary healthcare reform. While comprehensive care supports effective healthcare delivery, comprehensive care must also be regarded beyond immediate patient management to reflect the broader system purpose in the care continuum with institutions, community agencies and government. Furthermore, health reform may be facilitated through integrated service delivery (ISD). ISD in specialty haemophilia care has the potential to reduce repetition of assessments, enhance care plan communication between providers and families, provide 24-h access to care, improve information availability regarding care quality and outcomes, consolidate access for multiple healthcare encounters and facilitate family self-efficacy and autonomy [1]. Three core aspects of ISD have been distinguished: clinical integration, information management and technology and vertical integration in local communities [2]. Selected examples taken from Canadian haemophilia comprehensive care illustrate how practice innovations are bridged with a broader system level approach and may support initiatives in other contexts. These innovations are thought to indicate readiness regarding ISD. Reflecting on the existing capacity of haemophilia comprehensive care teams will assist providers to connect and direct their existing strengths towards ISD and health reform.

Adapting the Quebecois method for assessing implementation to the French National Alzheimer Plan 2008–2012: lessons for gerontological services integration

PubMed Central

Somme, Dominique; Trouvé, Hélène; Perisset, Catherine; Corvol, Aline; Ankri, Joël; Saint-Jean, Olivier; de Stampa, Matthieu

2014-01-01

Introduction Many countries face ageing-related demographic and epidemiological challenges, notably neurodegenerative disorders, due to the multiple care services they require, thereby pleading for a more integrated system of care. The integrated Quebecois method issued from the Programme of Research to Integrate Services for the Maintenance of Autonomy inspired a French pilot experiment and the National Alzheimer Plan 2008–2012. Programme of Research to Integrate Services for the Maintenance of Autonomy method implementation was rated with an evaluation grid adapted to assess its successive degrees of completion. Discussion The approaching end of the president's term led to the method's institutionalization (2011–2012), before the implementation study ended. When the government changed, the study was interrupted. The results extracted from that ‘lost’ study (presented herein) have, nonetheless, ‘found’ some key lessons. Key lessons/conclusion It was possible to implement a Quebecois integrated-care method in France. We describe the lessons and pitfalls encountered in adapting this evaluation tool. This process is necessarily multidisciplinary and requires a test phase. A simple tool for quantitative assessment of integration was obtained. The first assessment of the tool was unsatisfactory but requires further studies. In the meantime, we recommend using mixed methodologies to assess the services integration level. PMID:24959112

Preparing Pre-Service Teachers to Teach Primary Science: An Integrated Approach Using the Theme of Sustainability

ERIC Educational Resources Information Center

King, Donna

2014-01-01

An integrated approach to assessment afforded pre-service teachers the opportunity to learn about a local sustainability issue through three learning areas: science and technology, the arts and studies of society and environment (SOSE). Three sustainability issues chosen by the pre-service teachers are presented in this paper highlighting the…

Patients' Preference for Integrating Homoeopathy Services within the Secondary Health Care Settings in India: The Part 3 (PPIH-3) Study.

PubMed

Manchanda, Rajkumar; Koley, Munmun; Saha, Subhranil; Sarkar, Debabrata; Mondal, Ramkumar; Thakur, Prosenjit; Biswas, Debjyoti; Rawat, Birendra Singh; Rajachandrasekar, Bhuvaneswari; Mittal, Renu

2016-05-23

Indian patients' preference for integrated homoeopathy services remains underresearched. Two earlier surveys revealed favorable attitude toward and satisfaction from integrated services. The objectives of this study were to examine knowledge, attitudes, and practice of homoeopathy and to evaluate preference toward its integration into secondary-level health care. A cross-sectional survey was conducted during May to October 2015 among 659 adult patients visiting randomly selected secondary-level conventional health care setups in Kolkata, Mumbai, Kottayam, and New Delhi (India) using a self-administered 24-item questionnaire in 4 local vernaculars (Bengali, Marathi, Malayalam, and Hindi). Knowledge and practice scores were compromised; attitude scores toward integration and legal regulation were high. Respondents were uncertain regarding side effects of homoeopathy and concurrent use and interactions with conventional medicines. A total of 82.40% (95% confidence interval = 79.23, 85.19) of the participants were in favor of integrating homoeopathy services. Preference was significantly higher in Delhi and lower in Kottayam. Probable strategic measures for further development of integrated models are discussed. © The Author(s) 2016.

Integrated Automatic Workflow for Phylogenetic Tree Analysis Using Public Access and Local Web Services.

PubMed

Damkliang, Kasikrit; Tandayya, Pichaya; Sangket, Unitsa; Pasomsub, Ekawat

2016-11-28

At the present, coding sequence (CDS) has been discovered and larger CDS is being revealed frequently. Approaches and related tools have also been developed and upgraded concurrently, especially for phylogenetic tree analysis. This paper proposes an integrated automatic Taverna workflow for the phylogenetic tree inferring analysis using public access web services at European Bioinformatics Institute (EMBL-EBI) and Swiss Institute of Bioinformatics (SIB), and our own deployed local web services. The workflow input is a set of CDS in the Fasta format. The workflow supports 1,000 to 20,000 numbers in bootstrapping replication. The workflow performs the tree inferring such as Parsimony (PARS), Distance Matrix - Neighbor Joining (DIST-NJ), and Maximum Likelihood (ML) algorithms of EMBOSS PHYLIPNEW package based on our proposed Multiple Sequence Alignment (MSA) similarity score. The local web services are implemented and deployed into two types using the Soaplab2 and Apache Axis2 deployment. There are SOAP and Java Web Service (JWS) providing WSDL endpoints to Taverna Workbench, a workflow manager. The workflow has been validated, the performance has been measured, and its results have been verified. Our workflow's execution time is less than ten minutes for inferring a tree with 10,000 replicates of the bootstrapping numbers. This paper proposes a new integrated automatic workflow which will be beneficial to the bioinformaticians with an intermediate level of knowledge and experiences. All local services have been deployed at our portal http://bioservices.sci.psu.ac.th.

Integrated Automatic Workflow for Phylogenetic Tree Analysis Using Public Access and Local Web Services.

PubMed

Damkliang, Kasikrit; Tandayya, Pichaya; Sangket, Unitsa; Pasomsub, Ekawat

2016-03-01

At the present, coding sequence (CDS) has been discovered and larger CDS is being revealed frequently. Approaches and related tools have also been developed and upgraded concurrently, especially for phylogenetic tree analysis. This paper proposes an integrated automatic Taverna workflow for the phylogenetic tree inferring analysis using public access web services at European Bioinformatics Institute (EMBL-EBI) and Swiss Institute of Bioinformatics (SIB), and our own deployed local web services. The workflow input is a set of CDS in the Fasta format. The workflow supports 1,000 to 20,000 numbers in bootstrapping replication. The workflow performs the tree inferring such as Parsimony (PARS), Distance Matrix - Neighbor Joining (DIST-NJ), and Maximum Likelihood (ML) algorithms of EMBOSS PHYLIPNEW package based on our proposed Multiple Sequence Alignment (MSA) similarity score. The local web services are implemented and deployed into two types using the Soaplab2 and Apache Axis2 deployment. There are SOAP and Java Web Service (JWS) providing WSDL endpoints to Taverna Workbench, a workflow manager. The workflow has been validated, the performance has been measured, and its results have been verified. Our workflow's execution time is less than ten minutes for inferring a tree with 10,000 replicates of the bootstrapping numbers. This paper proposes a new integrated automatic workflow which will be beneficial to the bioinformaticians with an intermediate level of knowledge and experiences. The all local services have been deployed at our portal http://bioservices.sci.psu.ac.th.

General practice, primary care, and health service psychology: concepts, competencies, and the Combined-Integrated model.

PubMed

Schulte, Timothy J; Isley, Elayne; Link, Nancy; Shealy, Craig N; Winfrey, LaPearl Logan

2004-10-01

The profession of psychology is being impacted profoundly by broader changes within the national system of health care, as mental and behavioral health services are being recognized as essential components of a comprehensive, preventive, and cost-efficient primary care system. To fully define and embrace this role, the discipline of professional psychology must develop a shared disciplinary identity of health service psychology and a generalized competency-based model for doctoral education and training. This very framework has been adopted by Combined-Integrated (C-I) doctoral programs in professional psychology, which train across the practice areas (clinical, counseling, and school psychology) to provide a general and integrative foundation for their students. Because C-I programs produce general practitioners who are competent to function within a variety of health service settings, this innovative training approach has great potential to educate and train psychologists for a changing health care marketplace. Copyright 2004 Wiley Periodicals, Inc.

Does service integration improve technical quality of care in low-resource settings? An evaluation of a model integrating HIV care into family planning services in Kenya

PubMed Central

Mutemwa, Richard; Mayhew, Susannah H; Warren, Charlotte E; Abuya, Timothy; Ndwiga, Charity; Kivunaga, Jackline

2017-01-01

Abstract The aim of this study was to investigate association between HIV and family planning integration and technical quality of care. The study focused on technical quality of client–provider consultation sessions. The cross-sectional study observed 366 client–provider consultation sessions and interviewed 37 health care providers in 12 public health facilities in Kenya. Multilevel random intercept and linear regression models were fitted to the matched data to investigate relationships between service integration and technical quality of care as well as associations between facility-level structural and provider factors and technical quality of care. A sensitivity analysis was performed to test for hidden bias. After adjusting for facility-level structural factors, HIV/family planning integration was found to have significant positive effect on technical quality of the consultation session, with average treatment effect 0.44 (95% CI: 0.63–0.82). Three of the 12 structural factors were significantly positively associated with technical quality of consultation session including: availability of family planning commodities (9.64; 95% CI: 5.07–14.21), adequate infrastructure (5.29; 95% CI: 2.89–7.69) and reagents (1.48; 95% CI: 1.02–1.93). Three of the nine provider factors were significantly positively associated with technical quality of consultation session: appropriate provider clinical knowledge (3.14; 95% CI: 1.92–4.36), job satisfaction (2.02; 95% CI: 1.21–2.83) and supervision (1.01; 95% CI: 0.35–1.68), while workload (−0.88; 95% CI: −1.75 to − 0.01) was negatively associated. Technical quality of the client–provider consultation session was also determined by duration of the consultation and type of clinic visit and appeared to depend on whether the clinic visit occurred early or later in the week. Integration of HIV care into family planning services can improve the technical quality of client–provider consultation sessions

Does service integration improve technical quality of care in low-resource settings? An evaluation of a model integrating HIV care into family planning services in Kenya.

PubMed

Mutemwa, Richard; Mayhew, Susannah H; Warren, Charlotte E; Abuya, Timothy; Ndwiga, Charity; Kivunaga, Jackline

2017-11-01

The aim of this study was to investigate association between HIV and family planning integration and technical quality of care. The study focused on technical quality of client-provider consultation sessions. The cross-sectional study observed 366 client-provider consultation sessions and interviewed 37 health care providers in 12 public health facilities in Kenya. Multilevel random intercept and linear regression models were fitted to the matched data to investigate relationships between service integration and technical quality of care as well as associations between facility-level structural and provider factors and technical quality of care. A sensitivity analysis was performed to test for hidden bias. After adjusting for facility-level structural factors, HIV/family planning integration was found to have significant positive effect on technical quality of the consultation session, with average treatment effect 0.44 (95% CI: 0.63-0.82). Three of the 12 structural factors were significantly positively associated with technical quality of consultation session including: availability of family planning commodities (9.64; 95% CI: 5.07-14.21), adequate infrastructure (5.29; 95% CI: 2.89-7.69) and reagents (1.48; 95% CI: 1.02-1.93). Three of the nine provider factors were significantly positively associated with technical quality of consultation session: appropriate provider clinical knowledge (3.14; 95% CI: 1.92-4.36), job satisfaction (2.02; 95% CI: 1.21-2.83) and supervision (1.01; 95% CI: 0.35-1.68), while workload (-0.88; 95% CI: -1.75 to - 0.01) was negatively associated. Technical quality of the client-provider consultation session was also determined by duration of the consultation and type of clinic visit and appeared to depend on whether the clinic visit occurred early or later in the week. Integration of HIV care into family planning services can improve the technical quality of client-provider consultation sessions as measured by both health facility

Integrating palliative care into neurology services: what do the professionals say?

PubMed Central

Gao, Wei; Evans, Catherine J; Jackson, Diana; van Vliet, Liesbeth M; Byrne, Anthony; Crosby, Vincent; Groves, Karen E; Lindsay, Fiona; Higginson, Irene J

2018-01-01

Objectives Evaluations of new services for palliative care in non-cancer conditions are few. OPTCARE Neuro is a multicentre trial evaluating the effectiveness of short-term integrated palliative care (SIPC) for progressive long-term neurological conditions. Here, we present survey results describing the current levels of collaboration between neurology and palliative care services and exploring the views of professionals towards the new SIPC service. Methods Neurology and palliative care teams from six UK trial sites (London, Nottingham, Liverpool, Cardiff, Brighton and Chertsey) were approached via email to complete an online survey. The survey was launched in July 2015 and consisted of multiple choice or open comment questions with responses collected using online forms. Results 33 neurology and 26 palliative care professionals responded. Collaborations between the two specialties were reported as being ‘good/excellent’ by 36% of neurology and by 58% of palliative care professionals. However, nearly half (45%) of neurology compared with only 12% of palliative care professionals rated current levels as being ‘poor/none’. Both professional groups felt that the new SIPC service would influence future collaborations for the better. However, they identified a number of barriers for the new SIPC service such as resources and clinician awareness. Conclusions Our results demonstrate the opportunity to increase collaboration between neurology and palliative care services for people with progressive neurological conditions, and the acceptability of SIPC as a model to support this. Trial registration number ISRCTN18337380; Pre-results. PMID:28774963

Developing Pre-Service Teachers' Subject Matter Knowledge of Electromagnetism by Integrating Concept Maps and Collaborative Learning

ERIC Educational Resources Information Center

Govender, Nadaraj

2015-01-01

This case study explored the development of two pre-service teachers' subject matter knowledge (SMK) of electromagnetism while integrating the use of concept maps (CM) and collaborative learning (CL) strategies. The study aimed at capturing how these pre-service teachers' SMK in electromagnetism was enhanced after having been taught SMK in a…

Advancing the Field of Elder Mistreatment: A New Model for Integration of Social and Medical Services

ERIC Educational Resources Information Center

Mosqueda, Laura; Burnight, Kerry; Liao, Solomon; Kemp, Bryan

2004-01-01

Purpose: The purpose of this work is to describe the development and operation of a new model for integration of medical and social services. The Vulnerable Adult Specialist Team (VAST) provides Adult Protective Services (APS) and criminal justice agencies with access to medical experts who examine medical and psychological injuries of victims of…

A bilateral integrative health-care knowledge service mechanism based on 'MedGrid'.

PubMed

Liu, Chao; Jiang, Zuhua; Zhen, Lu; Su, Hai

2008-04-01

Current health-care organizations are encountering impression of paucity of medical knowledge. This paper classifies medical knowledge with new scopes. The discovery of health-care 'knowledge flow' initiates a bilateral integrative health-care knowledge service, and we make medical knowledge 'flow' around and gain comprehensive effectiveness through six operations (such as knowledge refreshing...). Seizing the active demand of Chinese health-care revolution, this paper presents 'MedGrid', which is a platform with medical ontology and knowledge contents service. Each level and detailed contents are described on MedGrid info-structure. Moreover, a new diagnosis and treatment mechanism are formed by technically connecting with electronic health-care records (EHRs).

Evaluating the Impact of Integrated Care on Service Utilization in Serious Mental Illness.

PubMed

Waters, Heidi C; Furukawa, Michael F; Jorissen, Shari L

2018-06-14

Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality, and use of high-cost healthcare services including hospitalizations and emergency department visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study assessed whether there was a predictive relationship between integrated healthcare clinic enrollment and inpatient and emergency department utilization for consumers with SMI when controlling for demographic characteristics and disease severity. While findings indicated no statistically significant impact of integrated care clinic enrollment on utilization, the sample had lower levels of utilization than would have been expected. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.

Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases.

PubMed

Schwartz, Jeremy I; Dunkle, Ashley; Akiteng, Ann R; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K; Mutungi, Gerald; Rabin, Tracy L; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet

2015-01-01

The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda.

SBMLmod: a Python-based web application and web service for efficient data integration and model simulation.

PubMed

Schäuble, Sascha; Stavrum, Anne-Kristin; Bockwoldt, Mathias; Puntervoll, Pål; Heiland, Ines

2017-06-24

Systems Biology Markup Language (SBML) is the standard model representation and description language in systems biology. Enriching and analysing systems biology models by integrating the multitude of available data, increases the predictive power of these models. This may be a daunting task, which commonly requires bioinformatic competence and scripting. We present SBMLmod, a Python-based web application and service, that automates integration of high throughput data into SBML models. Subsequent steady state analysis is readily accessible via the web service COPASIWS. We illustrate the utility of SBMLmod by integrating gene expression data from different healthy tissues as well as from a cancer dataset into a previously published model of mammalian tryptophan metabolism. SBMLmod is a user-friendly platform for model modification and simulation. The web application is available at http://sbmlmod.uit.no , whereas the WSDL definition file for the web service is accessible via http://sbmlmod.uit.no/SBMLmod.wsdl . Furthermore, the entire package can be downloaded from https://github.com/MolecularBioinformatics/sbml-mod-ws . We envision that SBMLmod will make automated model modification and simulation available to a broader research community.

Integrated Services for Frail Elders (SIPA): A Trial of a Model for Canada

ERIC Educational Resources Information Center

Beland, Francois; Bergman, Howard; Lebel, Paule; Dallaire, Luc; Fletcher, John; Contandriopoulos, Andre-Pierre; Solidage, Tousignant Pierre

2006-01-01

The complex formed by chronic illness, episodes of acute illness, physiological disabilities, functional limitations, and cognitive problems is prevalent among frail elderly persons. These individuals rely on assistance from social and health care programs, which in Canada are still fragmented. SIPA is an integrated service model based on…

An Integrated Parent-Teacher-Related Service Team Approach to Communication Intervention. Final Report.

ERIC Educational Resources Information Center

Stremel, Kathleen; Wilson, Rebecca

This final report describes a federally funded 3-year project for integrating related services within educational objectives for children (ages 3-10) with dual vision and hearing impairments. A Training-Utilization model of inservice training and technical assistance was developed, implemented, and evaluated to address the communication needs of…

Creating a Successful Training Program for Frontline Staff: The University of Minnesota's Integrated Student Services Model

ERIC Educational Resources Information Center

Peterson, Heather L.; Otto, Carrie L.

2011-01-01

Successfully preparing frontline counseling staff in an integrated student services model is a challenge--one that management staff in One Stop Student Services at the University of Minnesota, Twin Cities (UMTC) have been fine-tuning for almost ten years. The effort has required collaboration across units in a series of trial and error attempts…

Integration of prevention and care of sexually transmitted infections with family planning services: what is the evidence for public health benefits?

PubMed Central

Dehne, K. L.; Snow, R.; O'Reilly, K. R.

2000-01-01

It has been widely believed that, by combining the services for preventing and treating sexually transmitted infections (STI) with those for family planning (FP), STI coverage would increase and the combined service would be of higher quality and more responsive to the needs of women. So far, there is little concrete evidence that integration has had such an impact. Besides the absence of documentation, a clear definition of integration is lacking. We therefore carried out a comprehensive review of concrete experiences with integrated services, and present a summary of our findings in this article. The results indicate that the tasks of STI prevention, such as education for risk reduction and counselling, have been integrated into family planning services much more frequently than the tasks of STI diagnosis and treatment. Some STI/FP integration efforts appear to have been beneficial, for instance when the integration of STI/HIV prevention had a positive impact on client satisfaction, and on the acceptance of family planning. Less clear is whether STI prevention, when concentrated among traditional FP clients, is having a positive impact on STI risk behaviours or condom use. A few projects have reported increases in STI caseloads following integration. In some projects, FP providers were trained in STI case management, but few clients were subsequently treated. PMID:10859857

Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study.

PubMed

Catalao, Raquel; Eshetu, Tigist; Tsigebrhan, Ruth; Medhin, Girmay; Fekadu, Abebaw; Hanlon, Charlotte

2018-05-21

In order to tackle the considerable treatment gap for epilepsy in many low- and middle-income countries (LMICs), a task sharing model is recommended whereby care is integrated into primary health services. However, there are limited data on implementation and impact of such services in LMICs. Our study aimed to explore the perspectives of service users and caregivers on the accessibility, experience and perceived impact of epilepsy treatment received in a task-shared model in a rural district of Ethiopia. A qualitative study was carried out using interviews with purposively sampled service users (n = 13) and caregivers (n = 3) from a community-ascertained cohort of people with epilepsy receiving integrated services in primary care in rural Ethiopia. Interviews followed a topic guide with questions regarding acceptability, satisfaction, barriers to access care, pathways through care and impact of services. Framework analysis was employed to analyse the data. Proximity of the new service in local primary health centers decreased the cost of transportation for the majority of service users thus improving access to services. First-hand experience of services was in some cases associated with a willingness to promote the services and inform others of the existence of effective biomedical treatment for epilepsy. However, most service users and their caregivers continued to seek help from traditional healers alongside biomedical care. Most of the care received was focused on medication provision with limited information provided on how to manage their illness and its effects. Caregivers and service users spoke about the high emotional and financial burden of the disease and lack of ongoing practical and emotional support. The majority of participants reported clinical improvement on medication, which in over half of the participants was associated with ability to return to money generating activities. Task-sharing improved the accessibility of epilepsy care for

Multigranular integrated services optical network

NASA Astrophysics Data System (ADS)

Yu, Oliver; Yin, Leping; Xu, Huan; Liao, Ming

2006-12-01

Based on all-optical switches without requiring fiber delay lines and optical-electrical-optical interfaces, the multigranular optical switching (MGOS) network integrates three transport services via unified core control to efficiently support bursty and stream traffic of subwavelength to multiwavelength bandwidth. Adaptive robust optical burst switching (AR-OBS) aggregates subwavelength burst traffic into asynchronous light-rate bursts, transported via slotted-time light paths established by fast two-way reservation with robust blocking recovery control. Multiwavelength optical switching (MW-OS) decomposes multiwavelength stream traffic into a group of timing-related light-rate streams, transported via a light-path group to meet end-to-end delay-variation requirements. Optical circuit switching (OCS) simply converts wavelength stream traffic from an electrical-rate into a light-rate stream. The MGOS network employs decoupled routing, wavelength, and time-slot assignment (RWTA) and novel group routing and wavelength assignment (GRWA) to select slotted-time light paths and light-path groups, respectively. The selected resources are reserved by the unified multigranular robust fast optical reservation protocol (MG-RFORP). Simulation results show that elastic traffic is efficiently supported via AR-OBS in terms of loss rate and wavelength utilization, while connection-oriented wavelength traffic is efficiently supported via wavelength-routed OCS in terms of connection blocking and wavelength utilization. The GRWA-tuning result for MW-OS is also shown.

Past, present and future of Integrated Child Development Services (I.C.D.S.).

PubMed

Lal, S; Sachar, R K

1993-01-01

India's Integrated Child Development Services (ICDS) was established in 33 projects in 1975 and is spread over 22 states; 67 additional projects were begun in 1977, and over the next 2 years; 100 additional projects were added. By 1991=92, coverage was almost 50% of the country with 2696 projects; the expectation is for 100% coverage by the year 2000. An infrastructure chart identifies the organization and integration between level and social welfare and health departments. Objectives are clearly identified and the departments functionally linked. Linkages are achieved by shared space and activities at various levels. Over the past 17 years, services have included minimum needs programs, integrated rural development and poverty alleviation, national health policy and education policy, universal immunization, and the development of women and children in rural areas. ICDS is sponsored 100% by the status and uniquely relies on the honorary anganwadi worker (AWW), who is a woman, recruited and chosen by the community, aged 21-45 years and middle-school educated. The AWW was responsibility for 2000 households or 1000 persons in rural areas and 700 persons in tribal areas. The AWW is crucial to the functioning of the program and receives an honorarium of Rs. 225-275/month for implementing the ICDs program; AWWs have helpers who are paid Rs. 110/month. Training over a 3-year period is conducted at the Bal Sevika Training Institute by the Indian Council of Child Welfare. Additional health personnel and their role and the number of persons/per area AWWS are responsible for, equipment, and functions are also described. The AWW is responsible for nonformal preschool education, organization of supplementary nutrition feeding, health and nutrition education of women and families, immunization of women and children, treatment and referral of common illnesses, growing monitoring, and community participation. Presently, there are 2506 central sector projects and 190 state sector

Integrated care

PubMed Central

Gröne, Oliver; Garcia-Barbero, Mila

2001-01-01

Abstract The WHO European Office for Integrated Health Care Services in Barcelona is an integral part of the World Health Organizations' Regional Office for Europe. The main purpose of the Barcelona office is within the integration of services to encourage and facilitate changes in health care services in order to promote health and improve management and patient satisfaction by working for quality, accessibility, cost-effectiveness and participation. This position paper outlines the need for Integrated Care from a European perspective, provides a theoretical framework for the meaning of Integrated Care and its strategies and summarizes the programmes of the office that will support countries in the WHO European Region to improve health services. PMID:16896400

Integrating Faculty Led Service Learning Training to Quantify Height of Natural Resources from a Spatial Science Perspective

ERIC Educational Resources Information Center

Unger, Daniel R.; Kulhavy, David L.; Busch-Petersen, Kai; Hung, I.-Kuai

2016-01-01

Arthur Temple College of Forestry and Agriculture (ATCOFA) faculty members were trained how to integrate service learning activities within senior level classes at Stephen F. Austin State University (SFASU) in Nacogdoches, Texas. The service learning training, taught under the acronym Mentored Undergraduate Scholarship (MUGS), involved meeting…

Exploring experiences in peer mentoring as a strategy for capacity building in sexual reproductive health and HIV service integration in Kenya

PubMed Central

2014-01-01

Background The Integra Initiative designed, tested, and adapted protocols for peer mentorship in order to improve service providers’ skills, knowledge, and capacity to provide quality integrated HIV and sexual and reproductive health (SRH) services. This paper describes providers’ experiences in mentoring as a method of capacity building. Service providers who were skilled in the provision of FP or PNC services were selected to undergo a mentorship training program and to subsequently build the capacity of their peers in SRH-HIV integration. Methods A qualitative assessment was conducted to assess provider experiences and perceptions about peer mentoring. In-depth interviews were conducted with twelve mentors and twenty-three mentees who were trained in SRH and HIV integration. Interviews were recorded, transcribed, and imported to NVivo 9 for analysis. Thematic analysis methods were used to develop a coding framework from the research questions and other emerging themes. Results Mentorship was perceived as a feasible and acceptable method of training among mentors and mentees. Both mentors and mentees agreed that the success of peer mentoring largely depended on cordial relationship and consensus to work together to achieve a specific set of skills. Mentees reported improved knowledge, skills, self-confidence, and team work in delivering integrated SRH and HIV services as benefits associated with mentoring. They also associated mentoring with an increase in the range of services available and the number of clients seeking those services. Successful mentorship was conditional upon facility management support, sufficient supplies and commodities, a positive work environment, and mentors selection. Conclusion Mentoring was perceived by both mentors and mentees as a sustainable method for capacity building, which increased providers’ ability to offer a wide range of and improved access to integrated SRH and HIV services. PMID:24581143

Exploring experiences in peer mentoring as a strategy for capacity building in sexual reproductive health and HIV service integration in Kenya.

PubMed

Ndwiga, Charity; Abuya, Timothy; Mutemwa, Richard; Kimani, James Kelly; Colombini, Manuela; Mayhew, Susannah; Baird, Averie; Muia, Ruth Wayua; Kivunaga, Jackline; Warren, Charlotte E

2014-03-01

The Integra Initiative designed, tested, and adapted protocols for peer mentorship in order to improve service providers' skills, knowledge, and capacity to provide quality integrated HIV and sexual and reproductive health (SRH) services. This paper describes providers' experiences in mentoring as a method of capacity building. Service providers who were skilled in the provision of FP or PNC services were selected to undergo a mentorship training program and to subsequently build the capacity of their peers in SRH-HIV integration. A qualitative assessment was conducted to assess provider experiences and perceptions about peer mentoring. In-depth interviews were conducted with twelve mentors and twenty-three mentees who were trained in SRH and HIV integration. Interviews were recorded, transcribed, and imported to NVivo 9 for analysis. Thematic analysis methods were used to develop a coding framework from the research questions and other emerging themes. Mentorship was perceived as a feasible and acceptable method of training among mentors and mentees. Both mentors and mentees agreed that the success of peer mentoring largely depended on cordial relationship and consensus to work together to achieve a specific set of skills. Mentees reported improved knowledge, skills, self-confidence, and team work in delivering integrated SRH and HIV services as benefits associated with mentoring. They also associated mentoring with an increase in the range of services available and the number of clients seeking those services. Successful mentorship was conditional upon facility management support, sufficient supplies and commodities, a positive work environment, and mentors selection. Mentoring was perceived by both mentors and mentees as a sustainable method for capacity building, which increased providers' ability to offer a wide range of and improved access to integrated SRH and HIV services.

Quasi-Experimental Study of the Effectiveness of an Integrated Service Delivery Network for the Frail Elderly

ERIC Educational Resources Information Center

Tourigny, Andre; Durand, Pierre J.; Bonin, Lucie; Hebert, Rejean; Rochette, Louis

2004-01-01

The aim of this study was to examine the effectiveness of a new, integrated service delivery (ISD) network of health and social services for frail elderly living in a semi-urban community. A quasi-experimental study was conducted from 1997 to 2000, with measures taken before implementation (T0) and every 12 months after implementation for a 3-year…

Secondary Mathematics Pre-Service Teachers' Processes of Selection and Integration of Technology

ERIC Educational Resources Information Center

Uzan, Erol

2017-01-01

This study investigated secondary mathematics pre-service teachers' (PSTs) knowledge of resources in terms of digital technologies, and explored the processes of both selection and integration of technology into their lesson plans. This study employed a case study design. Participants were six secondary mathematics PSTs who enrolled in a methods…

Australian integrative oncology services: a mixed-method study exploring the views of cancer survivors.

PubMed

Hunter, Jennifer; Ussher, Jane; Parton, Chloe; Kellett, Andrew; Smith, Caroline; Delaney, Geoff; Oyston, Eleanor

2018-05-09

The significant use of traditional and complementary medicine (T&CM) by cancer survivors is well documented. The aim of this study was to explore cancer survivors' views on integrating T&CM services with conventional cancer care. A mixed-method study design with an emphasis on qualitative methodology was used to conduct and analyse four focus group interviews and an on-line survey. Purposive sampling recruited 33 cancer survivors and caregivers from Arabic, Vietnamese, Chinese and Anglo-European Australian backgrounds who participated in one of four focus group interviews, and 121 cancer survivors who responded to an on-line survey. The inductive thematic analysis was augmented with a descriptive statistical analysis. Most participants had used T&CM therapies or consulted T&CM practitioners as an adjuvant during and/or after their initial cancer treatment. Two themes emerged: 'positive perceptions and experiences' and 'barriers and unmet needs'. Participants emphasised that T&CM was not a 'luxury item', rather it was considered important for managing side effects and comorbidities, rehabilitation and quality of life. A wide range of complex, interrelated barriers and solutions to IO service provision and access were identified. Structural barriers included inadequate service provision, medical practitioner attitudes, logistical constraints and funding. Personal barriers were influenced by the severity of impairment and disability; attitudes, beliefs and knowledge about T&CM; and available resources (e.g. finances, time, transport). Unmet need and inequitable access was exacerbated by geographical location, ethnicity and ability to pay. There was a mismatch between where participants were accessing T&CM services and their preference for IO service delivery. Participants perceived hospital-based IO services availability to have several benefits, including the T&CM practitioners having more expert knowledge about cancer care, the convenience of co-locating oncology

Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases

PubMed Central

Schwartz, Jeremy I.; Dunkle, Ashley; Akiteng, Ann R.; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K.; Mutungi, Gerald; Rabin, Tracy L.; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet

2015-01-01

Background The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Methods Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. Results In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Discussion Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda. PMID:25563451

Integrating the provision of ecosystem services and trawl fisheries for the management of the marine environment.

PubMed

Muntadas, Alba; de Juan, Silvia; Demestre, Montserrat

2015-02-15

The species interaction and their biological traits (BT) determine the function of benthic communities and, hence, the delivery of ecosystem services. Therefore, disturbance of benthic communities by trawling may compromise ecosystem service delivery, including fisheries' catches. In this work, we explore 1) the impact of trawling activities on benthic functional components (after the BTA approach) and 2) how trawling impact may affect the ecosystem services delivered by benthic communities. To this aim, we assessed the provision of ecosystem services by adopting the concept of Ecosystem Service Providers (ESP), i.e. ecological units that perform ecosystem functions that will ultimately deliver ecosystem services. We studied thirteen sites subjected to different levels of fishing effort in the Mediterranean. From a range of environmental variables included in the study, we found ESPs to be mainly affected by fishing effort and grain size. Our results suggested that habitat type has significant effects on the distribution of ESPs and this natural variability influences ESP response to trawling at a specific site. In order to summarize the complex relationships between human uses, ecosystem components and the demand for ecosystem services in trawling grounds, we adapted a DPSIR (Drivers-Pressures-State Change-Impact-Response) framework to the study area, emphasizing the role of society as Drivers of change and actors demanding management Responses. This integrative framework aims to inform managers about the interactions between all the elements involved in the management of trawling grounds, highlighting the need for an integrated approach in order to ensure ecosystem service provision. Copyright © 2014 Elsevier B.V. All rights reserved.

Academic medicine amenities unit: developing a model to integrate academic medical care with luxury hotel services.

PubMed

Kennedy, David W; Kagan, Sarah H; Abramson, Kelly Brennen; Boberick, Cheryl; Kaiser, Larry R

2009-02-01

The interface between established values of academic medicine and the trend toward inpatient amenities units requires close examination. Opinions of such units can be polarized, reflecting traditional reservations about the ethical dilemma of offering exclusive services only to an elite patient group. An amenities unit was developed at the University of Pennsylvania Health System in 2007, using an approach that integrated academic medicine values with the benefits of philanthropy and service excellence to make amenities unit services available to all patients. Given inherent internal political concerns, a broadly based steering committee of academic and hospital leadership was developed. An academically appropriate model was conceived, anchored by four principles: (1) integration of academic values, (2) interdisciplinary senior leadership, (3) service excellence, and (4) recalibrated occupancy expectations based on multiple revenue streams. Foremost is ensuring the same health care is afforded all patients throughout the hospital, thereby overcoming ethical challenges and optimizing teaching experiences. Service excellence frames the service ethic for all staff, and this, in addition to luxury hotel-style amenities, differentiates the style and feel of the unit from others in the hospital. Recalibrated occupancy creates program viability given revenue streams redefined to encompass gifts and patient revenue, including both reimbursement and self-pay. The medical-surgical amenities patient-care unit has enjoyed a successful first year and a growing stream of returning patients and admitting physicians. Implications for other academic medical centers include opportunities to extrapolate service excellence throughout the hospital and to cultivate philanthropy to benefit services throughout the medical center.

Mitigation for one & all: An integrated framework for mitigation of development impacts on biodiversity and ecosystem services

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

Tallis, Heather, E-mail: htallis@tnc.org; Kennedy, Christina M., E-mail: ckennedy@tnc.org; Ruckelshaus, Mary

Emerging development policies and lending standards call for consideration of ecosystem services when mitigating impacts from development, yet little guidance exists to inform this process. Here we propose a comprehensive framework for advancing both biodiversity and ecosystem service mitigation. We have clarified a means for choosing representative ecosystem service targets alongside biodiversity targets, identified servicesheds as a useful spatial unit for assessing ecosystem service avoidance, impact, and offset options, and discuss methods for consistent calculation of biodiversity and ecosystem service mitigation ratios. We emphasize the need to move away from area- and habitat-based assessment methods for both biodiversity and ecosystemmore » services towards functional assessments at landscape or seascape scales. Such comprehensive assessments more accurately reflect cumulative impacts and variation in environmental quality, social needs and value preferences. The integrated framework builds on the experience of biodiversity mitigation while addressing the unique opportunities and challenges presented by ecosystem service mitigation. These advances contribute to growing potential for economic development planning and execution that will minimize impacts on nature and maximize human wellbeing. - Highlights: • This is the first framework for biodiversity and ecosystem service mitigation. • Functional, landscape scale assessments are ideal for avoidance and offsets. • Servicesheds define the appropriate spatial extent for ecosystem service mitigation. • Mitigation ratios should be calculated consistently and based on standard factors. • Our framework meets the needs of integrated mitigation assessment requirements.« less

The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings

PubMed Central

Obure, Carol Dayo; Sweeney, Sedona; Darsamo, Vanessa; Michaels-Igbokwe, Christine; Guinness, Lorna; Terris-Prestholt, Fern; Muketo, Esther; Nhlabatsi, Zelda; Warren, Charlotte E.; Mayhew, Susannah; Watts, Charlotte; Vassall, Anna

2015-01-01

Objective To present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services. Design A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland. Methods Economic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider’s perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars. Results The mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to $Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity. Conclusion For all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements. PMID:25933414

The Costs of Delivering Integrated HIV and Sexual Reproductive Health Services in Limited Resource Settings.

PubMed

Obure, Carol Dayo; Sweeney, Sedona; Darsamo, Vanessa; Michaels-Igbokwe, Christine; Guinness, Lorna; Terris-Prestholt, Fern; Muketo, Esther; Nhlabatsi, Zelda; Warren, Charlotte E; Mayhew, Susannah; Watts, Charlotte; Vassall, Anna

2015-01-01

To present evidence on the total costs and unit costs of delivering six integrated sexual reproductive health and HIV services in a high and medium HIV prevalence setting, in order to support policy makers and planners scaling up these essential services. A retrospective facility based costing study conducted in 40 non-government organization and public health facilities in Kenya and Swaziland. Economic and financial costs were collected retrospectively for the year 2010/11, from each study site with an aim to estimate the cost per visit of six integrated HIV and SRH services. A full cost analysis using a combination of bottom-up and step-down costing methods was conducted from the health provider's perspective. The main unit of analysis is the economic unit cost per visit for each service. Costs are converted to 2013 International dollars. The mean cost per visit for the HIV/SRH services ranged from $Int 14.23 (PNC visit) to $Int 74.21 (HIV treatment visit). We found considerable variation in the unit costs per visit across settings with family planning services exhibiting the least variation ($Int 6.71-52.24) and STI treatment and HIV treatment visits exhibiting the highest variation in unit cost ranging from ($Int 5.44-281.85) and ($Int 0.83-314.95), respectively. Unit costs of visits were driven by fixed costs while variability in visit costs across facilities was explained mainly by technology used and service maturity. For all services, variability in unit costs and cost components suggest that potential exists to reduce costs through better use of both human and capital resources, despite the high proportion of expenditure on drugs and medical supplies. Further work is required to explore the key drivers of efficiency and interventions that may facilitate efficiency improvements.

Integrating child health services into malaria control services of village malaria workers in remote Cambodia: service utilization and knowledge of malaria management of caregivers.

PubMed

Hasegawa, Aya; Yasuoka, Junko; Ly, Po; Nguon, Chea; Jimba, Masamine

2013-08-23

Malaria and other communicable diseases remain major threats in developing countries. In Cambodia, village malaria workers (VMWs) have been providing malaria control services in remote villages to cope with the disease threats. In 2009, the VMW project integrated child health services into the original malaria control services. However, little has been studied about the utilization of VMWs' child health services. This study aimed to identify determinants of caregivers' VMW service utilization for childhood illness and caregivers' knowledge of malaria management. A cross-sectional study was conducted in 36 VMW villages of Kampot and Kampong Thom provinces in July-September 2012. An equal number of VMW villages with malaria control services only (M) and those with malaria control plus child health services (M+C) were selected from each province. Using structured questionnaires, 800 caregivers of children under five and 36 VMWs, one of the two VMWs who was providing VMW services in each study village were interviewed. Among the caregivers, 23% in M villages and 52% in M+C villages utilized VMW services for childhood illnesses. Determinants of caregivers' utilization of VMWs in M villages included their VMWs' length of experience (AOR = 11.80, 95% confidence interval [CI] = 4.46-31.19) and VMWs' service quality (AOR = 2.04, CI = 1.01-4.11). In M+C villages, VMWs' length of experience (AOR = 2.44, CI = 1.52-3.94) and caregivers' wealth index (AOR = 0.35, CI = 0.18-0.68) were associated with VMW service utilization. Meanwhile, better service quality of VMWs (AOR = 3.21, CI = 1.34-7.66) and caregivers' literacy (AOR = 9.91, CI = 4.66-21.05) were positively associated with caregivers' knowledge of malaria management. VMWs' service quality and length of experience are important determinants of caregivers' utilization of VMWs' child health services and their knowledge of malaria management. Caregivers are seeking VMWs' support for childhood illnesses even if they are

Integration of HIV/AIDS services into African primary health care: lessons learned for health system strengthening in Mozambique - a case study

PubMed Central

2010-01-01

Introduction In 2004, Mozambique, supported by large increases in international disease-specific funding, initiated a national rapid scale-up of antiretroviral treatment (ART) and HIV care through a vertical "Day Hospital" approach. Though this model showed substantial increases in people receiving treatment, it diverted scarce resources away from the primary health care (PHC) system. In 2005, the Ministry of Health (MOH) began an effort to use HIV/AIDS treatment and care resources as a means to strengthen their PHC system. The MOH worked closely with a number of NGOs to integrate HIV programs more effectively into existing public-sector PHC services. Case Description In 2005, the Ministry of Health and Health Alliance International initiated an effort in two provinces to integrate ART into the existing primary health care system through health units distributed across 23 districts. Integration included: a) placing ART services in existing units; b) retraining existing workers; c) strengthening laboratories, testing, and referral linkages; e) expanding testing in TB wards; f) integrating HIV and antenatal services; and g) improving district-level management. Discussion: By 2008, treatment was available in nearly 67 health facilities in 23 districts. Nearly 30,000 adults were on ART. Over 80,000 enrolled in the HIV/AIDS program. Loss to follow-up from antenatal and TB testing to ART services has declined from 70% to less than 10% in many integrated sites. Average time from HIV testing to ART initiation is significantly faster and adherence to ART is better in smaller peripheral clinics than in vertical day hospitals. Integration has also improved other non-HIV aspects of primary health care. Conclusion The integration approach enables the public sector PHC system to test more patients for HIV, place more patients on ART more quickly and efficiently, reduce loss-to-follow-up, and achieve greater geographic HIV care coverage compared to the vertical model. Through the

Scope of Work for Integration Management and Installation Services of the National Ignition Facility Beampath Infrastructure System

NASA Astrophysics Data System (ADS)

Coyle, P. D.

2000-03-01

The goal of the National Ignition Facility (NIF) project is to provide an above ground experimental capability for maintaining nuclear competence and weapons effects simulation and to provide a facility capable of achieving fusion ignition using solid-state lasers as the energy driver. The facility will incorporate 192 laser beams, which will be focused onto a small target located at the center of a spherical target chamber-the energy from the laser beams will be deposited in a few billionths of a second. The target will then implode, forcing atomic nuclei to sufficiently high temperatures and densities necessary to achieve a miniature fusion reaction. The NIF is under construction, at Livermore, California, located approximately 50 miles southeast of San Francisco, California. The University of California, Lawrence Livermore National Laboratory (LLNL), operating under Prime Contract W-7405-ENG. 48 with the U.S. Department of Energy (DOE), shall subcontract for Integration Management and Installation (IMI) Services for the Beampath Infrastructure System (BIS). The BIS includes Beampath Hardware and Beampath Utilities. Conventional Facilities work for the NIF Laser and Target Area Building (LTAB) and Optics Assembly Building (OAB) is over 86 percent constructed. This Scope of Work is for Integration Management and Installation (IMI) Services corresponding to Management Services, Design Integration Services, Construction Services, and Commissioning Services for the NIB BIS. The BIS includes Beampath Hardware and Beampath Utilities. Beampath Hardware and Beampath Utilities include beampath vessels, enclosures, and beam tubes; auxiliary and utility systems; and support structures. A substantial amount of GFE will be provided by the University for installation as part of the infrastructure packages.

Reculturing for Equity through Integrated Services: A Case Study of One District's Reform

ERIC Educational Resources Information Center

Dentith, Audrey; Frattura, Elise; Kaylor, Maria

2013-01-01

The purpose of this paper is to analyse the early stages of an urban district's special education reform effort in which the entire district moved from a programme model to an integrated services delivery approach. We studied teacher and building administrator's responses garnered through focus group, individual interviews and observations at five…

The Use of Idea-Based Policy Instruments in Promoting School-Linked Service Integration.

ERIC Educational Resources Information Center

Cohen, Carolyn

This paper analyzes the potential of a specific public policy tool to further principles of programs devoted exclusively to the Integration of Education and Human Services (IEHS). Section 1 describes the nature of the problem in establishing the need for IEHS. Section 2 describes policy tools currently used to implement IEHS, introducing the…

Sustaining School-Based Services: Insights from New Mexico's Integrated School-Based Services. Research-to-Results Practitioner Insights. Publication #2010-09

ERIC Educational Resources Information Center

Collins, Ashleigh; Carrier, David; Moore, Kristin Anderson; Paisano-Trujillo, Renee

2010-01-01

Practitioners, school leaders, and policymakers serving the needs of youth and their families in New Mexico gathered in Albuquerque in June 2009 for four Roundtable discussions on sustaining integrated health, extended learning, and other social services in middle schools across the state that are a part of the Elev8 New Mexico initiative. Elev8…

Barriers and facilitators to the integration of mental health services into primary health care: a systematic review protocol.

PubMed

Wakida, Edith K; Akena, Dickens; Okello, Elialilia S; Kinengyere, Alison; Kamoga, Ronald; Mindra, Arnold; Obua, Celestino; Talib, Zohray M

2017-08-25

Mental health is an integral part of health and well-being and yet health systems have not adequately responded to the burden of mental disorders. Integrating mental health services into primary health care (PHC) is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. PHC was formally adapted by the World Health Organization (WHO), and they have since invested enormous amounts of resources across the globe to ensure that integration of mental health services into PHC works. This review will use the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework approach to identify experiences of mental health integration into PHC; the findings will be reported using the "Best fit" framework synthesis. PubMed, EMBASE, PsycINFO, and Cochrane Central Register of Controlled trials (CENTRAL) will be searched including other sources like the WHO website and OpenGrey database. Assessment of bias and quality will be done at study level using two separate tools to check for the quality of evidence presented. Data synthesis will take on two synergistic approaches (qualitative and quantitative studies). Synthesizing evidence from countries across the globe will provide useful insights into the experiences of integrating mental health services into PHC and how the barriers and challenges have been handled. The findings will be useful to a wide array of stakeholders involved in the implementation of the mental health integration into PHC. The SPIDER framework has been chosen for this review because of its suitable application to qualitative and mixed methods research and will be used as a guide when selecting articles for inclusion. Data extracted will be synthesized using the "Best fit" framework because it has been used before and proved its suitability in producing new conceptual models for explaining decision-making and possible behaviors. Synthesizing evidence from countries across the globe

More than what the eye can see: the emotional journey and experience of powerlessness of integrated care service users and their carers

PubMed Central

Boudioni, Markella; Hallett, Nina; Lora, Cristina; Couchman, Wendy

2015-01-01

Purpose This article presents the emotional journey and experience of powerlessness of integrated care service users and carers. Materials and methods The experiences of seven integrated care service users and carers affected by complex conditions in a London borough were captured as video stories. The integrated care service coordinated a system of health and social care: primary care, community matrons, social workers, and the voluntary sector. The service was designed to respond to identified cases of high-risk individuals with long-term, multiple, and age-related conditions needing preventive interventions. The video stories were analyzed by researchers in collaboration with service users using a visual thematic qualitative approach. This report is part of an independent analysis of the integrated care service evaluation that used the experience-based codesign model. Results The findings are presented in the respective contexts of people with complex conditions and their carers. The overwhelming feelings and emotions of both were loss of control and power throughout their emotional journey, with family carers adopting a protective attitude toward the patients. Their experience of powerlessness was variable throughout their emotional journey. They were affected more strongly when in need of extra help and support and while they were undergoing the process of receiving extra services. When they were receiving help and support outside and within hospitals, some participants were empowered, gaining skills and knowledge by being provided with the mechanisms to cope with their condition at present and in the future. Conclusion Feelings of powerlessness were very common among integrated care service users and their carers. Powerless/empowerment has been poorly investigated to date. Visual methods and collaborative visual analysis with service users have proved to be powerful methods too, but have been rarely reported. PMID:25848232

Service-oriented model-encapsulation strategy for sharing and integrating heterogeneous geo-analysis models in an open web environment

NASA Astrophysics Data System (ADS)

Yue, Songshan; Chen, Min; Wen, Yongning; Lu, Guonian

2016-04-01

Earth environment is extremely complicated and constantly changing; thus, it is widely accepted that the use of a single geo-analysis model cannot accurately represent all details when solving complex geo-problems. Over several years of research, numerous geo-analysis models have been developed. However, a collaborative barrier between model providers and model users still exists. The development of cloud computing has provided a new and promising approach for sharing and integrating geo-analysis models across an open web environment. To share and integrate these heterogeneous models, encapsulation studies should be conducted that are aimed at shielding original execution differences to create services which can be reused in the web environment. Although some model service standards (such as Web Processing Service (WPS) and Geo Processing Workflow (GPW)) have been designed and developed to help researchers construct model services, various problems regarding model encapsulation remain. (1) The descriptions of geo-analysis models are complicated and typically require rich-text descriptions and case-study illustrations, which are difficult to fully represent within a single web request (such as the GetCapabilities and DescribeProcess operations in the WPS standard). (2) Although Web Service technologies can be used to publish model services, model users who want to use a geo-analysis model and copy the model service into another computer still encounter problems (e.g., they cannot access the model deployment dependencies information). This study presents a strategy for encapsulating geo-analysis models to reduce problems encountered when sharing models between model providers and model users and supports the tasks with different web service standards (e.g., the WPS standard). A description method for heterogeneous geo-analysis models is studied. Based on the model description information, the methods for encapsulating the model-execution program to model services and

Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: summary guidance from CDC and the U.S. Department of Health and Human Services.

PubMed

2012-11-09

This report summarizes current (as of 2011) guidelines or recommendations published by multiple agencies of the U.S. Department of Health and Human Services (DHHS) for prevention and control of human immunodeficiency virus (HIV) infection, viral hepatitis, sexually transmitted diseases (STDs), and tuberculosis (TB) for persons who use drugs illicitly. It also summarizes existing evidence of effectiveness for practices to support delivery of integrated prevention services. Implementing integrated services for prevention of HIV infection, viral hepatitis, STDs, and TB is intended to provide persons who use drugs illicitly with increased access to services, to improve timeliness of service delivery, and to increase effectiveness of efforts to prevent infectious diseases that share common risk factors, behaviors, and social determinants. This guidance is intended for use by decision makers (e.g., local and federal agencies and leaders and managers of prevention and treatment services), health-care providers, social service providers, and prevention and treatment support groups. Consolidated guidance can strengthen efforts of health-care providers and public health providers to prevent and treat infectious diseases and substance use and mental disorders, use resources efficiently, and improve health-care services and outcomes in persons who use drugs illicitly. An integrated approach to service delivery for persons who use drugs incorporates recommended science-based public health strategies, including 1) prevention and treatment of substance use and mental disorders; 2) outreach programs; 3) risk assessment for illicit use of drugs; 4) risk assessment for infectious diseases; 5) screening, diagnosis, and counseling for infectious diseases; 6) vaccination; 7) prevention of mother-to-child transmission of infectious diseases; 8) interventions for reduction of risk behaviors; 9) partner services and contact follow-up; 10) referrals and linkage to care; 11) medical

Critical insights for a sustainability framework to address integrated community water services: Technical metrics and approaches.

PubMed

Xue, Xiaobo; Schoen, Mary E; Ma, Xin Cissy; Hawkins, Troy R; Ashbolt, Nicholas J; Cashdollar, Jennifer; Garland, Jay

2015-06-15

Planning for sustainable community water systems requires a comprehensive understanding and assessment of the integrated source-drinking-wastewater systems over their life-cycles. Although traditional life cycle assessment and similar tools (e.g. footprints and emergy) have been applied to elements of these water services (i.e. water resources, drinking water, stormwater or wastewater treatment alone), we argue for the importance of developing and combining the system-based tools and metrics in order to holistically evaluate the complete water service system based on the concept of integrated resource management. We analyzed the strengths and weaknesses of key system-based tools and metrics, and discuss future directions to identify more sustainable municipal water services. Such efforts may include the need for novel metrics that address system adaptability to future changes and infrastructure robustness. Caution is also necessary when coupling fundamentally different tools so to avoid misunderstanding and consequently misleading decision-making. Published by Elsevier Ltd.

Towards a Service-Oriented Enterprise: The Design of a Cloud Business Integration Platform in a Medium-Sized Manufacturing Enterprise

ERIC Educational Resources Information Center

Stamas, Paul J.

2013-01-01

This case study research followed the two-year transition of a medium-sized manufacturing firm towards a service-oriented enterprise. A service-oriented enterprise is an emerging architecture of the firm that leverages the paradigm of services computing to integrate the capabilities of the firm with the complementary competencies of business…

Integrating HIV Surveillance and Field Services: Data Quality and Care Continuum in King County, Washington, 2010-2015.

PubMed

Hood, Julia E; Katz, David A; Bennett, Amy B; Buskin, Susan E; Dombrowski, Julia C; Hawes, Stephen E; Golden, Matthew R

2017-12-01

To assess how integration of HIV surveillance and field services might influence surveillance data and linkage to care metrics. We used HIV surveillance and field services data from King County, Washington, to assess potential impact of misclassification of prior diagnoses on numbers of new diagnoses. The relationship between partner services and linkage to care was evaluated with multivariable log-binomial regression models. Of the 2842 people who entered the King County HIV Surveillance System in 2010 to 2015, 52% were newly diagnosed, 41% had a confirmed prior diagnosis in another state, and 7% had an unconfirmed prior diagnosis. Twelve percent of those classified as newly diagnosed for purposes of national HIV surveillance self-reported a prior HIV diagnosis that was unconfirmed. Partner services recipients were more likely than nonrecipients to link to care within 30 days (adjusted risk ratio [RR] = 1.10; 95% confidence interval [CI] = 1.03, 1.18) and 90 days (adjusted RR = 1.07; 95% CI = 1.01, 1.14) of diagnosis. Integration of HIV surveillance, partner services, and care linkage efforts may improve the accuracy of HIV surveillance data and facilitate timely linkage to care.

The role of nurse specialists in the delivery of integrated diabetes care: a cross-sectional survey of diabetes nurse specialist services

PubMed Central

Riordan, Fiona; McHugh, Sheena M; Murphy, Katie; Barrett, Julie; Kearney, Patricia M

2017-01-01

Objectives International evidence suggests the diabetes nurse specialist (DNS) has a key role in supporting integrated management of diabetes. We examine whether hospital and community DNS currently support the integration of care, examine regional variation in aspects of the service relevant to the delivery of integrated care and identify barriers to service delivery and areas for improvement. Design A cross-sectional survey of hospital and community-based DNS in Ireland. Methods Between September 2015 and April 2016, a 67-item online survey, comprising closed and open questions on their clinical role, diabetes clinics, multidisciplinary working, and barriers and facilitators to service delivery, was administered to all eligible DNS (n=152) in Ireland. DNS were excluded if they were retired or on maternity leave or extended leave. Results The response rate was 66.4% (n=101): 60.6% (n=74) and 89.3% (n=25) among hospital and community DNS, respectively. Most DNS had patients with stable (81.8%) and complicated type 2 diabetes mellitus (89.9%) attending their service. The majority were delivering nurse-led clinics (81.1%). Almost all DNS had a role liaising with (91%), and providing support and education to (95%), other professionals. However, only a third reported that there was local agreement on how their service should operate between the hospital and primary care. Barriers to service delivery that were experienced by DNS included deficits in the availability of specialist staff (allied health professionals, endocrinologists and DNS), insufficient space for clinics, structured education and issues with integration. Conclusions Delivering integrated diabetes care through a nurse specialist-led approach requires that wider service issues, including regional disparities in access to specialist resources and formalising agreements and protocols on multidisciplinary working between settings, be explicitly addressed. PMID:28801394

Are integrated HIV services less stigmatizing than stand-alone models of care? A comparative case study from Swaziland

PubMed Central

Church, Kathryn; Wringe, Alison; Fakudze, Phelele; Kikuvi, Joshua; Simelane, Dudu; Mayhew, Susannah H

2013-01-01

Introduction Integrating HIV with primary health services has the potential to reduce HIV-related stigma through delivering care in settings disassociated with HIV. This study investigated the relationship between integrated care and felt stigma. The study design was a comparative case study of four models of HIV care in Swaziland, ranging from fully integrated to fully stand-alone HIV care. Methods An exit survey (N=602) measured differences in felt stigma across model of care; the primary outcome “perception of HIV status exposure through clinic attendance” was analyzed using multivariable logistic regression. In-depth interviews (N=22) explored whether and how measured differences in stigma experiences were related to service integration. Results There were significant differences in perceived status exposure across models of care. After adjustment for potential confounding between sites, those at a partially integrated site and a partially stand-alone site had greater odds of perceived status exposure than those at the fully stand-alone site (aOR 3.33, 95% CI 1.98–5.60; and aOR 11.84, 95% CI 6.89–20.36, respectively). There was no difference between the fully stand-alone and the fully integrated clinic. Qualitative data suggested that many clients at HIV-only sites felt greater confidentiality knowing that those around them were positive, and support was gained from other HIV care clients. Confidentiality was maintained in various ways, even in stand-alone sites, through separate waiting areas for HIV testing and HIV treatment, and careful clinic and room labelling. Conclusions The relationship between model of care and stigma was complex, and the hypothesis that stigma is higher at stand-alone sites did not hold true in this high prevalence setting. Policy-makers should ensure that service integration does not increase stigma, in particular within partially integrated models of care. PMID:23336726

The 2011 Tuscaloosa tornado: integration of pediatric disaster services into regional systems of care.

PubMed

Kanter, Robert K

2012-09-01

To empirically describe the integration of pediatric disaster services into regional systems of care after the April 27, 2011, tornado in Tuscaloosa, Alabama, a community with no pediatric emergency department or pediatric intensive care unit and few pediatric subspecialists. Data were obtained in interviews with key informants including professional staff and managers from public health and emergency management agencies, prehospital emergency medical services, fire departments, hospital nurses, physicians, and the trauma program coordinator. A single hospital in Tuscaloosa served 800 patients on the night of the tornado. More than 100 of these patients were children, including more than 20 with critical injuries. Many children were unaccompanied and unidentified on arrival. Resuscitation and stabilization were performed by nonpediatric prehospital and emergency department staff. More than 20 children were secondarily transported to the nearest children's hospital an hour's drive away under the care of nonpediatric local emergency medical services providers. No preventable adverse events were identified in the resuscitation and secondary transport phases of care. Stockpiled supplies and equipment were adequate to serve the needs of the disaster victims, including the children. Essential aspects of preparation include pediatric-specific clinical skills, supplies and equipment, operational disaster plans, and interagency practice embedded in everyday work. Opportunities for improvement identified include more timely response to warnings, improved practices for identifying unaccompanied children, and enhanced child safety in shelters. Successful responses depended on integration of pediatric services into regional systems of care. Copyright © 2012 Mosby, Inc. All rights reserved.

SeWeR: a customizable and integrated dynamic HTML interface to bioinformatics services.

PubMed

Basu, M K

2001-06-01

Sequence analysis using Web Resources (SeWeR) is an integrated, Dynamic HTML (DHTML) interface to commonly used bioinformatics services available on the World Wide Web. It is highly customizable, extendable, platform neutral, completely server-independent and can be hosted as a web page as well as being used as stand-alone software running within a web browser.