Teachers' Demographic Factors on Attitude towards Guidance and Counselling Services in Public Primary Schools of Kimilili Subcounty, Kenya

ERIC Educational Resources Information Center

Nasilumbi, Wesonga Joanne; Jenniffer, Munyau K.; Prisca, Tarus

2016-01-01

The government of Kenya through the Ministry of education banned corporal punishment in schools. This necessitated strengthening of guidance and counseling (G&C) services in schools. This study aimed to: determine the teachers' attitude towards guidance and counseling services in public primary schools in Kimilili Sub-County and determine the…

Influences on corporate executive decision behavior in government acquisitions

NASA Technical Reports Server (NTRS)

Wetherington, J. R.

1986-01-01

This paper presents extensive exploratory research which had as its primary objective, the discovery and determination of major areas of concern exhibited by U.S. corporate executives in the preparation and submittal of proposals and bids to the Federal government. The existence of numerous unique concerns inherent in corporate strategies within the government market environment was established. A determination of the relationship of these concerns to each other was accomplished utilizing statistical factor analysis techniques resulting in the identification of major groupings of management concerns. Finally, using analysis of variance, an analysis and discovery of the interrelationship of the factors to corporate demographics was accomplished. The existence of separate and distinct concerns exhibited by corporate executives when contemplating sales and operations in the government marketplace was established. It was also demonstrated that quantifiable relationships exist between such variables and that the decision behavior exhibited by the responsible executives has an interrelationship to their company's demographics.

Political, cultural and economic foundations of primary care in Europe.

PubMed

Kringos, Dionne S; Boerma, Wienke G W; van der Zee, Jouke; Groenewegen, Peter P

2013-12-01

This article explores various contributing factors to explain differences in the strength of the primary care (PC) structure and services delivery across Europe. Data on the strength of primary care in 31 European countries in 2009/10 were used. The results showed that the national political agenda, economy, prevailing values, and type of healthcare system are all important factors that influence the development of strong PC. Wealthier countries are associated with a weaker PC structure and lower PC accessibility, while Eastern European countries seemed to have used their growth in national income to strengthen the accessibility and continuity of PC. Countries governed by left-wing governments are associated with a stronger PC structure, accessibility and coordination of PC. Countries with a social-security based system are associated with a lower accessibility and continuity of PC; the opposite is true for transitional systems. Cultural values seemed to affect all aspects of PC. It can be concluded that strengthening PC means mobilising multiple leverage points, policy options, and political will in line with prevailing values in a country. Copyright © 2013 Elsevier Ltd. All rights reserved.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes.

PubMed

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

PubMed Central

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally. PMID:29623271

Investigating the Factors Influencing Teachers' Use of ICT in Teaching in Bruneian Secondary Schools

ERIC Educational Resources Information Center

Salleh, Sallimah M.; Laxman, Kumar

2014-01-01

The primary focus of the research study described in this paper was to assess the status quo of teachers' use of Information and Communication Technology in teaching in terms of the factors that influence their use. Using a survey questionnaire, data was collected from a total of 1,891 secondary school teachers in all government schools in Negara…

Effects of Corporate Social Responsibility and Governance on Its Credit Ratings

PubMed Central

Kim, Dong-young

2014-01-01

This study reviews the impact of corporate social responsibility (CSR) and corporate governance on its credit rating. The result of regression analysis to credit ratings with relevant primary independent variables shows that both factors have significant effects on it. As we have predicted, the signs of both regression coefficients have a positive sign (+) proving that corporates with excellent CSR and governance index (CGI) scores have higher credit ratings and vice versa. The results show nonfinancial information also may have effects on corporate credit rating. The investment on personal data protection could be an example of CSR/CGI activities which have positive effects on corporate credit ratings. PMID:25401134

Effects of corporate social responsibility and governance on its credit ratings.

PubMed

Kim, Dong-young; Kim, JeongYeon

2014-01-01

This study reviews the impact of corporate social responsibility (CSR) and corporate governance on its credit rating. The result of regression analysis to credit ratings with relevant primary independent variables shows that both factors have significant effects on it. As we have predicted, the signs of both regression coefficients have a positive sign (+) proving that corporates with excellent CSR and governance index (CGI) scores have higher credit ratings and vice versa. The results show nonfinancial information also may have effects on corporate credit rating. The investment on personal data protection could be an example of CSR/CGI activities which have positive effects on corporate credit ratings.

5 CFR 950.104 - Local Federal Coordinating Committee responsibilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

.... CFC loaned executives' time should be charged to regular working hours. It is not appropriate to place... not use the services of consulting firms, advertising firms or similar business organizations to... accuracy in solicitations, and sound governance and fiscal management practices as the primary factors in...

5 CFR 950.104 - Local Federal Coordinating Committee responsibilities.

Code of Federal Regulations, 2011 CFR

2011-01-01

.... CFC loaned executives' time should be charged to regular working hours. It is not appropriate to place... not use the services of consulting firms, advertising firms or similar business organizations to... accuracy in solicitations, and sound governance and fiscal management practices as the primary factors in...

Organizational factors influencing successful primary care and public health collaboration.

PubMed

Valaitis, Ruta; Meagher-Stewart, Donna; Martin-Misener, Ruth; Wong, Sabrina T; MacDonald, Marjorie; O'Mara, Linda

2018-06-07

Public health and primary care are distinct sectors within western health care systems. Within each sector, work is carried out in the context of organizations, for example, public health units and primary care clinics. Building on a scoping literature review, our study aimed to identify the influencing factors within these organizations that affect the ability of these health care sectors to collaborate with one another in the Canadian context. Relationships between these factors were also explored. We conducted an interpretive descriptive qualitative study involving in-depth interviews with 74 key informants from three provinces, one each in western, central and eastern Canada, and others representing national organizations, government, or associations. The sample included policy makers, managers, and direct service providers in public health and primary care. Seven major organizational influencing factors on collaboration were identified: 1) Clear Mandates, Vision, and Goals; 2) Strategic Coordination and Communication Mechanisms between Partners; 3) Formal Organizational Leaders as Collaborative Champions; 4) Collaborative Organizational Culture; 5) Optimal Use of Resources; 6) Optimal Use of Human Resources; and 7) Collaborative Approaches to Programs and Services Delivery. While each influencing factor was distinct, the many interactions among these influences are indicative of the complex nature of public health and primary care collaboration. These results can be useful for those working to set up new or maintain existing collaborations with public health and primary care which may or may not include other organizations.

Prevalence of depression among women attending a primary urban care clinic in Malaysia.

PubMed

Sidik, Sherina Mohd; Arroll, Bruce; Goodyear-Smith, Felicity; Ahmad, Rozali

2012-07-01

Depression affects more women than men in Malaysia. The objective of this paper was to determine the prevalence of depression and its associated factors among women attending a government primary care clinic. A cross-sectional study was conducted in a government-funded primary care clinic in Malaysia. Consecutive adult female patients attending the clinic during the data collection period were invited to participate. The participants completed self-administered questionnaires (including the validated Patient Health Questionnaire [PHQ-9], which was translated into the Malay language). A total of 895 female patients participated in the study (response rate 87.5%). The prevalence of depression (PHQ-9 scores ≥ 10) was 12.1%. Based on multiple logistic regression analysis, certain stressful life events were found to be associated with depression (p < 0.05). These factors, arranged from highest to lowest risk, were financial problems (odds ratio [OR] 3.7, 95% confidence interval [CI] 2.2-6.2), unhappiness in the parent-child relationship (OR 3.0, 95% CI 1.2-7.5), history of serious illness (OR 2.4, 95% CI 1.1-5.2), unhappiness in family relationships (OR 2.3, 95% CI 1.1-4.7) and unhappiness at work (OR 2.2, 95% CI 1.1-4.3) (p < 0.05). The prevalence of depression among participants in this study was clinically significant and corresponded with the findings of other international studies. Factors associated with depression need to be highlighted and addressed accordingly. Clinicians in Malaysia should be aware of this prevalence when making diagnoses in primary care.

Scenarios Creation and Use in the Arctic Council's Arctic Marine Shipping Assessment

NASA Astrophysics Data System (ADS)

Brigham, L. W.

2016-12-01

The Arctic Council's Arctic Marine Shipping Assessment (AMSA), conducted 2004-2009, used a scenarios-based approach to reveal the complexity of future Arctic marine navigation and to develop a set of plausible futures. The initial task was to use experts and stakeholders in brainstorming sessions to identify the key drivers and uncertainties for Arctic marine navigation. AMSA scenario participants identified 120 driving forces or factors that may influence future levels of marine activity. This effort illustrated the broad, global connections that can impact future use of the Arctic Ocean. Two primary factors were selected to anchor, as axes of uncertainty, the scenarios matrix: resources and trade (the level of demand for Arctic natural resources and trade); and, governance (the degree of relative stability of rules and standards for marine use both within the Arctic and internationally). Four scenarios were created by crossing the two primary drivers: a Polar Lows scenario (low demand and unstable governance); an Arctic Race scenario (high demand and unstable governance); a Polar Preserve scenario (low demand and stable governance); and, an Arctic Saga scenario (high demand and stable governance). The AMSA scenarios effort proved to be an effective and powerful way to communicate to the Arctic Council diplomats, Arctic indigenous peoples, maritime stakeholders and many other actors in the global community the complexities influencing the future of Arctic shipping and marine operations. The scenarios approach facilitated unconstrained thinking and identified the many plausible linkages of the Arctic to the global economic system. The AMSA scenarios work was influential in the Arctic ministers' approval of the framework set of AMSA recommendations that are being implemented today to enhance Arctic marine safety and environmental protection.

The Environmental Impact Study Of Micro Hydro Power In Pekalongan Indonesia

NASA Astrophysics Data System (ADS)

Suwarto; Hadi, Sudharto P.; Hermawan

2018-02-01

Curugmuncar II micro hydro power (MHP) located in Petungkriyono sub district is one of three MHPs installed in Pekalongan district. This study aims to analyze the MHP operation environmental impact. The study used qualitative method, with interviews, observations, and material testing. The data used are primary and secondary data. This research was conducted in Curugmuncar Village, Petungkriyono Subdistrict, Pekalongan Regency, Indonesia. MHP has power capacity of 100 KW with power usage of 50 KW. MHP used by 155 users with load capacity 2 A 220 volt AC. The community more used of lights as the houses and street lighting. The MHP operation had several environmental factors such as: sociology, technically feasible, hydrology, physical and chemical water quality, ergonomics, economically feasible, irrigation, clean water supply, government policy, and others. The supporting factors sustainability of MHP were sociology, irrigation, ergonomics, clean water supply, physical and chemical water quality, hydrology, and government policy. The inhibiting factors of MHP operation were technically feasible, economically feasible, and government policy. The results showed that the MHP environment requires a professional management system to achieve the MHP sustainability

Political economy of decentralising HIV and AIDS treatment services to primary healthcare facilities in three Nigerian states.

PubMed

Mbachu, Chinyere; Onwujekwe, Obinna; Ezumah, Nkoli; Ajayi, Olayinka; Sanwo, Olusola; Uzochukwu, Benjamin

2016-09-01

Decentralisation is defined as the dispersion, distribution or transfer of resources, functions and decision-making power from a central authority to regional and local authorities. It is usually accompanied by assignment of accountability and responsibility for results. Fundamental to understanding decentralisation is learning what motivates central governments to give up power and resources to local governments, and the practical significance of this on their positions regarding decentralisation. This study examined key political and institutional influences on role-players' capacity to support decentralisation of HIV and AIDS treatment services to primary healthcare facilities, and implications for sustainability. In-depth interviews were conducted with 55 purposively selected key informants, drawn from three Nigerian states that were at different stages of decentralising HIV and AIDS treatment services to primary care facilities. Key informants represented different categories of role-players involved in HIV and AIDS control programmes. Thematic framework analysis of data was done. Support for decentralisation of HIV and AIDS treatment services to primary healthcare facilities was substantial among different categories of actors. Political factors such as the local and global agenda for health, political tenure and party affiliations, and institutional factors such as consolidation of decision-making power and improvements in career trajectories, influenced role-players support for decentralisation of HIV and AIDS treatment services. It is feasible and acceptable to decentralise HIV and AIDS treatment services to primary healthcare facilities, to help improve coverage. However, role-players' support largely depends on how well the reform aligns with political structures and current institutional practices.

Primary health care reform, dilemmatic space and risk of burnout among health workers.

PubMed

Freeman, Toby; Baum, Fran; Labonté, Ronald; Javanparast, Sara; Lawless, Angela

2018-05-01

Health system changes may increase primary health care workers' dilemmatic space, created when reforms contravene professional values. Dilemmatic space may be a risk factor for burnout. This study partnered with six Australian primary health care services (in South Australia: four state government-managed services including one Aboriginal health team and one non-government organisation and in Northern Territory: one Aboriginal community-controlled service) during a period of change and examined workers' dilemmatic space and incidence of burnout. Dilemmatic space and burnout were assessed in a survey of 130 staff across the six services (58% response rate). Additionally, 63 interviews were conducted with practitioners, managers, regional executives and health department staff. Dilemmatic space occurred across all services and was associated with higher rates of self-reported burnout. Three conditions associated with dilemmatic space were (1) conditions inherent in comprehensive primary health care, (2) stemming from service provision for Aboriginal and Torres Strait Islander peoples and (3) changes wrought by reorientation to selective primary health care in South Australia. Responses to dilemmatic space included ignoring directives or doing work 'under the radar', undertaking alternative work congruent with primary health care values outside of hours, or leaving the organisation. The findings show that comprehensive primary health care was contested and political. Future health reform processes would benefit from considering alignment of changes with staff values to reduce negative effects of the reform and safeguard worker wellbeing.

Isolation and Characterization of Rat Pituitary Endothelial Cells

PubMed Central

Chaturvedi, Kirti; Sarkar, Dipak K.

2010-01-01

Most previous studies that determined the effect of estradiol on angiogenesis used endothelial cells from nonpituitary sources. Because pituitary tumor tissue receives its blood supply via portal and arterial circulation, it is important to use pituitary-derived endothelial cells in studying pituitary angiogenesis. We have developed a magnetic separation technique to isolate endothelial cells from pituitary tissues and have characterized these cells in primary cultures. Endothelial cells of the pituitary showed the existence of endothelial cell marker, CD31, and of von Willebrand factor protein. These cells in cultures also showed immunore-activity of estrogen receptors alpha and beta. The angiogenic factors, vascular endothelial growth factor and basic fibroblast growth factor, significantly increased proliferation and migration of the pituitary-derived endothelial cells in primary cultures. These results suggest that a magnetic separation technique can be used for enrichment of pituitary-derived endothelial cells for determination of cellular mechanisms governing the vascularization in the pituitary. PMID:17028416

The midwives service scheme: a qualitative comparison of contextual determinants of the performance of two states in central Nigeria.

PubMed

Okpani, Arnold I; Abimbola, Seye

2016-01-01

The federal government of Nigeria started the Midwives Service Scheme in 2009 to address the scarcity of skilled health workers in rural communities by temporarily redistributing midwives from urban to rural communities. The scheme was designed as a collaboration among federal, state and local governments. Six years on, this study examines the contextual factors that account for the differences in performance of the scheme in Benue and Kogi, two contiguous states in central Nigeria. We obtained qualitative data through 14 in-depth interviews and 2 focus group discussions: 14 government officials at the federal, state and local government levels were interviewed to explore their perceptions on the design, implementation and sustainability of the Midwives Service Scheme. In addition, mothers in rural communities participated in 2 focus group discussions (one in each state) to elicit their views on Midwives Service Scheme services. The qualitative data were analysed for themes. The inability of the federal government to substantially influence the health care agenda of sub-national governments was a significant impediment to the achievement of the objectives of the Midwives Service Scheme. Participants identified differences in government prioritisation of primary health care between Benue and Kogi as relevant to maternal and child health outcomes in those states: Kogi was far more supportive of the Midwives Service Scheme and primary health care more broadly. High user fees in Benue was a significant barrier to the uptake of available maternal and child health services. Differential levels of political support and prioritisation, alongside financial barriers, contribute substantially to the uptake of maternal and child health services. For collaborative health sector strategies to gain sufficient traction, where federating units determine their health care priorities, they must be accompanied by strong and enforceable commitment by sub-national governments.

A Phenomenological Study of Autonomous Management Performance Schools (AMPS) in the Chicago Public Schools

ERIC Educational Resources Information Center

Moore, Forrest W.

2009-01-01

The primary objective of this qualitative study is to explore the impact of autonomy on the relationship between schools and districts of the school level across governance, operations, curriculum and instruction and the decision making that accompanies the each of these factors. More specifically, this study focuses the impact of autonomy within…

Universal Health Coverage and Primary Healthcare: Lessons From Japan

PubMed Central

Bloom, Gerald

2017-01-01

A recent editorial by Naoki Ikegami has proposed three key lessons from Japan’s experience of achieving virtually universal coverage with primary healthcare services: the need to integrate the existing providers of primary healthcare services into the organised health system; the need to limit government commitments to finance hospital services and the need to empower providers of primary healthcare to influence decisions that influence their livelihoods. Although the context of low- and middle-income countries (LMICs) differs in many ways from Japan in the late 19th and early 20th centuries, the lesson that short-term initiatives to achieve universal coverage need to be complemented by an understanding of the factors influencing long-term change management remains highly relevant. PMID:28812806

All Paths Lead to TRIM25.

PubMed

Zhou, Hengbo; Costello, James C

2017-10-01

Identifying key factors that regulate the transition from primary to metastatic cancer is a fundamental challenge. Walsh et al. took a systems biology approach integrating computational, in vitro, and in vivo experiments to identify TRIM25 (tripartite motif containing 25) as a key factor that regulates metastatic gene signatures both at the transcriptional and post-transcriptional level in breast cancer. Targeting TRIM25 therapeutically is attractive because it governs a broad set of coordinated transcriptional modules that dictate metastatic progression. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors affecting electronic health record adoption in long-term care facilities.

PubMed

Cherry, Barbara; Carter, Michael; Owen, Donna; Lockhart, Carol

2008-01-01

Electronic health records (EHRs) hold the potential to significantly improve the quality of care in long-term care (LTC) facilities, yet limited research has been done on how facilities decide to adopt these records. This study was conducted to identify factors that hinder and facilitate EHR adoption in LTC facilities. Study participants were LTC nurses, administrators, and corporate executives. Primary barriers identified were costs, the need for training, and the culture change required to embrace technology. Primary facilitators were training programs, well-defined implementation plans, government assistance with implementation costs, evidence that EHRs will improve care outcomes, and support from state regulatory agencies. These results offer a framework of action for policy makers, LTC Leaders, and researchers.

The development of English primary care group governance. A scenario analysis.

PubMed

Sheaff, R

1999-01-01

At present there is a policy vacuum about what English Primary Care Groups' (PCGs) governance will be when they develop into Primary Care Trusts (PCTs). Draft legislation leaves many options open, so PCT governance is likely to 'emerge' as PCTs are created. It also remains uncertain how general practitioners (GPs) will react to the formation of PCTs and how the UK government will then respond in turn. A scenario analysis suggests three possible lines of development. The base (likeliest) scenario predicts a mainly networked form of PCT governance. An alternative scenario is of PCT governance resembling the former National Health Service internal market. A third scenario predicts 'franchise model' PCTs employing some GPs and subcontracting others. To different degrees all three scenarios predict that PCTs will retain elements of networked governance. If it fails to make GPs as accountable to NHS management as the UK government wishes, networked governance may prove only a transitional stage before English PCTs adopt either quasi-market or hierarchical governance.

Complex adaptive systems (CAS): an overview of key elements, characteristics and application to management theory.

PubMed

Ellis, Beverley; Herbert, Stuart Ian

2011-01-01

To identify key elements and characteristics of complex adaptive systems (CAS) relevant to implementing clinical governance, drawing on lessons from quality improvement programmes and the use of informatics in primary care. The research strategy includes a literature review to develop theoretical models of clinical governance of quality improvement in primary care organisations (PCOs) and a survey of PCOs. Complex adaptive system theories are a valuable tool to help make sense of natural phenomena, which include human responses to problem solving within the sampled PCOs. The research commenced with a survey; 76% (n16) of respondents preferred to support the implementation of clinical governance initiatives guided by outputs from general practice electronic health records. There was considerable variation in the way in which consultation data was captured, recorded and organised. Incentivised information sharing led to consensus on coding policies and models of data recording ahead of national contractual requirements. Informatics was acknowledged as a mechanism to link electronic health record outputs, quality improvement and resources. Investment in informatics was identified as a development priority in order to embed clinical governance principles in practice. Complex adaptive system theory usefully describes evolutionary change processes, providing insight into how the origins of quality assurance were predicated on rational reductionism and linearity. New forms of governance do not neutralise previous models, but add further dimensions to them. Clinical governance models have moved from deterministic and 'objective' factors to incorporate cultural aspects with feedback about quality enabled by informatics. The socio-technical lessons highlighted should inform healthcare management.

Gender Factor in Decision Making: Challenges Facing Women Leadership Development in Primary Schools' Management in Kenya

ERIC Educational Resources Information Center

Choge, Jepkemboi Ruth

2015-01-01

The degree of attention given to women leadership in Education in Kenya has increased considerably in the recent years especially after the government introduced the affirmative action for both girls and women in education and employment in support of Millennium Development Goals, World Conventions, the Kenya Vision 2030 blue print for economic…

Determinants of Educational Continuation Decisions of Higher Secondary School Students in India: An Application of Theory of Planned Behavior

ERIC Educational Resources Information Center

Edannur, Sreekala; Firsad, Samsu

2016-01-01

The determinants of educational and occupational continuation of younger people in India are still attributed to their socio economic background (primary effects). This deters the government from taking steps to bring the disadvantaged youngsters' higher education, since there is not much one can do to improve the social origin factors. The…

Causes of Male Dropout Rate in Pakistan

ERIC Educational Resources Information Center

Ud Din, Muhammad Naseer; Dad, Hukam; Iqbal, Javid; Shah, Syed Shafqat Ali; Niazi, Muhammad Imran

2011-01-01

This study aimed to seek the cause of male students' dropout rate at the primary level of F.R. Peshawar. The main objectives of the study were: 1) to study the teacher problems and attitudes of the dropouts, 2) to determine the factors that cause dropouts, 3) to study the government's strategy of dropouts, and 4) to provide suggestions to overcome…

Opening Doors to Success in Multilingual Classrooms: Bilingualism, Codeswitching and the Professional Identities of Ethnic Minority Primary Teachers

ERIC Educational Resources Information Center

Conteh, Jean

2007-01-01

In England, government initiatives to recruit more ethnic minority teachers into mainstream schools have met with only limited success. One important reason for this may be that the factors that contribute to their distinctive professional skills and identities, and their potential to help raise the achievements of ethnic minority pupils, are not…

Beyond the limits of clinical governance? The case of mental health in English primary care

PubMed Central

Gask, Linda; Rogers, Anne; Campbell, Stephen; Sheaff, Rod

2008-01-01

Background Little research attention has been given to attempts to implement organisational initiatives to improve quality of care for mental health care, where there is a high level of indeterminacy and clinical judgements are often contestable. This paper explores recent efforts made at an organisational level in England to improve the quality of primary care for people with mental health problems through the new institutional processes of 'clinical governance'. Methods Framework analysis, based on the Normalisation Process Model (NPM), of attempts over a five year period to develop clinical governance for primary mental health services in Primary Care Trusts (PCTs). The data come from a longitudinal qualitative multiple case-study approach in a purposive sample of 12 PCTs, chosen to reflect a maximum variety of organisational contexts for mental health care provision. Results The constant change within the English NHS provided a difficult context in which to attempt to implement 'clinical governance' or, indeed, to reconstruct primary mental health care. In the absence of clear evidence or direct guidance about what 'primary mental health care' should be, and a lack of actors with the power or skills to set about realising it, the actors in 'clinical governance' had little shared knowledge or understanding of their role in improving the quality of mental health care. There was a lack of ownership of 'mental health' as an integral, normalised part of primary care. Conclusion Despite some achievements in regard to monitoring and standardisation of prescribing practice, mental health care in primary care seems to have so far largely eluded the gaze of 'clinical governance'. Clinical governance in English primary mental health care has not yet become normalised. We make some policy recommendations which we consider would assist in the process normalisation and suggest other contexts to which our findings might apply. PMID:18366779

Intersecting Global and Local: The Intercultural and Intersubjective Constructions of "Expatriate" and "Local" Teachers in the Search for the "X Factor"

ERIC Educational Resources Information Center

Bridges, Susan; emerald, elke

2013-01-01

In 1998, the government of the Hong Kong Special Administrative Region began a large-scale project to import qualified, experienced native-speaking teachers of English into Hong Kong secondary schools. The Native-speaking English Teacher (NET) scheme later expanded to include Hong Kong primary schools. Currently, teachers from around the world are…

Inclusive Education in Government Primary Schools: Teacher Perceptions

ERIC Educational Resources Information Center

Khan, Itfaq Khaliq; Hashmi, ShujahatHaider; Khanum, Nabeela

2017-01-01

The perceptions of primary school teachers towards inclusive education was investigated in mainstream government schools of Islamabad capital territory where inclusive education was being supported by Sight savers and other international organizations. The study was carried out involving 54 teachers in six randomly selected primary schools. The…

Exploring the Values of Chaplains in Government Primary Schools

ERIC Educational Resources Information Center

Isaacs, Amy Kate; Mergler, Amanda

2018-01-01

Minimal prior research has examined the school chaplaincy programme in Australia. This exploratory study sought to identify the values primary school chaplains feel are the most important to them personally, and in their role as chaplain. Eight chaplains working in government primary schools were interviewed. Inductive thematic analysis was used…

Insiders and outsiders: local government and NGO engagement in disaster response in Guimaras, Philippines.

PubMed

Espia, Juhn Chris P; Fernandez, Pepito

2015-01-01

This paper examines local government and non-governmental organisation (NGO) engagement in disaster response in the wake of the M/T Solar 1 oil spill in Guimaras, Western Visayas, Philippines, on 11 August 2006. It assesses the response activities of these two entities as well as the institutional factors that affected their interaction on the ground. Local government and NGO engagement was shaped by multi-layered, overlapping, and oftentimes contending government-designed response frameworks. Within these frameworks, government actors played the role of primary implementer and provider of relief, allowing them to determine who could be involved and the extent of their involvement. The absence of formal roles for NGOs in these frameworks not only undermines their ability to work in a setting where such institutional set-ups are operational but also it reaffirms their 'outsider' status. This study of the Guimaras oil spill illustrates the complexity and the institutional difficulties inherent in disaster response and coordination in the Philippines. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

The factors affecting Nigeria's success toward implementation of global public health priorities.

PubMed

Echebiri, Vitalis C

2015-06-01

This paper examines the challenges facing the Nigerian government toward the implementation of global public health priories. The Nigerian government recognizes the need to implement these priorities by putting in place the necessary policy framework, but political instability, poor infrastructural development and inadequate funding have remained barriers toward the achievement of success in implementing these priorities. The rest of the paper elucidates the fact that despite leadership and influence from the World Health Organization and other United Nations agencies, and some responses from the Nigerian government, tackling these public health problems requires much more fundamental reform to primary health services and a reduction in poverty. Although the government has shown enough political will to tackle these problems, it is expected that a better result will be achieved through injecting more funds into the Nigerian health sector, and deploying astute health administrators to manage the sector rather than pure health professionals without managerial acumen. © The Author(s) 2014.

Basic Education from Early Childhood: Impacts of Free Primary Education and Subsidized Secondary Education on Public ECDE Centers in Nyahururu District, Kenya

ERIC Educational Resources Information Center

Mwangi, Peter Murage; Serem, T. D. K.

2013-01-01

Kenya must invest more in education to realize her vision 2030. The government commitment to Education for All's goal has been expressed through provision of basic education in pre-primary, primary and secondary school levels. To this end, the government introduced two kitties; Free Primary Education in 2003 and Subsidized Secondary Education in…

Time to ignition is influenced by both moisture content and soluble carbohydrates in live Douglas fir and Lodgepole pine needles

Treesearch

Matt Jolly; Sara McAllister; Mark Finney; Ann Hadlow

2010-01-01

Living plants are often the primary fuels burning in wildland fire but little is known about the factors that govern their ignition behavior. Moisture content has long been hypothesized to determine the characteristics of fires spreading in live fuels but moisture content alone fails to explain observed differences in the ignition of various species at different times...

United States Policy for Southern Africa.

DTIC Science & Technology

1986-03-01

tribes . A primary rivalry is between the nearly six million Zulus and the Xhosa-speaking tribes . The principle Zulu party, Inkatha, led by Chief...impact of tribalism and tribe loyalty as a devisive factor in the South African political scene. "The land is divided among 10 separate black tribal...dividing the blacks by tribe . White government officials argue that the experience elsewhere in Africa has taught them that efforts towards tribal

Attitudes towards Science of Intellectually Gifted and Mainstream Upper Primary Students in Singapore

ERIC Educational Resources Information Center

Caleon, Imelda S.; Subramaniam, R.

2008-01-01

The attitudes towards science of upper-primary students in three ability strands (average, above average, and gifted) were investigated. A total of 580 upper primary students from co-educational government and government-aided schools in Singapore were involved in this study. The attitude subscales investigated were enjoyment of science,…

Community participation in health service reform: the development of an innovative remote Aboriginal primary health-care service.

PubMed

Reeve, Carole; Humphreys, John; Wakerman, John; Carroll, Vicki; Carter, Maureen; O'Brien, Tim; Erlank, Carol; Mansour, Rafik; Smith, Bec

2015-01-01

The aim of this study was to describe the reorientation of a remote primary health-care service, in the Kimberley region of Australia, its impact on access to services and the factors instrumental in bringing about change. A unique community-initiated health service partnership was developed between a community-controlled Aboriginal health organisation, a government hospital and a population health unit, in order to overcome the challenges of delivering primary health care to a dispersed, highly disadvantaged Aboriginal population in a very remote area. The shared goals and clear delineation of responsibilities achieved through the partnership reoriented an essentially acute hospital-based service to a prevention-focussed comprehensive primary health-care service, with a focus on systematic screening for chronic disease, interdisciplinary follow up, health promotion, community advocacy and primary prevention. This formal partnership enabled the primary health-care service to meet the major challenges of providing a sustainable, prevention-focussed service in a very remote and socially disadvantaged area.

The Impact of Financial Centralization on the Support for Education: The Case of Michigan

ERIC Educational Resources Information Center

Husted, Thomas A.

2005-01-01

The primary responsibility for the financing of U.S. primary and secondary education rests with state and local governments. In 1970-1971, local governments had, by far, the greatest role in education financing, providing 52.5% of the total education revenue. State governments contributed 39.1% of total education revenue. Since the early 1970s,…

Efficient and resilient governance of social-ecological systems.

PubMed

Erickson, Adam

2015-09-01

New institutions are critically needed to improve the resilience of social-ecological systems globally. Watershed management offers an important model due to its ability to govern mixed-ownership landscapes through common property regimes, translating national goals into local action. Here, I assess the efficacy of state watershed management institutions in the Pacific Northwest, based on their ability to support local watershed groups. I use document analysis to describe and compare state institutions in Washington, Oregon, Idaho, and California. Results indicate that state institutional efficiency and resilience are the key factors determining watershed group activity and stability. The primary drivers of institutional efficiency and resilience were institutional unification, robust funding portfolios, low agency conflict, and strong support for economic multiplier effects, creative partnerships, and scholarly research. My findings elucidate the critical role of institutional efficiency and resilience in governing dynamic and complex social-ecological systems, enabling the flexibility to address emergent transformations.

Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence.

PubMed

Phillips, Christine B; Pearce, Christopher M; Hall, Sally; Travaglia, Joanne; de Lusignan, Simon; Love, Tom; Kljakovic, Marjan

2010-11-15

To review the literature on different models of clinical governance and to explore their relevance to Australian primary health care, and their potential contributions on quality and safety. 25 electronic databases, scanning reference lists of articles and consultation with experts in the field. We searched publications in English after 1999, but a search of the German language literature for a specific model type was also undertaken. The grey literature was explored through a hand search of the medical trade press and websites of relevant national and international clearing houses and professional or industry bodies. 11 software packages commonly used in Australian general practice were reviewed for any potential contribution to clinical governance. 19 high-quality studies that assessed outcomes were included. All abstracts were screened by one researcher, and 10% were screened by a second researcher to crosscheck screening quality. Studies were reviewed and coded by four reviewers, with all studies being rated using standard critical appraisal tools such as the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Two researchers reviewed the Australian general practice software. Interviews were conducted with 16 informants representing service, regional primary health care, national and international perspectives. Most evidence supports governance models which use targeted, peer-led feedback on the clinician's own practice. Strategies most used in clinical governance models were audit, performance against indicators, and peer-led reflection on evidence or performance. The evidence base for clinical governance is fragmented, and focuses mainly on process rather than outcomes. Few publications address models that enhance safety, efficiency, sustainability and the economics of primary health care. Locally relevant clinical indicators, the use of computerised medical record systems, regional primary health care organisations that have the capacity to support the uptake of clinical governance at the practice level, and learning from the Aboriginal community-controlled sector will help integrate clinical governance into primary care.

U.S. News Media Coverage of Pharmaceutical Pollution in the Aquatic Environment: A Content Analysis of the Problems and Solutions Presented by Actors.

PubMed

Blair, Benjamin; Zimny-Schmitt, Daniel; Rudd, Murray A

2017-08-01

Pharmaceutical pollution in the aquatic environment is an issue of concern that has attracted attention by the news media. Understanding the factors that contribute to media framing of pharmaceutical pollution may lead to a better understanding of the management and governance of this issue, including why these pollutants are generally unregulated at this time. This study conducted a content analysis of 405 newspaper articles (81 had substantive information on the topic) from 2007 to 2014, using the search terms "water" and "pharmaceuticals" in the Chicago Tribune, Denver Post, Los Angeles Times, New York Daily News, New York Times, USA Today, Wall Street Journal, and Washington Post. We sought to analyze the factors that contributed to the news media presentation of pharmaceutical pollution in the United States, including the presentation of the risks/safety and solutions by various actors. We found that the primary issues in the news media were uncertainty regarding public health and harm to the environment. The primary solutions recommended within the news media were implementing additional water treatment technologies, taking unused pharmaceuticals to predetermined sites for disposal (take-back programs), and trash disposal of unused pharmaceuticals. Water utilities and scientists presented improved water treatment technology, government actors presented take-back programs, and pharmaceutical representatives, while sparsely involved in the news media, presented trash disposal as their primary solutions. To advance the understanding of the management of pharmaceutical pollution, this article offers further insight into the debate and potential solutions within the news media presentation of this complex scientific topic.

U.S. News Media Coverage of Pharmaceutical Pollution in the Aquatic Environment: A Content Analysis of the Problems and Solutions Presented by Actors

NASA Astrophysics Data System (ADS)

Blair, Benjamin; Zimny-Schmitt, Daniel; Rudd, Murray A.

2017-08-01

Pharmaceutical pollution in the aquatic environment is an issue of concern that has attracted attention by the news media. Understanding the factors that contribute to media framing of pharmaceutical pollution may lead to a better understanding of the management and governance of this issue, including why these pollutants are generally unregulated at this time. This study conducted a content analysis of 405 newspaper articles (81 had substantive information on the topic) from 2007 to 2014, using the search terms "water" and "pharmaceuticals" in the Chicago Tribune, Denver Post, Los Angeles Times, New York Daily News, New York Times, USA Today, Wall Street Journal, and Washington Post. We sought to analyze the factors that contributed to the news media presentation of pharmaceutical pollution in the United States, including the presentation of the risks/safety and solutions by various actors. We found that the primary issues in the news media were uncertainty regarding public health and harm to the environment. The primary solutions recommended within the news media were implementing additional water treatment technologies, taking unused pharmaceuticals to predetermined sites for disposal (take-back programs), and trash disposal of unused pharmaceuticals. Water utilities and scientists presented improved water treatment technology, government actors presented take-back programs, and pharmaceutical representatives, while sparsely involved in the news media, presented trash disposal as their primary solutions. To advance the understanding of the management of pharmaceutical pollution, this article offers further insight into the debate and potential solutions within the news media presentation of this complex scientific topic.

Endothelin-1 gene regulation

PubMed Central

Stow, Lisa R.; Jacobs, Mollie E.; Wingo, Charles S.; Cain, Brian D.

2011-01-01

Over two decades of research have demonstrated that the peptide hormone endothelin-1 (ET-1) plays multiple, complex roles in cardiovascular, neural, pulmonary, reproductive, and renal physiology. Differential and tissue-specific production of ET-1 must be tightly regulated in order to preserve these biologically diverse actions. The primary mechanism thought to control ET-1 bioavailability is the rate of transcription from the ET-1 gene (edn1). Studies conducted on a variety of cell types have identified key transcription factors that govern edn1 expression. With few exceptions, the cis-acting elements bound by these factors have been mapped in the edn1 regulatory region. Recent evidence has revealed new roles for some factors originally believed to regulate edn1 in a tissue or hormone-specific manner. In addition, other mechanisms involved in epigenetic regulation and mRNA stability have emerged as important processes for regulated edn1 expression. The goal of this review is to provide a comprehensive overview of the specific factors and signaling systems that govern edn1 activity at the molecular level.—Stow, L. R., Jacobs, M. E., Wingo, C. S., Cain, B. D. Endothelin-1 gene regulation. PMID:20837776

Measuring governance at health facility level: developing and validation of simple governance tool in Zambia.

PubMed

Mutale, Wilbroad; Mwanamwenge, Margaret Tembo; Balabanova, Dina; Spicer, Neil; Ayles, Helen

2013-08-09

Governance has been cited as a key determinant of economic growth, social advancement and overall development. Achievement of millennium development goals is partly dependant on governance practices. In 2007, Health Systems 20/20 conducted an Internet-based survey on the practice of good governance. The survey posed a set of good practices related to health governance and asked respondents to indicate whether their experience confirmed or disconfirmed those practices. We applied the 17 governance statements in rural health facilities of Zambia. The aim was to establish whether the statements were reliable and valid for assessing governance practices at primary care level. Both quantitative and qualitative methods were used. We first applied the governance statements developed by the health system 20/20 and then conducted focus group discussion and In-depth interviews to explore some elements of governance including accountability and community participation. The target respondents were the health facility management team and community members. The sample size include 42 health facilities. Data was analyzed using SPSS version 17 and Nvivo version 9. The 95% one-sided confidence interval for Cronbach's alpha was between 0.69 and 0.74 for the 16 items.The mean score for most of the items was above 3. Factor analysis yielded five principle components: Transparency, community participation, Intelligence & vision, Accountability and Regulation & oversight. Most of the items (6) clustered around the transparency latent factor. Chongwe district performed poorly in overall mean governance score and across the five domains of governance. The overall scores in Chongwe ranged between 51 and 94% with the mean of 80%. Kafue and Luangwa districts had similar overall mean governance scores (88%). Community participation was generally low. Generally, it was noted that community members lacked capacity to hold health workers accountable for drugs and medical supplies. The study successfully validated and applied the new tool for evaluating health system governance at health facility level. The results have shown that it is feasible to measure governance practices at health facility level and that the adapted tool is fairly reliable with the 95% one-sided confidence interval for Cronbach's alpha laying between 0.69 and 0.74 for the 16 items. Caution should be taken when interpreting overall scores as they tended to mask domain specific variations.

Factors associated to infant mortality in Sub-Saharan Africa

PubMed Central

Ester, Pablo Viguera; Torres, Alberto; Freire, José M.; Hernández, Valentín; Gil, Ángel

2011-01-01

Half of the 10 million children who die annually in the world are from Sub-Saharan Africa (SSA). The reasons are known, but lack of will and resources avoid the development of sustainable policies. Associated factors to the high infant mortality rate (IMR) in SSA have been investigated in this research. An ecological multi-group study was designed comparing rates within SSA. The dependent variable is the IMR and health services, economic and development indicators are the independent variables. Information and data sources were WHO, World Bank, UNICEF and UNDP (1997–2007). IMR mean value is 92.2 (per 1000 live births) and a relationship with several of the factors could be observed. In the bi-variate analysis direct relationship was observed with maternal mortality rate and an inverse relationship was observed with prenatal care coverage, births assisted by skilled health personnel, gross national income per capita, per capita government expenditure on health, social security expenditure, adult literacy rate, net primary school enrolment rate, population with access to safe drinking water (in urban and rural areas) and with population with access to basic sanitation in rural areas. In the multi-variate analysis IMR had an inverse relationship with children under 5 years with diarrhoea who receive oral re-hydration, with social security expenditure as percentage of general government expenditure on health and with per capita government expenditure on health. The situation in SSA would change if their inhabitants received education and information to demand more equitable polices and better investments from their governments. PMID:28299068

[Impact on environmental factors on the reproductive system and fetal development].

PubMed

Dulskiene, Virginija; Maroziene, Ligita

2002-01-01

A literature review discusses the effect of selected environmental factors on women reproductive system, fetal development and growth. According to recent reports, 2-3% of newborns have congenital malformations. These malformations are caused by interaction of genetic and environmental factors. Exposure of paternal or maternal organisms to environmental hazards may damage germ cells or interfere fetal development, resulting in malformation of various organ systems. Since environmental hazards exposures are complex, it is difficult to establish the primary effect of single factor. Factors, that are known to increase the risk of congenital malformations, preterm delivery or spontaneous abortion, are classified into five groups--psychological, social, biological, physical and chemical factors. The governments of most counties recognize the effect of hazardous environmental factors on public health as global problem. World Health Organization encourages researches, aimed at evaluation of various environmental factors impact on health of pregnant women and their offsprings.

Influencing policy change: the experience of health think tanks in low- and middle-income countries

PubMed Central

Bennett, Sara; Corluka, Adrijana; Doherty, Jane; Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Jesani, Amar; Kyabaggu, Joseph; Namaganda, Grace; Hussain, A M Zakir; de-Graft Aikins, Ama

2012-01-01

In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to: (i) investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and (ii) assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Case studies drew on document review, analysis of financial information, semi-structured interviews with staff and other stakeholders, and iterative feedback of draft findings. Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy advice and most undertook policy-relevant research. Relatively few were engaged in conducting policy dialogues, or systematic reviews, or commissioning research. Much of the work undertaken by institutes was driven by requests from government or donors, and the primary outputs for most institutes were research reports, frequently combined with verbal briefings. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. While the formal relationship of the institute to government was not found to be critical, units within government faced considerable difficulties. PMID:21558320

Influencing policy change: the experience of health think tanks in low- and middle-income countries.

PubMed

Bennett, Sara; Corluka, Adrijana; Doherty, Jane; Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Jesani, Amar; Kyabaggu, Joseph; Namaganda, Grace; Hussain, A M Zakir; de-Graft Aikins, Ama

2012-05-01

In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to: (i) investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and (ii) assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Case studies drew on document review, analysis of financial information, semi-structured interviews with staff and other stakeholders, and iterative feedback of draft findings. Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy advice and most undertook policy-relevant research. Relatively few were engaged in conducting policy dialogues, or systematic reviews, or commissioning research. Much of the work undertaken by institutes was driven by requests from government or donors, and the primary outputs for most institutes were research reports, frequently combined with verbal briefings. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. While the formal relationship of the institute to government was not found to be critical, units within government faced considerable difficulties.

Community governance in primary health care: towards an international Ideal Type.

PubMed

Meads, Geoffrey; Russell, Grant; Lees, Amanda

2017-10-01

Against a global background of increased resource management responsibilities for primary health care agencies, general medical practices, in particular, are increasingly being required to demonstrate the legitimacy of their decision making in market oriented environments. In this context a scoping review explores the potential utility for health managers in primary health care of community governance as a policy concept. The review of recent research suggests that applied learning from international health systems with enhanced approaches to public and patient involvement may contribute to meeting this requirement. Such approaches often characterise local health systems in Latin America and North West Europe where innovative models are beginning to respond effectively to the growing demands on general practice. The study design draws on documentary and secondary data analyses to identify common components of community governance from the countries in these regions, supplemented by other relevant international studies and sources where appropriate. Within a comprehensive framework of collaborative governance the components are aggregated in an Ideal Type format to provide a point of reference for possible adaptation and transferable learning across market oriented health systems. Each component is illustrated with international exemplars from recent organisational practices in primary health care. The application of community governance is considered for the particular contexts of GP led Clinical Commissioning Groups in England and Primary Health Networks in Australia. Some components of the Ideal Type possess potentially powerful negative as well as positive motivational effects, with PPI at practice levels sometimes hindering the development of effective local governance. This highlights the importance of careful and competent management of the growing resources attributed to primary health care agencies, which possess an increasingly diverse range of non-governmental status. Future policy and research priorities are outlined. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

A case study of outsourced primary healthcare services in Sindh, Pakistan: is this a real reform?

PubMed

Tanzil, Sana; Zahidie, Aysha; Ahsan, Adeel; Kazi, Ambreen; Shaikh, Babar Tasneem

2014-06-25

Since a decade, low and middle income countries have a rising trend of contracting their primary healthcare services to NGOs. In Pakistan, public sector often lacks capacity to effectively & equitably manage the healthcare services. It led the government to outsource the administration of primary health care services to a semi-autonomous government entity i.e. Peoples' Primary Healthcare Initiative (PPHI). This small scale study has assessed the quality of healthcare services at the contracted Basic Health Units (BHUs) with the PPHI and compared it with those managed by the local district government in the province of Sindh. A cross-sectional mix methods survey was conducted in November 2011. Two BHUs of each type were selected from the districts Karachi and Thatta in Sindh province. BHUs were selected randomly and a purposive sampling technique was used to recruit the study participants at the two study sites. Focus group discussions were conducted with patients visiting the facility while in-depth interviews were conducted with service providers. An observation based resource availability checklist was also administered. There was a significant difference between the PPHI and the district government administered BHUs with regard to infrastructure, availability of essential medicines, basic medical appliances, mini-lab facilities and vehicles for referrals. These BHUs were found to have sufficient number of trained clinical staff and no punctuality and retention issues whatsoever. The district government administered BHUs presented a dismal picture in all the aspects. Out-sourcing of primary healthcare facilities has resulted in significantly improved certain aspects quality and responsiveness of primary healthcare services. This strategy is likely to achieve an efficient and perhaps an equitable healthcare delivery in low and middle income countries where governments have limited capacity to manage healthcare services.

A case study of outsourced primary healthcare services in Sindh, Pakistan: is this a real reform?

PubMed Central

2014-01-01

Background Since a decade, low and middle income countries have a rising trend of contracting their primary healthcare services to NGOs. In Pakistan, public sector often lacks capacity to effectively & equitably manage the healthcare services. It led the government to outsource the administration of primary health care services to a semi-autonomous government entity i.e. Peoples’ Primary Healthcare Initiative (PPHI). This small scale study has assessed the quality of healthcare services at the contracted Basic Health Units (BHUs) with the PPHI and compared it with those managed by the local district government in the province of Sindh. Methods A cross-sectional mix methods survey was conducted in November 2011. Two BHUs of each type were selected from the districts Karachi and Thatta in Sindh province. BHUs were selected randomly and a purposive sampling technique was used to recruit the study participants at the two study sites. Focus group discussions were conducted with patients visiting the facility while in-depth interviews were conducted with service providers. An observation based resource availability checklist was also administered. Results There was a significant difference between the PPHI and the district government administered BHUs with regard to infrastructure, availability of essential medicines, basic medical appliances, mini-lab facilities and vehicles for referrals. These BHUs were found to have sufficient number of trained clinical staff and no punctuality and retention issues whatsoever. The district government administered BHUs presented a dismal picture in all the aspects. Conclusion Out-sourcing of primary healthcare facilities has resulted in significantly improved certain aspects quality and responsiveness of primary healthcare services. This strategy is likely to achieve an efficient and perhaps an equitable healthcare delivery in low and middle income countries where governments have limited capacity to manage healthcare services. PMID:24965769

Prevalence of anxiety among women attending a primary care clinic in Malaysia

PubMed Central

Sidik, Sherina Mohd; Arroll, Bruce; Goodyear-Smith, Felicity

2011-01-01

Background This is the first study investigating anxiety among women attending a primary care clinic in Malaysia. Aim The objective was to determine the factors associated with anxiety among these women. Design This cross-sectional study was conducted in a government-funded primary care clinic in Malaysia. Consecutive female patients attending the clinic during the data-collection period were invited to participate in the study. Method Participants were given self-administered questionnaires, which included the validated Generalised Anxiety Disorder-7 questionnaire (GAD-7) Malay version to detect anxiety. Results Of the 1023 patients who were invited, 895 agreed to participate (response rate 87.5%). The prevalence of anxiety in this study was 7.8%, based on the GAD-7 (score ≥8). Multiple logistic regression analysis found that certain stressful life events and the emotional aspect of domestic violence were significantly associated with anxiety (P<0.05). Conclusion The prevalence of anxiety among women in this study is similar to that found in other countries. Factors found to be associated with anxiety, especially issues on domestic violence, need to be addressed and managed appropriately. PMID:21801511

Research on evaluation of third-party governance operation services for environmental pollution

NASA Astrophysics Data System (ADS)

Xu, Bingsheng; Ling, Lin; Jin, Huang

2017-11-01

This paper focuses on the evaluation of third-party governance operation services for environmental pollution, and determines the evaluation indicator system composed of 5 primary indicators as the basic competence of enterprise, operation of equipment, technique economics, environmental benefit and management level, and 26 secondary indicators via policies and regulations, standards, literature research and expert consultation in combination with the composition elements, service value judgment factors and full-life cycle of the work, providing theoretical support for the effect evaluation of third-governance over the environmental pollution in China. Then, the hierarchical analytic matrix is formed by analyzing the environmental pollution governance evaluation indicator system via analytic hierarchy process and scoring the importance of various indicators by experts by applying the Delphi method. The feature vector of the matrix is then calculated to obtain the weight of each indicator and verify the effectiveness of the Delphi method and obtain the comprehensive weight by judging the consistency of the matrix, so as to finally determine the overall ordering level of the importance of secondary indicators.

Divisions of general practice in Australia: how do they measure up in the international context?

PubMed Central

Smith, Judith; Sibthorpe, Beverly

2007-01-01

Background Since the late 1980s, there has been evidence of an international trend towards more organised primary care. This has taken a number of forms including the emergence of primary care organisations. Underpinning such developments is an inherent belief in evidence that suggests that well-developed primary care is associated with improved health outcomes and greater cost-effectiveness within health systems. In Australia, primary care organisations have emerged as divisions of general practice. These are professionally-led, regionally-based, and largely government-funded voluntary associations of general practitioners that seek to co-ordinate local primary care services, and improve the quality of care and health outcomes for local communities. Discussion In this paper, we examine and debate the development of divisions in the international context, using six roles of primary care organisations outlined in published research. The six roles that are used as the basis for the critique are the ability of primary care organisations to: improve health outcomes; manage demand and control costs; engage primary care physicians; enable greater integration of health services; develop more accessible services in community and primary care settings; and enable greater scrutiny and assurance of quality of primary care services. Summary We conclude that there has been an evolutionary approach to divisions' development and they now appear embedded as geographically-based planning and development organisations within the Australian primary health care system. The Australian Government has to date been cautious in its approach to intervention in divisions' direction and performance. However, options for the next phase include: making greater use of contracts between government and divisions; introducing and extending proposed national quality targets for divisions, linked with financial or other incentives for performance; government sub-contracting with state-based organisations to act as purchasers of care; pursuing a fund-holding approach within divisions; and developing divisions as a form of health maintenance organisation. The challenge for the Australian Government, should it wish to see divisions' role expand, is to find mechanisms to enable this without compromising the relatively strong GP engagement that increasingly distinguishes divisions of general practice within the international experience of primary care organisations. PMID:17626642

An analysis of 1150 cases of abortions from the Government R.S.R.M. Lying-in Hospital, Madras.

PubMed

Francis, O

1959-09-01

The Government R.S.R.M. Lying-in Hospital is located in one of the poorest sections of Madras, India, where the abortion rate is very high. The total number of complete abortions during the period, October 1957-November 1958, is 1150; the total number of deliveries including abortions is 10,367, an incidence rate of 11.09%. Of the 1150 cases, 789 (68.61%) were early abortions, up to 12 weeks; 361 (31.39%) were late, from the 13th to 28th week. An analysis of 1000 spontaneous abortions by Simons found that about 75% occurred before the 12th week. 758 abortions were performed on women aged 21-30; 204 occurred among those 31-40. 253 (22%) were primary abortions, i.e. the first pregnancy ended in an abortion and 897 (78%) were secondary abortions, i.e. there were 1 or more viable pregnancies before the abortion. Fetal death may be caused by abnormalities of the ovum, genital tract, or general maternal causes, or rare paternal causes. No cause could be found in 549 (47.74%) cases, but an associated abnormality was found in 601 (52.25%) cases. In 518 cases a single factor caused the abortion; in 83 cases more than a single etiological factor was found. There were 89 habitual aborters (7.74%). 19 of these were primary and 70 were secondary abortions.

Introducing out-of-pocket payment for general practice in Denmark: feasibility and support.

PubMed

Poulsen, Camilla Aavang

2014-07-01

The financing of General Practice (GP) is a much-debated topic. In spite of out-of-pocket (OOP) payment for other primary health care provided by self-employed professionals, there is no OOP payment for the use of GP in Denmark. This article aims to explore the arguments, the actors and the decision-making context. An analysis of the healthcare-policy debate in Parliament and the media from 1990 until September 2012. The materials are parliamentary hearings/discussions and newspaper articles. Kingdon's model on Policy Windows and the Advocacy Coalition framework by Sabatier and Jenkins are used to investigate explanations. The arguments from the proponents are: that OOP payment for GP will reduce pressure on the primary sector; that the current allocation of OOP payment in the sector is historically conditioned; and that resistance towards OOP payment is based on emotions. The main argument from the opponents is that OOP payment will increase social inequality in health. There is little connection between the attitudes and ideological backgrounds of the political parties. Despite factors such as perceived expert/scientific evidence for OOP payment, changes of government, financial crisis and a market-based reform wave, no government has introduced OOP payment for GP. This article suggests that governmental positions, public- and especially health-professional support are important factors in the decision-making context. Copyright © 2014. Published by Elsevier Ireland Ltd.

Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study.

PubMed

Upadhaya, Nawaraj; Jordans, Mark J D; Pokhrel, Ruja; Gurung, Dristy; Adhikari, Ramesh P; Petersen, Inge; Komproe, Ivan H

2017-01-01

Assessing and understanding health systems governance is crucial to ensure accountability and transparency, and to improve the performance of mental health systems. There is a lack of systematic procedures to assess governance in mental health systems at a country level. The aim of this study was to appraise mental health systems governance in Nepal, with the view to making recommendations for improvements. In-depth individual interviews were conducted with national-level policymakers (n = 17) and district-level planners (n = 11). The interview checklist was developed using an existing health systems governance framework developed by Siddiqi and colleagues as a guide. Data analysis was done with NVivo 10, using the procedure of framework analysis. The mental health systems governance assessment reveals a few enabling factors and many barriers. Factors enabling good governance include availability of mental health policy, inclusion of mental health in other general health policies and plans, increasing presence of Non-Governmental Organizations (NGOs) and service user organizations in policy forums, and implementation of a few mental health projects through government-NGO collaborations. Legal and policy barriers include the failure to officially revise or fully implement the mental health policy of 1996, the existence of legislation and several laws that have discriminatory provisions for people with mental illness, and lack of a mental health act and associated regulations to protect against this. Other barriers include lack of a mental health unit within the Ministry of Health, absence of district-level mental health planning, inadequate mental health record-keeping systems, inequitable allocation of funding for mental health, very few health workers trained in mental health, and the lack of availability of psychotropic drugs at the primary health care level. In the last few years, some positive developments have emerged in terms of policy recognition for mental health, as well as the increased presence of NGOs, increased presence of service users or caregivers in mental health governance, albeit restricted to only some of its domains. However, the improvements at the policy level have not been translated into implementation due to lack of strong leadership and governance mechanisms.

People and Teams Matter in Organizational Change: Professionals’ and Managers’ Experiences of Changing Governance and Incentives in Primary Care

PubMed Central

Allan, Helen T; Brearley, Sally; Byng, Richard; Christian, Sara; Clayton, Julie; Mackintosh, Maureen; Price, Linnie; Smith, Pam; Ross, Fiona

2014-01-01

ObjectivesTo explore the experiences of governance and incentives during organizational change for managers and clinical staff. Study SettingThree primary care settings in England in 2006–2008. Study DesignData collection involved three group interviews with 32 service users, individual interviews with 32 managers, and 56 frontline professionals in three sites. The Realistic Evaluation framework was used in analysis to examine the effects of new policies and their implementation. Principal FindingsIntegrating new interprofessional teams to work effectively is a slow process, especially if structures in place do not acknowledge the painful feelings involved in change and do not support staff during periods of uncertainty. ConclusionsEliciting multiple perspectives, often dependent on individual occupational positioning or place in new team configurations, illuminates the need to incorporate the emotional as well as technocratic and system factors when implementing change. Some suggestions are made for facilitating change in health care systems. These are discussed in the context of similar health care reform initiatives in the United States. PMID:23829292

Navigating the legal and ethical foundations of informed consent and confidentiality in integrated primary care.

PubMed

Hudgins, Cathy; Rose, Sandra; Fifield, Peter Y; Arnault, Steve

2013-03-01

This article describes findings from ongoing research and analysis of current literature in addition to discussions with leaders in the field, communications with lawyers and administrators of advocacy and government agencies pertaining to integrated primary care (IPC). Standards of care are established based on a myriad of factors, including professional codes of ethics, case law, state and federal laws, professional standards, existing best practices, current professional guidelines, administrative rules and regulations, and licensing board regulations. Regulations may differ for behavioral health and medical providers, posing challenges in IPC settings. This article provides a review of these regulations, particularly 42CFR Part 2, a federal law governing confidentiality for substance abuse programs, Health Insurance Portability and Accountability Act (HIPAA), and state laws relevant to patient care in IPC settings. On the basis of findings from the study, the authors make recommendations related to patient care practices concerning informed consent and release of information procedures, treatment and warm hand-off protocols, documentation and electronic record keeping, agreements with other providers, and billing. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Socioeconomic Determinants of Multimorbidity: A Population-Based Household Survey of Hong Kong Chinese.

PubMed

Chung, Roger Y; Mercer, Stewart; Lai, Francisco T T; Yip, Benjamin H K; Wong, Martin C S; Wong, Samuel Y S

2015-01-01

Multimorbidity has been well researched in terms of consequences and healthcare implications. Nevertheless, its risk factors and determinants, especially in the Asian context, remain understudied. We tested the hypothesis of a negative relationship between socioeconomic status and multimorbidity, with contextually different patterns from those observed in the West. We conducted our study in the general Hong Kong (HK) population. Data on current health conditions, health behaviours, socio-demographic and socioeconomic characteristics was obtained from HK Government's Thematic Household Survey. 25,780 individuals aged 15 or above were sampled. Binary logistic and negative binomial regression analyses were conducted to identify risk factors for presence of multimorbidity and number of chronic conditions, respectively. Sub-analysis of possible mediation effect through financial burden borne by private housing residents on multimorbidity was also conducted. Unadjusted and adjusted models showed that being female, being 25 years or above, having an education level of primary schooling or below, having less than HK$15,000 monthly household income, being jobless or retired, and being past daily smoker were significant risk factors for the presence of multimorbidity and increased number of chronic diseases. Living in private housing was significantly associated with higher chance of multimorbidity and increased number of chronic diseases only after adjustments. Less advantaged people tend to have higher risks of multimorbidity and utilize healthcare from the public sector with poorer primary healthcare experience. Moreover, middle-class people who are not eligible for government subsidized public housing may be of higher risk of multimorbidity due to psychosocial stress from paying for the severely unaffordable private housing.

Some behavioural risk factors for intestinal helminthiasis in nursery and primary school children in Enugu, south eastern Nigeria.

PubMed

Ilechukwu, G C; Ilechukwu, C G A; Ozumba, A N; Ojinnaka, N C; Ibe, B C; Onwasigwe, C N

2010-09-01

The objective of this study was to determine some common behavioural risk factors for intestinal helminthiasis in nursery and primary school children in Enugu. A cross-sectional survey on 460 children attending nursery and primary schools in Enugu was carried out in 2003 with a view to determine some behavioural risk factors for intestinal helminthiasis. This study was carried out in the research laboratory of the Federal Ministry of Health, National Arbovirus and Vector Research Centre, Enugu. Intestinal helminthiasis was diagnosed using the kato-katz method in analysing fresh stool samples collected from nursery and primary school children in Enugu. These fresh stool samples were collected into appropriately labeled clean containers. Questionnaires were administered by the researchers to obtain data from the children and their parents or guardians as regards some behavioural risk factors for intestinal helminthiasis. The results from this study showed that the prevalence of intestinal helminthiasis was significantly affected by various behavioural risk factors. The rate of helminthic infection varied significantly with hand washing habits after defeacation (chi2 = 75.77; df= 2; p = 0.001) and with different habits of washing fruits before eating (chi2 = 52.79; df=2; p = 0.001) among the pupils. Also, the rate ofhelminthic infection varied significantly with the source of drinking water (chi2 = 55.12; df = 3; p = 0.01), water boiling habits (chi2 = 40.89; df = 2; p = 0.001), use of footwear after school hours (chi2 = 30.72; df = 2; p = 0.001). Sites utilized for defeacation by the pupils (chi2 = 80.25; df=3; p = 0.001) also significantly influenced the rate ofhelminthic infection. Various behavioural factors which significantly affect the rate of helminthic infection abound in children living in Enugu. The government should give attention to the control of these behavioural risk factors. A lot of health education will be needed to curb the poor personal hygienic habits which are obvious risk factors for intestinal helminthiasis.

Sensitivity of the diagnostic radiological index of protection to procedural factors in fluoroscopy.

PubMed

Jones, A Kyle; Pasciak, Alexander S; Wagner, Louis K

2016-07-01

To evaluate the sensitivity of the diagnostic radiological index of protection (DRIP), used to quantify the protective value of radioprotective garments, to procedural factors in fluoroscopy in an effort to determine an appropriate set of scatter-mimicking primary beams to be used in measuring the DRIP. Monte Carlo simulations were performed to determine the shape of the scattered x-ray spectra incident on the operator in different clinical fluoroscopy scenarios, including interventional radiology and interventional cardiology (IC). Two clinical simulations studied the sensitivity of the scattered spectrum to gantry angle and patient size, while technical factors were varied according to measured automatic dose rate control (ADRC) data. Factorial simulations studied the sensitivity of the scattered spectrum to gantry angle, field of view, patient size, and beam quality for constant technical factors. Average energy (Eavg) was the figure of merit used to condense fluence in each energy bin to a single numerical index. Beam quality had the strongest influence on the scattered spectrum in fluoroscopy. Many procedural factors affect the scattered spectrum indirectly through their effect on primary beam quality through ADRC, e.g., gantry angle and patient size. Lateral C-arm rotation, common in IC, increased the energy of the scattered spectrum, regardless of the direction of rotation. The effect of patient size on scattered radiation depended on ADRC characteristics, patient size, and procedure type. The scattered spectrum striking the operator in fluoroscopy is most strongly influenced by primary beam quality, particularly kV. Use cases for protective garments should be classified by typical procedural primary beam qualities, which are governed by the ADRC according to the impacts of patient size, anatomical location, and gantry angle.

Community perspectives on roles and responsibilities for strengthening primary health care in rural Ethiopia.

PubMed

Curry, Leslie A; Alpern, Rachelle; Webster, Tashonna R; Byam, Patrick; Zerihun, Abraham; Tarakeshwar, Nalini; Cherlin, Emily J; Bradley, Elizabeth H

2012-01-01

Government-community partnerships are central to developing effective, sustainable models of primary health care in low-income countries; however, evidence about the nature of partnerships lacks the perspective of community members. Our objective was to characterise community perspectives regarding the respective roles and responsibilities of government and the community in efforts to strengthen primary health care in low-income settings. We conducted a qualitative study using focus groups (n=14 groups in each of seven primary health care units in Amhara and Oromia, Ethiopia, with a total of 140 participants) in the context of the Ethiopian Millennium Rural Initiative. Results indicated that community members defined important roles and responsibilities for both communities and governments. Community roles included promoting recommended health behaviours; influencing social norms regarding health; and contributing resources as feasible. Government roles included implementing oversight of health centres; providing human resources, infrastructure, equipment, medication and supplies; and demonstrating support for community health workers, who are seen as central to the rural health system. Renewed efforts in health system strengthening highlight the importance of community participation in initiatives to improve primary health care in rural settings. Community perspectives provide critical insights to defining, implementing and sustaining partnerships in these settings.

Comparison of Primary Care Experiences in Village Clinics with Different Ownership Models in Guangdong Province, China

PubMed Central

Feng, Shanshan; Shi, Leiyu; Zeng, Jiazhi; Chen, Wen; Ling, Li

2017-01-01

Objectives In order to improve the quality of services at village clinics (VCs), which are important primary care service providers in rural China, the Chinese government has encouraged the township hospitals to own and manage VCs. There are currently three models of ownership and management of VCs: township hospital-owned and -managed (HVC), village committee-owned and -managed (VVC), and private-owned and -managed (PVC). This study aims to examine the association between these ownership models of VCs and patients' primary care experiences. Methods Villagers were selected by multistage stratified sampling and their experiences with primary care were measured using the Primary Care Assessment Tool—Adult Edition (PCAT-AS). Data were collected through face-to-face interviews and the questionnaires administered by investigators in the cross-sectional study from February to April 2015. The PCAT scores were compared among the three models by covariance analysis, and multiple linear regression was used to analyze factors associated with the PCAT total scores. Results A total of 1491 questionnaires were collected. After controlling for covariates, HVCs reported the highest PCAT scores and satisfaction rate. In terms of the domains, HVC reported the highest scores in the coordination and comprehensiveness domains, while PVC had the highest scores in the first contact-accessibility domain. Multivariate linear regression showed that HVC, married participants, aged 60 and older, satisfied with the services, receiving six or more visits, and those with medical expenditures over 20% of their total family expenditures, were also positively associated with better primary care quality. Conclusions This study demonstrates that villagers receiving medical care at HVCs perceived better primary care than those at PVCs and VVCs. In order to improve the quality of primary care at VCs, it is necessary to increase government subsidies for public service packages, tighten the township hospital's supervision of PVCs and VVCs, and develop performance-based incentive plans to motivate improvements in the accessibility of HVCs. PMID:28056038

Interprofessional primary care in academic family medicine clinics: implications for education and training.

PubMed

Drummond, Neil; Abbott, Karen; Williamson, Tyler; Somji, Behnaz

2012-08-01

To explore the status and processes of interprofessional work environments and the implications for interprofessional education in a sample of family medicine teaching clinics. Focus group interviews using a purposive sampling procedure. Four academic family medicine clinics in Alberta. Seven family physicians, 9 registered nurses, 5 licensed practical nurses, 2 residents, 1 psychologist, 1 informatics specialist, 1 pharmacist, 1 dietitian, 1 nurse practitioner, 1 receptionist, and 1 respiratory therapist. Assessment of clinic status and performance in relation to established principles of interprofessional work and education was explored using semistructured focus group interviews. Our data supported the D'Amour and Oandasan model of successful interprofessional collaborative practice in terms of the model's main "factors" (ie, shared goals and vision, sense of belonging, governance, and the structuring of clinical care) and their constituent "elements." It is reasonable to conclude that the extent to which these factors and elements are both present and positively oriented in academic clinic settings is an important contributory factor to the establishment of interprofessional collaborative practice in primary care. Using this model, 2 of the 4 clinics were rated as expressing substantial progress in relation to interprofessional work, while the other 2 clinics were rated as less successful on that dimension. None of the clinics was identified as having a clear and explicit focus on providing interprofessional education. The key factor in relation to the implementation of interprofessional work in primary care appears to be the existence of clear and explicit leadership in that direction. Substantial scope exists for improvement in the organization, conduct, and promotion of interprofessional education for Canadian primary care.

Attitudes towards primary care career in community health centers among medical students in China.

PubMed

Zhang, Lingling; Bossert, Thomas; Mahal, Ajay; Hu, Guoqing; Guo, Qing; Liu, Yuanli

2016-07-16

Very few of the primary care doctors currently working in China's community health centers have a college degree (issued by 5-year medical schools). How to attract college graduates to community services in the future, therefore, has major policy relevance in the government's ongoing efforts to reform community health care and fill in the long-absent role of general physicians in China. This paper examined medical school students' attitudes towards working in communities and the factors that may affect their career choices in primary care to inform policy on this subject. A cross-sectional survey was designed upon the issuance of community health reform policy in 2006 by the Chinese government. The survey was conducted among 2714 medical students from three medical schools in representative regions in China. Binomial and multinomial regression analyses were carried out using a collection of plausible predictors such as place of rearing, income, etc. to assess their willingness to work in communities. Of the 2402 valid responses, besides 5.7 % objection to working in communities, 19.1 % expressed definite willingness. However, the majority (41.5 %) of students only consider community job as a temporary transition, in addition to 33.7 % using it as their backup option. The survey analyses found that medical students who are more likely to be willing to work in communities tend to come from rural backgrounds, have more exposure to community health reform, and possess certain personally held value and fit. To attract more graduates from 5-year medical schools to work in communities, a targeted recruiting approach or admission policy stands a better chance of success. The findings on the influencing factors of medical students' career choice can help inform policymakers, medical educators, and community health managers to improve the willingness of swing students to enter primary care to strengthen basic health services.

A public health framework to translate risk factors related to political violence and war into multi-level preventive interventions.

PubMed

De Jong, Joop T V M

2010-01-01

Political violence, armed conflicts and human rights violations are produced by a variety of political, economic and socio-cultural factors. Conflicts can be analyzed with an interdisciplinary approach to obtain a global understanding of the relative contribution of risk and protective factors. A public health framework was designed to address these risk factors and protective factors. The framework resulted in a matrix that combined primary, secondary and tertiary interventions with their implementation on the levels of the society-at-large, the community, and the family and individual. Subsequently, the risk and protective factors were translated into multi-sectoral, multi-modal and multi-level preventive interventions involving the economy, governance, diplomacy, the military, human rights, agriculture, health, and education. Then the interventions were slotted in their appropriate place in the matrix. The interventions can be applied in an integrative form by international agencies, governments and non-governmental organizations, and molded to meet the requirements of the historic, political-economic and socio-cultural context. The framework maps the complementary fit among the different actors while engaging themselves in preventive, rehabilitative and reconstructive interventions. The framework shows how the economic, diplomatic, political, criminal justice, human rights, military, health and rural development sectors can collaborate to promote peace or prevent the aggravation or continuation of violence. A deeper understanding of the association between risk and protective factors and the developmental pathways of generic, country-specific and culture-specific factors leading to political violence is needed.

A cross-sectional study of the income sources of primary care health workers in the Democratic Republic of Congo.

PubMed

Maini, Rishma; Hotchkiss, David R; Borghi, Josephine

2017-02-20

In the Democratic Republic of Congo (DRC), the state system to remunerate health workers is poorly functional, encouraging diversification of income sources and corruption. Given the central role that health workers play in health systems, policy-makers need to ensure health workers are remunerated in a way which best incentivises them to provide effective and good quality services. This study describes the different sources and quantities of income paid to primary care health workers in Equateur, Maniema, Kasai Occidental, Province Orientale and Kasai Oriental provinces. It also explores characteristics associated with the receipt of different sources of income. Quantitative data on the income received by health workers were collected through baseline surveys. Descriptive statistics explored the demographic characteristics of health workers surveyed, and types and amounts of incomes received. A series of regression models were estimated to examine the health worker and facility-level determinants of receiving each income source and of levels received. Qualitative data collection was carried out in Kasai Occidental province to explore perceptions of each income source and reasons for receiving each. Nurses made up the majority of workers in primary care. Only 31% received a government salary, while 75% reported compensation from user fees. Almost half of all nurses engaged in supplemental non-clinical activities. Receipt of government payments was associated with income from private practice and non-clinical activities. Male nurses were more likely to receive per diems, performance payments, and higher total remuneration compared to females. Contextual factors such as provincial location, presence of externally financed health programmes and local user fee policy also influenced the extent to which nurses received many income sources. The receipt of government payments was unreliable and had implications for receipt of other income sources. A mixture of individual, facility and geographical factors were associated with the receipt of various income sources. Greater co-ordination is needed between partners involved in health worker remuneration to design more effective financial incentive packages, reduce the fragmentation of incomes and improve transparency in the payment of workers in the DRC.

Do project management and network governance contribute to inter-organisational collaboration in primary care? A mixed methods study.

PubMed

Schepman, Sanneke; Valentijn, Pim; Bruijnzeels, Marc; Maaijen, Marlies; de Bakker, Dinny; Batenburg, Ronald; de Bont, Antoinette

2018-06-07

The need for organisational development in primary care has increased as it is accepted as a means of curbing rising costs and responding to demographic transitions. It is only within such inter-organisational networks that small-scale practices can offer treatment to complex patients and continuity of care. The aim of this paper is to explore, through the experience of professionals and patients, whether, and how, project management and network governance can improve the outcomes of projects which promote inter-organisational collaboration in primary care. This paper describes a study of projects aimed at improving inter-organisational collaboration in Dutch primary care. The projects' success in project management and network governance was monitored by interviewing project leaders and board members on the one hand, and improvement in the collaboration by surveying professionals and patients on the other. Both qualitative and quantitative methods were applied to assess the projects. These were analysed, finally, using multi-level models in order to account for the variation in the projects, professionals and patients. Successful network governance was associated positively with the professionals' satisfaction with the collaboration; but not with improvements in the quality of care as experienced by patients. Neither patients nor professionals perceived successful project management as associated with the outcomes of the collaboration projects. This study shows that network governance in particular makes a difference to the outcomes of inter-organisational collaboration in primary care. However, project management is not a predictor for successful inter-organisational collaboration in primary care.

Endosomal receptor kinetics determine the stability of intracellular growth factor signalling complexes

PubMed Central

Tzafriri, A. Rami; Edelman, Elazer R.

2006-01-01

There is an emerging paradigm that growth factor signalling continues in the endosome and that cell response to a growth factor is defined by the integration of cell surface and endosomal events. As activated receptors in the endosome are exposed to a different set of binding partners, they probably elicit differential signals compared with when they are at the cell surface. As such, complete appreciation of growth factor signalling requires understanding of growth factor–receptor binding and trafficking kinetics both at the cell surface and in endosomes. Growth factor binding to surface receptors is well characterized, and endosomal binding is assumed to follow surface kinetics if one accounts for changes in pH. Yet, specific binding kinetics within the endosome has not been examined in detail. To parse the factors governing the binding state of endosomal receptors we analysed a whole-cell mathematical model of epidermal growth factor receptor trafficking and binding. We discovered that the stability of growth factor–receptor complexes within endosomes is governed by three primary independent factors: the endosomal dissociation constant, total endosomal volume and the number of endosomal receptors. These factors were combined into a single dimensionless parameter that determines the endosomal binding state of the growth factor–receptor complex and can distinguish different growth factors from each other and different cell states. Our findings indicate that growth factor binding within endosomal compartments cannot be appreciated solely on the basis of the pH-dependence of the dissociation constant and that the concentration of receptors in the endosomal compartment must also be considered. PMID:17117924

Public Health Policy in Support of Insurance Coverage for Smoking Cessation Treatments

PubMed Central

Schwartz, Robert; Haji, Farzana; Babayan, Alexey; Longo, Christopher; Ferrence, Roberta

2017-01-01

Insurance coverage for evidence-based smoking cessation treatments (SCTs) promotes uptake and reduces smoking rates. Published studies in this area are based in the US where employers are the primary source of health insurance. In Ontario, Canada, publicly funded healthcare does not cover SCTs, but it can be supplemented with employer-sponsored benefit plans. This study explores factors affecting the inclusion/exclusion of smoking cessation (SC) benefits. In total, 17 interviews were conducted with eight employers (auto, retail, banking, municipal and university industries), four health insurers, two government representatives and three advisors/consultants. Overall, SCT coverage varied among industries; it was inconsistently restrictive and SCT differed by coverage amount and length of use. Barriers impeding coverage included the lack of the following: Canadian-specific return on investment (ROI), SC cost information, employer demand, government regulations/incentives and employee awareness of and demand. A Canadian evidence-based calculation of ROI for SC coupled with government incentives and public education may be needed to promote uptake of SCT coverage by employers. PMID:28617238

The prescribing of specialist medicines: what factors influence GPs' decision making?

PubMed

Crowe, Sarah; Tully, Mary P; Cantrill, Judith A

2009-08-01

As Governments worldwide strive to integrate efficient health care delivery across the primary-secondary care divide, particular significance has been placed on the need to understand GPs' prescribing of specialist drugs. To explore the factors which influence GPs' decision-making process when requested to prescribe specialist drugs. A qualitative approach was used to explore the perspectives of a wide range of practice-, primary care trust-, strategic health authority-level staff and other relevant stakeholders in the North-West of England. All semi-structured interviews (n = 47) were analysed comprehensively using the five-stage 'framework' approach. Six diverse factors were identified as having a crucial bearing on how GPs evaluate initial requests and subsequently decide whether or not to prescribe. These include GPs' lack of knowledge and expertise in using specialist drugs, the shared care arrangement, the influence of a locally agreed advisory list, financial and resource considerations, patient convenience and understanding and GPs' specific areas of interest. This exploration of GPs' decision-making process is needed to support future integrated health care delivery.

A Framework for Sexual Decision-Making Among Female Sex Workers in Jamaica.

PubMed

Bailey, Althea; Figueroa, J Peter

2016-05-01

The Jamaican government has provided targeted HIV and sexually transmitted infection prevention, treatment, and other services for female sex workers (FSW) since 1989. HIV prevalence among FSW declined from 20 to 12% between 1989 and 1994, then to 9% in 2005, 5% in 2008, and 4.1% in 2011. This article distills the literature and two decades of experience working with FSW in Jamaica. Drawing on the constant comparative method, we put forward an innovative conceptual framework for explaining sexual decision-making and risk behaviors within both transactional and relational sexual situations. This framework helps fill the gaps in existing models that focus on individual behaviors. The model identifies interactions between environmental and structural elements of sex work, and three individual-level factors: risk perception, perceived relationship intimacy, and perceived control, as the four primary mediating factors influencing sexual decision-making among FSW. We propose that other factors such as violence, socioeconomic vulnerability, and policy/legal frameworks influence sexual decision-making through these primary mediating factors. This conceptual model may offer a useful framework for planning and evaluating prevention interventions among sex workers. However, it remains to be tested in order to establish its value.

Development and validation of the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ) for primary care patients with type 2 diabetes.

PubMed

Fu, Sau Nga; Chin, Weng Yee; Wong, Carlos King Ho; Yeung, Vincent Tok Fai; Yiu, Ming Pong; Tsui, Hoi Yee; Chan, Ka Hung

2013-01-01

To develop and evaluate the psychometric properties of a Chinese questionnaire which assesses the barriers and enablers to commencing insulin in primary care patients with poorly controlled Type 2 diabetes. Questionnaire items were identified using literature review. Content validation was performed and items were further refined using an expert panel. Following translation, back translation and cognitive debriefing, the translated Chinese questionnaire was piloted on target patients. Exploratory factor analysis and item-scale correlations were performed to test the construct validity of the subscales and items. Internal reliability was tested by Cronbach's alpha. Twenty-seven identified items underwent content validation, translation and cognitive debriefing. The translated questionnaire was piloted on 303 insulin naïve (never taken insulin) Type 2 diabetes patients recruited from 10 government-funded primary care clinics across Hong Kong. Sufficient variability in the dataset for factor analysis was confirmed by Bartlett's Test of Sphericity (P<0.001). Using exploratory factor analysis with varimax rotation, 10 factors were generated onto which 26 items loaded with loading scores > 0.4 and Eigenvalues >1. Total variance for the 10 factors was 66.22%. Kaiser-Meyer-Olkin measure was 0.725. Cronbach's alpha coefficients for the first four factors were ≥0.6 identifying four sub-scales to which 13 items correlated. Remaining sub-scales and items with poor internal reliability were deleted. The final 13-item instrument had a four scale structure addressing: 'Self-image and stigmatization'; 'Factors promoting self-efficacy; 'Fear of pain or needles'; and 'Time and family support'. The Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ) appears to be a reliable and valid measure for assessing barriers to starting insulin. This short instrument is easy to administer and may be used by healthcare providers and researchers as an assessment tool for Chinese diabetic primary care patients, including the elderly, who are unwilling to start insulin.

Dynamic epigenetic regulation of glioblastoma tumorigenicity through LSD1 modulation of MYC expression

PubMed Central

Kozono, David; Li, Jie; Nitta, Masayuki; Sampetrean, Oltea; Gonda, David; Kushwaha, Deepa S.; Merzon, Dmitry; Ramakrishnan, Valya; Zhu, Shan; Zhu, Kaya; Matsui, Hiroko; Harismendy, Olivier; Hua, Wei; Mao, Ying; Kwon, Chang-Hyuk; Saya, Hideyuki; Nakano, Ichiro; Pizzo, Donald P.; VandenBerg, Scott R.; Chen, Clark C.

2015-01-01

The available evidence suggests that the lethality of glioblastoma is driven by small subpopulations of cells that self-renew and exhibit tumorigenicity. It remains unclear whether tumorigenicity exists as a static property of a few cells or as a dynamically acquired property. We used tumor-sphere and xenograft formation as assays for tumorigenicity and examined subclones isolated from established and primary glioblastoma lines. Our results indicate that glioblastoma tumorigenicity is largely deterministic, yet the property can be acquired spontaneously at low frequencies. Further, these dynamic transitions are governed by epigenetic reprogramming through the lysine-specific demethylase 1 (LSD1). LSD depletion increases trimethylation of histone 3 lysine 4 at the avian myelocytomatosis viral oncogene homolog (MYC) locus, which elevates MYC expression. MYC, in turn, regulates oligodendrocyte lineage transcription factor 2 (OLIG2), SRY (sex determining region Y)-box 2 (SOX2), and POU class 3 homeobox 2 (POU3F2), a core set of transcription factors required for reprogramming glioblastoma cells into stem-like states. Our model suggests epigenetic regulation of key transcription factors governs transitions between tumorigenic states and provides a framework for glioblastoma therapeutic development. PMID:26159421

Exploring Context and the Factors Shaping Team-Based Primary Healthcare Policies in Three Canadian Provinces: A Comparative Analysis.

PubMed

Misfeldt, Renée; Suter, Esther; Mallinson, Sara; Boakye, Omenaa; Wong, Sabrina; Nasmith, Louise

2017-08-01

This paper discusses findings from a high-level scan of the contextual factors and actors that influenced policies on team-based primary healthcare in three Canadian provinces: British Columbia, Alberta and Saskatchewan. The team searched diverse sources (e.g., news reports, press releases, discussion papers) for contextual information relevant to primary healthcare teams. We also conducted qualitative interviews with key health system informants from the three provinces. Data from documents and interviews were analyzed qualitatively using thematic analysis. We then wrote narrative summaries highlighting pivotal policy and local system events and the influence of actors and context. Our overall findings highlight the value of reviewing the context, relationships and power dynamics, which come together and create "policy windows" at different points in time. We observed physician-centric policy processes with some recent moves to rebalance power and be inclusive of other actors and perspectives. The context review also highlighted the significant influence of changes in political leadership and prioritization in driving policies on team-based care. While this existed in different degrees in the three provinces, the push and pull of political and professional power dynamics shaped Canadian provincial policies governing team-based care. If we are to move team-based primary healthcare forward in Canada, the provinces need to review the external factors and the complex set of relationships and trade-offs that underscore the policy process. Copyright © 2017 Longwoods Publishing.

Laptop Classes in Some Australian Government Primary Schools

ERIC Educational Resources Information Center

Fluck, Andrew E.

2011-01-01

Australia was once a world leader for laptop adoption in schools. Now overtaken by extensive roll-outs of laptops in Maine and Uruguay, this paper seeks to explain why this lead was lost. Six case studies of government primary schools were undertaken to gather data about current initiatives. Comparative analysis shows how the potential of…

Analysis of Terrestrial Conditions and Dynamics

NASA Technical Reports Server (NTRS)

Goward, S. N.

1985-01-01

An ecological model is developed to estimate annual net primary productivity of vegetation in twelve major North American biomes. Three models are adapted and combined, each addressing a different factor known to govern primary productivity, i.e., photosynthesis, respiration, and moisture availability. Measures of intercepted photosynthetically active radiation (1PAR) for input to the photosynthesis model are derived from spectral vegetation index data. Normalized Difference Vegetation Index (NDVI) data are produced from NOAA-7 Advanced Very High Resolution Radiometer (AVHRR) observations for April 1982 through March 1983. NDVI values are sampled from within the biomes at locations for which climatological data are available. Monthly estimates of Net Primary Productivity (NPP) for each sample location are generated and summed over the twelve month period. These monthly estimates are averaged to produce a single annual estimated NPP value for each biomes. Comparison of estimated NPP values with figures reported in the literature produces a correlation coefficient of 85.

5 CFR 2634.403 - Qualified blind trusts.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 2634.403 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS EXECUTIVE BRANCH... of this subpart by the Director of the Office of Government Ethics, and which includes in the trust... of Government Ethics, and must provide that: (1) The primary purpose of the blind trust is to confer...

Mapping South African allied health primary care clinical guideline activity: establishing a stakeholder reference sample.

PubMed

Dizon, Janine Margarita; Grimmer, Karen; Machingaidze, Shingai; McLaren, Pam; Louw, Quinette

2016-10-10

Little is known about allied health (AH) clinical practice guideline (CPG) activity in South Africa, and particularly in relation to primary health care (PHC). This paper reports on a scoping study undertaken to establish a reference framework, from which a comprehensive maximum variation sample could be selected. This was required to underpin robust sampling for a qualitative study aimed at understanding South African primary care AH therapy CPG activities. This paper builds on findings from the South African Guidelines Evaluation (Project SAGE) Flagship grant. South African government websites were searched for structures of departments and portfolios, and available CPGs. Professional AH association websites were searched for CPGs, purposively-identified key informants were interviewed, and CPGs previously identified for priority South African primary care conditions were critiqued for AH therapy involvement. Key informants described potentially complex relationships between players who may be engaged in South African AH CPGs, in both public and private sectors. There were disability/rehabilitation portfolios at national and provincial governments, but no uniformity in provincial government organisation of, or support for, PHC AH services. There were no AH primary care therapy CPGs on government websites, although there was 'clinical guidance' in various forms on professional association websites. Only two CPGs of priority South African PHC conditions included mention of any AH therapy (physiotherapy for adult asthma and chronic obstructive pulmonary disease). A comprehensive and wide-reaching stakeholder reference framework would be required in order to capture the heterogeneity of AH primary care CPG activity in South Africa. This should involve the voices of national and purposively-selected provincial governments, academic institutions, consultants, public sector managers and clinicians, private practitioners, professional associations, and private sector insurers. Provincial governments should be selected to reflect heterogeneity in local economics, population demographics and availability of university AH training programs. This investigation should aim to determine the areas of PHC in which AH are engaged.

[Local government and public dental health services: an analysis of inequality in use].

PubMed

Soares, Felipe Fagundes; Chaves, Sônia Cristina Lima; Cangussu, Maria Cristina Teixeira

2015-03-01

The aim of this study was to identify factors associated with the use of primary and specialized public dental health services and private services. A population-based household survey was conducted in two cities of Bahia State, Brazil. Key informants provided data on socioeconomic variables and use of dental health services. Organization of the local public dental health service was ranked as worse versus better. Univariate and multivariate polytomous logistic regression was performed. Of the total of 1,290 individuals, 38.76% used private services, 33.80% used public primary care, and 17.29% used both primary care and the Center for Dental Specialties. Less use of both primary care and specialized public services was associated with lower education (OR = 1.47; 95%CI: 1.03-2.10) and worse organization of services (OR = 1.74; 95%CI: 1.22-2.48), when compared to the exclusive use of primary care. The study showed inequality in the use of dental services, even when comparing more homogeneous groups, namely users of public services.

Ontario's Primary Class Size Reduction Initiative: Report on Early Implementation

ERIC Educational Resources Information Center

Bascia, Nina

2010-01-01

Reduction in the size of classes from Kindergarten to Grade 3 was a major Liberal Party campaign promise in Ontario's 2003 provincial election. It was intended to demonstrate a new government's commitment to improving public education. By the 2008-09 school year, the provincial government's goals had been achieved: over 90% of all primary classes…

The Relationship of Financial Pressures and Community Characteristics to Closure of Private Safety Net Clinics.

PubMed

Li, Suhui; Dor, Avi; Pines, Jesse M; Zocchi, Mark S; Hsia, Renee Y

2016-10-01

In order to better understand what threatens vulnerable populations' access to primary care, it is important to understand the factors associated with closing safety net clinics. This article examines how a clinic's financial position, productivity, and community characteristics are associated with its risk of closure. We examine patterns of closures among private-run primary care clinics (PCCs) in California between 2006 and 2012. We use a discrete-time proportional hazard model to assess relative hazard ratios of covariates, and a random-effect hazard model to adjust for unobserved heterogeneity among PCCs. We find that lower net income from patient care, smaller amount of government grants, and lower productivity were associated with significantly higher risk of PCC closure. We also find that federally qualified health centers and nonfederally qualified health centers generally faced the same risk factors of closure. These results underscore the critical role of financial incentives in the long-term viability of safety net clinics. © The Author(s) 2015.

Integrated primary health care in Australia.

PubMed

Davies, Gawaine Powell; Perkins, David; McDonald, Julie; Williams, Anna

2009-10-14

To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.

Implementing a successful tuberculosis programme within primary care services in a conflict area using the stop TB strategy: Afghanistan case study

PubMed Central

2014-01-01

Introduction Afghanistan has faced health consequences of war including those due to displacement of populations, breakdown of health and social services, and increased risks of disease transmission for over three decades. Yet it was able to restructure its National Tuberculosis Control Programme (NTP), integrate tuberculosis treatment into primary health care and achieve most of its targets by the year 2011. What were the processes that enabled the programme to achieve its targets? More importantly, what were the underpinning factors that made this success possible? We addressed these important questions through a case study. Case description We adopted a processes and outcomes framework for this study, which began with examining the change in key programme indicators, followed by backwards tracing of the processes and underlying factors, responsible for this change. Methods included review of the published and grey literature along with in-depth interviews of 15 key informants involved with the care of tuberculosis patients in Afghanistan. Discussion and evaluation TB incidence and mortality per 100,000 decreased from 325 and 92 to 189 and 39 respectively, while case notification and treatment success improved during the decade under study. Efficient programme structures were enabled through high political commitment from the Government, strong leadership from the programme, effective partnership and coordination among stakeholders, and adequate technical and financial support from the development partners. Conclusions The NTP Afghanistan is an example that public health programmes can be effectively implemented in fragile states. High political commitment and strong local leadership are essential factors for such programmes. To ensure long-term effectiveness of the NTP, the international support should be withdrawn in a phased manner, coupled with a sequential increase in resources allocated to the NTP by the Government of Afghanistan. PMID:24507446

Job satisfaction: rural versus urban primary health care workers' perception in Ogun State of Nigeria.

PubMed

Campbell, P C; Ebuehi, O M

2011-01-01

Job satisfaction implies doing a job one enjoys, doing it well, and being suitably rewarded for one' efforts. Several factors affect job satisfaction. To compare factors influencing job satisfaction amongst rural and urban primary health care workers in southwestern Nigeria. A cross sectional comparative study recruited qualified health workers selected by multi stage sampling technique from rural and urban health facilities in four local government areas (LGAs) of Ogun State in Southwestern Nigeria. Data were collected and analysed using Epi info V 3.5.1 RESULTS: The response rates were 88(88%) and 91(91%) respectively in the rural and urban areas. While urban workers derived satisfaction from availability of career development opportunities, materials and equipment, in their current job, rural workers derived satisfaction from community recognition of their work and improved staff relationship. Major de-motivating factors common to both groups were lack of supportive supervision, client-provider relationship and lack of in-service training. However more rural 74(84.1%) than urban 62(68.1%) health workers would prefer to continue working in their present health facilities (p=0.04). There was a statistically significant difference between the two groups in job satisfaction with respect to tools availability and career development opportunities (p<0.05). There is dissimilarity in factors influencing job satisfaction between rural and urban healthcare workers. There is need for human resource policy to be responsive to the diverse needs of health workers particularly at the primary level.

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

Jones, A. Kyle, E-mail: kyle.jones@mdanderson.org

Purpose: To evaluate the sensitivity of the diagnostic radiological index of protection (DRIP), used to quantify the protective value of radioprotective garments, to procedural factors in fluoroscopy in an effort to determine an appropriate set of scatter-mimicking primary beams to be used in measuring the DRIP. Methods: Monte Carlo simulations were performed to determine the shape of the scattered x-ray spectra incident on the operator in different clinical fluoroscopy scenarios, including interventional radiology and interventional cardiology (IC). Two clinical simulations studied the sensitivity of the scattered spectrum to gantry angle and patient size, while technical factors were varied according tomore » measured automatic dose rate control (ADRC) data. Factorial simulations studied the sensitivity of the scattered spectrum to gantry angle, field of view, patient size, and beam quality for constant technical factors. Average energy (E{sub avg}) was the figure of merit used to condense fluence in each energy bin to a single numerical index. Results: Beam quality had the strongest influence on the scattered spectrum in fluoroscopy. Many procedural factors affect the scattered spectrum indirectly through their effect on primary beam quality through ADRC, e.g., gantry angle and patient size. Lateral C-arm rotation, common in IC, increased the energy of the scattered spectrum, regardless of the direction of rotation. The effect of patient size on scattered radiation depended on ADRC characteristics, patient size, and procedure type. Conclusions: The scattered spectrum striking the operator in fluoroscopy is most strongly influenced by primary beam quality, particularly kV. Use cases for protective garments should be classified by typical procedural primary beam qualities, which are governed by the ADRC according to the impacts of patient size, anatomical location, and gantry angle.« less

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

Jones, A; Pasciak, A; Wagner, L

Purpose: To evaluate the sensitivity of the Diagnostic Radiological Index of Protection (DRIP) to procedural factors in fluoroscopy in an effort to determine an appropriate set of scatter-mimicking primary beams (SMPB) to be used in measuring the DRIP. Methods: A series of clinical and factorial Monte Carlo simulations were conducted to determine the shape of the scattered X-ray spectra incident on the operator in different clinical fluoroscopy scenarios. Two clinical evaluations studied the sensitivity of the scattered spectrum to gantry angle and patient size while technical factors were varied according to measured automatic dose rate control (ADRC) data. Factorial evaluationsmore » studied the sensitivity of the scattered spectrum to gantry angle, field of view, patient size and beam quality for constant technical factors. Average energy was the figure of merit used to condense fluence in each energy bin to a single numerical index. Results: Beam quality had the strongest influence on the scattered spectrum in fluoroscopy. Many procedural factors affected the scattered spectrum indirectly through their effects on primary beam quality through ADRC, e.g., gantry angle and patient size. Lateral C-arm rotation, common in interventional cardiology, increased the energy of the scattered spectrum, regardless of the direction of rotation. The effect of patient size on scattered radiation depended on ADRC characteristics, patient size, and procedure type. Conclusion: The scattered spectrum striking the operator in fluoroscopy, and therefore the DRIP, is most strongly influenced by primary beam quality, particularly kV. Use cases for protective garments should be classified by typical procedural primary beam qualities, which are governed by the ADRC according to the impacts of patient size, anatomical location, and gantry angle. These results will help determine an appropriate set of SMPB to be used for measuring the DRIP.« less

Patients' experiences in different models of community health centers in southern China.

PubMed

Wang, Harry H X; Wong, Samuel Y S; Wong, Martin C S; Wei, Xiao Lin; Wang, Jia Ji; Li, Donald K T; Tang, Jin Ling; Gao, Gemma Y; Griffiths, Sian M

2013-01-01

Current health care reforms in China have an overall goal of strengthening primary care through the establishment and expansion of primary care networks based on community health centers (CHCs). Implementation in urban areas has led to the emergence of different models of ownership and management. The objective of this study was to evaluate the primary care experiences of patients in the Pearl River Delta as measured by the Primary Care Assessment Tool (PCAT) and the relationships with ownership and management in the 3 different models we describe. This cross-sectional study was conducted on-site at CHCs in 3 cities within the Pearl River Delta, China, using a multistage cluster sampling method. A validated Mandarin Chinese version of the PCAT-Adult Edition (short version) was adopted to collect information from adult patients regarding their experiences with primary care sources. PCAT scores for individual primary care attributes and total primary care assessment scores were assessed with respect to sociodemographic characteristics, health characteristics, and health care service utilization across 3 primary care models. One thousand four hundred forty (1,440) primary care patients responded to the survey, for an overall response rate of 86.1%. Respondents gave government-owned and -managed CHCs the highest overall PCAT scores when compared with CHCs either managed by hospitals (95.18 vs 90.81; P = .005) or owned by private and social entities (95.18 vs 90.69; P =.007) as a result of better first-contact care (better first-contact utilization) and coordination of care (better service coordination and information system). Factors that were positively and significantly associated with higher overall assessment scores included the presence of a chronic condition (P <.001), having medical insurance (P = .006), and a self-reported good health status (P <.001). This study suggests that government-owned and -managed CHCs may be able to provide better first-contact care in terms of utilization and coordination of care, and may be better at solving the problem of underutilization of the CHCs as the first-contact point of care, one key problem facing the reforms in China.

An Economic Theory of School Governance.

ERIC Educational Resources Information Center

Rada, Roger D.

Working from the basic assumption that the primary motivation for those involved in school governance is self-interest, this paper develops and discusses 15 hypotheses that form the essential elements of an economic theory of school governance. The paper opens with a review of previous theories of governance and their origins in social science…

The 11-item Medication Adherence Reasons Scale: reliability and factorial validity among patients with hypertension in Malaysian primary healthcare settings

PubMed Central

Shima, Razatul; Farizah, Hairi; Majid, Hazreen Abdul

2015-01-01

INTRODUCTION The aim of this study was to assess the reliability and validity of a modified Malaysian version of the Medication Adherence Reasons Scale (MAR-Scale). METHODS In this cross-sectional study, the 15-item MAR-Scale was administered to 665 patients with hypertension who attended one of the four government primary healthcare clinics in the Hulu Langat and Klang districts of Selangor, Malaysia, between early December 2012 and end-March 2013. The construct validity was examined in two phases. Phase I consisted of translation of the MAR-Scale from English to Malay, a content validity check by an expert panel, a face validity check via a small preliminary test among patients with hypertension, and exploratory factor analysis (EFA). Phase II involved internal consistency reliability calculations and confirmatory factor analysis (CFA). RESULTS EFA verified five existing factors that were previously identified (i.e. issues with medication management, multiple medications, belief in medication, medication availability, and the patient’s forgetfulness and convenience), while CFA extracted four factors (medication availability issues were not extracted). The final modified MAR-Scale model, which had 11 items and a four-factor structure, provided good evidence of convergent and discriminant validities. Cronbach’s alpha coefficient was > 0.7, indicating good internal consistency of the items in the construct. The results suggest that the modified MAR-Scale has good internal consistencies and construct validity. CONCLUSION The validated modified MAR-Scale (Malaysian version) was found to be suitable for use among patients with hypertension receiving treatment in primary healthcare settings. However, the comprehensive measurement of other factors that can also lead to non-adherence requires further exploration. PMID:25902719

The 11-item Medication Adherence Reasons Scale: reliability and factorial validity among patients with hypertension in Malaysian primary healthcare settings.

PubMed

Shima, Razatul; Farizah, Hairi; Majid, Hazreen Abdul

2015-08-01

The aim of this study was to assess the reliability and validity of a modified Malaysian version of the Medication Adherence Reasons Scale (MAR-Scale). In this cross-sectional study, the 15-item MAR-Scale was administered to 665 patients with hypertension who attended one of the four government primary healthcare clinics in the Hulu Langat and Klang districts of Selangor, Malaysia, between early December 2012 and end-March 2013. The construct validity was examined in two phases. Phase I consisted of translation of the MAR-Scale from English to Malay, a content validity check by an expert panel, a face validity check via a small preliminary test among patients with hypertension, and exploratory factor analysis (EFA). Phase II involved internal consistency reliability calculations and confirmatory factor analysis (CFA). EFA verified five existing factors that were previously identified (i.e. issues with medication management, multiple medications, belief in medication, medication availability, and the patient's forgetfulness and convenience), while CFA extracted four factors (medication availability issues were not extracted). The final modified MAR-Scale model, which had 11 items and a four-factor structure, provided good evidence of convergent and discriminant validities. Cronbach's alpha coefficient was > 0.7, indicating good internal consistency of the items in the construct. The results suggest that the modified MAR-Scale has good internal consistencies and construct validity. The validated modified MAR-Scale (Malaysian version) was found to be suitable for use among patients with hypertension receiving treatment in primary healthcare settings. However, the comprehensive measurement of other factors that can also lead to non-adherence requires further exploration.

Unexpected School Reform: Academisation of Primary Schools in England. CEP Discussion Paper No. 1455

ERIC Educational Resources Information Center

Eyles, Andrew; Machin, Stephen; McNally, Sandra

2016-01-01

The change of government in 2010 provoked a large structural change in the English education landscape. Unexpectedly, the new government offered primary schools the chance to have "the freedom and the power to take control of their own destiny", with better performing schools given a green light to convert to become an academy school on…

Child Participation in School Governance: The Case of Prefects at a Primary School in Lesotho

ERIC Educational Resources Information Center

Morojele, Pholoho; Muthukrishna, Nithi

2011-01-01

This paper draws on literature that has theorised child participation within the sociology of childhood framework to examine how children participate in governance within school spaces. Four children aged between 13 and 17 (in grades six and seven) who serve as prefects at a primary school in Lesotho were participants in this study. Data was…

"One Man One Job": The Marriage Ban and the Employment of Women Teachers in Irish Primary Schools

ERIC Educational Resources Information Center

Redmond, Jennifer; Harford, Judith

2010-01-01

In 1932, the Irish government, facing an economic downturn, introduced a marriage ban which required that female primary school teachers were required to resign on marriage. This followed a series of restrictive legislative measures adopted by Irish governments throughout the 1920s which sought to limit women's participation in public life and the…

Changing School Board Governance in Primary Education through School Inspections

ERIC Educational Resources Information Center

Ehren, Melanie C. M.; Honingh, M. E.; Hooge, E. H.; O'Hara, J.

2016-01-01

This paper addresses if, and to what extent, the current working methods of the Dutch Inspectorate of Education affect the governance of school boards in schools for primary education. A key facet of the working method is the inspection meeting with the school board. Drawing upon a large quantitative study (n = 244) we are able to identify some…

Exploring shared risks through public-private partnerships in public health programs: a mixed method.

PubMed

Alonazi, Wadi B

2017-06-12

The natural assimilation of the process through which health partners sustain long-term relationships is a key issue in maintaining social well-being, reducing health risk factors, and sustaining public health programs. One global initiative in building effective healthcare systems is public-private partnerships (PPPs). This study elucidates the proposed key performance indicators initiated by the Ministry of Health of Saudi Arabia based on the projections of the government, known as Vision 2030, from the perspective of health risk factors. Through an inductive content analysis, this study assessed primary and secondary data in relation to the Saudi National Transformation Program (NTP). To identify the institutions that played a role in formulating the new Saudi Healthcare System, health policies, regulations, and reports published between 1996 and 2016 were categorized. After ranking the risk factors, the investigator selected 13 healthcare professionals in four focus group interviews to insightfully explore the challenges that the NTP faces from a health risk perspective. Thus, the study employed qualitative data gathered through focus group interviews with key figures as well as data extracted from written sources to identify distinct but interrelated partnerships practiced within risk management. A methodological overview of NTP priority and implementation offered practical guidance in the healthcare context. The five critical factors in maintaining successful and sustainable PPPs were (1) trustworthiness, (2) technological capability, (3) patient-centeredness, (4) competence, and (5) flexibility. Concession on primary and secondary healthcare services might be a good option based on the literature review and considering its popularity in other countries. A high outcome-based risk of PPPs was found as the most commonly shared perspective in risk management. Although the impact of the NTP rise has yet to be explored, its potential for challenging health consequences requires consideration and substantial regulatory action. This study contributes to the emerging critical analysis on local health initiatives by highlighting how integration may only be possible with a more radical conceptualization of national health governance.

A near miss: the importance of context in a public health informatics project in a New Zealand case study.

PubMed

Wells, Stewart; Bullen, Chris

2008-01-01

This article describes the near failure of an information technology (IT) system designed to support a government-funded, primary care-based hepatitis B screening program in New Zealand. Qualitative methods were used to collect data and construct an explanatory model. Multiple incorrect assumptions were made about participants, primary care workflows and IT capacity, software vendor user knowledge, and the health IT infrastructure. Political factors delayed system development and it was implemented untested, almost failing. An intensive rescue strategy included system modifications, relaxation of data validity rules, close engagement with software vendors, and provision of intensive on-site user support. This case study demonstrates that consideration of the social, political, technological, and health care contexts is important for successful implementation of public health informatics projects.

Aeronautics in NACA and NASA

NASA Technical Reports Server (NTRS)

1991-01-01

Initiated in 1915, the National Advisory Committee for Aeronautics/National Aeronautics and Space Administration (NACA/NASA) aeronautical programs have been the keystone of a sustained U.S. Government, industry, and university research effort which has been a primary factor in the development of our remarkable air transportation systems, the country's largest positive trade balance component, and the world's finest military Air Force. This overview summarizes the flow of events, and the major trends, that have led from the NACA origins to the present NASA Aeronautics program, and indicates some important directions for the years ahead.

Analytic structure of the S-matrix for singular quantum mechanics

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

Camblong, Horacio E.; Epele, Luis N.; Fanchiotti, Huner

2015-06-15

The analytic structure of the S-matrix of singular quantum mechanics is examined within a multichannel framework, with primary focus on its dependence with respect to a parameter (Ω) that determines the boundary conditions. Specifically, a characterization is given in terms of salient mathematical and physical properties governing its behavior. These properties involve unitarity and associated current-conserving Wronskian relations, time-reversal invariance, and Blaschke factorization. The approach leads to an interpretation of effective nonunitary solutions in singular quantum mechanics and their determination from the unitary family.

Parental Attitudes and Factors Associated With Varicella Vaccination in Preschool and Schoolchildren in Hong Kong: A Cross-Sectional Study.

PubMed

Tam, Wilson W S; Chan, Johnny; Lo, Kenneth K H; Lee, Albert; Chan, Paul K S; Chan, Denise; Nelson, E Anthony S

2015-09-01

This study investigates parental attitudes and factors associated with varicella vaccination among preschool and schoolchildren prior to introduction of the vaccine into Hong Kong's universal Childhood Immunization Program.Fourteen kindergartens and 5 primary schools in Hong Kong were randomly selected in 2013. Parents of the students were invited to answer the self-administered questionnaires. Acquired information included demographic characteristics and socioeconomic statuses of families, children's history of chickenpox infection and vaccination, and reasons for getting children vaccinated. Logistic regression was applied to examine the factors associated with vaccination.From the 3484 completed questionnaires, the calculated rates of varicella infection and vaccination were 20.7% and 69.0%, respectively. Barriers to vaccination included parental uncertainties about vaccine effectiveness, lack of recommendation from the government, and concerns on adverse effects. Overall, 71.8%, 69.0%, and 45.7% of the parents rated family doctors, specialists, and the government, respectively, as very important motivators of vaccination. Higher parental educational level and family income, better perceived knowledge of varicella and chance of infection, discussion with a family doctor, and positive health belief towards vaccination were associated with vaccination (all P < 0.05).The rate of vaccination in Hong Kong was higher than that of some other countries that also did not include the vaccine in their routine immunization programs. More positive parental attitudes, higher socioeconomic status, and discussion with a family doctor are associated with greater vaccination rates. The important roles that health professionals and the government play in promoting varicella vaccination were emphasized.

Parental Attitudes and Factors Associated With Varicella Vaccination in Preschool and Schoolchildren in Hong Kong

PubMed Central

Tam, Wilson W.S.; Chan, Johnny; Lo, Kenneth K.H.; Lee, Albert; Chan, Paul K.S.; Chan, Denise; Nelson, E. Anthony S.

2015-01-01

Abstract This study investigates parental attitudes and factors associated with varicella vaccination among preschool and schoolchildren prior to introduction of the vaccine into Hong Kong's universal Childhood Immunization Program. Fourteen kindergartens and 5 primary schools in Hong Kong were randomly selected in 2013. Parents of the students were invited to answer the self-administered questionnaires. Acquired information included demographic characteristics and socioeconomic statuses of families, children's history of chickenpox infection and vaccination, and reasons for getting children vaccinated. Logistic regression was applied to examine the factors associated with vaccination. From the 3484 completed questionnaires, the calculated rates of varicella infection and vaccination were 20.7% and 69.0%, respectively. Barriers to vaccination included parental uncertainties about vaccine effectiveness, lack of recommendation from the government, and concerns on adverse effects. Overall, 71.8%, 69.0%, and 45.7% of the parents rated family doctors, specialists, and the government, respectively, as very important motivators of vaccination. Higher parental educational level and family income, better perceived knowledge of varicella and chance of infection, discussion with a family doctor, and positive health belief towards vaccination were associated with vaccination (all P < 0.05). The rate of vaccination in Hong Kong was higher than that of some other countries that also did not include the vaccine in their routine immunization programs. More positive parental attitudes, higher socioeconomic status, and discussion with a family doctor are associated with greater vaccination rates. The important roles that health professionals and the government play in promoting varicella vaccination were emphasized. PMID:26356725

Bringing Democratic Governance into Practice: Policy Enactments Responding to Neoliberal Governance in Spanish Public Schools

ERIC Educational Resources Information Center

Prieto-Flores, Òscar; Feu, Jordi; Serra, Carles; Lázaro, Laura

2018-01-01

This article explores different ways in which public primary schools sustain democratic governance structures created beyond those mandated by law in Spain. These new institutional designs, while not opposed to policy text requirements of having a governing body with representatives of parents, teachers and public administration, are being carried…

Mayoral Governance and Student Achievement: How Mayor-Led Districts Are Improving School and Student Performance

ERIC Educational Resources Information Center

Wong, Kenneth K.; Shen, Francis X.

2013-01-01

Mayoral control and accountability is one of very few major education reforms that aim at governance coherence in this nation's highly fragmented urban school systems. A primary feature of mayoral governance is that it holds the office of the mayor accountable for school performance. As an institutional redesign, mayoral governance integrates…

Hierarchy in factors affecting fish biodiversity in floodplain lakes of the Mississippi Alluvial Valley

USGS Publications Warehouse

Dembkowski, D.J.; Miranda, L.E.

2012-01-01

River-floodplain ecosystems offer some of the most diverse and dynamic environments in the world. Accordingly, floodplain habitats harbor diverse fish assemblages. Fish biodiversity in floodplain lakes may be influenced by multiple variables operating on disparate scales, and these variables may exhibit a hierarchical organization depending on whether one variable governs another. In this study, we examined the interaction between primary variables descriptive of floodplain lake large-scale features, suites of secondary variables descriptive of water quality and primary productivity, and a set of tertiary variables descriptive of fish biodiversity across a range of floodplain lakes in the Mississippi Alluvial Valley of Mississippi and Arkansas (USA). Lakes varied considerably in their representation of primary, secondary, and tertiary variables. Multivariate direct gradient analyses indicated that lake maximum depth and the percentage of agricultural land surrounding a lake were the most important factors controlling variation in suites of secondary and tertiary variables, followed to a lesser extent by lake surface area. Fish biodiversity was generally greatest in large, deep lakes with lower proportions of watershed agricultural land. Our results may help foster a holistic approach to floodplain lake management and suggest the framework for a feedback model wherein primary variables can be manipulated for conservation and restoration purposes and secondary and tertiary variables can be used to monitor the success of such efforts. ?? 2011 Springer Science+Business Media B.V.

Factors affecting fish biodiversity in floodplain lakes of the Mississippi Alluvial Valley

USGS Publications Warehouse

Miranda, Leandro E.; Dembkowski, Daniel J.

2012-01-01

River-floodplain ecosystems offer some of the most diverse and dynamic environments in the world. Accordingly, floodplain habitats harbor diverse fish assemblages. Fish biodiversity in floodplain lakes may be influenced by multiple variables operating on disparate scales, and these variables may exhibit a hierarchical organization depending on whether one variable governs another. In this study, we examined the interaction between primary variables descriptive of floodplain lake large-scale features, suites of secondary variables descriptive of water quality and primary productivity, and a set of tertiary variables descriptive of fish biodiversity across a range of floodplain lakes in the Mississippi Alluvial Valley of Mississippi and Arkansas (USA). Lakes varied considerably in their representation of primary, secondary, and tertiary variables. Multivariate direct gradient analyses indicated that lake maximum depth and the percentage of agricultural land surrounding a lake were the most important factors controlling variation in suites of secondary and tertiary variables, followed to a lesser extent by lake surface area. Fish biodiversity was generally greatest in large, deep lakes with lower proportions of watershed agricultural land. Our results may help foster a holistic approach to floodplain lake management and suggest the framework for a feedback model wherein primary variables can be manipulated for conservation and restoration purposes and secondary and tertiary variables can be used to monitor the success of such efforts.

To Prevent, React, and Rebuild: Health Research and the Prevention of Genocide

PubMed Central

Adler, Reva N; Smith, James; Fishman, Paul; Larson, Eric B

2004-01-01

Objective To develop an approach to the primary prevention of genocide, based on established public health-based violence prevention methods derived from a variety of high-risk settings. Data Sources (1) Peer-reviewed literature in the fields of public health, violence/injury prevention, medicine, economics, sociology, psychology, history, and genocide studies, (2) demographic and health data bases made available by governments and international organizations, (3) reports on recent episodes of genocide published by international and nongovernmental organizations, (4) newspaper and journalistic accounts of recent and past genocides, (5) archival testimonies of genocide victims and perpetrators, and (6) court transcripts of international genocide prosecutions. Study Design The research was conducted as a medical-historical policy analysis synthesizing data within the following framework: (1) Assessment of current violence and injury prevention models for suitability in the prevention of extreme, population-wide violence, (2) analysis of morbidity and mortality data to quantify the impact of genocide on the health of populations, (3) making an inventory of the known societal risk factors for genocidal violence, (4) identification of the theorized, modifiable attitudinal risk factors for genocidal behavior within a population health model, and (5) assessment of existing projects targeting primary violence and injury prevention in high risk jurisdictions, for future adaptation within a structured, public health approach. Principal Findings Mortality rates due to genocidal violence are far in excess of other public health emergencies including malaria and HIV/AIDS. The immediate and long-range health consequences of genocide include the sequelae of infectious diseases, organ system failure, and psychiatric disorders, conferring an increased burden of disease on affected populations for multiple subsequent generations. The impact of genocide on local health economies is catastrophic, and the opportunity costs of diverting scarce global health dollars toward ameliorating genocide related outcomes are substantial. Structural risk factors for genocide within societies include: totalitarian government, exclusionary ideologies, armed conflict, economic hardship, and inaction of bystander nations. Proposed psychological risk factors for genocidal behavior include: moral exclusion, authority orientation, action in self-interest, desensitization, and compartmentalized thinking. Violence and injury prevention models, incorporating what is currently known about the societal and behavioral risk factors for genocide in high-risk populations, may be modified to address the primary prevention of catastrophic violence on a population-wide scale. A number of existent global peace building initiatives may serve as models for the design of future prevention initiatives in high-risk, pre-genocide jurisdictions. Conclusions Our analysis suggests that genocide is one of the most pressing threats to the health of populations in the twenty-first century. Recent advances in the public health discipline of violence prevention provide a blueprint for approaches to primary genocide prevention based on epidemiological methods. PMID:15544643

Nuclear Localization of the C1 Factor (Host Cell Factor) in Sensory Neurons Correlates with Reactivation of Herpes Simplex Virus from Latency

NASA Astrophysics Data System (ADS)

Kristie, Thomas M.; Vogel, Jodi L.; Sears, Amy E.

1999-02-01

After a primary infection, herpes simplex virus is maintained in a latent state in neurons of sensory ganglia until complex stimuli reactivate viral lytic replication. Although the mechanisms governing reactivation from the latent state remain unknown, the regulated expression of the viral immediate early genes represents a critical point in this process. These genes are controlled by transcription enhancer complexes whose assembly requires and is coordinated by the cellular C1 factor (host cell factor). In contrast to other tissues, the C1 factor is not detected in the nuclei of sensory neurons. Experimental conditions that induce the reactivation of herpes simplex virus in mouse model systems result in rapid nuclear localization of the protein, indicating that the C1 factor is sequestered in these cells until reactivation signals induce a redistribution of the protein. The regulated localization suggests that C1 is a critical switch determinant of the viral lytic-latent cycle.

The proliferation and differentiation of primary pig preadipocytes is suppressed when cultures are incubated at 37°Celsius compared to euthermic conditions in pigs

PubMed Central

Bohan, Amy E; Purvis, Katelyn N; Bartosh, Julia L; Brandebourg, Terry D

2014-01-01

Given similarities in metabolic parameters and cardiovascular physiology, the pig is well positioned as a biomedical model for metabolic disease and obesity in humans. Better understanding molecular mechanisms governing porcine adipocyte hyperplasia may provide insight into the regulation of adipose tissue development that is useful both when considering the pig as a commodity and when extrapolating porcine data to human disease. Primary cultures of pig stromal-vascular cells have served as a useful tool for investigating factors that regulate preadipocyte proliferation and differentiation. However, such cultures have generally been maintained at 37°C in vitro despite euthermia being 39°C in pigs. To address potential concerns about the physiological relevance of culturing primary pig preadipocytes under what would be hypothermic conditions in vivo, the objective of this study was to investigate the effect of culture temperature on the proliferation and differentiation of pig preadipocytes in primary culture. Culturing primary preadipocytes at 37 rather than 39°C decreases their proliferation rates based upon cleavage of the tetrazolium salt, MTT (P < 0.001), reduction of resazurin (P < 0.001), and daily cell counts (P < 0.001). Likewise, culturing primary porcine preadipocytes at 37°C suppressed their adipogenic potential based upon monitoring adipogenesis morphologically, biochemically, and via the expression of mRNA encoding adipogenic marker genes. Collectively, these data indicate the proliferation and differentiation of primary pig preadipocytes is suppressed when cultures are incubated at 37°C compared to normal body temperature of pigs. This may confound investigation of factors that impact adipocyte hyperplasia in the pig. PMID:26317057

The case for comparability in financial reporting.

PubMed

Harmer, W G

1992-03-01

Government-owned organizations are accountable to citizens and their elected representatives. These organizations must provide financial information that will help in determining whether they are effectively pursuing their primary goal, which is to promote the general welfare. Regardless of the kind of service provided by a government-owned organization, the information needs of citizens and their elected representatives must be considered when developing accounting rules. If these needs are ignored or compromised in favor of the needs of other users, such as investors or creditors (the primary users of business financial reports), then financial reporting by government-owned organizations will not meet its objectives.

Perspectives: Using Results from HRSA's Health Workforce Simulation Model to Examine the Geography of Primary Care.

PubMed

Streeter, Robin A; Zangaro, George A; Chattopadhyay, Arpita

2017-02-01

Inform health planning and policy discussions by describing Health Resources and Services Administration's (HRSA's) Health Workforce Simulation Model (HWSM) and examining the HWSM's 2025 supply and demand projections for primary care physicians, nurse practitioners (NPs), and physician assistants (PAs). HRSA's recently published projections for primary care providers derive from an integrated microsimulation model that estimates health workforce supply and demand at national, regional, and state levels. Thirty-seven states are projected to have shortages of primary care physicians in 2025, and nine states are projected to have shortages of both primary care physicians and PAs. While no state is projected to have a 2025 shortage of primary care NPs, many states are expected to have only a small surplus. Primary care physician shortages are projected for all parts of the United States, while primary care PA shortages are generally confined to Midwestern and Southern states. No state is projected to have shortages of all three provider types. Projected shortages must be considered in the context of baseline assumptions regarding current supply, demand, provider-service ratios, and other factors. Still, these findings suggest geographies with possible primary care workforce shortages in 2025 and offer opportunities for targeting efforts to enhance workforce flexibility. © Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Democratic Governance for Inclusion: A Case Study of a Greek Primary School Welcoming Roma Pupils

ERIC Educational Resources Information Center

Noula, Ioanna; Cowan, Steven; Govaris, Christos

2015-01-01

The focus of this paper is how changes in school governance in one state primary school in a city in central Greece have resulted in a significant degree of inclusion for Roma children. This inclusivity runs counter to the disturbing occurrence of the social and ethnic segregation of a group of locally resident Roma children within schools. This…

The Future of Government Funding for Persons with Disabilities: Some Key Factors.

ERIC Educational Resources Information Center

Ross, E. Clarke

1980-01-01

The paper identifies and discusses key factors associated with government funding for disabled individuals. An introductory section traces the growth of public expenditures in recent years. Five key factors affecting government funding are examined (sample subtopics in parentheses): state government tax and spending limits (Proposition 13 and the…

Discover Primary Science: Developing Primary Science in Ireland

ERIC Educational Resources Information Center

Horner, Margaret; Palmer, Marion

2007-01-01

"Discover Primary Science" is a major project in primary science education in Ireland. In 2006-2007 it involves 2400 primary schools, 45 host centres, and two government departments. However, it started out as a local initiative taken by one state agency in 2002 involving four Institutes of Technology and 40 primary schools. The aim of…

Public Health Policy in Support of Insurance Coverage for Smoking Cessation Treatments.

PubMed

Schwartz, Robert; Haji, Farzana; Babayan, Alexey; Longo, Christopher; Ferrence, Roberta

2017-05-01

Insurance coverage for evidence-based smoking cessation treatments (SCTs) promotes uptake and reduces smoking rates. Published studies in this area are based in the US where employers are the primary source of health insurance. In Ontario, Canada, publicly funded healthcare does not cover SCTs, but it can be supplemented with employer-sponsored benefit plans. This study explores factors affecting the inclusion/exclusion of smoking cessation (SC) benefits. In total, 17 interviews were conducted with eight employers (auto, retail, banking, municipal and university industries), four health insurers, two government representatives and three advisors/consultants. Overall, SCT coverage varied among industries; it was inconsistently restrictive and SCT differed by coverage amount and length of use. Barriers impeding coverage included the lack of the following: Canadian-specific return on investment (ROI), SC cost information, employer demand, government regulations/incentives and employee awareness of and demand. A Canadian evidence-based calculation of ROI for SC coupled with government incentives and public education may be needed to promote uptake of SCT coverage by employers. Copyright © 2017 Longwoods Publishing.

Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance.

PubMed

Campbell, S M; Sheaff, R; Sibbald, B; Marshall, M N; Pickard, S; Gask, L; Halliwell, S; Rogers, A; Roland, M O

2002-03-01

To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. Qualitative case studies using semi-structured interviews and documentation review. Twelve purposively sampled PCG/Ts in England. Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. Participants' perceptions of the role of clinical governance in PCG/Ts. PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance.

Primary care in Ontario, Canada: New proposals after 15 years of reform.

PubMed

Marchildon, Gregory P; Hutchison, Brian

2016-07-01

Primary care has proven to be extremely difficult to reform in Canada because of the original social compact between the state and physicians that led to the introduction of universal medical care insurance in the 1960s. However, in the past decade, the provincial government of Ontario has led the way in Canada in funding a suite of primary care practice models, some of which differ substantially from traditional solo and group physician practices based on fee-for-service payment. Independent evaluations show some positive improvements in patient care. Nonetheless, the Ontario government's large investment in the reform combined with high expectations concerning improved performance and the deteriorating fiscal position of the province's finances have led to major conflict with organized medicine over physician budgets and the government's consideration of an even more radical restructuring of the system of primary care in the province. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

State and local governments

NASA Technical Reports Server (NTRS)

Barnes, Dennis

1990-01-01

The Virginia Space Grant Consortium approach to a close working relation to state and local governments is presented as a model for consideration. State government relations are especially important in that this is a primary resource in securing matching funds. Avenues for establishing these relationships are listed and discussed.

Social, economic, and political factors in progress towards improving child survival in developing nations.

PubMed

Lykens, Kristine; Singh, Karan P; Ndukwe, Elewichi; Bae, Sejong

2009-01-01

Child mortality is a persistent health problem faced by developing nations. In 2000 the United Nations (UN) established a set of high priority goals to address global problems of poverty and health, the Millennium Development Goals, which address extreme poverty, hunger, primary education, child mortality, maternal health, infectious diseases, environmental sustainability, and partnerships for development. Goal 4 aims to reduce by two thirds, between 2000 and 2015, the under-five mortality rate in developing countries. In sub-Saharan Africa from 2000 to 2006 these rates have only been reduced from 167 per 1,000 live births to 157, and 27 nations in this region have made no progress towards the goal. A country-specific database was developed from the UN Millennium Development Goal tracking project and other international sources which include age distribution, under-nutrition, per capita income, government expenditures on health, external resources for health, civil liberties, and political rights. A multiple regression analysis examined the extent to which these factors explain the variance in child mortality rates in developing countries. Nutrition, external resources, and per capita income were shown to be significant factors in child survivability. Policy options include developed countries' renewed commitment of resources, and developing nations' commitments towards governance, development, equity, and transparency.

Novel applications of trophic factors, Wnt and WISP for neuronal repair and regeneration in metabolic disease

PubMed Central

Maiese, Kenneth

2015-01-01

Diabetes mellitus affects almost 350 million individuals throughout the globe resulting in significant morbidity and mortality. Of further concern is the growing population of individuals that remain undiagnosed but are susceptible to the detrimental outcomes of this disorder. Diabetes mellitus leads to multiple complications in the central and peripheral nervous systems that include cognitive impairment, retinal disease, neuropsychiatric disease, cerebral ischemia, and peripheral nerve degeneration. Although multiple strategies are being considered, novel targeting of trophic factors, Wnt signaling, Wnt1 inducible signaling pathway protein 1, and stem cell tissue regeneration are considered to be exciting prospects to overcome the cellular mechanisms that lead to neuronal injury in diabetes mellitus involving oxidative stress, apoptosis, and autophagy. Pathways that involve insulin-like growth factor-1, fibroblast growth factor, epidermal growth factor, and erythropoietin can govern glucose homeostasis and are intimately tied to Wnt signaling that involves Wnt1 and Wnt1 inducible signaling pathway protein 1 (CCN4) to foster control over stem cell proliferation, wound repair, cognitive decline, β-cell proliferation, vascular regeneration, and programmed cell death. Ultimately, cellular metabolism through Wnt signaling is driven by primary metabolic pathways of the mechanistic target of rapamycin and AMP activated protein kinase. These pathways offer precise biological control of cellular metabolism, but are exquisitely sensitive to the different components of Wnt signaling. As a result, unexpected clinical outcomes can ensue and therefore demand careful translation of the mechanisms that govern neural repair and regeneration in diabetes mellitus. PMID:26170801

The ABAG biogenic emissions inventory project

NASA Technical Reports Server (NTRS)

Carson-Henry, C. (Editor)

1982-01-01

The ability to identify the role of biogenic hydrocarbon emissions in contributing to overall ozone production in the Bay Area, and to identify the significance of that role, were investigated in a joint project of the Association of Bay Area Governments (ABAG) and NASA/Ames Research Center. Ozone, which is produced when nitrogen oxides and hydrocarbons combine in the presence of sunlight, is a primary factor in air quality planning. In investigating the role of biogenic emissions, this project employed a pre-existing land cover classification to define areal extent of land cover types. Emission factors were then derived for those cover types. The land cover data and emission factors were integrated into an existing geographic information system, where they were combined to form a Biogenic Hydrocarbon Emissions Inventory. The emissions inventory information was then integrated into an existing photochemical dispersion model.

Introducing Children to Democratic Government

ERIC Educational Resources Information Center

Alleman, Janet; Brophy, Jere

2006-01-01

Researchers have been studying children's knowledge, thinking, and attitudes about government for several decades. However, the studies focusing on elementary students, and especially primary students, have little or nothing to say about children's ideas about democracy or democratic government. That is because children at these ages have not yet…

Clinical governance. Onus points.

PubMed

Malbon, G; Gillam, S; Mays, N

1998-11-19

A survey of lead GPs in total purchasing pilots revealed poor understanding of the responsibilities of clinical governance. Many saw it in a negative light and were concerned about its administrative costs. Explicit guidance is needed, spelling out the clinical governance responsibilities of GPs and others in primary care groups.

Cost analysis of a primary health centre in northern India.

PubMed

Anand, K; Kapoor, S K; Pandav, C S

1993-01-01

Cost data are useful in health planning, budgeting and for assessing the efficiency of services. However, such data are not easily available from developing countries. We therefore estimated the cost incurred for the year 1991-92 on a primary health centre in northern India, which is affiliated to an academic institution. The total costs incurred included the capital costs for land, building, furniture, vehicles and equipment as well as the recurrent costs for salaries, drugs and vaccines, diesel and maintenance. Except for land, where the 'opportunity cost' was calculated, the current market rates were considered for all other factors. A discount rate of 10% was used in the study. A total of Rs 777,015 (US $24,282) was incurred on the primary health centre in the study year, 80% being recurrent costs. Salaries constituted 62% of the total costs. A sum of Rs 30 (US $0.94) per head per year on primary health care was being incurred. Salaries constitute the bulk of the cost incurred on health. Approximately Rs 28 (40%) of the Rs 69 spent per head per year on health services by the Government of India is incurred on providing primary health care services.

Universal Health Coverage and Primary Healthcare: Lessons From Japan Comment on "Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries".

PubMed

Bloom, Gerald

2016-08-28

A recent editorial by Naoki Ikegami has proposed three key lessons from Japan's experience of achieving virtually universal coverage with primary healthcare services: the need to integrate the existing providers of primary healthcare services into the organised health system; the need to limit government commitments to finance hospital services and the need to empower providers of primary healthcare to influence decisions that influence their livelihoods. Although the context of low- and middle-income countries (LMICs) differs in many ways from Japan in the late 19th and early 20th centuries, the lesson that short-term initiatives to achieve universal coverage need to be complemented by an understanding of the factors influencing long-term change management remains highly relevant. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Alignment between Chronic Disease Policy and Practice: Case Study at a Primary Care Facility

PubMed Central

Draper, Claire A.; Draper, Catherine E.; Bresick, Graham F.

2014-01-01

Background Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. Methods One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. Results The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. Conclusions Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar findings and factors are present at other primary care facilities in Cape Town. At a philosophical level, this research highlights the tension between primary health care principles and a diseased-based approach in a primary care setting. PMID:25141191

Alignment between chronic disease policy and practice: case study at a primary care facility.

PubMed

Draper, Claire A; Draper, Catherine E; Bresick, Graham F

2014-01-01

Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar findings and factors are present at other primary care facilities in Cape Town. At a philosophical level, this research highlights the tension between primary health care principles and a diseased-based approach in a primary care setting.

Is There an Islamist Political Advantage?

PubMed Central

Cammett, Melani; Luong, Pauline Jones

2014-01-01

There is a widespread presumption that Islamists have an advantage over their opponents when it comes to generating mass appeal and winning elections. The question remains, however, as to whether these advantages—or, what we refer to collectively as an Islamist political advantage—actually exist. We argue that—to the extent that Islamists have a political advantage—the primary source of this advantage is reputation rather than the provision of social services, organizational capacity, or ideological hegemony. Our purpose is not to dismiss the main sources of the Islamist governance advantage identified in scholarly literature and media accounts, but to suggest a different causal path whereby each of these factors individually and sometimes jointly promotes a reputation for Islamists as competent, trustworthy, and pure. It is this reputation for good governance that enables Islamists to distinguish themselves in the streets and at the ballot box. PMID:25767370

Economic credentialing: the propriety of managing physician costs through privileging.

PubMed

Dahl, B A

1999-01-01

Hospital executives face the unique task of managing the costs of an institution in which they have no direct managerial authority over the primary cost drivers, namely, the physicians who practice in the hospital. Perhaps the most controversial method of controlling physician costs consists of the application of economic factors to the credentialing process. Using the credentialing process as a technique to exert fiscal control over physicians affords hospital executives and their governing boards a tremendous cost-management opportunity. The legal propriety of economic credentialing remains unsettled. Many commentators, relying on limited case law, conclude that hospitals can engage in economic credentialing. Nevertheless, hospitals should exercise care when employing an economic rationale to restrict privileges lest they stir up legal challenges. Moreover, if hospitals use economic credentialing to limit medicaid patients' access to hospitals by excluding these patients' physicians from the hospital, the federal government may have the last word on the propriety of the practice.

Regulatory Mechanisms for Nursing Training and Practice: Meeting Primary Health Care Needs. World Health Organization Technical Report Series No. 738. Report of a WHO Study Group.

ERIC Educational Resources Information Center

World Health Organization, Geneva (Switzerland).

A report on laws and regulations governing nursing education and practice in 81 countries belonging to the World Health Organization and effects on primary health care is presented by an international group of experts. Suggestions for training and licensure are provided to national governments and nursing regulatory bodies to promote the goal of…

Development and Validation of the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ) for Primary Care Patients with Type 2 Diabetes

PubMed Central

Fu, Sau Nga; Chin, Weng Yee; Wong, Carlos King Ho; Yeung, Vincent Tok Fai; Yiu, Ming Pong; Tsui, Hoi Yee; Chan, Ka Hung

2013-01-01

Objectives To develop and evaluate the psychometric properties of a Chinese questionnaire which assesses the barriers and enablers to commencing insulin in primary care patients with poorly controlled Type 2 diabetes. Research Design and Method Questionnaire items were identified using literature review. Content validation was performed and items were further refined using an expert panel. Following translation, back translation and cognitive debriefing, the translated Chinese questionnaire was piloted on target patients. Exploratory factor analysis and item-scale correlations were performed to test the construct validity of the subscales and items. Internal reliability was tested by Cronbach’s alpha. Results Twenty-seven identified items underwent content validation, translation and cognitive debriefing. The translated questionnaire was piloted on 303 insulin naïve (never taken insulin) Type 2 diabetes patients recruited from 10 government-funded primary care clinics across Hong Kong. Sufficient variability in the dataset for factor analysis was confirmed by Bartlett’s Test of Sphericity (P<0.001). Using exploratory factor analysis with varimax rotation, 10 factors were generated onto which 26 items loaded with loading scores > 0.4 and Eigenvalues >1. Total variance for the 10 factors was 66.22%. Kaiser-Meyer-Olkin measure was 0.725. Cronbach’s alpha coefficients for the first four factors were ≥0.6 identifying four sub-scales to which 13 items correlated. Remaining sub-scales and items with poor internal reliability were deleted. The final 13-item instrument had a four scale structure addressing: ‘Self-image and stigmatization’; ‘Factors promoting self-efficacy; ‘Fear of pain or needles’; and ‘Time and family support’. Conclusion The Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ) appears to be a reliable and valid measure for assessing barriers to starting insulin. This short instrument is easy to administer and may be used by healthcare providers and researchers as an assessment tool for Chinese diabetic primary care patients, including the elderly, who are unwilling to start insulin. PMID:24236071

A critical analysis of the implementation of service user involvement in primary care research and health service development using normalization process theory.

PubMed

Tierney, Edel; McEvoy, Rachel; O'Reilly-de Brún, Mary; de Brún, Tomas; Okonkwo, Ekaterina; Rooney, Michelle; Dowrick, Chris; Rogers, Anne; MacFarlane, Anne

2016-06-01

There have been recent important advances in conceptualizing and operationalizing involvement in health research and health-care service development. However, problems persist in the field that impact on the scope for meaningful involvement to become a routine - normalized - way of working in primary care. In this review, we focus on current practice to critically interrogate factors known to be relevant for normalization - definition, enrolment, enactment and appraisal. Ours was a multidisciplinary, interagency team, with community representation. We searched EBSCO host for papers from 2007 to 2011 and engaged in an iterative, reflexive approach to sampling, appraising and analysing the literature following the principles of a critical interpretive synthesis approach and using Normalization Process Theory. Twenty-six papers were chosen from 289 papers, as a purposeful sample of work that is reported as service user involvement in the field. Few papers provided a clear working definition of service user involvement. The dominant identified rationale for enrolling service users in primary care projects was linked with policy imperatives for co-governance and emancipatory ideals. The majority of methodologies employed were standard health services research methods that do not qualify as research with service users. This indicates a lack of congruence between the stated aims and methods. Most studies only reported positive outcomes, raising questions about the balance or completeness of the published appraisals. To improve normalization of meaningful involvement in primary care, it is necessary to encourage explicit reporting of definitions, methodological innovation to enhance co-governance and dissemination of research processes and findings. © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Managerialism and Higher Education Governance: Implications for South African Universities?

ERIC Educational Resources Information Center

Adams, F.

2006-01-01

This article identifies some of the implications of corporate forms of higher education governance for the management of South African universities. It explores corporate higher educational governance with reference to institutional autonomy incorporating academic freedom. It is the contention of this article that the primary driver of higher…

E-Governance in Education: Pursuit of Education Excellence

ERIC Educational Resources Information Center

Natarajan, Sundarapandiyan

2015-01-01

This article aims to explore today's educational challenges, being technologically supreme, the primary focus on education is to bring out the outcome and value based education to the community. Electronic Governance (e- Governance) focuses not only the technological infrastructure and getting the learning environment sync is the major challenge.…

Government and African Control of Education in the Bechuanaland Protectorate, 1928-48.

ERIC Educational Resources Information Center

Mgadla, P. T.

1995-01-01

Presents an in-depth portrait of the British government's educational policy in the Bechuanaland protectorate. The government systematized the primary school syllabus, regularized payment and training of teachers, and established cattle post schools. However, blatant discrimination favored support of European schools over African and little…

50 CFR 660.231 - Limited entry fixed gear sablefish primary fishery.

Code of Federal Regulations, 2011 CFR

2011-10-01

... sablefish primary fishery. This section applies to the sablefish primary season for the limited entry fixed... the sablefish primary season north of 36° N. lat. is governed by routine management measures imposed... sablefish primary season for the limited entry fixed gear fishery, unless at least one limited entry permit...

Primary health care in Canada: systems in motion.

PubMed

Hutchison, Brian; Levesque, Jean-Frederic; Strumpf, Erin; Coyle, Natalie

2011-06-01

During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

Multivariate co-integration analysis of the Kaya factors in Ghana.

PubMed

Asumadu-Sarkodie, Samuel; Owusu, Phebe Asantewaa

2016-05-01

The fundamental goal of the Government of Ghana's development agenda as enshrined in the Growth and Poverty Reduction Strategy to grow the economy to a middle income status of US$1000 per capita by the end of 2015 could be met by increasing the labour force, increasing energy supplies and expanding the energy infrastructure in order to achieve the sustainable development targets. In this study, a multivariate co-integration analysis of the Kaya factors namely carbon dioxide, total primary energy consumption, population and GDP was investigated in Ghana using vector error correction model with data spanning from 1980 to 2012. Our research results show an existence of long-run causality running from population, GDP and total primary energy consumption to carbon dioxide emissions. However, there is evidence of short-run causality running from population to carbon dioxide emissions. There was a bi-directional causality running from carbon dioxide emissions to energy consumption and vice versa. In other words, decreasing the primary energy consumption in Ghana will directly reduce carbon dioxide emissions. In addition, a bi-directional causality running from GDP to energy consumption and vice versa exists in the multivariate model. It is plausible that access to energy has a relationship with increasing economic growth and productivity in Ghana.

48 CFR 1335.014 - Government property and title.

Code of Federal Regulations, 2010 CFR

2010-10-01

... primary purpose is the conduct of scientific research is set forth in CAM 1301.70. ... CATEGORIES OF CONTRACTING RESEARCH AND DEVELOPMENT CONTRACTING 1335.014 Government property and title. The...

48 CFR 1335.014 - Government property and title.

Code of Federal Regulations, 2011 CFR

2011-10-01

... primary purpose is the conduct of scientific research is set forth in CAM 1301.70. ... CATEGORIES OF CONTRACTING RESEARCH AND DEVELOPMENT CONTRACTING 1335.014 Government property and title. The...

[A study of factors related to Korean physicians' trust in the government: on the target for board members of physicians' associations].

PubMed

Lee, Sunhee; Yang, Gunmo; Seo, Juhyun; Kim, Juhye

2010-09-01

This study aims to investigate the factors related to Korean physicians' trust in the government. We used structured questionnaires that were composed of multidimensional scales for each of the various categories. The recognition levels of trust of the government by Korean physicians were not high, and they ranged from 3.6 to 4.8 for ten scales. The factors related to trust in the government were categorized into seven factors on the basis of a factor analysis. On the regression analysis, a positive relationship was found between "the individual propensity to trust" and trust in the government, while a negative relationship was found between "the recognition level regarding the government as an authoritarian power" and trust in the government. "Confidence about participation in the policy process" as internal efficacy and "belief in governmental ability and motivation toward public demand" as external efficacy also showed a strong positive relationship with trust in the government. From these results, we can draw the conclusion that making efforts to improve the recognition level of trust in the government among physicians is an important policy task. To increase the trust level, participation of physicians in the policy process in various ways and open communication between the physicians'associations and the government should be facilitated.

Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance

PubMed Central

Campbell, S; Sheaff, R; Sibbald, B; Marshall, M; Pickard, S; Gask, L; Halliwell, S; Rogers, A; Roland, M

2002-01-01

Objectives: To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. Design: Qualitative case studies using semi-structured interviews and documentation review. Setting: Twelve purposively sampled PCG/Ts in England. Participants: Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. Main outcome measures: Participants' perceptions of the role of clinical governance in PCG/Ts. Results: PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). Conclusion: PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance. PMID:12078380

The role and experiences of advanced nurse practitioners working in out of hours urgent care services in a primary care setting.

PubMed

Yuill, Jacci

2018-05-30

GPs' workload has increased significantly in recent years affecting their ability to provide high-quality services, and consequently there is increasing focus on nurses to provide a solution. There is little evidence of how advanced nurse practitioners (ANPs) experience their role in out of hours (OOH) services, and it is important to understand their perceptions of this and the challenges they may face in supporting service development and improvement. This article evaluates the role and experiences of ANPs working in an OOH urgent primary care service and identifies important factors that affect their roles. Positive factors enable job satisfaction, but challenges associated with knowledge base, perceptions, role definitions and isolation must be considered for quality and governance purposes. The article describes how supportive systems must be in place to enable mentorship, supervision programmes and development of this group of advanced practitioners. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

School Choice for the Poor? The Limits of Marketisation of Primary Education in Rural India. CREATE Pathways to Access. Research Monograph No. 23

ERIC Educational Resources Information Center

Harma, Joanna

2010-01-01

In recent years India has seen an explosion in low-fee private (LFP) schooling aimed at the poorer strata of society. This marketisation of primary education is a reaction to the well-documented failings of the government system. This paper looks at LFP schooling in one rural district of Uttar Pradesh, and compares government to low cost private…

Towards people-centred health systems: a multi-level framework for analysing primary health care governance in low- and middle-income countries.

PubMed

Abimbola, Seye; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra

2014-09-01

Although there is evidence that non-government health system actors can individually or collectively develop practical strategies to address primary health care (PHC) challenges in the community, existing frameworks for analysing health system governance largely focus on the role of governments, and do not sufficiently account for the broad range of contribution to PHC governance. This is important because of the tendency for weak governments in low- and middle-income countries (LMICs). We present a multi-level governance framework for use as a thinking guide in analysing PHC governance in LMICs. This framework has previously been used to analyse the governance of common-pool resources such as community fisheries and irrigation systems. We apply the framework to PHC because, like common-pool resources, PHC facilities in LMICs tend to be commonly owned by the community such that individual and collective action is often required to avoid the 'tragedy of the commons'-destruction and degradation of the resource resulting from lack of concern for its continuous supply. In the multi-level framework, PHC governance is conceptualized at three levels, depending on who influences the supply and demand of PHC services in a community and how: operational governance (individuals and providers within the local health market), collective governance (community coalitions) and constitutional governance (governments at different levels and other distant but influential actors). Using the example of PHC governance in Nigeria, we illustrate how the multi-level governance framework offers a people-centred lens on the governance of PHC in LMICs, with a focus on relations among health system actors within and between levels of governance. We demonstrate the potential impact of health system actors functioning at different levels of governance on PHC delivery, and how governance failure at one level can be assuaged by governance at another level. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Towards people-centred health systems: a multi-level framework for analysing primary health care governance in low- and middle-income countries

PubMed Central

Abimbola, Seye; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra

2014-01-01

Although there is evidence that non-government health system actors can individually or collectively develop practical strategies to address primary health care (PHC) challenges in the community, existing frameworks for analysing health system governance largely focus on the role of governments, and do not sufficiently account for the broad range of contribution to PHC governance. This is important because of the tendency for weak governments in low- and middle-income countries (LMICs). We present a multi-level governance framework for use as a thinking guide in analysing PHC governance in LMICs. This framework has previously been used to analyse the governance of common-pool resources such as community fisheries and irrigation systems. We apply the framework to PHC because, like common-pool resources, PHC facilities in LMICs tend to be commonly owned by the community such that individual and collective action is often required to avoid the ‘tragedy of the commons’—destruction and degradation of the resource resulting from lack of concern for its continuous supply. In the multi-level framework, PHC governance is conceptualized at three levels, depending on who influences the supply and demand of PHC services in a community and how: operational governance (individuals and providers within the local health market), collective governance (community coalitions) and constitutional governance (governments at different levels and other distant but influential actors). Using the example of PHC governance in Nigeria, we illustrate how the multi-level governance framework offers a people-centred lens on the governance of PHC in LMICs, with a focus on relations among health system actors within and between levels of governance. We demonstrate the potential impact of health system actors functioning at different levels of governance on PHC delivery, and how governance failure at one level can be assuaged by governance at another level. PMID:25274638

The effect of social geographic factors on the untreated tooth decay among head start children.

PubMed

Heima, Masahiro; Ferretti, Margaret; Qureshi, Mehveen; Ferretti, Gerald

2017-10-01

Disparities among untreated dental caries exist for children from low-income families in the United States. Understanding of the mechanism of the disparities is required to reduce it and social geographic factors are one of the important influences. Although the effect of fluoridated water has been well reported, studies of other sociogeograpic factors, such as the density of available dentists, are still very limited. The objective of this study is to explore the effect of sociogeographic factors on the number of primary teeth with untreated dental caries among children from low-income families who are enrolled in Head Start programs throughout Northeast Ohio of the United States. This was a cross-sectional chart review study. Three hundred-eighty-eight charts were reviewed, and the number of primary teeth with untreated dental caries (dt) and the children's addresses were retrieved. The sociogeographic variables, including fluoridated water availability and the density of available dentists who accept a government-supported insurance (Medicaid dentists), were collected. The mean (standard deviation) of children's age was 3.51 (1.14) years with a range of 7 months to 5 years. A negative binomial regression model analysis, which used dt as a dependent variable and children's characteristic factors (i.e. age, gender, insurance type, and total number of primary teeth) and sociogeographic factors (i.e. Population, total number of Medicaid dentists, density of Medicaid dentist, and Fluoride water availability) of cities, as independent variables, demonstrated that only the density of Medicaid dentist in the sociogeographic factors indicated a significant effect (Estimated ß-Coefficients (Standard Errors)=-0.003 (0.002), p =0.030). This study demonstrated a significant negative association between the density of available dentists and untreated dental caries among children from low-income families in Head Start programs in Northeast Ohio. Increasing available dentists may be a strategy to reduce the number of early childhood caries. Key words: Child, poverty, dental caries, Health Services Accessibility.

Interprofessional primary care in academic family medicine clinics

PubMed Central

Drummond, Neil; Abbott, Karen; Williamson, Tyler; Somji, Behnaz

2012-01-01

Abstract Objective To explore the status and processes of interprofessional work environments and the implications for interprofessional education in a sample of family medicine teaching clinics. Design Focus group interviews using a purposive sampling procedure. Setting Four academic family medicine clinics in Alberta. Participants Seven family physicians, 9 registered nurses, 5 licensed practical nurses, 2 residents, 1 psychologist, 1 informatics specialist, 1 pharmacist, 1 dietitian, 1 nurse practitioner, 1 receptionist, and 1 respiratory therapist. Methods Assessment of clinic status and performance in relation to established principles of interprofessional work and education was explored using semistructured focus group interviews. Main findings Our data supported the D’Amour and Oandasan model of successful interprofessional collaborative practice in terms of the model’s main “factors” (ie, shared goals and vision, sense of belonging, governance, and the structuring of clinical care) and their constituent “elements.” It is reasonable to conclude that the extent to which these factors and elements are both present and positively oriented in academic clinic settings is an important contributory factor to the establishment of interprofessional collaborative practice in primary care. Using this model, 2 of the 4 clinics were rated as expressing substantial progress in relation to interprofessional work, while the other 2 clinics were rated as less successful on that dimension. None of the clinics was identified as having a clear and explicit focus on providing interprofessional education. Conclusion The key factor in relation to the implementation of interprofessional work in primary care appears to be the existence of clear and explicit leadership in that direction. Substantial scope exists for improvement in the organization, conduct, and promotion of interprofessional education for Canadian primary care. PMID:22893347

Epidemiological aspects of Pediculosis capitis and treatment evaluation in primary-school children in Iran.

PubMed

Motovali-Emami, Mohammad; Aflatoonian, Mohammad Reza; Fekri, Alireza; Yazdi, Mahbobeh

2008-01-15

This study was undertaken to assess the prevalence of and epidemiological factors associated with, head lice infections in Iranian primary schools in 2006 and evaluate data on the therapeutic efficacy of lindane shampoo. A total of 40586 children (19774 boys (48.72%) and 20812 girls (51.28%)] from 198 Governmentprimary schools in Kerman, were screened for head lice between March and June 2006. The diagnosis of head lice infestation was confirmed by clinical inspection of scalp and hair for the presence of adult lice nymphal stage, or eggs (nit) by line-toothed head lice comb. All children infested with lice were treated with lindane shampoo (1% gamma benzene hexachloride). The overall prevalence of head lice infestation was 1.8%. The prevalence of infestation was significantly higher in girls (2.9%) than in boys (0.6%) (p = 0.000). The infestation rate was greater among pupils who were living in rural areas (4.6%) than in urban areas (1.5%). Of the 721 children with a positive examination result, 424 pupils (58.8%) were reported as having been infested with head lice in the previous 6 months. Mother's education level was a significant risk factor in this model (p < 0.05). At 2 weeks after the primary treatment, the success rates of treatment were 49%. Comprehensive survey in our work showed the better future of the disease and related factors. Education campaigns by health care officials, physicians and teachers are expected to be helpful for head lice control. It is essential that governments should be supported form cooperation between the school authorities and public health centers to successful control head lice infestation in primary school. Also there is an urgent need to identify safe, novel insecticides for proved efficacy.

Effectively engaging the private sector through vouchers and contracting - A case for analysing health governance and context.

PubMed

Nachtnebel, Matthias; O'Mahony, Ashleigh; Pillai, Nandini; Hort, Kris

2015-11-01

Health systems of low and middle income countries in the Asia Pacific have been described as mixed, where public and private sector operate in parallel. Gaps in the provision of primary health care (PHC) services have been picked up by the private sector and led to its growth; as can an enabling regulatory environment. The question whether governments should purchase services from the private sector to address gaps in service provision has been fiercely debated. This purposive review draws evidence from systematic reviews, and additional published and grey literature, for input into a policy brief on purchasing PHC-services from the private sector for underserved areas in the Asia Pacific region. Additional published and grey literature on vouchers and contracting as mechanisms to engage the private sector was used to supplement the conclusions from systematic reviews. We analysed the literature through a policy lens, or alternatively, a 'bottom-up' approach which incorporates components of a realist review. Evidence indicates that both vouchers and contracting can improve health service outcomes in underserved areas. These outcomes however are strongly influenced by (1) contextual factors, such as roles and functions attributable to a shared set of key actors (2) the type of delivered services and community demand (3) design of the intervention, notably provider autonomy and trust (4) governance capacity and provision of stewardship. Examining the experience of vouchers and contracting to expand health services through engagement with private sector providers in the Asia Pacific found positive effects with regards to access and utilisation of health services, but more importantly, highlighted the significance of contextual factors, appropriate selection of mechanism for services provided, and governance arrangements and stewardship capacity. In fact, for governments seeking to engage the private sector, analysis of context and capacities are potentially a more useful frame than generalizable outcomes of effectiveness. Copyright © 2015 Elsevier Ltd. All rights reserved.

48 CFR 45.303 - Use of Government property on independent research and development programs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT GOVERNMENT PROPERTY Authorizing the Use... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Use of Government property... research and development (IR&D) program, if— (a) Such use will not conflict with the primary use of the...

48 CFR 45.303 - Use of Government property on independent research and development programs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT GOVERNMENT PROPERTY Authorizing the Use... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Use of Government property... research and development (IR&D) program, if— (a) Such use will not conflict with the primary use of the...

29 CFR 510.25 - Traditional functions of government.

Code of Federal Regulations, 2012 CFR

2012-07-01

... whose primary function falls within one or more of the activities listed in paragraph (a) or (b) of this... 29 Labor 3 2012-07-01 2012-07-01 false Traditional functions of government. 510.25 Section 510.25... RICO Classification of Industries § 510.25 Traditional functions of government. (a) Section 6(c)(4) of...

29 CFR 510.25 - Traditional functions of government.

Code of Federal Regulations, 2013 CFR

2013-07-01

... whose primary function falls within one or more of the activities listed in paragraph (a) or (b) of this... 29 Labor 3 2013-07-01 2013-07-01 false Traditional functions of government. 510.25 Section 510.25... RICO Classification of Industries § 510.25 Traditional functions of government. (a) Section 6(c)(4) of...

29 CFR 510.25 - Traditional functions of government.

Code of Federal Regulations, 2014 CFR

2014-07-01

... whose primary function falls within one or more of the activities listed in paragraph (a) or (b) of this... 29 Labor 3 2014-07-01 2014-07-01 false Traditional functions of government. 510.25 Section 510.25... RICO Classification of Industries § 510.25 Traditional functions of government. (a) Section 6(c)(4) of...

31 CFR 560.549 - Policy governing Iranian news organizations' offices in the United States.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Policy governing Iranian news... Policy § 560.549 Policy governing Iranian news organizations' offices in the United States. Specific... operation of news bureaus in the United States by Iranian organizations whose primary purpose is the...

31 CFR 560.549 - Policy governing Iranian news organizations' offices in the United States.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Policy governing Iranian news... Policy § 560.549 Policy governing Iranian news organizations' offices in the United States. Specific... operation of news bureaus in the United States by Iranian organizations whose primary purpose is the...

Short and Fraught: The History of Primary Education in England

ERIC Educational Resources Information Center

Gillard, Derek

2009-01-01

Official reports on primary education are a bit like London buses. You wait ages and then three come along at once. There has been no major report on primary education since the 1967 Plowden Report "Children and their Primary Schools". Now, final reports are awaited from the Cambridge Primary Review and the government-appointed…

[Governance of primary health-care-based health-care organization].

PubMed

Báscolo, Ernesto

2010-01-01

An analytical framework was developed for explaining the conditions for the effectiveness of different strategies promoting integrated primary health-care (PHC) service-based systems in Latin-America. Different modes of governance (clan, incentives and hierarchy) were characterised from a political economics viewpoint for representing alternative forms of regulation promoting innovation in health-service-providing organisations. The necessary conditions for guaranteeing the modes of governance's effectiveness are presented, as are their implications in terms of posts in play. The institutional construction of an integrated health system is interpreted as being a product of a social process in which different modes of governance are combined, operating with different ways of resolving normative aspects for regulating service provision (with the hierarchical mode), resource distribution (with the incentives mode) and on the social values legitimising such process (with the clan mode).

Eukaryotic Initiation Factor 4E Binding Protien Family of Protiens: Sentinels at a Translational Control Checkpoint in Lung Tumor Defense

PubMed Central

Kim, Yong Y; Von Weymarn, Linda; Larsson, Ola; Fan, Danhua; Underwood, Jon M; Hecht, Stephen S; Polunovsky, Vitaly A; Bitterman, Peter B

2009-01-01

The usurping of translational control by sustained activation of translation initiation factors is oncogenic. Here we show that the primary negative regulators of these oncogenic initiation factors - the 4E-BP protein family - operate as guardians of a translational control checkpoint in lung tumor defense. When challenged with the tobacco carcinogen NNK, 4ebp1−/−/4ebp2−/− mice showed increased sensitivity to tumorigenesis compared to their wild type counterparts. The 4E-BP deficient state per se creates pro-oncogenic, genome-wide skewing of the molecular landscape - with translational activation of genes governing angiogenesis, growth and proliferation; and translational activation of the precise cytochrome p450 enzyme isoform (CYP2A5) that bioactivates NNK into mutagenic metabolites. Our study provides in vivo proof for a translational control checkpoint in lung tumor defense. PMID:19843855

Factors influencing the regioselectivity of the oxidation of asymmetric secondary amines with singlet oxygen.

PubMed

Ushakov, Dmitry B; Plutschack, Matthew B; Gilmore, Kerry; Seeberger, Peter H

2015-04-20

Aerobic amine oxidation is an attractive and elegant process for the α functionalization of amines. However, there are still several mechanistic uncertainties, particularly the factors governing the regioselectivity of the oxidation of asymmetric secondary amines and the oxidation rates of mixed primary amines. Herein, it is reported that singlet-oxygen-mediated oxidation of 1° and 2° amines is sensitive to the strength of the α-C-H bond and steric factors. Estimation of the relative bond dissociation energy by natural bond order analysis or by means of one-bond C-H coupling constants allowed the regioselectivity of secondary amine oxidations to be explained and predicted. In addition, the findings were utilized to synthesize highly regioselective substrates and perform selective amine cross-couplings to produce imines. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Causal factors of corporate crime in Taiwan: qualitative and quantitative findings.

PubMed

Mon, Wei-Teh

2002-04-01

Street crimes are a primary concern of most criminologists in Taiwan. In recent years, however, crimes committed by corporations have increased greatly in this country. Employing the empirical approach to collect data about causal factors of corporate crime, the research presented in this article is the first systematic empirical study concerning corporate crime in Taiwan. The research sample was selected from a corporation with a criminal record of pollution caused by the release of toxic chemicals into the environment and a corporation with no criminal record. Questionnaire survey and interviews of corporate employees and managers were conducted, and secondary data were collected from official agencies. This research indicated the causal factors of corporate crime as follows: the failure of government regulation, lack of corporate self-regulation, lack of public concern about corporate crime, corporate mechanistic structure, and the low self-control tendency of corporate managers.

A governance model for integrated primary/secondary care for the health-reforming first world – results of a systematic review

PubMed Central

2013-01-01

Background Internationally, key health care reform elements rely on improved integration of care between the primary and secondary sectors. The objective of this systematic review is to synthesise the existing published literature on elements of current integrated primary/secondary health care. These elements and how they have supported integrated healthcare governance are presented. Methods A systematic review of peer-reviewed literature from PubMed, MEDLINE, CINAHL, the Cochrane Library, Informit Health Collection, the Primary Health Care Research and Information Service, the Canadian Health Services Research Foundation, European Foundation for Primary Care, European Forum for Primary Care, and Europa Sinapse was undertaken for the years 2006–2012. Relevant websites were also searched for grey literature. Papers were assessed by two assessors according to agreed inclusion criteria which were published in English, between 2006–2012, studies describing an integrated primary/secondary care model, and had reported outcomes in care quality, efficiency and/or satisfaction. Results Twenty-one studies met the inclusion criteria. All studies evaluated the process of integrated governance and service delivery structures, rather than the effectiveness of services. They included case reports and qualitative data analyses addressing policy change, business issues and issues of clinical integration. A thematic synthesis approach organising data according to themes identified ten elements needed for integrated primary/secondary health care governance across a regional setting including: joint planning; integrated information communication technology; change management; shared clinical priorities; incentives; population focus; measurement – using data as a quality improvement tool; continuing professional development supporting joint working; patient/community engagement; and, innovation. Conclusions All examples of successful primary/secondary care integration reported in the literature have focused on a combination of some, if not all, of the ten elements described in this paper, and there appears to be agreement that multiple elements are required to ensure successful and sustained integration efforts. Whilst no one model fits all systems these elements provide a focus for setting up integration initiatives which need to be flexible for adapting to local conditions and settings. PMID:24359610

A governance model for integrated primary/secondary care for the health-reforming first world - results of a systematic review.

PubMed

Nicholson, Caroline; Jackson, Claire; Marley, John

2013-12-20

Internationally, key health care reform elements rely on improved integration of care between the primary and secondary sectors. The objective of this systematic review is to synthesise the existing published literature on elements of current integrated primary/secondary health care. These elements and how they have supported integrated healthcare governance are presented. A systematic review of peer-reviewed literature from PubMed, MEDLINE, CINAHL, the Cochrane Library, Informit Health Collection, the Primary Health Care Research and Information Service, the Canadian Health Services Research Foundation, European Foundation for Primary Care, European Forum for Primary Care, and Europa Sinapse was undertaken for the years 2006-2012. Relevant websites were also searched for grey literature. Papers were assessed by two assessors according to agreed inclusion criteria which were published in English, between 2006-2012, studies describing an integrated primary/secondary care model, and had reported outcomes in care quality, efficiency and/or satisfaction. Twenty-one studies met the inclusion criteria. All studies evaluated the process of integrated governance and service delivery structures, rather than the effectiveness of services. They included case reports and qualitative data analyses addressing policy change, business issues and issues of clinical integration. A thematic synthesis approach organising data according to themes identified ten elements needed for integrated primary/secondary health care governance across a regional setting including: joint planning; integrated information communication technology; change management; shared clinical priorities; incentives; population focus; measurement - using data as a quality improvement tool; continuing professional development supporting joint working; patient/community engagement; and, innovation. All examples of successful primary/secondary care integration reported in the literature have focused on a combination of some, if not all, of the ten elements described in this paper, and there appears to be agreement that multiple elements are required to ensure successful and sustained integration efforts. Whilst no one model fits all systems these elements provide a focus for setting up integration initiatives which need to be flexible for adapting to local conditions and settings.

The impact of employee level and work stress on mental health and GP service use: an analysis of a sample of Australian government employees.

PubMed

Parslow, Ruth A; Jorm, Anthony F; Christensen, Helen; Broom, Dorothy H; Strazdins, Lyndall; D' Souza, Rennie M

2004-09-30

This study sought to identify the extent to which employee level and work stressors were associated with mental health problems experienced by Australian government employees, and with their use of primary care services. 806 government employees aged between 40 and 44 years were surveyed as part of an epidemiological study conducted in Australia. Data collected from participants included sociodemographic attributes, physical health, psychological measures and work stressors relating to job control, job demands, job security and skills discretion at work. For 88% of these participants, information on visits made to general practitioners (GPs) for the six months before and after their survey interview was obtained from health insurance records. When work stress and personal factors were taken into account, men at more junior levels reported better mental health, more positive affect and used fewer GP services. Women at middle-management levels obtained less GP care than their more senior counterparts. Both men and women who reported higher levels of work stress were found to have poorer mental health and well-being. The impact of such stressors on GP service use, however, differed for men and women. Measures of work stress and not employee level affect the mental health and well-being of government employees. For governments with responsibility for funding health care services, reducing work stress experienced by their own employees offers potential benefits by improving the health of their workforce and reducing outlays for such services.

Critical Care Organizations in Academic Medical Centers in North America: A Descriptive Report.

PubMed

Pastores, Stephen M; Halpern, Neil A; Oropello, John M; Kostelecky, Natalie; Kvetan, Vladimir

2015-10-01

With the exception of a few single-center descriptive reports, data on critical care organizations are relatively sparse. The objectives of our study were to determine the structure, governance, and experience to date of established critical care organizations in North American academic medical centers. A 46-item survey questionnaire was electronically distributed using Survey Monkey to the leadership of 27 identified critical care organizations in the United States and Canada between September 2014 and February 2015. A critical care organization had to be headed by a physician and have primary governance over the majority, if not all, of the ICUs in the medical center. We received 24 responses (89%). The majority of the critical care organizations (83%) were called departments, centers, systems, or operations committees. Approximately two thirds of respondents were from larger (> 500 beds) urban institutions, and nearly 80% were primary university medical centers. On average, there were six ICUs per academic medical center with a mean of four ICUs under critical care organization governance. In these ICUs, intensivists were present in-house 24/7 in 49%; advanced practice providers in 63%; hospitalists in 21%; and telemedicine coverage in 14%. Nearly 60% of respondents indicated that they had a separate hospital budget to support data management and reporting, oversight of their ICUs, and rapid response teams. The transition from the traditional model of ICUs within departmentally controlled services or divisions to a critical care organization was described as gradual in 50% and complete in only 25%. Nearly 90% indicated that their critical care organization governance structure was either moderately or highly effective; a similar number suggested that their critical care organizations were evolving with increasing domain and financial control of the ICUs at their respective institutions. Our survey of the very few critical care organizations in North American academic medical centers showed that the governance models of critical care organizations vary and continue to evolve. Additional studies are warranted to improve our understanding of the factors that can foster the growth of critical care organizations and how they can be effective.

78 FR 58861 - Presidential Determination With Respect to Foreign Governments' Efforts Regarding Trafficking in...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-25

... the United States Government; (4) has as its primary objective the improvement of Zimbabwe's legal system, including in areas that impact Zimbabwe's ability to investigate and prosecute trafficking cases...

Auditing Nicaragua's anti-corruption struggle, 1998 to 2009.

PubMed

Arosteguí, Jorge; Hernandez, Carlos; Suazo, Harold; Cárcamo, Alvaro; Reyes, Rosa Maria; Andersson, Neil; Ledogar, Robert J

2011-12-21

Four social audits in 1998, 2003, 2006 and 2009 identified actions that Nicaragua could take to reduce corruption and public perception in primary health care and other key services. In a 71-cluster sample, weighted according to the 1995 census and stratified by geographic region and settlement type, we audited the same five public services: health centres and health posts, public primary schools, municipal government, transit police and the courts. Some 6,000 households answered questions about perception and personal experience of unofficial and involuntary payments, payments without obtaining receipts or to the wrong person, and payments "to facilitate" services in municipal offices or courts. Additional questions covered complaints about corruption and confidence in the country's anti-corruption struggle. Logistic regression analyses helped clarify local variations and explanatory variables. Feedback to participants and the services at both national and local levels followed each social audit. Users' experience of corruption in health services, education and municipal government decreased. The wider population's perception of corruption in these sectors decreased also, but not as quickly. Progress among traffic police faltered between 2006 and 2009 and public perception of police corruption ticked upwards in parallel with drivers' experience. Users' experience of corruption in the courts worsened over the study period--with the possible exception of Managua between 2006 and 2009--but public perception of judicial corruption, after peaking in 2003, declined from then on. Confidence in the anti-corruption struggle grew from 50% to 60% between 2003 and 2009. Never more than 8% of respondents registered complaints about corruption.Factors associated with public perception of corruption were: personal experience of corruption, quality of the service itself, and the perception that municipal government takes community opinion into account and keeps people informed about how it uses public funds. Lowering citizens' perception of corruption in public services depends on reducing their experience of it, on improving service quality and access and--perhaps most importantly--on making citizens feel they are well-informed participants in the work of government.

40 CFR 173.3 - Initiation of rescission proceedings.

Code of Federal Regulations, 2010 CFR

2010-07-01

... PROGRAMS PROCEDURES GOVERNING THE RESCISSION OF STATE PRIMARY ENFORCEMENT RESPONSIBILITY FOR PESTICIDE USE... State having primary enforcement responsibility for pesticide use violations is not carrying out such... Administrator shall notify the State in writing of his intent to rescind its primary enforcement responsibility...

Evaluation of Risk Perception and Risk-Comparison Information Regarding Dietary Radionuclides after the 2011 Fukushima Nuclear Power Plant Accident.

PubMed

Murakami, Michio; Nakatani, Jun; Oki, Taikan

2016-01-01

In the wake of the 2011 Fukushima Daiichi Nuclear Power Station accident, to facilitate evidence-based risk communication we need to understand radiation risk perception and the effectiveness of risk-comparison information. We measured and characterized perceptions of dread risks and unknown risks regarding dietary radionuclides in residents of Fukushima, Tokyo, and Osaka to identify the primary factors among location, evacuation experience, gender, age, employment status, absence/presence of spouse, children and grandchildren, educational background, humanities/science courses, smoking habits, and various types of trustworthy information sources. We then evaluated the effects of these factors and risk-comparison information on multiple outcomes, including subjective and objective understanding, perceived magnitude of risk, perceived accuracy of information, backlash against information, and risk acceptance. We also assessed how risk-comparison information affected these multiple outcomes for people with high risk perception. Online questionnaires were completed by people (n = 9249) aged from 20 to 69 years in the three prefectures approximately 5 years after the accident. We gave each participant one of 15 combinations of numerical risk data and risk-comparison information, including information on standards, smoking-associated risk, and cancer risk, in accordance with Covello's guidelines. Dread-risk perception among Fukushima residents with no experience of evacuation was much lower than that in Osaka residents, whereas evacuees had strikingly higher dread-risk perception, irrespective of whether their evacuation had been compulsory or voluntary. We identified location (distance from the nuclear power station), evacuation experience, and trust of central government as primary factors. Location (including evacuation experience) and trust of central government were significantly associated with the multiple outcomes above. Only information on "cancer risk from radiation and smoking risk" enhanced both subjective and objective understanding without diminishing trust in all participants and in the high dread-risk perception group; use of other risk-comparison information could lead the public to overestimate risk.

Evaluation of Risk Perception and Risk-Comparison Information Regarding Dietary Radionuclides after the 2011 Fukushima Nuclear Power Plant Accident

PubMed Central

Murakami, Michio; Nakatani, Jun; Oki, Taikan

2016-01-01

In the wake of the 2011 Fukushima Daiichi Nuclear Power Station accident, to facilitate evidence-based risk communication we need to understand radiation risk perception and the effectiveness of risk-comparison information. We measured and characterized perceptions of dread risks and unknown risks regarding dietary radionuclides in residents of Fukushima, Tokyo, and Osaka to identify the primary factors among location, evacuation experience, gender, age, employment status, absence/presence of spouse, children and grandchildren, educational background, humanities/science courses, smoking habits, and various types of trustworthy information sources. We then evaluated the effects of these factors and risk-comparison information on multiple outcomes, including subjective and objective understanding, perceived magnitude of risk, perceived accuracy of information, backlash against information, and risk acceptance. We also assessed how risk-comparison information affected these multiple outcomes for people with high risk perception. Online questionnaires were completed by people (n = 9249) aged from 20 to 69 years in the three prefectures approximately 5 years after the accident. We gave each participant one of 15 combinations of numerical risk data and risk-comparison information, including information on standards, smoking-associated risk, and cancer risk, in accordance with Covello’s guidelines. Dread-risk perception among Fukushima residents with no experience of evacuation was much lower than that in Osaka residents, whereas evacuees had strikingly higher dread-risk perception, irrespective of whether their evacuation had been compulsory or voluntary. We identified location (distance from the nuclear power station), evacuation experience, and trust of central government as primary factors. Location (including evacuation experience) and trust of central government were significantly associated with the multiple outcomes above. Only information on “cancer risk from radiation and smoking risk” enhanced both subjective and objective understanding without diminishing trust in all participants and in the high dread-risk perception group; use of other risk-comparison information could lead the public to overestimate risk. PMID:27802304

Can the States Address Equity and Innovation? Rethinking the State's Fiscal Role in Public Education.

ERIC Educational Resources Information Center

Wong, Kenneth K.; Shen, Francis X.

With federal funds accounting for only 7% of public elementary and secondary education revenue, funding responsibility for K-12 education is split primarily between state and local governments. Since the 1980s, state governments have generally assumed primary fiscal responsibility, with local governments supplying the rest of the necessary…

5 CFR Appendix C to Part 2634 - Privacy Act and Paperwork Reduction Act Notices for Appendixes A and B

Code of Federal Regulations, 2013 CFR

2013-01-01

... burden, to: Deputy Director for Administration and Information Management, U.S. Office of Government... Government Ethics (OGE) require the reporting of this information for the administration of qualified trusts under the Ethics Act. The primary use of the information on this certificate is for review by Government...

5 CFR Appendix C to Part 2634 - Privacy Act and Paperwork Reduction Act Notices for Appendixes A and B

Code of Federal Regulations, 2011 CFR

2011-01-01

... burden, to: Deputy Director for Administration and Information Management, U.S. Office of Government... Government Ethics (OGE) require the reporting of this information for the administration of qualified trusts under the Ethics Act. The primary use of the information on this certificate is for review by Government...

[Professional quality of life in the clinical governance model of Asturias (Spain)].

PubMed

Díaz Corte, Carmen; Suárez Álvarez, Óscar; Fueyo Gutiérrez, Alejandra; Mola Caballero de Rodas, Pablo; Rancaño García, Iván; Sánchez Fernández, Ana María; Suárez Gutiérrez, Rebeca; Díaz Vázquez, Carlos

2013-01-01

To evaluate professional quality of life in our clinical governance model by comparing differences according to the time since the model's implementation (1-3 years) and the setting (primary or hospital care). A cross-sectional descriptive study was performed. The 35-item, anonymous, self-administered Professional Quality of Life Questionnaire, with three additional questions, was applied. A minimum sample size for each clinical governance unit/area (CGU/CGA) was calculated. Descriptive, univariate and bivariate analyses were performed using the 35 items separately. The subscales of « management support », « workload » and « intrinsic motivation » were used as dependant variables, and the setting and time since implementation of the CGU/CGA as independent variables. Of the study population of 2572 professionals, 1395 (54%) responded (67% in primary care and 51% in hospital care). A total of 87% had been working for 5 years or more in their positions. Thirty-three percent had worked for less than a year in clinical governance. The item with the highest score was job training (8.39 ± 1.42) and that with the lowest was conflicts with peers (3.23 ± 2.2). Primary healthcare professionals showed better results in management support and quality of life at work and hospital professionals in workload. The clinical governance model obtained the best scores at 3 years and the worst at 1 year. These differences were especially favorable for clinical governance in hospitals: professionals working longer perceived a lower workload and more intrinsic motivation and quality of life. A longer time working in the clinical governance model was associated with better perception of professional quality of life, especially in hospital care. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

Implementing new care models: learning from the Greater Manchester demonstrator pilot experience.

PubMed

Elvey, Rebecca; Bailey, Simon; Checkland, Kath; McBride, Anne; Parkin, Stephen; Rothwell, Katy; Hodgson, Damian

2018-06-19

Current health policy focuses on improving accessibility, increasing integration and shifting resources from hospitals to community and primary care. Initiatives aimed at achieving these policy aims have supported the implementation of various 'new models of care', including general practice offering 'additional availability' appointments during evenings and at weekends. In Greater Manchester, six 'demonstrator sites' were funded: four sites delivered additional availability appointments, other services included case management and rapid response. The aim of this paper is to explore the factors influencing the implementation of services within a programme designed to improve access to primary care. The paper consists of a qualitative process evaluation undertaken within provider organisations, including general practices, hospitals and care homes. Semi-structured interviews, with the data subjected to thematic analysis. Ninety-one people participated in interviews. Six key factors were identified as important for the establishment and running of the demonstrators: information technology; information governance; workforce and organisational development; communications and engagement; supporting infrastructure; federations and alliances. These factors brought to light challenges in the attempt to provide new or modify existing services. Underpinning all factors was the issue of trust; there was consensus amongst our participants that trusting relationships, particularly between general practices, were vital for collaboration. It was also crucial that general practices trusted in the integrity of anyone external who was to work with the practice, particularly if they were to access data on the practice computer system. A dialogical approach was required, which enabled staff to see themselves as active rather than passive participants. The research highlights various challenges presented by the context within which extended access is implemented. Trust was the fundamental underlying issue; there was consensus amongst participants that trusting relationships were vital for effective collaboration in primary care.

The social problems and strategies of the government GIS in China

NASA Astrophysics Data System (ADS)

Chen, Nan; Fu, Zhongliang

2007-06-01

GIS has wider and wider applications. The application in the field of administrative management and assistant decision-making have formed a specific research area--the government GIS. As an information industry with great sociality, GIS and its development are influenced by many technical factors and social factors. As for the government GIS in China, the social factors often play a more important role in it. A description of the current development status of the government GIS, both in China and abroad, was made in this paper. After the description, researchers pointed out the deficiency of Chinese government GIS. On the basis of this, the rational suggestion of government GIS in China were put forward at last.

The service industry strategy-A case study of tourism hotel in Taiwan

NASA Astrophysics Data System (ADS)

Lu, Chunwei; Huang, Jui-Chan; Wen, Hao-Ming; Hairui, Ji

2017-06-01

Regarding to raising living standard in Taiwan, service industry had stand more than 65% GDP and manufacturing is around 35% recently. The data from Council for Economic Planning and Development of Taiwan, in 2015, the service industry stand more than 73% of GDP, and the tourism industry has played one of the most important rules. In service industry, recently, the policy of Taiwan government encourages overseas tourists come to Taiwan for resort and it made many new tourism hotels built, and they also had to do the overall reform to satisfy their customers of global, especially respecting on Eastern Asia. In this study, experts and scholars in the fields of industry academia were interviewed. Survey were issued to the object companies and a comparative case study was conducted to analyze the influencing factors and extent to which differences on the competitive edge and strategies of Taiwan tourism hotels and those which benefit most or least from business operation current situation that conducted with governments' support and internal management. By primary data and literature reviews, this study hope that an effective reference for improving industrial competitiveness and models of competitiveness could be available for the governments and the companies.

The Usage of E-Governance Applications by Higher Education Students

ERIC Educational Resources Information Center

Öktem, M. Kemal; Demirhan, Kamil; Demirhan, Haydar

2014-01-01

This study aims to analyze the factors affecting the Internet usage of university students using e-governance applications. It is important to examine these factors to understand why the online citizen participation is not increasing as expected, while Information and Communication Technologies (ICT) usage is improving in governance. Governance is…

Brazilian multicentre study of common mental disorders in primary care: rates and related social and demographic factors.

PubMed

Gonçalves, Daniel Almeida; Mari, Jair de Jesus; Bower, Peter; Gask, Linda; Dowrick, Christopher; Tófoli, Luis Fernando; Campos, Monica; Portugal, Flávia Batista; Ballester, Dinarte; Fortes, Sandra

2014-03-01

Mental health problems are common in primary health care, particularly anxiety and depression. This study aims to estimate the prevalence of common mental disorders and their associations with socio-demographic characteristics in primary care in Brazil (Family Health Strategy). It involved a multicenter cross-sectional study with patients from Rio de Janeiro, São Paulo, Fortaleza (Ceará State) and Porto Alegre (Rio Grande do Sul State), assessed using the General Health Questionnaire (GHQ-12) and the Hospital Anxiety and Depression Scale (HAD). The rate of mental disorders in patients from Rio de Janeiro, São Paulo, Fortaleza and Porto Alegre were found to be, respectively, 51.9%, 53.3%, 64.3% and 57.7% with significant differences between Porto Alegre and Fortaleza compared to Rio de Janeiro after adjusting for confounders. Prevalence proportions of mental problems were especially common for females, the unemployed, those with less education and those with lower incomes. In the context of the Brazilian government's moves towards developing primary health care and reorganizing mental health policies it is relevant to consider common mental disorders as a priority alongside other chronic health conditions.

Governance matters: an ecological association between governance and child mortality

PubMed Central

Lin, Ro-Ting; Chien, Lung-Chang; Chen, Ya-Mei; Chan, Chang-Chuan

2014-01-01

Background Governance of a country may have widespread effects on the health of its population, yet little is known about the effect of governance on child mortality in a country that is undergoing urbanization, economic development, and disease control. Methods We obtained indicators of six dimensions of governance (perceptions of voice and accountability, political stability and absence of violence, government effectiveness, regulatory quality, rule of law, and control of corruption) and national under-5 mortality rates for 149 countries between 1996 and 2010. We applied a semi-parametric generalized additive mixed model to examine associations after controlling for the effects of development factors (urbanization level and economy), disease control factors (hygienic conditions and vaccination rates), health expenditures, air quality, and time. Results Governance, development, and disease control showed clear inverse relations with the under-5 mortality rate (p<0.001). Per unit increases in governance, development, and disease control factors, the child mortality rate had a 0.901-, 0.823-, and 0.922-fold decrease, respectively, at fixed levels of the other two factors. Conclusions In the effort to reduce the global under-5 mortality rate, addressing a country's need for better governance is as important as improvements in development and disease control. PMID:24711600

Early childhood development in deprived urban settlements.

PubMed

Nair, M K C; Radhakrishnan, S Rekha

2004-03-01

Poverty, the root cause of the existence of slums or settlement colonies in urban areas has a great impact on almost all aspects of life of the urban poor, especially the all-round development of children. Examples from countries, across the globe provide evidence of improved early child development, made possible through integrated slum improvement programs, are few in numbers. The observed 2.5% prevalence of developmental delay in the less than 2 year olds of deprived urban settlements, the presence of risk factors for developmental delay like low birth weight, birth asphyxia, coupled with poor environment of home and alternate child care services, highlights the need for simple cost effective community model for promoting early child development. This review on early child development focuses on the developmental status of children in the deprived urban settlements, who are yet to be on the priority list of Governments and international agencies working for the welfare of children, the contributory nature-nurture factors and replicable working models like infant stimulation, early detection of developmental delay in infancy itself, developmental screening of toddlers, skill assessment for preschool children, school readiness programs, identification of mental sub-normality and primary education enhancement program for primary school children. Further, the review probes feasible intervention strategies through community owned early child care and development facilities, utilizing existing programs like ICDS, Urban Basic Services and by initiating services like Development Friendly Well Baby Clinics, Community Extension services, Child Development Referral Units at district hospitals and involving trained manpower like anganwadi/creche workers, public health nurses and developmental therapists. With the decentralization process the local self-government at municipalities and city corporations are financially equipped to be the prime movers to initiate, monitor and promote early child development programs, to emerge as a part and parcel of community owned sustainable development process.

Evaluating the interior thermal performance of mosques in the tropical environment

NASA Astrophysics Data System (ADS)

Nordin, N. I.; Misni, A.

2018-02-01

This study introduces the methodology applied in conducting data collection and data analysis. Data collection is the process of gathering and measuring information on targeted variables in an established systematic method. Qualitative and quantitative methods are combined in collecting data from government departments, site experiments and observation. Furthermore, analysing the indoor thermal performance data in the heritage and new mosques were used thermal monitoring tests, while validation will be made by meteorology data. Origin 8 version of the software is used to analyse all the data. Comparison techniques were applied to analyse several factors that influence the indoor thermal performance of mosques, namely building envelope include floor area, opening, and material used. Building orientation, location, surrounding vegetation and water elements are also recorded as supported building primary data. The comparison of primary data using these variables for four mosques include heritage and new buildings were revealed.

Rethinking the model of osteoarthritis: a clinical viewpoint.

PubMed

Wade, Greg J

2011-11-01

The prevailing model of joint degeneration based on age-related, genetic, and familial factors implies inevitable progression and limited palliation from manual therapy. This model is presented to primary care physicians and the public on Web sites and in resource texts and is implicit in many published research articles. The author presents a synthesized model of the progression of osteoarthritis, combining radiographic, histologic, and clinical evidence. The revised model suggests that the progression of primary osteoarthritis is divided into an initial reversible arthrosis phase and a later arthritis phase, with both phases linked to accepted histologic and radiographic observations. The revised model also suggests a number of novel concepts, including the influence of dominance bias and laterality. The author concludes that a small change in understanding could translate into important changes in the therapeutic management of osteoarthritis, with implications for government public health policy.

Does Teaching English in Saudi Primary Schools Affect Students' Academic Achievement in Arabic Subjects?

ERIC Educational Resources Information Center

Aljohani, Othman

2016-01-01

The global trend of introducing second language learning, namely, English, in primary schools is increasing. In Saudi Arabia, where English has never been taught in primary schools, the government to implement English as a second language at the primary level in 2005; however, this generated controversy. Opposition to the learning of English has…

Large Reductions In Amenable Mortality Associated With Brazil's Primary Care Expansion And Strong Health Governance.

PubMed

Hone, Thomas; Rasella, Davide; Barreto, Mauricio; Atun, Rifat; Majeed, Azeem; Millett, Christopher

2017-01-01

Strong health governance is key to universal health coverage. However, the relationship between governance and health system performance is underexplored. We investigated whether expansion of the Brazilian Estratégia de Saúde da Família (ESF; family health strategy), a community-based primary care program, reduced amenable mortality (mortality avoidable with timely and effective health care) and whether this association varied by municipal health governance. Fixed-effects longitudinal regression models were used to identify the relationship between ESF coverage and amenable mortality rates in 1,622 municipalities in Brazil over the period 2000-12. Municipal health governance was measured using indicators from a public administration survey, and the resulting scores were used in interactions. Overall, increasing ESF coverage from 0 percent to 100 percent was associated with a reduction of 6.8 percent in rates of amenable mortality, compared with no increase in ESF coverage. The reductions were 11.0 percent for municipalities with the highest governance scores and 4.3 percent for those with the lowest scores. These findings suggest that strengthening local health governance may be vital for improving health services effectiveness and health outcomes in decentralized health systems. Project HOPE—The People-to-People Health Foundation, Inc.

Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan

PubMed Central

Shah, Sayed Masoom; Zaidi, Shehla; Ahmed, Jamil; Rehman, Shafiq Ur

2016-01-01

Background: Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan’s health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan. Methods: An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental factors. Qualitative research methods comprising of semi-structured interviews with doctors working in basic health units (BHUs) and in-depth interviews with district and provincial government health managers were used. Document review of postings, rules of business and policy actions was also conducted. Triangulation of findings was carried out to arrive at the final synthesis. Results: Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies and medical facilities contributed to lack of motivation among both male and female doctors. The physicians accepted government jobs in BHUs with a belief that these jobs were more secure, with convenient working hours. Male physicians seemed to be more motivated because they faced less challenges than their female counterparts in BHUs especially during relocations. Overall, the organizational factors emerged as the most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits played an important role. Gender and marital status of female doctors was regarded as most important individual factor affecting retention and motivation of female doctors in BHUs. Conclusion: Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies, and medical facilities contributed to lack of motivation in physicians in our study. Our study advocates that by addressing the retention and motivation challenges, service delivery can be made more responsive to the patients and communities in Pakistan and other similar settings. PMID:27694660

Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan.

PubMed

Shah, Sayed Masoom; Zaidi, Shehla; Ahmed, Jamil; Rehman, Shafiq Ur

2016-04-09

Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan's health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan. An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental factors. Qualitative research methods comprising of semi-structured interviews with doctors working in basic health units (BHUs) and in-depth interviews with district and provincial government health managers were used. Document review of postings, rules of business and policy actions was also conducted. Triangulation of findings was carried out to arrive at the final synthesis. Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies and medical facilities contributed to lack of motivation among both male and female doctors. The physicians accepted government jobs in BHUs with a belief that these jobs were more secure, with convenient working hours. Male physicians seemed to be more motivated because they faced less challenges than their female counterparts in BHUs especially during relocations. Overall, the organizational factors emerged as the most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits played an important role. Gender and marital status of female doctors was regarded as most important individual factor affecting retention and motivation of female doctors in BHUs. Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies, and medical facilities contributed to lack of motivation in physicians in our study. Our study advocates that by addressing the retention and motivation challenges, service delivery can be made more responsive to the patients and communities in Pakistan and other similar settings. © 2016 by Kerman University of Medical Sciences

Instrumentation Failure after Partial Corpectomy with Instrumentation of a Metastatic Spine

PubMed Central

Park, Sung Bae; Kim, Ki Jeong; Han, Sanghyun; Oh, Sohee; Kim, Chi Heon; Chung, Chun Kee

2018-01-01

Objective To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis. Methods We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest. Results There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure (p=0.049 and 0.050, respectively). Conclusion When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion. PMID:29631384

Instrumentation Failure after Partial Corpectomy with Instrumentation of a Metastatic Spine.

PubMed

Park, Sung Bae; Kim, Ki Jeong; Han, Sanghyun; Oh, Sohee; Kim, Chi Heon; Chung, Chun Kee

2018-05-01

To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis. We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest. There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure ( p =0.049 and 0.050, respectively). When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion.

How is Primary Health Care conceptualised in nursing in Australia? A review of the literature.

PubMed

Henderson, Julie; Koehne, Kristy; Verrall, Claire; Gebbie, Kristine; Fuller, Jeffrey

2014-07-01

Australia, in common with many other countries, is expanding the role of Primary Health Care (PHC) to manage the growing burden of chronic disease and prevent hospitalisation. Australia's First National Primary Health Care Strategy released in 2010 places general practice at the centre of care delivery, reflecting a constitutional division of labour in which the Commonwealth government's primary means of affecting care delivery in this sector is through rebates for services delivered from the universal healthcare system Medicare. A review of Australian nursing literature was undertaken for 2006-2011. This review explores three issues in relation to these changes: How PHC is conceptualised within Australian nursing literature; who is viewed as providing PHC; and barriers and enablers to the provision of comprehensive PHC. A review of the literature suggests that the terms 'PHC' and 'primary care' are used interchangeably and that PHC is now commonly associated with services provided by practice nurses. Four structural factors are identified for a shift away from comprehensive PHC, namely fiscal barriers, educational preparation for primary care practice, poor role definition and interprofessional relationships. The paper concludes that while moves towards increasing capacity in general practice have enhanced nursing roles, current policy and the nature of private business funding alongside some medical opposition limit opportunities for Australian nurses working in general practice. © 2013 John Wiley & Sons Ltd.

Policy Levers Key for Primary Health Care Organizations to Support Primary Care Practices in Meeting Medical Home Expectations: Comparing Leading States to the Australian Experience.

PubMed

Takach, Mary

2016-10-01

Several countries with highly ranked delivery systems have implemented locally-based, publicly-funded primary health care organizations (PHCOs) as vehicles to strengthen their primary care foundations. In the United States, state governments have started down a similar pathway with models that share similarities with international PHCOs. The objective of this study was to determine if these kinds of organizations were working with primary care practices to improve their ability to provide comprehensive, coordinated, and accessible patient-centered care that met quality, safety, and efficiency outcomes-all core attributes of a medical home. This qualitative study looked at 4 different PHCO models-3 from the United States and 1 from Australia-with similar objectives and scope. Primary and secondary data included semi-structured interviews with 26 PHCOs and a review of government documents. The study found that the 4 PHCO models were engaging practices to meet a number of medical home expectations, but the US PHCOs were more uniform in efforts to work with practices and focused on arranging services to meet the needs of complex patients. There was significant variation in level of effort between the Australian PHCOs. These differences can be explained through the state governments' selection of payment models and use of data frameworks to support collaboration and incentivize performance of both PHCOs and practices. These findings offer policy lessons to inform health reform efforts under way to better capitalize on the potential of PHCOs to support a high-functioning primary health foundation as an essential component to a reformed health system.

A Comparative Evaluation of Public Health Centers with Private Health Training Centers on Primary Healthcare Parameters in India: a Study by Data Envelopment Analysis Technique

PubMed Central

Davey, Sanjeev; Raghav, Santosh Kumar; Singh, Jai Vir; Davey, Anuradha; Singh, Nirankar

2015-01-01

Background: The evaluation of primary healthcare services provided by health training centers of a private medical college has not been studied in comparison with government health facilities in Indian context. Data envelopment analysis (DEA) is one such technique of operations research, which can be used on health facilities for identifying efficient operating practices and strategies for relatively efficient or inefficient health centers by calculating their efficiency scores. Materials and Methods: This study was carried out by DEA technique by using basic radial models (constant ratio to scale (CRS)) in linear programming via DEAOS free online Software among four decision making units (DMUs; by comparing efficiency of two private health centers of a private medical college of India with two public health centers) in district Muzaffarnagar of state Uttar Pradesh. The input and output records of all these health facilities (two from private and two from Government); for 6 months duration from 1st Jan 2014 to 1st July 2014 was taken for deciding their efficiency scores. Results: The efficiency scores of primary healthcare services in presence of doctors (100 vs 30%) and presence of health staff (100 vs 92%) were significantly better from government health facilities as compared to private health facilities (P < 0.0001). Conclusions: The evaluation of primary healthcare services delivery by DEA technique reveals that the government health facilities group were more efficient in delivery of primary healthcare services as compared to private training health facilities group, which can be further clarified in by more in-depth studies in future. PMID:26435598

Identifying challenges and barriers in the delivery of primary healthcare at the district level: a study in one Thai province.

PubMed

Tejativaddhana, Phudit; Briggs, David; Fraser, John; Minichiello, Victor; Cruickshank, Mary

2013-01-01

In 2001, the universal health coverage policy was adopted by Thailand with primary healthcare (PHC) as the major focus of the policy. In order to understand the structural and institutional factors affecting the implementation of PHC in rural Thailand, a qualitative study, utilising individual interviews with national and provincial policy decision makers, community health directors, heads of hospital primary care units, chiefs of district health offices, heads of health centres and community representatives, from one rural province was undertaken. Findings showed that the sustainability of PHC service provision under the administration of community hospitals is problematic as barriers exist at the policy and operational levels and access to PHC for all citizens may not be achieved until these barriers are addressed. Furthermore, although PHC needs to be acknowledged and implemented by all stakeholders within the health industry and government, the roles and responsibilities of the stakeholders in health services management at the district level need to be clarified. Copyright © 2012 John Wiley & Sons, Ltd.

Primary Health Care Reform in the cities of Lisbon and Rio de Janeiro: context, strategies, results, learning and challenges.

PubMed

Soranz, Daniel; Pisco, Luís Augusto Coelho

2017-03-01

On the 30th anniversary of Alma-Ata, the World Health Organization published in 2008 the "Primary Health Care Now More Than Ever" Report, calling on all governments to reflect on the need to reflect on four sets of reforms. These included: (i) universal coverage reforms; (ii) service delivery reforms; (iii) public policies reforms that would ensure healthier communities; and (iv) leadership reforms. In this context, in the period 2005-2016, the cities of Rio de Janeiro and Lisbon developed a profound primary healthcare reform, and did so by sharing many of the solutions based on the best internationally recognized organizational practices. Several factors were fundamental throughout Lisbon and Rio de Janeiro's path of reforms, namely: (i) teamwork with professional motivation; (ii) internal and external communication; (iii) strengthening of training activities; (iv) investment in facilities and equipment; (v) commitment to the information system and computerization; (vi) pay-for-performance; (vii) health care contractualisation between funders and providers; (viii) technical leadership; (ix) political leadership; and finally (x) quality and accreditation of facilities by public agency.

[Governance in a project addressing care of disabled elderly persons within the regional healthcare system of Tuscany, Italy].

PubMed

Pedace, Claudio; Rosa, Antonella; Francesconi, Paolo; Acampora, Anna; Ricciardi, Walter; Damiani, Gianfranco

2017-01-01

Population aging and the concurrent increase of age-related chronic degenerative diseases and disability are associated with an increased proportion of elderly persons who are dependent in activities of daily living (ADL). ADL-dependent persons need continuous and long-term health and social care according to the "taking charge" rationale, in order to warrant access and continuity of care. A healthcare system needs to respond to the long-term and complex needs, such as those of disabled elderly people, by providing appropriate health and social care services in Primary Care. A Primary Health Care system is organized according to two governance levels have distinct aims but are closely inter-dependent in their operational mechanisms. The system governance is accountable for the community and individual health protection while the delivery governance is accountable for the provision of services in accordance with appropriateness, safety and economic criteria. Delivery governance can be considered "integrated governance" as a synergy exists between two decision-making systems guiding provider choices, which are corporate governance and clinical governance. The aim of this study was to analyse the abovementioned governance levels within the healthcare system in Tuscany (Italy) referring to long-term residential care for disabled elderly people. The case of excessive accesses to emergency departments from different types of Nursing Homes (NH) is used as an example to analyse different levels of responsibility involved in the management of a critical phenomenon. Suggestions for improvement in the different levels of governance for disabled elderly people are provided, in order to support institutional programming activities.

Hope or Despair? Learning in Pakistan's Primary Schools.

ERIC Educational Resources Information Center

Warwick, Donald P.; Reimers, Fernando

This book reports on the research findings of the Pakistan Study, a collaboration between the Harvard Institute for International Development and other organizations in Pakistan. The focus is primarily on what affects student learning in Pakistan's government-sponsored primary schools. Chapter 1 discusses primary schools in Pakistan and the…

All in a Day's Work: Primary Teachers "Performing" and "Caring"

ERIC Educational Resources Information Center

Forrester, Gillian

2005-01-01

This article discusses the current nature of primary teachers' work, which is explored in terms of "performing" and "caring" activities. It considers how the education policies of successive Governments in the UK, particularly for England, have given rise to a "performance culture" in primary schools which emphasises…

Establishing a faith-based organisation nursing school within a national primary health care programme in rural Tanzania: an auto-ethnographic case study.

PubMed

Bischoff, Alexander

2016-01-01

In 2007, the Tanzanian government called for improvements in its primary health care services. Part of this initiative was to accelerate the training rate for nurses qualified to work in rural areas. The aim of this study was to reflect on the issues experienced whilst establishing and implementing a faith-based organisation (FBO) nursing school and make recommendations for other similar initiatives. This paper describes an auto-ethnographic case study design to identify the key difficulties involved with establishing and implementing a new nursing school, and which factors helped the project achieve its goals. Six themes emerged from the experiences that shaped the course of the project: 1) Motivation can be sustained if the rationale of the project is in line with its aims. Indeed, the project's primary health care focus was to strengthen the nursing workforce and build a public-private partnership with an FBO. All these were strengths, which helped in the midst of all the uncertainties. 2) Communication was an important and often underrated factor for all types of development projects. 3) Managing the unknown and 4) managing expectations characterised the project inception. Almost all themes had to do with 5) handling conflicts. With so many participants having their own agendas, tensions were unavoidable. A final theme was 6) the need to adjust to ever-changing targets. This retrospective auto-ethnographic manuscript serves as a small-scale case study, to illustrate how issues that can be generalised to other settings can be deconstructed to demonstrate how they influence health development projects in developing countries. From this narrative of experiences, key recommendations include the following: 1) Find the right ratio of stakeholders, participants, and agendas, and do not overload the project; 2) Be alert and communicate as much as possible with staff and do not ignore issues hoping they will solve themselves; 3) Think flexibly and do not stubbornly stick to original plans that might not be working; 4) Be realistic and do not romanticise. Embarking on such a project was a timely response to the Tanzanian's government call for strengthening Primary Health Care and for rapidly accelerating the training of nurses able to work in rural areas.

Establishing a faith-based organisation nursing school within a national primary health care programme in rural Tanzania: an auto-ethnographic case study

PubMed Central

Bischoff, Alexander

2016-01-01

Background In 2007, the Tanzanian government called for improvements in its primary health care services. Part of this initiative was to accelerate the training rate for nurses qualified to work in rural areas. The aim of this study was to reflect on the issues experienced whilst establishing and implementing a faith-based organisation (FBO) nursing school and make recommendations for other similar initiatives. Design This paper describes an auto-ethnographic case study design to identify the key difficulties involved with establishing and implementing a new nursing school, and which factors helped the project achieve its goals. Results Six themes emerged from the experiences that shaped the course of the project: 1) Motivation can be sustained if the rationale of the project is in line with its aims. Indeed, the project's primary health care focus was to strengthen the nursing workforce and build a public–private partnership with an FBO. All these were strengths, which helped in the midst of all the uncertainties. 2) Communication was an important and often underrated factor for all types of development projects. 3) Managing the unknown and 4) managing expectations characterised the project inception. Almost all themes had to do with 5) handling conflicts. With so many participants having their own agendas, tensions were unavoidable. A final theme was 6) the need to adjust to ever-changing targets. Conclusions This retrospective auto-ethnographic manuscript serves as a small-scale case study, to illustrate how issues that can be generalised to other settings can be deconstructed to demonstrate how they influence health development projects in developing countries. From this narrative of experiences, key recommendations include the following: 1) Find the right ratio of stakeholders, participants, and agendas, and do not overload the project; 2) Be alert and communicate as much as possible with staff and do not ignore issues hoping they will solve themselves; 3) Think flexibly and do not stubbornly stick to original plans that might not be working; 4) Be realistic and do not romanticise. Embarking on such a project was a timely response to the Tanzanian's government call for strengthening Primary Health Care and for rapidly accelerating the training of nurses able to work in rural areas. PMID:27238652

How decentralisation influences the retention of primary health care workers in rural Nigeria.

PubMed

Abimbola, Seye; Olanipekun, Titilope; Igbokwe, Uchenna; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra; Ihebuzor, Nnenna; Aina, Muyi

2015-01-01

In Nigeria, the shortage of health workers is worst at the primary health care (PHC) level, especially in rural communities. And the responsibility for PHC - usually the only form of formal health service available in rural communities - is shared among the three tiers of government (federal, state, and local governments). In addition, the responsibility for community engagement in PHC is delegated to community health committees. This study examines how the decentralisation of health system governance influences retention of health workers in rural communities in Nigeria from the perspective of health managers, health workers, and people living in rural communities. The study adopted a qualitative approach, and data were collected using semi-structured in-depth interviews and focus group discussions. The multi-stakeholder data were analysed for themes related to health system decentralisation. The results showed that decentralisation influences the retention of rural health workers in two ways: 1) The salary of PHC workers is often delayed and irregular as a result of delays in transfer of funds from the national to sub-national governments and because one tier of government can blame failure on another tier of government. Further, the primary responsibility for PHC is often left to the weakest tier of government (local governments). And the result is that rural PHC workers are attracted to working at levels of care where salaries are higher and more regular - in secondary care (run by state governments) and tertiary care (run by the federal government), which are also usually in urban areas. 2) Through community health committees, rural communities influence the retention of health workers by working to increase the uptake of PHC services. Community efforts to retain health workers also include providing social, financial, and accommodation support to health workers. To encourage health workers to stay, communities also take the initiative to co-finance and co-manage PHC services in order to ensure that PHC facilities are functional. In Nigeria and other low- and middle-income countries with decentralised health systems, intervention to increase the retention of health workers in rural communities should seek to reform and strengthen governance mechanisms, using both top-down and bottom-up strategies to improve the remuneration and support for health workers in rural communities.

How decentralisation influences the retention of primary health care workers in rural Nigeria

PubMed Central

Abimbola, Seye; Olanipekun, Titilope; Igbokwe, Uchenna; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra; Ihebuzor, Nnenna; Aina, Muyi

2015-01-01

Background In Nigeria, the shortage of health workers is worst at the primary health care (PHC) level, especially in rural communities. And the responsibility for PHC – usually the only form of formal health service available in rural communities – is shared among the three tiers of government (federal, state, and local governments). In addition, the responsibility for community engagement in PHC is delegated to community health committees. Objective This study examines how the decentralisation of health system governance influences retention of health workers in rural communities in Nigeria from the perspective of health managers, health workers, and people living in rural communities. Design The study adopted a qualitative approach, and data were collected using semi-structured in-depth interviews and focus group discussions. The multi-stakeholder data were analysed for themes related to health system decentralisation. Results The results showed that decentralisation influences the retention of rural health workers in two ways: 1) The salary of PHC workers is often delayed and irregular as a result of delays in transfer of funds from the national to sub-national governments and because one tier of government can blame failure on another tier of government. Further, the primary responsibility for PHC is often left to the weakest tier of government (local governments). And the result is that rural PHC workers are attracted to working at levels of care where salaries are higher and more regular – in secondary care (run by state governments) and tertiary care (run by the federal government), which are also usually in urban areas. 2) Through community health committees, rural communities influence the retention of health workers by working to increase the uptake of PHC services. Community efforts to retain health workers also include providing social, financial, and accommodation support to health workers. To encourage health workers to stay, communities also take the initiative to co-finance and co-manage PHC services in order to ensure that PHC facilities are functional. Conclusions In Nigeria and other low- and middle-income countries with decentralised health systems, intervention to increase the retention of health workers in rural communities should seek to reform and strengthen governance mechanisms, using both top-down and bottom-up strategies to improve the remuneration and support for health workers in rural communities. PMID:25739967

Governance matters: an ecological association between governance and child mortality.

PubMed

Lin, Ro-Ting; Chien, Lung-Chang; Chen, Ya-Mei; Chan, Chang-Chuan

2014-09-01

Governance of a country may have widespread effects on the health of its population, yet little is known about the effect of governance on child mortality in a country that is undergoing urbanization, economic development, and disease control. We obtained indicators of six dimensions of governance (perceptions of voice and accountability, political stability and absence of violence, government effectiveness, regulatory quality, rule of law, and control of corruption) and national under-5 mortality rates for 149 countries between 1996 and 2010. We applied a semi-parametric generalized additive mixed model to examine associations after controlling for the effects of development factors (urbanization level and economy), disease control factors (hygienic conditions and vaccination rates), health expenditures, air quality, and time. Governance, development, and disease control showed clear inverse relations with the under-5 mortality rate (p<0.001). Per unit increases in governance, development, and disease control factors, the child mortality rate had a 0.901-, 0.823-, and 0.922-fold decrease, respectively, at fixed levels of the other two factors. In the effort to reduce the global under-5 mortality rate, addressing a country's need for better governance is as important as improvements in development and disease control. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Armed Services Board of Contract Appeals: Analysis of Sustained Decisions on DoD Supply Contract Disputes.

DTIC Science & Technology

1986-12-01

Contract Law are the primary sources of policy and interpretation, since these are the informa- tion sources relied upon by field contracting officers, in...FAR is the governing regulation of the Government [Ref. 13:pp. 1106-7]. In no other area of contract law has one party been given such complete...Washington: Government Printing Office, April 1984. 4. Mahoy, J.O., Government Contract Law , 6th ed., Gunter Air Force Station AL, Extension Course Institute

Structural Insights into the Mechanisms of Antibody-Mediated Neutralization of Flavivirus Infection: Implications for Vaccine Development

PubMed Central

Pierson, Theodore C.; Fremont, Daved H.; Kuhn, Richard J.; Diamond, Michael S.

2009-01-01

Flaviviruses are a group of small RNA viruses that cause severe disease in humans worldwide and are the target of several vaccine development programs. A primary goal of these efforts is to elicit a protective humoral response directed against the envelope proteins arrayed on the surface of the flavivirus virion. Advances in the structural biology of these viruses has catalyzed rapid progress toward understanding the complexity of the flavivirus immunogen and the molecular basis of antibody-mediated neutralization. These insights have identified factors that govern the potency of neutralizing antibodies and will inform the design and evaluation of novel vaccines. PMID:18779049

Dynamic Analysis of Darrieus Vertical Axis Wind Turbine Rotors

NASA Technical Reports Server (NTRS)

Lobitz, D. W.

1981-01-01

The dynamic response characteristics of the vertical axis wind turbine (VAWT) rotor are important factors governing the safety and fatigue life of VAWT systems. The principal problems are the determination of critical rotor speeds (resonances) and the assessment of forced vibration response amplitudes. The solution to these problems is complicated by centrifugal and Coriolis effects which can have substantial influence on rotor resonant frequencies and mode shapes. The primary tools now in use for rotor analysis are described and discussed. These tools include a lumped spring mass model (VAWTDYN) and also finite-element based approaches. The accuracy and completeness of current capabilities are also discussed.

Analysis of government investment in primary healthcare institutions to promote equity during the three-year health reform program in China.

PubMed

Zhang, Xiaopeng; Xiong, Yuqi; Ye, Jing; Deng, Zhaohua; Zhang, Xinping

2013-03-25

The World Health Report 2000 stated that increased public financing for healthcare was an integral part of the efforts to achieve equity of access. In 2009, the Chinese government launched a three-year health reform program to achieve equity of access. Through this reform program, the government intended to increase its investment in primary healthcare institutions (PHIs). However, reports about the outcome and the improvement of the equity of access have yet to be presented. Stratified sampling was employed in this research. The samples used for the study comprised 34 community health service centers (CHSCs) and 92 township hospitals (THs) from six provinces of China. Collected data, which were publicly available, consisted of the total revenue, financial revenue, and the number of people for the periods covering January 2010 to September 2010 and January 2011 to September 2011. Revenue information for 2009 and 2010 was obtained from China's Health Statistics Yearbook.By using indicators such as government investment, government finance proportion and per capita revenue, t-tests for paired and independent samples were used to analyze the changes in government investment. Government invest large amount of money to the primary healthcare institutions. Government finance proportion in 2008 was 18.2%. This percentage increased to 38.84% in 2011, indicating statistical significance (p = 0.000) between 2010 and 2011. The per capita financial input was 20.92 yuan in 2010 and 31.10 yuan in 2011. Compared with the figures from 2008 to 2010, the gap in different health sectors narrowed in 2011, and differences emerged. The government finance proportion in CHSCs revenue was 6.9% higher than that of THs, while the per capita revenue of CHSCs was higher. In 2011, the highest and lowest government finance proportions were 48.80% (Shaanxi) and 19.36% (Shandong), respectively. In that same year, the per capita revenue of Shaanxi (40.69 Yuan) was higher than that of Liaoning (28.79 Yuan). Comparing the 2011 figures with those from 2008 to 2010, the gap in 2011 clearly narrowed. In the three-year health reform program, the Chinese government increased its investment to PHIs gradually and significantly. Thus promote equity to access and universal coverage. However, the increase in government investment stemmed from political desire and from the lack of institutionalization of practice and experience. Hence, a mode of financial allocation must be formulated to promote consistency in government input after the three-year health reform program.

Analysis of government investment in primary healthcare institutions to promote equity during the three-year health reform program in China

PubMed Central

2013-01-01

Background The World Health Report 2000 stated that increased public financing for healthcare was an integral part of the efforts to achieve equity of access. In 2009, the Chinese government launched a three-year health reform program to achieve equity of access. Through this reform program, the government intended to increase its investment in primary healthcare institutions (PHIs). However, reports about the outcome and the improvement of the equity of access have yet to be presented. Methods Stratified sampling was employed in this research. The samples used for the study comprised 34 community health service centers (CHSCs) and 92 township hospitals (THs) from six provinces of China. Collected data, which were publicly available, consisted of the total revenue, financial revenue, and the number of people for the periods covering January 2010 to September 2010 and January 2011 to September 2011. Revenue information for 2009 and 2010 was obtained from China’s Health Statistics Yearbook. By using indicators such as government investment, government finance proportion and per capita revenue, t-tests for paired and independent samples were used to analyze the changes in government investment. Results Government invest large amount of money to the primary healthcare institutions. Government finance proportion in 2008 was 18.2%. This percentage increased to 38.84% in 2011, indicating statistical significance (p = 0.000) between 2010 and 2011. The per capita financial input was 20.92 yuan in 2010 and 31.10 yuan in 2011. Compared with the figures from 2008 to 2010, the gap in different health sectors narrowed in 2011, and differences emerged. The government finance proportion in CHSCs revenue was 6.9% higher than that of THs, while the per capita revenue of CHSCs was higher. In 2011, the highest and lowest government finance proportions were 48.80% (Shaanxi) and 19.36% (Shandong), respectively. In that same year, the per capita revenue of Shaanxi (40.69 Yuan) was higher than that of Liaoning (28.79 Yuan). Comparing the 2011 figures with those from 2008 to 2010, the gap in 2011 clearly narrowed. Conclusion In the three-year health reform program, the Chinese government increased its investment to PHIs gradually and significantly. Thus promote equity to access and universal coverage. However, the increase in government investment stemmed from political desire and from the lack of institutionalization of practice and experience. Hence, a mode of financial allocation must be formulated to promote consistency in government input after the three-year health reform program. PMID:23530658

Third sector primary care for vulnerable populations.

PubMed

Crampton, P; Dowell, A; Woodward, A

2001-12-01

This paper aims to describe and explain the development of third sector primary care organisations in New Zealand. The third sector is the non-government, non-profit sector. International literature suggests that this sector fulfils an important role in democratic societies with market-based economies, providing services otherwise neglected by the government and private for-profit sectors. Third sector organisations provided a range of social services throughout New Zealand's colonial history. However, it was not until the 1980s that third sector organisations providing comprehensive primary medical and related services started having a significant presence in New Zealand. In 1994 a range of union health centres, tribally based Mäori health providers, and community-based primary care providers established a formal network -- Health Care Aotearoa. While not representing all third sector primary care providers in New Zealand, Health Care Aotearoa was the best-developed example of a grouping of third sector primary care organisations. Member organisations served populations that were largely non-European and lived in deprived areas, and tended to adopt population approaches to funding and provision of services. The development of Health Care Aotearoa has been consistent with international experience of third sector involvement -- there were perceived "failures" in government policies for funding primary care and private sector responses to these policies, resulting in lack of universal funding and provision of primary care and continuing patient co-payments. The principal policy implication concerns the role of the third sector in providing primary care services for vulnerable populations as a partial alternative to universal funding and provision of primary care. Such an alternative may be convenient for proponents of reduced state involvement in funding and provision of health care, but may not be desirable from the point of view of equity and social cohesion insofar as the role of the welfare state is diminished.

Comparison of health-seeking characteristics of German and Belgian university students.

PubMed

Koop, R; Kartounian, H; Devroey, D

2017-01-01

Introduction. The aim of this study was to determine whether the use of primary health care differs between students enrolled in Belgian and German government-funded universities. The secondary aim of the study was to determine the factors that might explain such a difference. Methods. Participants were recruited through all Belgian and German government-funded universities. Because not all the universities agreed to participate, recruiting was also done through social media groups of the universities. An anonymous online survey was used for data collection. Results. In total, 2238 completed surveys were evaluated, of which 544 from students in Belgium and 1694 from students in Germany. In Belgium, more students had a family physician (87%) as compared to the students in Germany (73%) (p < 0.001). During the two months prior to the study, 37% of the Belgian students and 35% of the German students attended a family physician (p = 0.37). More German students attended a specialist (40%) as compared to the Belgian students (24%) (p<0.001). The German students also attended the emergency department more frequently (6%) as compared to their Belgian counterparts (3%) (p = 0.004). Conclusion. Belgian university students were more likely to attend a primary care physician than the German students. The health care seemed to be better organized for Belgian students and they were more satisfied with the delivered care.

Fundamental Physical Limits for the Size of Future Planetary Surface Exploration Systems

NASA Astrophysics Data System (ADS)

Andrews, F.; Hobbs, S. E.; Honstvet, I.; Snelling, M.

2004-04-01

With the current interest in the potential use of Nanotechnology for spacecraft, it becomes increasingly likely that environmental sensor probes, such as the "lab-on-a-chip" concept, will take advantage of this technology and become orders of magnitude smaller than current sensor systems. This paper begins to investigate how small these systems could theoretically become, and what are the governing laws and limiting factors that determine that minimum size. The investigation focuses on the three primary subsystems for a sensor network of this nature Sensing, Information Processing and Communication. In general, there are few fundamental physical laws that limit the size of the sensor system. Limits tend to be driven by factors other than the laws of physics. These include user requirements, such as the acceptable probability of error, and the potential external environment.

Status Epilepticus: Epidemiology and Public Health Needs

PubMed Central

Sánchez, Sebastián; Rincon, Fred

2016-01-01

Status epilepticus (SE) is defined as a continuous clinical and/or electrographic seizure activity lasting five minutes or more or recurrent seizure activity without return to baseline. There is a paucity of epidemiological studies of SE, as most research is derived from small population studies. The overall incidence of SE is 9.9 to 41 per 100,000/year, with peaks in children and the elderly and with febrile seizures and strokes as its main etiologies. The etiology is the major determinant of mortality. Governments and the academic community should predominantly focus on the primary prevention of etiologies linked to SE, as these are the most important risk factors for its development. This review describes the incidence, prevalence, etiology, risk factors, outcomes and costs of SE and aims to identify future research and public health needs. PMID:27537921

The role of institutions on the effectiveness of malaria treatment in the Ghanaian health sector.

PubMed

Amporfu, Eugenia; Nonvignon, Justice

2015-04-19

The Ghanaian health sector has undertaken several policies to help improve the quality of care received by patients. This includes the construction of several health facilities, the increase in the training of health workers, especially nurses, and the introduction of incentive packages (such as salary increase) to motivate health workers. The important question is to what extent does the institutional arrangement between the health facilities and the government as well as between health workers and public health facility administration affect the quality of care? The objective of this study is to find the effect of institutional factors on the quality of care. The institutional factors examined were mainly the extent of decentralization between government and health facilities, as well as between health workers and facility administration, the hiring procedure, and job satisfaction. The study used primary data on former patients from sixty six health facilities in three administrative regions of Ghana: the Northern, the Ashanti and the Greater Accra regions. The quality indicator used was effectiveness of treatment as determined by the patient. Ordered logit regression was run for the indicator with patient and health facility characteristics as well as institutional factors as independent variables. The sample size was 2248. The results showed that the patient's level of formal education had a strong influence on the effectiveness of treatment. In addition, effectiveness of treatment differed according to the administrative region in which the facility was located, and according to the extent of decentralization between health facility and government. The quality of instruments used for treatment, the working conditions for health workers, and job satisfaction had no effect on the effectiveness of treatment. Decentralization, the flow of information from government to health facilities and from health facility administrators to health workers are important in ensuring effectiveness. The study recommends further decentralization between health facilities as well as between health workers and administrators. In addition, the study recommends the involvement of health facilities in malaria programs to ensure the flow of information needed for effectiveness of treatment.

An integrated structural intervention to reduce vulnerability to HIV and sexually transmitted infections among female sex workers in Karnataka state, south India

PubMed Central

2011-01-01

Background Structural factors are known to affect individual risk and vulnerability to HIV. In the context of an HIV prevention programme for over 60,000 female sex workers (FSWs) in south India, we developed structural interventions involving policy makers, secondary stakeholders (police, government officials, lawyers, media) and primary stakeholders (FSWs themselves). The purpose of the interventions was to address context-specific factors (social inequity, violence and harassment, and stigma and discrimination) contributing to HIV vulnerability. We advocated with government authorities for HIV/AIDS as an economic, social and developmental issue, and solicited political leadership to embed HIV/AIDS issues throughout governmental programmes. We mobilised FSWs and appraised them of their legal rights, and worked with FSWs and people with HIV/AIDS to implement sensitization and awareness training for more than 175 government officials, 13,500 police and 950 journalists. Methods Standardised, routine programme monitoring indicators on service provision, service uptake, and community activities were collected monthly from 18 districts in Karnataka between 2007 and 2009. Daily tracking of news articles concerning HIV/AIDS and FSWs was undertaken manually in selected districts between 2005 and 2008. Results The HIV prevention programme is now operating at scale, with over 60,000 FSWs regularly contacted by peer educators, and over 17,000 FSWs accessing project services for sexually transmitted infections monthly. FSW membership in community-based organisations has increased from 8,000 to 37,000, and over 46,000 FSWs have now been referred for government-sponsored social entitlements. FSWs were supported to redress > 90% of the 4,600 reported incidents of violence and harassment reported between 2007-2009, and monitoring of news stories has shown a 50% increase in the number of positive media reports on HIV/AIDS and FSWs. Conclusions Stigma, discrimination, violence, harassment and social equity issues are critical concerns of FSWs. This report demonstrates that it is possible to address these broader structural factors as part of large-scale HIV prevention programming. Although assessing the impact of the various components of a structural intervention on reducing HIV vulnerability is difficult, addressing the broader structural factors contributing to FSW vulnerability is critical to enable these vulnerable women to become sufficiently empowered to adopt the safer sexual behaviours which are required to respond effectively to the HIV epidemic. PMID:21962115

An integrated structural intervention to reduce vulnerability to HIV and sexually transmitted infections among female sex workers in Karnataka state, south India.

PubMed

Gurnani, Vandana; Beattie, Tara S; Bhattacharjee, Parinita; Mohan, H L; Maddur, Srinath; Washington, Reynold; Isac, Shajy; Ramesh, B M; Moses, Stephen; Blanchard, James F

2011-10-02

Structural factors are known to affect individual risk and vulnerability to HIV. In the context of an HIV prevention programme for over 60,000 female sex workers (FSWs) in south India, we developed structural interventions involving policy makers, secondary stakeholders (police, government officials, lawyers, media) and primary stakeholders (FSWs themselves). The purpose of the interventions was to address context-specific factors (social inequity, violence and harassment, and stigma and discrimination) contributing to HIV vulnerability. We advocated with government authorities for HIV/AIDS as an economic, social and developmental issue, and solicited political leadership to embed HIV/AIDS issues throughout governmental programmes. We mobilised FSWs and appraised them of their legal rights, and worked with FSWs and people with HIV/AIDS to implement sensitization and awareness training for more than 175 government officials, 13,500 police and 950 journalists. Standardised, routine programme monitoring indicators on service provision, service uptake, and community activities were collected monthly from 18 districts in Karnataka between 2007 and 2009. Daily tracking of news articles concerning HIV/AIDS and FSWs was undertaken manually in selected districts between 2005 and 2008. The HIV prevention programme is now operating at scale, with over 60,000 FSWs regularly contacted by peer educators, and over 17,000 FSWs accessing project services for sexually transmitted infections monthly. FSW membership in community-based organisations has increased from 8,000 to 37,000, and over 46,000 FSWs have now been referred for government-sponsored social entitlements. FSWs were supported to redress > 90% of the 4,600 reported incidents of violence and harassment reported between 2007-2009, and monitoring of news stories has shown a 50% increase in the number of positive media reports on HIV/AIDS and FSWs. Stigma, discrimination, violence, harassment and social equity issues are critical concerns of FSWs. This report demonstrates that it is possible to address these broader structural factors as part of large-scale HIV prevention programming. Although assessing the impact of the various components of a structural intervention on reducing HIV vulnerability is difficult, addressing the broader structural factors contributing to FSW vulnerability is critical to enable these vulnerable women to become sufficiently empowered to adopt the safer sexual behaviours which are required to respond effectively to the HIV epidemic.

Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme.

PubMed

Govender, Veloshnee; Chersich, Matthew F; Harris, Bronwyn; Alaba, Olufunke; Ataguba, John E; Nxumalo, Nonhlanhla; Goudge, Jane

2013-01-24

In 2005, the South African government introduced a voluntary, subsidised health insurance scheme for civil servants. In light of the global emphasis on universal coverage, empirical evidence is needed to understand the relationship between new health financing strategies and health care access thereby improving global understanding of these issues. This study analysed coverage of the South African government health insurance scheme, the population groups with low uptake, and the individual-level factors, as well as characteristics of the scheme, that influenced enrolment. Multi-stage random sampling was used to select 1,329 civil servants from the health and education sectors in four of South Africa's nine provinces. They were interviewed to determine factors associated with enrolment in the scheme. The analysis included both descriptive statistics and multivariate logistic regression. Notwithstanding the availability of a non-contributory option within the insurance scheme and access to privately-provided primary care, a considerable portion of socio-economically vulnerable groups remained uninsured (57.7% of the lowest salary category). Non-insurance was highest among men, black African or coloured ethnic groups, less educated and lower-income employees, and those living in informal-housing. The relatively poor uptake of the contributory and non-contributory insurance options was mostly attributed to insufficient information, perceived administrative challenges of taking up membership, and payment costs. Barriers to enrolment include insufficient information, unaffordability of payments and perceived administrative complexity. Achieving universal coverage requires good physical access to service providers and appropriate benefit options within pre-payment health financing mechanisms.

Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme

PubMed Central

Govender, Veloshnee; Chersich, Matthew F.; Harris, Bronwyn; Alaba, Olufunke; Ataguba, John E.; Nxumalo, Nonhlanhla; Goudge, Jane

2013-01-01

Background In 2005, the South African government introduced a voluntary, subsidised health insurance scheme for civil servants. In light of the global emphasis on universal coverage, empirical evidence is needed to understand the relationship between new health financing strategies and health care access thereby improving global understanding of these issues. Objectives This study analysed coverage of the South African government health insurance scheme, the population groups with low uptake, and the individual-level factors, as well as characteristics of the scheme, that influenced enrolment. Methods Multi-stage random sampling was used to select 1,329 civil servants from the health and education sectors in four of South Africa's nine provinces. They were interviewed to determine factors associated with enrolment in the scheme. The analysis included both descriptive statistics and multivariate logistic regression. Results Notwithstanding the availability of a non-contributory option within the insurance scheme and access to privately-provided primary care, a considerable portion of socio-economically vulnerable groups remained uninsured (57.7% of the lowest salary category). Non-insurance was highest among men, black African or coloured ethnic groups, less educated and lower-income employees, and those living in informal-housing. The relatively poor uptake of the contributory and non-contributory insurance options was mostly attributed to insufficient information, perceived administrative challenges of taking up membership, and payment costs. Conclusion Barriers to enrolment include insufficient information, unaffordability of payments and perceived administrative complexity. Achieving universal coverage requires good physical access to service providers and appropriate benefit options within pre-payment health financing mechanisms. PMID:23364093

48 CFR 1335.014 - Government property and title.

Code of Federal Regulations, 2013 CFR

2013-10-01

... to equipment purchased by nonprofit institutions of higher learning and nonprofit organizations whose primary purpose is the conduct of scientific research is set forth in CAM 1301.70. ... CATEGORIES OF CONTRACTING RESEARCH AND DEVELOPMENT CONTRACTING 1335.014 Government property and title. The...

48 CFR 35.014 - Government property and title.

Code of Federal Regulations, 2011 CFR

2011-10-01

... basic or applied scientific research, apply to contracts with nonprofit institutions of higher education and nonprofit organizations whose primary purpose is the conduct of scientific research: (1) If the... SPECIAL CATEGORIES OF CONTRACTING RESEARCH AND DEVELOPMENT CONTRACTING 35.014 Government property and...

The value of integrating policy people and space in research.

PubMed

Hecker, Louise; Birla, Ravi K

2009-03-01

In this article, we address several tangible and intangible factors, which are difficult to quantify and often overlooked yet are crucial for research success. We discuss three dimensions which encompass: (1) policy, (2) people, and (3) space. Policies, such as rules and regulations, define the culture of any research program/initiative. Governing rules and regulations defined within these policies are dictated by cultural values. Individuals who exhibit strong leadership, promote innovation, and exercise strategic planning often determine the governing policies. People are the most valuable asset available to any institution. Ensuring the professional growth (personal and scientific) and creating an environment which supports collaborative and collegial research through teamwork are factors that are important for individuals. Space, the physical work environment, is the third dimension of our model and is often an underutilized resource. In addition to the physical layout and design of the space, creating a positive work atmosphere which supports research initiatives is equally important and can create valuable momentum to research efforts. Collectively, these three dimensions (policy, people, and space) have a significant impact on the success of any research initiative. The primary objective of this article is to create awareness and emphasize the importance of implementing these variables within research initiatives in academic settings.

The Behavioral Intentions of Hong Kong Primary Teachers in Adopting Educational Technology

ERIC Educational Resources Information Center

Wong, Gary K. W.

2016-01-01

The use of educational technology by Hong Kong primary school teachers has been realized by the government's long-term support to the technology infrastructure, professional training, technical support, and development of teaching resources in local primary schools. However, the high adoption rate may not reflect the willingness of teachers to…

Primary Schools and Network Governance: A Policy Analysis of Reception Baseline Assessment

ERIC Educational Resources Information Center

Roberts-Holmes, Guy; Bradbury, Alice

2017-01-01

Primary school reception baseline assessment was designed to produce a single "baseline" data figure on the basis of which young children's progress across primary school could be measured and accounted for. This paper suggests that within the context of punitive performativity, head teachers might be considered "irresponsible"…

The Changing Roles of Science Specialists during a Capacity Building Program for Primary School Science

ERIC Educational Resources Information Center

Herbert, Sandra; Xu, Lihua; Kelly, Leissa

2017-01-01

Science education starts at primary school. Yet, recent research shows primary school teachers lack confidence and competence in teaching science (Prinsley & Johnston, 2015). A Victorian state government science specialist initiative responded to this concern by providing professional learning programs to schools across Victoria. Drawing on…

Preliminary investigation of the kinetics of primary creep of a two phase gamma TiAl alloy

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

Hayes, R.W.

1993-11-01

It is the intent of this communication to present and discuss some data regarding the kinetics of primary creep of a two phase gamma TiAl alloy which had been studied previously to determine the mechanisms giving rise to the minimum strain rate. In order to study the kinetics of primary creep of the present gamma TiAl alloy an approach previously taken by Dorn et al and also recently employed by Argon and Bhattacharya was taken. Dorn et al demonstrated that at a given constant stress, the strain rate during primary creep is governed by a combined time-temperature parameter [Theta] =more » t exp([minus]Q/RT) where Q is the activation energy for self diffusion which many times also governs the process of steady-state creep. It was shown that at the same constant stress level all primary creep curves were found to collapse on one another when the primary creep strain is plotted as a function of [Theta][sup (9)].« less

Factors associated with grade 1 hypertension: implications for hypertension care based on the Dietary Approaches to Stop Hypertension (DASH) in primary care settings.

PubMed

Wang, Harry H X; Wong, Martin C S; Mok, Rosina Y; Kwan, Mandy W M; Chan, Wai Man; Fan, Carmen K M; Lee, Catherine L S; Griffiths, Sian M

2015-02-27

A Reference Framework for Hypertension Care was recently developed by Hong Kong government to emphasise the importance of primary care for subjects with high blood pressure (BP). The Dietary Approaches to Stop Hypertension (DASH) interventional regime was recommended for patients aged 40-70 years with grade 1 hypertension (having systolic BP of 140-159 mmHg and/or diastolic BP of 90-99 mmHg). This study explored factors associated with grade 1 hypertension among subjects screened in primary care settings. The study sample consisted of community dwellers (N = 10,693) enrolled in a primary care programme in which participants overall had similar characteristics when compared to the Hong Kong population census. Invitation phone calls were given by trained researchers to a randomly selected subjects (N = 2,673, [50% of total subjects aged 40-70 years]) between January and June 2013. BP and body mass index (BMI) were measured by trained clinical professionals according to a standard protocol. Interviewer-administered survey questionnaires were used to collect self-report information on socio-demographics, family history, and lifestyle characteristics. Multiple logistic regression analysis was performed to explore factors associated with grade 1 hypertension. Adjusted odds ratios (aORs) were estimated with 95% confidence intervals (CI). A total of 679 out of 2,673 subjects agreed to participate in the screening and completed the baseline assessment (100% completion rate), among which, 320 subjects (47.1%, [320/679]) were grade 1 hypertensive. Unhealthy diet (aOR = 2.19, 95%CI 1.04-4.62), irregular meals (aOR = 1.47, 95%CI 1.11-1.95), BMI >27.5 kg/m(2) (aOR = 1.87, 95%CI 1.53-2.27), duration of cigarette smoking (aOR = 1.83 per year), increased daily cigarette consumption (aOR  =1.59 per pack [20 cigarettes per pack]), duration of alcohol drinking (aOR = 1.65 per year), and higher frequency of weekly binge drinking (aOR = 1.87 per occasion) were independently associated with grade 1 hypertension. The increase in the number of risk factors combined significantly correlated with higher predicted probability of grade 1 hypertension. Dietary-intake factors were significantly associated with grade 1 hypertension, echoing the recommendation in the Reference Framework on incorporating dietary-related intervention based on the DASH approach for hypertension care in primary care settings. The association between aggregate risk factors and grade 1 hypertension should also be taken into consideration in long-term preventive strategy.

Addressing challenges in scaling up TB and HIV treatment integration in rural primary healthcare clinics in South Africa (SUTHI): a cluster randomized controlled trial protocol.

PubMed

Naidoo, Kogieleum; Gengiah, Santhanalakshmi; Yende-Zuma, Nonhlanhla; Padayatchi, Nesri; Barker, Pierre; Nunn, Andrew; Subrayen, Priashni; Abdool Karim, Salim S

2017-11-13

A large and compelling clinical evidence base has shown that integrated TB and HIV services leads to reduction in human immunodeficiency virus (HIV)- and tuberculosis (TB)-associated mortality and morbidity. Despite official policies and guidelines recommending TB and HIV care integration, its poor implementation has resulted in TB and HIV remaining the commonest causes of death in several countries in sub-Saharan Africa, including South Africa. This study aims to reduce mortality due to TB-HIV co-infection through a quality improvement strategy for scaling up of TB and HIV treatment integration in rural primary healthcare clinics in South Africa. The study is designed as an open-label cluster randomized controlled trial. Sixteen clinic supervisors who oversee 40 primary health care (PHC) clinics in two rural districts of KwaZulu-Natal, South Africa will be randomized to either the control group (provision of standard government guidance for TB-HIV integration) or the intervention group (provision of standard government guidance with active enhancement of TB-HIV care integration through a quality improvement approach). The primary outcome is all-cause mortality among TB-HIV patients. Secondary outcomes include time to antiretroviral therapy (ART) initiation among TB-HIV co-infected patients, as well as TB and HIV treatment outcomes at 12 months. In addition, factors that may affect the intervention, such as conditions in the clinic and staff availability, will be closely monitored and documented. This study has the potential to address the gap between the establishment of TB-HIV care integration policies and guidelines and their implementation in the provision of integrated care in PHC clinics. If successful, an evidence-based intervention comprising change ideas, tools, and approaches for quality improvement could inform the future rapid scale up, implementation, and sustainability of improved TB-HIV integration across sub-Sahara Africa and other resource-constrained settings. Clinicaltrials.gov, NCT02654613 . Registered 01 June 2015.

Seasonal variability in chemical composition and source apportionment of sub-micron aerosol over a high altitude site in Western Ghats, India

NASA Astrophysics Data System (ADS)

Mukherjee, Subrata; Singla, Vyoma; Pandithurai, Govindan; Safai, P. D.; Meena, G. S.; Dani, K. K.; Anil Kumar, V.

2018-05-01

This manuscript reports the seasonal variation of chemically speciated sub-micron aerosol particles (diameter < 1 μm). An Aerosol Chemical Speciation Monitor (ACSM) was used to measure the mass concentration of non-refractory particulate matter (NR-PM1) at a high-altitude site in the Western Ghats, India from March 2016 to February 2017. The mass concentration of NR-PM1 averaged at 7.5 ± 6.5 μgm-3, with major contributions from organics (59%) and sulfates (23%). Positive matrix factorization (PMF) was applied on the measured mass spectra of organic aerosol (OA) to derive the sources distinctive of each season (Summer, Monsoon, Post-Monsoon and Winter). The four OA factors (two primary OA and two oxygenated OA) resolved during summer, post-monsoon and winter season. However, only one oxygenated factor resolved during monsoon and contributed only 20% to the total OA. The factors associated with primary emissions dominated during the monsoon, whereas factors related to secondary formation dominated in other three seasons. During summer, an isoprene derived SOA - IEPOX-OA (isoprene-epoxydiol OA) contributed ∼17% to the total OA. Cluster and concentration weighted trajectory (CWT) analyses were performed to identify the possible source regions of NR-PM1 mass concentration observed at the receptor site. The analysis identifies Central India as the potential source region of transported aerosol during post-monsoon and winter season. Our study suggests that contributions from both local sources and regional transport are important in governing mass concentration of PM1 over Mahabaleshwar.

Career Development in Australia.

ERIC Educational Resources Information Center

McCowan, Colin; Mountain, Elizabeth

Australia has a federal system, comprising the national Commonwealth government and eight state and territory governments. At the Commonwealth level, the ministries of Education, Training and Youth Affairs, and Employment, Workplace Relations and Small Business have primary roles in the career information and services field. Education and training…

78 FR 20693 - Agency Information Collection Activities; Proposed Collection; Comments Requested: Office of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-05

... of the functions of the agency, including whether the information will have practical utility... primary respondents are state agencies, tribal governments, local governments, colleges and universities, non- profit organizations, for-profit organizations, and faith-based organizations. The purpose of the...

The effect of social geographic factors on the untreated tooth decay among head start children

PubMed Central

Ferretti, Margaret; Qureshi, Mehveen; Ferretti, Gerald

2017-01-01

Background Disparities among untreated dental caries exist for children from low-income families in the United States. Understanding of the mechanism of the disparities is required to reduce it and social geographic factors are one of the important influences. Although the effect of fluoridated water has been well reported, studies of other sociogeograpic factors, such as the density of available dentists, are still very limited. The objective of this study is to explore the effect of sociogeographic factors on the number of primary teeth with untreated dental caries among children from low-income families who are enrolled in Head Start programs throughout Northeast Ohio of the United States. Material and Methods This was a cross-sectional chart review study. Three hundred-eighty-eight charts were reviewed, and the number of primary teeth with untreated dental caries (dt) and the children’s addresses were retrieved. The sociogeographic variables, including fluoridated water availability and the density of available dentists who accept a government-supported insurance (Medicaid dentists), were collected. Results The mean (standard deviation) of children’s age was 3.51 (1.14) years with a range of 7 months to 5 years. A negative binomial regression model analysis, which used dt as a dependent variable and children’s characteristic factors (i.e. age, gender, insurance type, and total number of primary teeth) and sociogeographic factors (i.e. Population, total number of Medicaid dentists, density of Medicaid dentist, and Fluoride water availability) of cities, as independent variables, demonstrated that only the density of Medicaid dentist in the sociogeographic factors indicated a significant effect (Estimated ß-Coefficients (Standard Errors)=-0.003 (0.002), p=0.030). Conclusions This study demonstrated a significant negative association between the density of available dentists and untreated dental caries among children from low-income families in Head Start programs in Northeast Ohio. Increasing available dentists may be a strategy to reduce the number of early childhood caries. Key words:Child, poverty, dental caries, Health Services Accessibility. PMID:29167713

Policy Levers Key for Primary Health Care Organizations to Support Primary Care Practices in Meeting Medical Home Expectations: Comparing Leading States to the Australian Experience

PubMed Central

2016-01-01

Abstract Several countries with highly ranked delivery systems have implemented locally-based, publicly-funded primary health care organizations (PHCOs) as vehicles to strengthen their primary care foundations. In the United States, state governments have started down a similar pathway with models that share similarities with international PHCOs. The objective of this study was to determine if these kinds of organizations were working with primary care practices to improve their ability to provide comprehensive, coordinated, and accessible patient-centered care that met quality, safety, and efficiency outcomes—all core attributes of a medical home. This qualitative study looked at 4 different PHCO models—3 from the United States and 1 from Australia—with similar objectives and scope. Primary and secondary data included semi-structured interviews with 26 PHCOs and a review of government documents. The study found that the 4 PHCO models were engaging practices to meet a number of medical home expectations, but the US PHCOs were more uniform in efforts to work with practices and focused on arranging services to meet the needs of complex patients. There was significant variation in level of effort between the Australian PHCOs. These differences can be explained through the state governments' selection of payment models and use of data frameworks to support collaboration and incentivize performance of both PHCOs and practices. These findings offer policy lessons to inform health reform efforts under way to better capitalize on the potential of PHCOs to support a high-functioning primary health foundation as an essential component to a reformed health system. PMID:26636485

Congressionally-Direct Homeland Defense and Civil Support Threat Information Collection

DTIC Science & Technology

2008-09-01

Colombia , France, and the United Kingdom. The primary byproducts of the study consisted of two published books. Entitled: “State Open Government...statutes of the 50 states as well as selected changes in national public information laws in Colombia , France, Israel, and the United Kingdom. The...government, and security. In addition, the conference included analysis of the open government approaches of Israel, France, Colombia , and the

Conflicts of interest in government-funded studies.

PubMed

Pickar, J H

2015-06-01

Conflict of interest in scientific publications has become a topic of critical importance. A primary focus has been the relationship between authors, journals and the pharmaceutical industry. That focus must be expanded to include government funding organizations. There are significant benefits to authors and investigators in participating in government-funded research, and to journals in publishing it. There are substantial risks to patients in not considering the potential for conflict of interest.

Vulnerability Factors and Effectiveness of Disaster Mitigation Measures in the Bangladesh Coast

NASA Astrophysics Data System (ADS)

Hossain, Md. Nazir; Paul, Shitangsu Kumar

2018-01-01

The major objective of this paper is to identify the vulnerability factors and examine the effectiveness of disaster mitigation measures undertaken by individuals, government and non-government organisations to mitigate the impacts of cyclones in the Bangladesh coast experiencing from Cyclone Aila. The primary data were collected from two villages of southwestern coastal areas of Bangladesh using questionnaire survey and interviews of the key informants. The data were analysed using the descriptive and inferential statistics. This paper reveals that the disaster management measures have a significant role to lessen the impacts of the cyclonic event, especially in pre-disaster preparedness, cyclone warning message dissemination, evacuation and post-disaster rehabilitation. The households, who have access to shelter, find weather forecast regularly and adopted pre-disaster awareness measures are relatively less susceptible to hazard's impacts. The disaster management measures undertaken by individuals and GOs and NGOs help coastal people to save their lives and property from the negative impacts of cyclones. The analysis shows that the NGOs' role is more effective and efficient than the GOs in cyclone disaster management. This paper identifies distance to shelter, participation in disaster training, efficient warning, etc. as the influential factors of vulnerability cyclones. The analysis finds the households as less affected who have adopted disaster preparedness measures. However, this paper concludes that the effective and proper disaster management and mitigation measures are very crucial to shield the lives and properties of the Bangladeshi coastal people.

Vulnerability Factors and Effectiveness of Disaster Mitigation Measures in the Bangladesh Coast

NASA Astrophysics Data System (ADS)

Hossain, Md. Nazir; Paul, Shitangsu Kumar

2018-05-01

The major objective of this paper is to identify the vulnerability factors and examine the effectiveness of disaster mitigation measures undertaken by individuals, government and non-government organisations to mitigate the impacts of cyclones in the Bangladesh coast experiencing from Cyclone Aila. The primary data were collected from two villages of southwestern coastal areas of Bangladesh using questionnaire survey and interviews of the key informants. The data were analysed using the descriptive and inferential statistics. This paper reveals that the disaster management measures have a significant role to lessen the impacts of the cyclonic event, especially in pre-disaster preparedness, cyclone warning message dissemination, evacuation and post-disaster rehabilitation. The households, who have access to shelter, find weather forecast regularly and adopted pre-disaster awareness measures are relatively less susceptible to hazard's impacts. The disaster management measures undertaken by individuals and GOs and NGOs help coastal people to save their lives and property from the negative impacts of cyclones. The analysis shows that the NGOs' role is more effective and efficient than the GOs in cyclone disaster management. This paper identifies distance to shelter, participation in disaster training, efficient warning, etc. as the influential factors of vulnerability cyclones. The analysis finds the households as less affected who have adopted disaster preparedness measures. However, this paper concludes that the effective and proper disaster management and mitigation measures are very crucial to shield the lives and properties of the Bangladeshi coastal people.

Primary care physician supply and other key determinants of health care utilisation: the case of Switzerland

PubMed Central

Busato, André; Künzi, Beat

2008-01-01

Background The Swiss government decided to freeze new accreditations for physicians in private practice in Switzerland based on the assumption that demand-induced health care spending may be cut by limiting care offers. This legislation initiated an ongoing controversial public debate in Switzerland. The aim of this study is therefore the determination of socio-demographic and health system-related factors of per capita consultation rates with primary care physicians in the multicultural population of Switzerland. Methods The data were derived from the complete claims data of Swiss health insurers for 2004 and included 21.4 million consultations provided by 6564 Swiss primary care physicians on a fee-for-service basis. Socio-demographic data were obtained from the Swiss Federal Statistical Office. Utilisation-based health service areas were created and were used as observational units for statistical procedures. Multivariate and hierarchical models were applied to analyze the data. Results Models within the study allowed the definition of 1018 primary care service areas with a median population of 3754 and an average per capita consultation rate of 2.95 per year. Statistical models yielded significant effects for various geographical, socio-demographic and cultural factors. The regional density of physicians in independent practice was also significantly associated with annual consultation rates and indicated an associated increase 0.10 for each additional primary care physician in a population of 10,000 inhabitants. Considerable differences across Swiss language regions were observed with reference to the supply of ambulatory health resources provided either by primary care physicians, specialists, or hospital-based ambulatory care. Conclusion The study documents a large small-area variation in utilisation and provision of health care resources in Switzerland. Effects of physician density appeared to be strongly related to Swiss language regions and may be rooted in the different cultural backgrounds of the served populations. PMID:18190705

Our chairman is very efficient: community participation in the delivery of primary health care in Ibadan, Southwest Nigeria.

PubMed

Iyanda, Omowunmi Folake; Akinyemi, Oluwaseun Oladapo

2017-01-01

Community participation is rapidly being viewed as a requirement for the successful acceptance of health services; it integrates a complicated process which involves customs, beliefs, culture and power relations, not only structures and policies. Yet, there is a wide knowledge gap and changes favouring community participation in primary health care is still minimal. This study aims to assess the process indicators and other factors influencing community participation in the delivery of primary health care. This descriptive cross-sectional study using qualitative methods was conducted in Ibadan South East Local Government Area of Oyo State, Nigeria between July and September, 2015. The interview and Focus Group Discussion guides centred around five participation indicators of needs assessment, leadership, resource mobilization, organization and management was used to collect data. A total of 12 in-depth interviews and four FGDs were conducted among male and female respondents consisting PHC service providers and community members purposively selected from four wards of the LGA. Spidergrams were constructed to visualize the levels of community participation from respondents' opinions. About 51.1% of the 45 respondents (with mean age 45.5 ± 8.09 years) were males. The respondents view community participation in the delivery of PHC in the LGA as being wide (open). Majority of the service users believe and agree that the level of community participation in their wards is about average while the service providers believed that participation was very high. However, respondents identified female representation, collaboration with pre-existing community structures, top-down and bottom-up approach to service delivery as factors affecting community participation in PHC delivery. This study provides a baseline data on community participation in the delivery of primary health care. Community participation is still an important principle in the delivery of primary health care and it guarantees the positive changes desired in the uptake and sustainability of primary health care programmes.

Our chairman is very efficient: community participation in the delivery of primary health care in Ibadan, Southwest Nigeria

PubMed Central

Iyanda, Omowunmi Folake; Akinyemi, Oluwaseun Oladapo

2017-01-01

Introduction Community participation is rapidly being viewed as a requirement for the successful acceptance of health services; it integrates a complicated process which involves customs, beliefs, culture and power relations, not only structures and policies. Yet, there is a wide knowledge gap and changes favouring community participation in primary health care is still minimal. This study aims to assess the process indicators and other factors influencing community participation in the delivery of primary health care. Methods This descriptive cross-sectional study using qualitative methods was conducted in Ibadan South East Local Government Area of Oyo State, Nigeria between July and September, 2015. The interview and Focus Group Discussion guides centred around five participation indicators of needs assessment, leadership, resource mobilization, organization and management was used to collect data. A total of 12 in-depth interviews and four FGDs were conducted among male and female respondents consisting PHC service providers and community members purposively selected from four wards of the LGA. Spidergrams were constructed to visualize the levels of community participation from respondents' opinions. Results About 51.1% of the 45 respondents (with mean age 45.5 ± 8.09 years) were males. The respondents view community participation in the delivery of PHC in the LGA as being wide (open). Majority of the service users believe and agree that the level of community participation in their wards is about average while the service providers believed that participation was very high. However, respondents identified female representation, collaboration with pre-existing community structures, top-down and bottom-up approach to service delivery as factors affecting community participation in PHC delivery. Conclusion This study provides a baseline data on community participation in the delivery of primary health care. Community participation is still an important principle in the delivery of primary health care and it guarantees the positive changes desired in the uptake and sustainability of primary health care programmes. PMID:29187927

Primary care physician supply and other key determinants of health care utilisation: the case of Switzerland.

PubMed

Busato, André; Künzi, Beat

2008-01-11

The Swiss government decided to freeze new accreditations for physicians in private practice in Switzerland based on the assumption that demand-induced health care spending may be cut by limiting care offers. This legislation initiated an ongoing controversial public debate in Switzerland. The aim of this study is therefore the determination of socio-demographic and health system-related factors of per capita consultation rates with primary care physicians in the multicultural population of Switzerland. The data were derived from the complete claims data of Swiss health insurers for 2004 and included 21.4 million consultations provided by 6564 Swiss primary care physicians on a fee-for-service basis. Socio-demographic data were obtained from the Swiss Federal Statistical Office. Utilisation-based health service areas were created and were used as observational units for statistical procedures. Multivariate and hierarchical models were applied to analyze the data. Models within the study allowed the definition of 1018 primary care service areas with a median population of 3754 and an average per capita consultation rate of 2.95 per year. Statistical models yielded significant effects for various geographical, socio-demographic and cultural factors. The regional density of physicians in independent practice was also significantly associated with annual consultation rates and indicated an associated increase 0.10 for each additional primary care physician in a population of 10,000 inhabitants. Considerable differences across Swiss language regions were observed with reference to the supply of ambulatory health resources provided either by primary care physicians, specialists, or hospital-based ambulatory care. The study documents a large small-area variation in utilisation and provision of health care resources in Switzerland. Effects of physician density appeared to be strongly related to Swiss language regions and may be rooted in the different cultural backgrounds of the served populations.

Critical Factors in Data Governance for Learning Analytics

ERIC Educational Resources Information Center

Elouazizi, Noureddine

2014-01-01

This paper identifies some of the main challenges of data governance modelling in the context of learning analytics for higher education institutions, and discusses the critical factors for designing data governance models for learning analytics. It identifies three fundamental common challenges that cut across any learning analytics data…

The molecular network governing nodule organogenesis and infection in the model legume Lotus japonicus.

PubMed

Madsen, Lene H; Tirichine, Leïla; Jurkiewicz, Anna; Sullivan, John T; Heckmann, Anne B; Bek, Anita S; Ronson, Clive W; James, Euan K; Stougaard, Jens

2010-04-12

Bacterial infection of interior tissues of legume root nodules is controlled at the epidermal cell layer and is closely coordinated with progressing organ development. Using spontaneous nodulating Lotus japonicus plant mutants to uncouple nodule organogenesis from infection, we have determined the role of 16 genes in these two developmental processes. We show that host-encoded mechanisms control three alternative entry processes operating in the epidermis, the root cortex and at the single cell level. Single cell infection did not involve the formation of trans-cellular infection threads and was independent of host Nod-factor receptors and bacterial Nod-factor signals. In contrast, Nod-factor perception was required for epidermal root hair infection threads, whereas primary signal transduction genes preceding the secondary Ca2+ oscillations have an indirect role. We provide support for the origin of rhizobial infection through direct intercellular epidermal invasion and subsequent evolution of crack entry and root hair invasions observed in most extant legumes.

INTEGRATING PARASITES AND PATHOGENS INTO THE STUDY OF GEOGRAPHIC RANGE LIMITS.

PubMed

Bozick, Brooke A; Real, Leslie A

2015-12-01

The geographic distributions of all species are limited, and the determining factors that set these limits are of fundamental importance to the fields of ecology and evolutionary biology. Plant and animal ranges have been of primary concern, while those of parasites, which represent much of the Earth's biodiversity, have been neglected. Here, we review the determinants of the geographic ranges of parasites and pathogens, and explore how parasites provide novel systems with which to investigate the ecological and evolutionary processes governing host/parasite spatial distributions. Although there is significant overlap in the causative factors that determine range borders of parasites and free-living species, parasite distributions are additionally constrained by the geographic range and ecology of the host species' population, as well as by evolutionary factors that promote host-parasite coevolution. Recently, parasites have been used to infer population demographic and ecological information about their host organisms and we conclude that this strategy can be further exploited to understand geographic range limitations of both host and parasite populations.

Content validity of critical success factors for e-Government implementation in Indonesia

NASA Astrophysics Data System (ADS)

Napitupulu, D.; Syafrullah, M.; Rahim, R.; Amar, A.; Sucahyo, YG

2018-05-01

The purpose of this research is to validate the Critical Success Factors (CSFs) of e-Government implementation in Indonesia. The e-Government initiative conducted only to obey the regulation but ignoring the quality. Defining CSFs will help government agencies to avoid failure of e-Government projects. A survey with the questionnaire was used to validate the item of CSF based on expert judgment through two round of Delphi. The result showed from 67 subjects in instrument tested; there are 11 invalid items deleted and remain only 56 items that had good content validity and internal reliability. Therefore, all 56 CSFs should be adopted by government agencies in Indonesia to support e-Government implementation.

Cross-Sector Collaboration: The Great Lakes Environmental Finance Center.

ERIC Educational Resources Information Center

Austrian, Ziona; Iannone, Donald

1997-01-01

The Great Lakes Environmental Finance Center is one of six university-based environmental finance centers established by the federal government. Its primary mission is to help state and local government and private-sector organizations devise effective financing strategies for environmental improvement projects. Cross-sector collaboration and…

The Moral Obligation of the Government to Recover POWs

DTIC Science & Technology

2012-03-12

Freedom by James Rowe, and Surviving Hell by Leo Thorsness, several of a great many primary sources that tell autobiographically of life as a POW. A...from the collective social memory , allowing the government to politically maneuver itself for the next adversarial engagement. The political climate

AFRICOM Engineers: Using Water in the Fight for Regional Security

DTIC Science & Technology

2008-01-01

states-states in which government authority has collapsed, violence has become endemic, and functional governance has ceased-have emerged in the period...primary health care services • Low immunization coverage • Lack of emergency obstetric care/child & mother preventive care • Poor education system

What variables should be considered in allocating Primary health care Pharmaceutical budgets to districts in Uganda?

PubMed

Mujasi, Paschal N; Puig-Junoy, Jaume

2015-01-01

A key policy question for the government of Uganda is how to equitably allocate primary health care pharmaceutical budgets to districts. This paper seeks to identify variables influencing current primary health care pharmaceutical expenditure and their usefulness in allocating prospective pharmaceutical budgets to districts. This was a cross sectional, retrospective observational study using secondary administrative data. We collected data on the value of pharmaceuticals procured by primary health care facilities in each district from National Medical Stores for the financial year 2011/2012. The dependent variable was expressed as per capita district pharmaceutical expenditure. By reviewing literature we identified 26 potential explanatory variables. They include supply, need and demand, and health system organization variables that may influence the demand and supply of health services and the corresponding pharmaceutical expenditure. We collected secondary data for these variables for all the districts in Uganda (n = 112). We performed econometric analysis to estimate parameters of various regression models. There is a significant correlation between per capita district pharmaceutical expenditure and total district population, rural poverty, access to drinking water and outpatient department (OPD) per capita utilisation.(P < 0.01). The percentage of health centre IIIs (HC III) among each district's health facilities is significantly correlated with per capita pharmaceutical expenditure (P < 0.05). OPD per capita utilisation has a relatively strong correlation with per capita pharmaceutical expenditure (r = 0.498); all the other significant factors are weakly correlated with per capita pharmaceutical expenditure (r < 0.5). From several iterations of an initially developed model, the proposed final model for explaining per capita pharmaceutical expenditure explains about 53% of the variation in pharmaceutical expenditure among districts in Uganda (Adjusted R(2) = 0.528). All variables in the model are significant (p < 0.01). From evaluation of the various models, proposed variables to consider in allocating prospective primary health care pharmaceutical budgets to districts in Uganda are: district outpatient department attendance per capita, total district population, total number of government health facilities in the district and the district human poverty index.

The political context of AIDS-related stigma and knowledge in a South African township community.

PubMed

Forsyth, Brian; Vandormael, Alain; Kershaw, Trace; Grobbelaar, Janis

2008-07-01

The purpose of this study was to examine the presentation of AIDS-related stigma and knowledge within the political context of the South African government's response to the AIDS epidemic. It was during the 2000 - 2004 period that key government officials publicly challenged the orthodox views of HIV/AIDS, with the South African president, Thabo Mbeki, actively positing the primary role of poverty and other socio-economic stressors in the progression of the AIDS epidemic. This discursive position had real-time effects for AIDS policy-making and ultimately delayed the implementation of a national antiretroviral (ARV) rollout programme. Consequently this position was criticised by commentators in the media and elsewhere for contributing to an already widespread climate of AIDS stigmatization and misinformation. To shed more light on these claims we conducted a survey in 2005 in Atteridgeville, a South African township, and compared results with those of a similar survey conducted shortly after ARV medications became available in 2004. Results indicated a reduction in AIDS stigma levels across the 1-year period, and that those participants who endorsed contentious political views (such as those expressed by key government officials) were more likely to have a higher level of AIDS-related stigma than those who disagreed. Nevertheless, this study cautions against drawing a causal relationship between the South African government's position and IDS-stigmatizing attitudes, and suggests that further political and social factors be accounted for in an attempt to gain a fuller understanding of this seemingly complex relationship.

Key factors limiting the open circuit voltage of n(+)pp(+) indium phosphide solar cells

NASA Technical Reports Server (NTRS)

Goradia, Chandra; Thesling, William; Weinberg, Irving

1991-01-01

Solar cells made from gallium arsenide (GaAs), with a room temperature bandgap of E(sub g) = 1.43 eV have exhibited the best measured open circuit voltage (V sub OC) of 1.05 V at 1 AMO, 25 C. The material InP is in many ways similar to GaAs. A simple calculation comparing InP to GaAs then shows that solar cells made from InP, with E(sub g) = 1.35 at 300 K, should exhibit the best measured (V sub OC) of approximately 950 mV at 1 AMO, 300 K. However, to date, the best measured V(sub OC) for InP solar cells made by any fabrication method is 899 mV at AM1.5, 25 C which would translate to 912 mV at 1 AMO, 25 C. The V(sub OC) of an n(+)pp(+) InP solar cell is governed by several factors. Of these, some factors, such as the thickness and doping of the emitter and base regions, are easily controlled and can be adjusted to desired values dictated by a good performance optimizing model. Such factors were not considered. There are other factors which also govern V(sub OC), and their values are not so easily controlled. The primary ones among these are (1) the indirect or Hall-Shockley-Read lifetimes in the various regions of the cell, (2) the low-doping intrinsic carrier concentration n(sub i) of the InP material, (3) the heavy doping factors in the emitter and BSF regions, and (4) the front surface recombination velocity S(sub F). The influence of these latter factors on the V(sub OC) of the n(+)pp(+) InP solar cell and the results were used to produce a near-optimum design of the n(+)pp(+) InP solar cell.

Efficiency of chlorophyll in gross primary productivity: A proof of concept and application in crops.

PubMed

Gitelson, Anatoly A; Peng, Yi; Viña, Andrés; Arkebauer, Timothy; Schepers, James S

2016-08-20

One of the main factors affecting vegetation productivity is absorbed light, which is largely governed by chlorophyll. In this paper, we introduce the concept of chlorophyll efficiency, representing the amount of gross primary production per unit of canopy chlorophyll content (Chl) and incident PAR. We analyzed chlorophyll efficiency in two contrasting crops (soybean and maize). Given that they have different photosynthetic pathways (C3 vs. C4), leaf structures (dicot vs. monocot) and canopy architectures (a heliotrophic leaf angle distribution vs. a spherical leaf angle distribution), they cover a large spectrum of biophysical conditions. Our results show that chlorophyll efficiency in primary productivity is highly variable and responds to various physiological and phenological conditions, and water availability. Since Chl is accessible through non-destructive, remotely sensed techniques, the use of chlorophyll efficiency for modeling and monitoring plant optimization patterns is practical at different scales (e.g., leaf, canopy) and under widely-varying environmental conditions. Through this analysis, we directly related a functional characteristic, gross primary production with a structural characteristic, canopy chlorophyll content. Understanding the efficiency of the structural characteristic is of great interest as it allows explaining functional components of the plant system. Copyright © 2016 Elsevier GmbH. All rights reserved.

C-Depth Method to Determine Diffusion Coefficient and Partition Coefficient of PCB in Building Materials.

PubMed

Liu, Cong; Kolarik, Barbara; Gunnarsen, Lars; Zhang, Yinping

2015-10-20

Polychlorinated biphenyls (PCBs) have been found to be persistent in the environment and possibly harmful. Many buildings are characterized with high PCB concentrations. Knowledge about partitioning between primary sources and building materials is critical for exposure assessment and practical remediation of PCB contamination. This study develops a C-depth method to determine diffusion coefficient (D) and partition coefficient (K), two key parameters governing the partitioning process. For concrete, a primary material studied here, relative standard deviations of results among five data sets are 5%-22% for K and 42-66% for D. Compared with existing methods, C-depth method overcomes the inability to obtain unique estimation for nonlinear regression and does not require assumed correlations for D and K among congeners. Comparison with a more sophisticated two-term approach implies significant uncertainty for D, and smaller uncertainty for K. However, considering uncertainties associated with sampling and chemical analysis, and impact of environmental factors, the results are acceptable for engineering applications. This was supported by good agreement between model prediction and measurement. Sensitivity analysis indicated that effective diffusion distance, contacting time of materials with primary sources, and depth of measured concentrations are critical for determining D, and PCB concentration in primary sources is critical for K.

The accuracy of clinical malaria case reporting at primary health care facilities in Honiara, Solomon Islands

PubMed Central

Kunimitsu, Ayano

2009-01-01

Background The accuracy of malaria case reporting is challenging due to restricted human and material resources in many countries. The reporting often depends on the clinical diagnosis because of the scarcity of microscopic examinations. Particularly, clinical malaria case reporting by primary health care facilities (local clinics), which constitutes the baseline data of surveillance, has never previously been sufficiently evaluated. In order to improve the malaria reporting system to the level required to eventually eliminate this disease, this study estimates the gaps between the records of clinics and government statistics regarding the incidence of clinical malaria, and then also examines some factors that might explain the data discrepancy, including such variables as clinic staffing and record keeping. Methods All medical records for outpatients in 2007, handwritten by nurses, were collected from local clinics in Honiara, the capital of the Solomon Islands. The all-monthly clinical malaria cases were then recalculated. The corresponding monthly data in official statistics were provided by the government. Next, in order to estimate any data discrepancy, the ratio of the cases recorded at clinics to the cases reported to the government was determined on the monthly basis. Finally, the associations between the monthly discrepancy and other variables were evaluated by a multiple regression analysis. Results The mean data discrepancy between the records of clinics and government statistics was 21.2% (n = 96). Significant associations were observed between the discrepancy and the average number of patients (coefficient: 0.05, 95%CI: 0.31, 0.07), illegible handwriting (coefficient: 0.09, 95%CI: 0.04, 0.15), the use of tally sheets (coefficient:-0.38, 95%CI: -0.54, -0.22), and the clinic level (coefficient:-0.48, 95%CI:-0.89,-0.06). Conclusion The findings of this study demonstrate the huge data discrepancy between the records of clinics and government statistics in regard to clinical malaria case reporting. Moreover, the high numbers of patients, illegible writing, the disuse of tally sheets, and insufficient resources at some clinics are likely to be related to the increase in the discrepancy. The clinical malaria case reporting at the local clinic level therefore urgently needs improvement, in order to achieve both better malaria surveillance and to also eventually eliminate this disease in the Solomon Islands. PMID:19389239

Multiple Frequency Parametric Sonar

DTIC Science & Technology

2015-09-28

300003 1 MULTIPLE FREQUENCY PARAMETRIC SONAR STATEMENT OF GOVERNMENT INTEREST [0001] The invention described herein may be manufactured and...a method for increasing the bandwidth of a parametric sonar system by using multiple primary frequencies rather than only two primary frequencies...2) Description of Prior Art [0004] Parametric sonar generates narrow beams at low frequencies by projecting sound at two distinct primary

47 CFR 5.85 - Frequencies and policy governing their assignment.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Stations within 4.8 kilometers (3 statute miles) with 50 watts or more average ERP in the primary plane of... statute miles) with 1 kW or more average ERP in the primary plane of polarization in the azimuthal... more average ERP in the primary plane of polarization in the azimuthal direction of the Monitoring...

Structural Dynamics of Education Reforms and Quality of Primary Education in Uganda

ERIC Educational Resources Information Center

Nyenje, Aida

2016-01-01

This paper examines Uganda's recent undertaking to reform her Primary School education System with a focus on the effect of structural dynamics of education reforms and the quality of primary education. Structural dynamics in the context of this study is in reference to the organizational composition of the education system at the government,…

Comparative Study of Pupils' Academic Performance between Private and Public Primary Schools

ERIC Educational Resources Information Center

Adeyemi, Sunday B.

2014-01-01

This paper compares pupils' academic performance between the private and public primary schools. The sample, made up of 240 pupils were randomly selected from the private and public primary schools in Ilesa East and West Local Government Council Areas of Osun State, Nigeria. Two instruments were used. A structured questionnaire and Pupils'…

The Collaborative Learning Behaviours of Middle Primary School Students in a Classroom Music Creation Activity

ERIC Educational Resources Information Center

Baker, William J.; Harvey, Georgina

2014-01-01

Located in a northern Tasmanian government primary school, this study presents the findings of an investigation into the learning behaviours of middle primary (Grade 3/4) students in a collaborative music soundscape task. Recent literature regarding music education and social development are presented and the design of the research described.…

Evaluating 'good governance': The development of a quantitative tool in the Greater Serengeti Ecosystem.

PubMed

Kisingo, Alex; Rollins, Rick; Murray, Grant; Dearden, Phil; Clarke, Marlea

2016-10-01

Protected areas (PAs) can provide important benefits to conservation and to communities. A key factor in the effective delivery of these benefits is the role of governance. There has been a growth in research developing frameworks to evaluate 'good' PA governance, usually drawing on a set of principles that are associated with groups of indicators. In contrast to dominant qualitative approaches, this paper describes the development of a quantitative method for measuring effectiveness of protected area governance, as perceived by stakeholders in the Greater Serengeti Ecosystem in Tanzania. The research developed a quantitative method for developing effectiveness measures of PA governance, using a set of 65 statements related to governance principles developed from a literature review. The instrument was administered to 389 individuals from communities located near PAs in the Greater Serengeti Ecosystem. The results of a factor analysis suggest that statements load onto 10 factors that demonstrate high psychometric validity as measured by factor loadings, explained variance, and Cronbach's alpha reliability. The ten common factors that were extracted were: 1) legitimacy, 2) transparency and accountability, 3) responsiveness, 4) fairness, 5) participation, 6) ecosystem based management (EBM) and connectivity, 7) resilience, 8) achievements, 9) consensus orientation, and 10) power. The paper concludes that quantitative surveys can be used to evaluate governance of protected areas from a community-level perspective. Copyright © 2016 Elsevier Ltd. All rights reserved.

A scoping literature review of collaboration between primary care and public health.

PubMed

Martin-Misener, Ruth; Valaitis, Ruta; Wong, Sabrina T; Macdonald, Marjorie; Meagher-Stewart, Donna; Kaczorowski, Janusz; O-Mara, Linda; Savage, Rachel; Austin, Patricia

2012-10-01

The purpose of this scoping literature review was to determine what is known about: 1) structures and processes required to build successful collaborations between primary care (PC) and public health (PH); 2) outcomes of such collaborations; and 3) markers of their success. Collaboration between PC and PH is believed to enable more effective individual and population services than what might be achieved by either alone. The study followed established methods for a scoping literature review and was guided by a framework that identifies systemic, organizational and interactional determinants for collaboration. The review was restricted to articles published between 1988 and 2008. Published quantitative and qualitative primary studies, evaluation research, systematic and other types of reviews, as well as descriptive accounts without an explicit research design, were included if they addressed either the structures or processes to build collaboration or the outcomes or markers of such collaboration, and were published in English. The combined search strategy yielded 6125 articles of which 114 were included. Systemic-level factors influencing collaboration included: government involvement, policy and fit with local needs; funding and resource factors, power and control issues; and education and training. Lack of a common agenda; knowledge and resource limitations; leadership, management and accountability issues; geographic proximity of partners; and shared protocols, tools and information sharing were influential at the organizational level. Interpersonal factors included having a shared purpose; philosophy and beliefs; clear roles and positive relationships; and effective communication and decision-making strategies. Reported benefits of collaboration included: improved chronic disease management; communicable disease control; and maternal child health. More research is needed to explore the conditions and contexts in which collaboration between PC and PH makes most sense and potential gains outweigh the associated risks and costs.

Integrated care reform in urban China: a qualitative study on design, supporting environment and implementation.

PubMed

Qian, Yi; Hou, Zhiyuan; Wang, Wei; Zhang, Donglan; Yan, Fei

2017-10-25

Initiatives on integrated care between hospitals and community health centers (CHCs) have been introduced to transform the current fragmented health care delivery system into an integrated system in China. Up to date no research has analyzed in-depth the experiences of these initiatives based on perspectives from various stakeholders. This study analyzed the integrated care pilot in Hangzhou City by investigating stakeholders' perspectives on its design features and supporting environment, their acceptability of this pilot, and further identifying the enabling and constraining factors that may influence the implementation of the integrated care reform. The qualitative study was carried out based on in-depth interviews and focus group discussions with 50 key informants who were involved in the policy-making process and implementation. Relevant policy documents were also collected for analysis. The pilot in Hangzhou was established as a CHC-led delivery system based on cooperation agreement between CHCs and hospitals to deliver primary and specialty care together for patients with chronic diseases. An innovative learning-from-practice mentorship system between specialists and general practitioners was also introduced to solve the poor capacity of general practitioners. The design of the pilot, its governance and organizational structure and human resources were enabling factors, which facilitated the integrated care reform. However, the main constraining factors were a lack of an integrated payment mechanism from health insurance and a lack of tailored information system to ensure its sustainability. The integrated care pilot in Hangzhou enabled CHCs to play as gate-keeper and care coordinator for the full continuum of services across the health care providers. The government put integrated care a priority, and constructed an efficient design, governance and organizational structure to enable its implementation. Health insurance should play a proactive role, and adopt a shared financial incentive system to support integrated care across providers in the future.

Internationalizing Higher Education in Thailand: Government and University Responses

ERIC Educational Resources Information Center

Lavankura, Pad

2013-01-01

Each country responds to internationalization differently and offers various interpretations of the concept. Thailand has incorporated the internationalization of higher education into its plans since 1990. This article aims to discuss the primary motivations of the government and of Thai universities in moving toward the goal of…

Primary Education in Vietnam: Extra Classes and Outcomes

ERIC Educational Resources Information Center

Ha, Tran Thu; Harpham, Trudy

2005-01-01

Extra classes are increasingly observed in both developed and developing countries. In Vietnam, a country where education reforms are at their height, extra classes are proliferating and have become a concern to society and the government. Although the government has banned extra classes that are independent of school administration, teachers…

Forests and Trees: The Role of Academics in Legislative Internships

ERIC Educational Resources Information Center

Pecorella, Robert F.

2007-01-01

The primary form of experiential education in political science is an internship in a government office. Too often, however, with little actual monitoring of their experiences, government interns become little more than classic office "gofers." Fortunately, there are strategies to make political internships not only useful learning experiences for…

Implementation of the Hong Kong Language Policy in Pre-School Settings

ERIC Educational Resources Information Center

Leung, Cheung-Shing Sam; Lim, Swee Eng Audrey; Li, Yuen Ling

2013-01-01

In the past, the Curriculum Development Council in Hong Kong [Curriculum Development Council (CDC). (1996). "Guide to the Pre-Primary Curriculum." Hong Kong: Government Printer; CDC. (2000). "Consultation Document: Learning to Learn: The Way Forward in Curriculum Development." Hong Kong: Government Printer; CDC. (2001).…

Budgetary Challenges of Higher Education: Evidence from Bangladesh

ERIC Educational Resources Information Center

Sarkar, Shakhawat Hossain; Hossain, Syed Zabid

2016-01-01

This study strives to ascertain the financial and nonfinancial challenges of higher education budget for human resources development (HRD) based on both primary and secondary sources of data. Inadequate budgetary support from the government and inappropriate implementation of the same due to nonexistence of good governance and inefficient…

Accelerating Harmonization in Digital Health.

PubMed

Moore, Carolyn; Werner, Laurie; BenDor, Amanda Puckett; Bailey, Mike; Khan, Nighat

2017-01-01

Digital tools play an important role in supporting front-line health workers who deliver primary care. This paper explores the current state of efforts undertaken to move away from single-purpose applications of digital health towards integrated systems and solutions that align with national strategies. Through examples from health information systems, data and health worker training, this paper demonstrates how governments and stakeholders are working to integrate digital health services. We emphasize three factors as crucial for this integration: development and implementation of national digital health strategies; technical interoperability and collaborative approaches to ensure that digital health has an impact on the primary care level. Consolidation of technologies will enable an integrated, scaleable approach to the use of digital health to support health workers. As this edition explores a paradigm shift towards harmonization in primary healthcare systems, this paper explores complementary efforts undertaken to move away from single-purpose applications of digital health towards integrated systems and solutions that align with national strategies. It describes a paradigm shift towards integrated and interoperable systems that respond to health workers' needs in training, data and health information; and calls for the consolidation and integration of digital health tools and approaches across health areas, functions and levels of the health system. It then considers the critical factors that must be in place to support this paradigm shift. This paper aims not only to describe steps taken to move from fractured pilots to effective systems, but to propose a new perspective focused on consolidation and collaboration guided by national digital health strategies.

Satellite animal tracking feasibility studies

NASA Technical Reports Server (NTRS)

Buechner, H. K.

1975-01-01

A study was initiated in Tsavo National Park to determine movements and home ranges of individual elephants and their relations to overall distribution patterns and environmental factors such as rainfall. Methods used were radio tracking and observations of visually identifiable individuals. Aerial counts provided data on overall distribution. Two bulls and two cows were radio-tagged in Tsavo West and two bulls and four cows in Tsavo East, providing home range and movement data. The movements of individuals were useful in interpreting relatively major shifts in elephant distribution. Results point to the following preliminary conclusions: (1) elephants in the Tsavo area undertook long distance movements in fairly direct response to localized rainfall; (2) a subdivision of the overall population into locally distinct units may exist during the dry season but did not occur after significant rainfall; and (3) food appears to be the primary factor governing movements and distribution of elephants in the area.

City image towards tourist attraction (case in Solo, Central Java) examining city image of solo as tourist attraction

NASA Astrophysics Data System (ADS)

Wiyana, T.; Putranto, T. S.; Zulkarnain, A.; Kusdiana, R. N.

2018-03-01

Affective and cognitive image are two main factors that influence destination in Solo. The purpose of this research is to examine the two main factors of Solo towards tourist attraction. The research method is quantitative. Data collected from observation and survey. A total of 113 respondents obtained from accidental sampling method. The results indicate based on cognitive and affective image. Cognitive consists of culture, batik, city tagline, and community. While, affective consists of tradition, culinary, purposes, climate, and welcoming. The findings show that image has weak correlation towards tourist attraction of Solo. It means most of the tourists are not influenced by city image when they choose Solo as one of their travel destination. The differences between primary and minor image are also examined. Research implication is directed for local government to pursue continuous improvement particularly for the branding of Solo.

Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams.

PubMed

Grant, Suzanne; Ring, Adele; Gabbay, Mark; Guthrie, Bruce; McLean, Gary; Mair, Frances S; Watt, Graham; Heaney, David; O'Donnell, Catherine

2015-01-01

In the UK National Health Service, primary care organisation (PCO) managers have traditionally relied on the soft leadership of general practitioners based on professional self-regulation rather than direct managerial control. The 2004 general medical services contract (nGMS) represented a significant break from this arrangement by introducing new performance management mechanisms for PCO managers to measure and improve general practice work. This article examines the impact of nGMS on the governance of UK general practice by PCO managers through a qualitative analysis of data from an empirical study in four UK PCOs and eight general practices, drawing on Hood's four-part governance framework. Two hybrids emerged: (i) PCO managers emphasised a hybrid of oversight, competition (comptrol) and peer-based mutuality by granting increased support, guidance and autonomy to compliant practices; and (ii) practices emphasised a broad acceptance of increased PCO oversight of clinical work that incorporated a restratified elite of general practice clinical peers at both PCO and practice levels. Given the increased international focus on the quality, safety and efficiency in primary care, a key issue for PCOs and practices will be to achieve an effective, contextually appropriate balance between the counterposing governance mechanisms of peer-led mutuality and externally led comptrol. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Auditing Nicaragua’s anti-corruption struggle, 1998 to 2009

PubMed Central

2011-01-01

Background Four social audits in 1998, 2003, 2006 and 2009 identified actions that Nicaragua could take to reduce corruption and public perception in primary health care and other key services. Methods In a 71-cluster sample, weighted according to the 1995 census and stratified by geographic region and settlement type, we audited the same five public services: health centres and health posts, public primary schools, municipal government, transit police and the courts. Some 6,000 households answered questions about perception and personal experience of unofficial and involuntary payments, payments without obtaining receipts or to the wrong person, and payments "to facilitate" services in municipal offices or courts. Additional questions covered complaints about corruption and confidence in the country's anti-corruption struggle. Logistic regression analyses helped clarify local variations and explanatory variables. Feedback to participants and the services at both national and local levels followed each social audit. Results Users' experience of corruption in health services, education and municipal government decreased. The wider population's perception of corruption in these sectors decreased also, but not as quickly. Progress among traffic police faltered between 2006 and 2009 and public perception of police corruption ticked upwards in parallel with drivers' experience. Users' experience of corruption in the courts worsened over the study period -- with the possible exception of Managua between 2006 and 2009 -- but public perception of judicial corruption, after peaking in 2003, declined from then on. Confidence in the anti-corruption struggle grew from 50% to 60% between 2003 and 2009. Never more than 8% of respondents registered complaints about corruption. Factors associated with public perception of corruption were: personal experience of corruption, quality of the service itself, and the perception that municipal government takes community opinion into account and keeps people informed about how it uses public funds. Conclusions Lowering citizens' perception of corruption in public services depends on reducing their experience of it, on improving service quality and access and -- perhaps most importantly -- on making citizens feel they are well-informed participants in the work of government. PMID:22375610

Primary care--opportunities and threats. Developing professional knowledge: making primary care education and research more relevant.

PubMed Central

Pearson, P.; Jones, K.

1997-01-01

The trio of recent government white papers heralds a new world for primary care. Many changes in the education of future primary health care professionals and in the research ethos of the discipline will be needed to realise this vision. New skills and attitudes, not least in multidisciplinary working; lifelong learning; and greater understanding of and participation in primary care research will have to emerge from educational efforts in the next few years. PMID:9081008

The detection and analysis of point processes in biological signals

NASA Technical Reports Server (NTRS)

Anderson, D. J.; Correia, M. J.

1977-01-01

A pragmatic approach to the detection and analysis of discrete events in biomedical signals is taken. Examples from both clinical and basic research are provided. Introductory sections discuss not only discrete events which are easily extracted from recordings by conventional threshold detectors but also events embedded in other information carrying signals. The primary considerations are factors governing event-time resolution and the effects limits to this resolution have on the subsequent analysis of the underlying process. The analysis portion describes tests for qualifying the records as stationary point processes and procedures for providing meaningful information about the biological signals under investigation. All of these procedures are designed to be implemented on laboratory computers of modest computational capacity.

A genetic platform to model sarcomagenesis from primary adult mesenchymal stem cells

PubMed Central

Guarnerio, Jlenia; Riccardi, Luisa; Taulli, Riccardo; Maeda, Takahiro; Wang, Guocan; Hobbs, Robin M.; Song, Min Sup; Sportoletti, Paolo; Bernardi, Rosa; Bronson, Roderick T.; Castillo-Martin, Mireia; Cordon-Cardo, Carlos; Lunardi, Andrea; Pandolfi, Pier Paolo

2015-01-01

The regulatory factors governing adult mesenchymal stem cells (MSCs) physiology and their tumorigenic potential are still largely unknown, which substantially delays the identification of effective therapeutic approaches for the treatment of aggressive and lethal form of MSC-derived mesenchymal tumors, such as undifferentiated sarcomas. Here we have developed a novel platform to screen and quickly identify genes and pathways responsible for adult MSCs transformation, modeled undifferentiated sarcoma in vivo, and, ultimately, tested the efficacy of targeting the identified oncopathways. Importantly, by taking advantage of this new platform, we demonstrate the key role of an aberrant LRF-DLK1-SOX9 pathway in the pathogenesis of undifferentiated sarcoma with important therapeutic implications. PMID:25614485

Burden of stroke in Malaysia.

PubMed

Loo, Keat Wei; Gan, Siew Hua

2012-02-01

Stroke is one of the top five leading causes of death and one of the top 10 causes for hospitalization in Malaysia. Stroke is also in the top five diseases with the greatest burden of disease, based on disability-adjusted life years. However, prospective studies on stroke in Malaysia are limited. To date, neither the prevalence of stroke nor its incidence nationally has been recorded. Hypertension is the major risk factor for stroke. The mean age of stroke patients in Malaysia is between 54.5 and 62.6 years. Traditional medicine is commonly practiced. With the increasing number of stroke cases annually, more government and nongovernment organizations should be involved in primary and secondary prevention strategies.

42 CFR 485.703 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... Public health agency. An official agency established by a State or local government, the primary function... the primary site. The extension location is part of the rehabilitation agency. The extension location... function or activity and that— (1) Includes initial direction and periodic observation of the actual...

42 CFR 485.703 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

.... Public health agency. An official agency established by a State or local government, the primary function... the primary site. The extension location is part of the rehabilitation agency. The extension location... function or activity and that— (1) Includes initial direction and periodic observation of the actual...

42 CFR 485.703 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... Public health agency. An official agency established by a State or local government, the primary function... the primary site. The extension location is part of the rehabilitation agency. The extension location... function or activity and that— (1) Includes initial direction and periodic observation of the actual...

42 CFR 485.703 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... Public health agency. An official agency established by a State or local government, the primary function... the primary site. The extension location is part of the rehabilitation agency. The extension location... function or activity and that— (1) Includes initial direction and periodic observation of the actual...

42 CFR 485.703 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... Public health agency. An official agency established by a State or local government, the primary function... the primary site. The extension location is part of the rehabilitation agency. The extension location... function or activity and that— (1) Includes initial direction and periodic observation of the actual...

Disentangling Mechanisms That Mediate the Balance Between Stochastic and Deterministic Processes in Microbial Succession

DOE PAGES

Dini-Andreote, Francisco; Stegen, James C.; van Elsas, Jan D.; ...

2015-03-17

Despite growing recognition that deterministic and stochastic factors simultaneously influence bacterial communities, little is known about mechanisms shifting their relative importance. To better understand underlying mechanisms, we developed a conceptual model linking ecosystem development during primary succession to shifts in the stochastic/deterministic balance. To evaluate the conceptual model we coupled spatiotemporal data on soil bacterial communities with environmental conditions spanning 105 years of salt marsh development. At the local scale there was a progression from stochasticity to determinism due to Na accumulation with increasing ecosystem age, supporting a main element of the conceptual model. At the regional-scale, soil organic mattermore » (SOM) governed the relative influence of stochasticity and the type of deterministic ecological selection, suggesting scale-dependency in how deterministic ecological selection is imposed. Analysis of a new ecological simulation model supported these conceptual inferences. Looking forward, we propose an extended conceptual model that integrates primary and secondary succession in microbial systems.« less

Proposed industrial recovered materials utilization targets for the metals and metal-products industry

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

None

1979-05-01

The introductory chapter provides a discussion of the factors that affect the recovery and reuse of secondary materials and the competition between the primary and secondary metals industries. It discusses these industries in terms of resource characteristics, industry technology, pollution control requirements, market structure, the economics of recycling, and the issues involved in econometrically estimating scrap supply response behavior. It further presents the methodology established by DOE for the metals, textiles, rubber, and pulp and paper industries. The areas in which government policies might have a significant impact on the utilization of primary and secondary metals and on any recyclingmore » targets between now and 1987 are noted. Chapter 3 presents general profiles for the major industrial segments comprising SIC 33. The profiles include such topics as industry structure, process technology, materials and recycling flow, and future trends. Chapter 4 specifically covers the evaluation of recycling targets for the ferrous, aluminum, copper, zinc, and lead industries. (MCW)« less

Active medulloblastoma enhancers reveal subgroup-specific cellular origins

PubMed Central

Lin, Charles Y.; Erkek, Serap; Tong, Yiai; Yin, Linlin; Federation, Alexander J.; Zapatka, Marc; Haldipur, Parthiv; Kawauchi, Daisuke; Risch, Thomas; Warnatz, Hans-Jörg; Worst, Barbara C.; Ju, Bensheng; Orr, Brent A.; Zeid, Rhamy; Polaski, Donald R.; Segura-Wang, Maia; Waszak, Sebastian M.; Jones, David T.W.; Kool, Marcel; Hovestadt, Volker; Buchhalter, Ivo; Sieber, Laura; Johann, Pascal; Chavez, Lukas; Gröschel, Stefan; Ryzhova, Marina; Korshunov, Andrey; Chen, Wenbiao; Chizhikov, Victor V.; Millen, Kathleen J.; Amstislavskiy, Vyacheslav; Lehrach, Hans; Yaspo, Marie-Laure; Eils, Roland; Lichter, Peter; Korbel, Jan O.; Pfister, Stefan M.; Bradner, James E.; Northcott, Paul A.

2016-01-01

Summary Medulloblastoma is a highly malignant paediatric brain tumour, often inflicting devastating consequences on the developing child. Genomic studies have revealed four distinct molecular subgroups with divergent biology and clinical behaviour. An understanding of the regulatory circuitry governing the transcriptional landscapes of medulloblastoma subgroups, and how this relates to their respective developmental origins, is lacking. Using H3K27ac and BRD4 ChIP-Seq, coupled with tissue-matched DNA methylation and transcriptome data, we describe the active cis-regulatory landscape across 28 primary medulloblastoma specimens. Analysis of differentially regulated enhancers and super-enhancers reinforced inter-subgroup heterogeneity and revealed novel, clinically relevant insights into medulloblastoma biology. Computational reconstruction of core regulatory circuitry identified a master set of transcription factors, validated by ChIP-Seq, that are responsible for subgroup divergence and implicate candidate cells-of-origin for Group 4. Our integrated analysis of enhancer elements in a large series of primary tumour samples reveals insights into cis-regulatory architecture, unrecognized dependencies, and cellular origins. PMID:26814967

What factors influence smoking prevalence and smoke free policy enactment across the European Union Member States.

PubMed

Bogdanovica, Ilze; McNeill, Ann; Murray, Rachael; Britton, John

2011-01-01

Smoking prevention should be a primary public health priority for all governments, and effective preventive policies have been identified for decades. The heterogeneity of smoking prevalence between European Union (EU) Member States therefore reflects, at least in part, a failure by governments to prioritise public health over tobacco industry or possibly other financial interests, and hence potentially government corruption. The aims of this study were to test the hypothesis that smoking prevalence is higher in countries with high levels of public sector corruption, and explore the ecological association between smoking prevalence and a range of other national characteristics in current EU Member States. Ecological data from 27 EU Member States were used to estimate univariate and multivariate correlations between smoking prevalence and the Transparency International Corruption Perceptions Index, and a range of other national characteristics including economic development, social inclusion, quality of life and importance of religion. We also explored the association between the Corruption Perceptions Index and measures of the extent to which smoke-free policies have been enacted and are enforced. In univariate analysis, smoking prevalence was significantly higher in countries with higher scores for corruption, material deprivation, and gender inequality; and lower in countries with higher per capita Gross Domestic Product, social spending, life satisfaction and human development scores. In multivariate analysis, only the corruption perception index was independently related to smoking prevalence. Exposure to tobacco smoke in the workplace was also correlated with corruption, independently from smoking prevalence, but not with the measures of national smoke-free policy implementation. Corruption appears to be an important risk factor for failure of national tobacco control activity in EU countries, and the extent to which key tobacco control policies have been implemented. Further research is needed to assess the causal relationships involved.

Determinants of child and forced marriage in Morocco: stakeholder perspectives on health, policies and human rights

PubMed Central

2013-01-01

Background In Morocco, the social and legal framework surrounding sexual and reproductive health has transformed greatly in the past decade, especially with the introduction of the new Family Law or Moudawana. Yet, despite raising the minimum age of marriage for girls and stipulating equal rights in the family, child and forced marriage is widespread. The objective of this research study was to explore perspectives of a broad range of professionals on factors that contribute to the occurrence of child and forced marriage in Morocco. Methods A qualitative approach was used to generate both primary and secondary data for the analysis. Primary data consist of individual semi-structured interviews that were conducted with 22 professionals from various sectors: health, legal, education, NGO’s and government. Sources of secondary data include academic papers, government and NGO reports, various legal documents and media reports. Data were analyzed using thematic qualitative analysis. Results Four major themes arose from the data, indicating that the following elements contribute to child and forced marriage: (1) the legal and social divergence in conceptualizing forced and child marriage; (2) the impact of legislation; (3) the role of education; and (4) the economic factor. Emphasis was especially placed on the new Family Code or Moudawana as having the greatest influence on advancement of women's rights in the sphere of marriage. However, participants pointed out that embedded patriarchal attitudes and behaviours limit its effectiveness. Conclusion The study provided a comprehensive understanding of the factors that compound the problem of child and forced marriage in Morocco. From the viewpoint of professionals, who are closely involved in tackling the issue, policy measures and the law have the greatest potential to bring child and forced marriage to a halt. However, the implementation of new legal tools is facing barriers and resistance. Additionally, the legal and policy framework should go hand in hand with both education and increased economic opportunities. Education and awareness-raising of all ages is considered essential, seeing that parents and the extended family play a huge role in marrying off girls and young women. PMID:24131501

Determinants of child and forced marriage in Morocco: stakeholder perspectives on health, policies and human rights.

PubMed

Sabbe, Alexia; Oulami, Halima; Zekraoui, Wahiba; Hikmat, Halima; Temmerman, Marleen; Leye, Els

2013-10-16

In Morocco, the social and legal framework surrounding sexual and reproductive health has transformed greatly in the past decade, especially with the introduction of the new Family Law or Moudawana. Yet, despite raising the minimum age of marriage for girls and stipulating equal rights in the family, child and forced marriage is widespread. The objective of this research study was to explore perspectives of a broad range of professionals on factors that contribute to the occurrence of child and forced marriage in Morocco. A qualitative approach was used to generate both primary and secondary data for the analysis. Primary data consist of individual semi-structured interviews that were conducted with 22 professionals from various sectors: health, legal, education, NGO's and government. Sources of secondary data include academic papers, government and NGO reports, various legal documents and media reports. Data were analyzed using thematic qualitative analysis. Four major themes arose from the data, indicating that the following elements contribute to child and forced marriage: (1) the legal and social divergence in conceptualizing forced and child marriage; (2) the impact of legislation; (3) the role of education; and (4) the economic factor. Emphasis was especially placed on the new Family Code or Moudawana as having the greatest influence on advancement of women's rights in the sphere of marriage. However, participants pointed out that embedded patriarchal attitudes and behaviours limit its effectiveness. The study provided a comprehensive understanding of the factors that compound the problem of child and forced marriage in Morocco. From the viewpoint of professionals, who are closely involved in tackling the issue, policy measures and the law have the greatest potential to bring child and forced marriage to a halt. However, the implementation of new legal tools is facing barriers and resistance. Additionally, the legal and policy framework should go hand in hand with both education and increased economic opportunities. Education and awareness-raising of all ages is considered essential, seeing that parents and the extended family play a huge role in marrying off girls and young women.

The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care.

PubMed

Goodwin, N

2001-01-01

This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital) services and also, potentially, social care. This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

The Future of Health Care in the Kurdistan Region - Iraq: Toward an Effective, High-Quality System with an Emphasis on Primary Care.

PubMed

Moore, Melinda; Anthony, C Ross; Lim, Yee-Wei; Jones, Spencer S; Overton, Adrian; Yoong, Joanne K

2014-01-01

At the request of the Kurdistan Regional Government (KRG), RAND researchers undertook a yearlong analysis of the health care system in the Kurdistan Region of Iraq, with a focus on primary care. RAND staff reviewed available literature on the Kurdistan Region and information relevant to primary care; interviewed a wide range of policy leaders, health practitioners, patients, and government officials to gather information and understand their priorities; collected and studied all available data related to health resources, services, and conditions; and projected future supply and demand for health services in the Kurdistan Region; and laid out the health financing challenges and questions. In this volume, the authors describe the strengths of the health care system in the Kurdistan Region as well as the challenges it faces. The authors suggest that a primary care-oriented health care system could help the KRG address many of these challenges. The authors discuss how such a system might be implemented and financed, and they make recommendations for better utilizing resources to improve the quality, access, effectiveness, and efficiency of primary care.

Email communication at the medical primary-secondary care interface: a qualitative exploration.

PubMed

Sampson, Rod; Barbour, Rosaline; Wilson, Philip

2016-07-01

There is little published research into the influence of email communication between primary and secondary care clinicians on patient care. To explore the use of email communication between clinicians across the primary- secondary care interface, and how this may relate to patient care. A qualitative study involving primary and secondary care services in the NHS Highland Health Board area, Scotland. Ten GPs and 12 hospital consultants were purposively sampled to reflect diversity. Eligible clinicians were invited to take part in a semi-structured interview. Data were analysed using a thematic analysis approach. Key themes that emerged for clinicians included general perceptions of email; using email in practice (managing workload, impact on patient journeys, and 'quick answers'); system issues (variability and governance); relational aspects; and email skills. Email communication between primary and secondary care clinicians generally has a positive impact on patient access to specialist expertise. Governance issues around the use of clinical email need to be defined. There may currently be a two-tier health service for those patients (and their GPs) requiring 'quick answers'. © British Journal of General Practice 2016.

Government Funding on Access to Secondary Education in Kenya: Challenges and Prospects

ERIC Educational Resources Information Center

Ndiku, J. Mualuko; Muhavi, S. Lucy

2013-01-01

One of the major challenges facing secondary education sub-sector in Kenya over the years is low transition rate from primary to secondary level of education. This has contributed to low enrolment at secondary schools with a wide gap existing between primary and secondary enrolment. With the introduction of Free Primary Education in 2003, the gap…

Academisation, School Collaboration and the Primary School Sector in England: A Story of Six School Leaders

ERIC Educational Resources Information Center

Keddie, Amanda

2016-01-01

This paper presents data from a study of five English primary schools. It examines some of the challenges associated with school autonomy and collaboration for state primary schools amid the uncertainty and complexity of governance in the present English education context. The paper features the voices of six leaders gathered from interviews that…

Experiences of Violence and Deficits in Academic Achievement among Urban Primary School Children in Jamaica

ERIC Educational Resources Information Center

Baker-Henningham, Helen; Meeks-Gardner, Julie; Chang, Susan; Walker, Susan

2009-01-01

Objective: The aim of this study was to examine the relationship between children's experiences of three different types of violence and academic achievement among primary school children in Kingston, Jamaica. Methods: A cross-sectional study of 1300 children in grade 5 [mean (S.D.) age: 11 (0.5) years] from 29 government primary schools in urban…

Formative and Summative Assessment of Science in English Primary Schools: Evidence from the Primary Science Quality Mark

ERIC Educational Resources Information Center

Earle, Sarah

2014-01-01

Background: Since the discontinuation of Standard Attainment Tests (SATs) in science at age 11 in England, pupil performance data in science reported to the UK government by each primary school has relied largely on teacher assessment undertaken in the classroom. Purpose: The process by which teachers are making these judgements has been unclear,…

Spending the Primary Physical Education and Sport Premium: A West Midlands Case Study

ERIC Educational Resources Information Center

Griggs, Gerald

2016-01-01

In March 2013 the government announced that it was to provide funding to improve provision of Physical Education and sport in primary schools in England. Entitled The Primary Physical Education and Sport Premium, this ring-fenced annual funding has been allocated to schools that are free to choose how the money is spent but are accountable for its…

An Evaluation of the Implementation of Early Childhood Education Curriculum in Osun State

ERIC Educational Resources Information Center

Okewole, Johnson Oludele; Abuovbo, Iluezi-Ogbedu Veronica; Abosede, Osinowo Olufunke

2015-01-01

Early Childhood Education as a subject in primary schools in Nigeria was first noticed among the private primary schools in the 80s while the public primary schools did not incorporate it in their curriculum in Nigeria. Of recent, some state governments in Nigeria have just adopted and organized early childhood education unit into their primary…

Indonesia--Innovation in the Management of Primary School Construction: A Case Study. Education Building Report 8.

ERIC Educational Resources Information Center

Hussin

This UNESCO report describes the progress of primary school building development under the second Five Year Plan of the Government of Indonesia. The main objective of the construction program was to increase the enrollement of children of primary school age to 85 per cent of all eligible children. Chapter I provides an historical perspective on…

Impact of Enrollment on the Quality of Learning in Primary Schools in Imenti Central District, Kenya

ERIC Educational Resources Information Center

Mwirigi, Silas Francis; Muthaa, George M.

2015-01-01

To promote participation and access to education, the government introduced free primary education. The introduction of FSE has resulted into increased enrolment at all levels which has been blamed for the poor performance of pupils in public primary school of Imenti Central District. The current study sought to determine the impact of enrollment…

Quantifying the Impact of the Acquisition Professional Development Program Certification Requirements on the Air Force Institute of Technology.

DTIC Science & Technology

1992-03-01

within DoD (12:104). Air Force Regulation (AFR) 36-1 governs the officer specialty classification system. The Air Force classifies the 8 types of primary...inefficient government spending, the proficiency of all personnel involved in the procurement process would have to be certified according to their...captures AFIT’s policy on course frequency, course content, and other Air Force regulations governing the training and educational process. The

Not All Parts Are Created Equal: The Impact Of Counterfeit Parts In The Air Force Supply Chain

DTIC Science & Technology

2017-04-06

Government implemented a whole of government approach to tackle this issue. This issue affects both DOD, defense contractors by increasing costs...and oversight to reduce Supply Chain Risk”.2 In other words, the issue has not been resolved. This issue affects both DOD, defense contractors by...U.S. parts distributors that sprang up virtually overnight after Congress did away with requiring primary government contractors to certify all

Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature.

PubMed

Bland, C J; Meurer, L N; Maldonado, G

1995-07-01

This paper analyzes and synthesizes the literature on primary care specialty choice from 1987 through 1993. To improve the validity and usefulness of the conclusions drawn from the literature, the authors developed a model of medical student specialty choice to guide the synthesis, and used only high-quality research (a final total of 73 articles). They found that students predominantly enter medical school with a preference for primary care careers, but that this preference diminishes over time (particularly over the clinical clerkship years). Student characteristics associated with primary care career choice are: being female, older, and married; having a broad undergraduate background; having non-physician parents; having relatively low income expectations; being interested in diverse patients and health problems; and having less interest in prestige, high technology, and surgery. Other traits, such as value orientation, personality, or life situation, yet to be reliably measured, may actually be responsible for some of these associations. Two curricular experiences are associated with increases in the numbers of students choosing primary care: required family practice clerkships and longitudinal primary care experiences. Overall, the number of required weeks in family practice shows the strongest association. Students are influenced by the cultures of the institutions in which they train, and an important factor in this influence is the relative representation of academically credible, full-time primary care faculty within each institution's governance and everyday operation. In turn, the institutional culture and faculty composition are largely determined by each school's mission and funding sources--explaining, perhaps, the strong and consistent association frequently found between public schools and a greater output of primary care physicians. Factors that do not influence primary care specialty choice include early exposure to family practice faculty or to family practitioners in their own clinics, having a high family medicine faculty-to-student ratio, and student debt level, unless exceptionally high. Also, students view a lack of understanding of the specialties as a major impediment to their career decisions, and it appears they acquire distorted images of the primary care specialties as they learn within major academic settings. Strikingly few schools produce a majority of primary care graduates who enter family practice, general internal medicine, or general practice residencies or who actually practice as generalists. Even specially designed tracks seldom produce more than 60% primary care graduates. Twelve recommendations for strategies to increase the proportion of primary care physicians are provided.

A survey of the governance capacity of national public health associations to enhance population health.

PubMed

Chauvin, James; Shukla, Mahesh; Rice, James; Rispel, Laetitia

2016-03-11

National public health associations (PHAs) are key partners with governments and communities to improve, protect and promote the public's health. Governance and organizational capacity are among the key determinants of a PHA's effectiveness as an advocate for appropriate public health policies and practice. During 2014, the World Federation of Public Health Associations (WFPHA) conducted an on-line survey of its 82 PHA members, to identify the state of organizational governance of national public health associations, as well as the factors that influence optimal organizational governance. The survey consisted of 13 questions and focused on the main elements of organizational governance: cultivating accountability; engaging stakeholders; setting shared direction; stewarding resources; and, continuous governance enhancement. Four questions included a qualitative open-ended response for additional comments. The survey data were analyzed using Microsoft Excel. The qualitative data was analyzed using thematic content analysis Responses were received from 62 PHAs, constituting a 75.6 % response rate. The two most important factors that support governance effectiveness were a high degree of integrity and ethical behavior of the PHA's leaders (77 %) and the competence of people serving on the PHA's governing body (76 %). The lack of financial resources was considered as the most important factor that negatively affected organizational governance effectiveness (73 %). The lack of mentoring for future PHA leaders; ineffective or incompetent leadership; lack of understanding about good governance practices; and lack of accurate information for strategic planning were identified as factors influencing PHA governance effectiveness. Critical elements for PHA sustainability included diversity, gender-responsiveness and inclusive governance practices, and strategies to build the future generation of public health leaders. National PHA have a responsibility to put into place the practices and infrastructure that enhance organizational governance. This will enhance their ability to be effective advocates for policies and practices that enhance, protect and promote the public's health. The WFPHA has an important role to play in providing the technical assistance and financial resources to assist PHAs in attaining and sustaining a higher level of governance capacity.

Contracting with private providers for primary care services: evidence from urban China.

PubMed

Wang, Yan; Eggleston, Karen; Yu, Zhenjie; Zhang, Qiong

2013-01-17

Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China's recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance.We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services.

Contracting with private providers for primary care services: evidence from urban China

PubMed Central

2013-01-01

Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China’s recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance. We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services. PMID:23327666

Expanding Medicaid Access without Expanding Medicaid: Why Did Some Nonexpansion States Continue the Primary Care Fee Bump?

PubMed

Wilk, Adam S; Evans, Leigh C; Jones, David K

2018-02-01

Six states that have rejected the Patient Protection and Affordable Care Act's (ACA) Medicaid expansion nonetheless extended the primary care "fee bump," by which the federal government increased Medicaid fees for primary care services up to 100 percent of Medicare fees during 2013-14. We conducted semistructured interviews with leaders in five of these states, as well as in three comparison states, to examine why they would continue a provision of the ACA that moderately expands access at significant state expense while rejecting the expansion and its large federal match, focusing on relevant economic, political, and procedural factors. We found that fee bump extension proposals were more successful where they were dissociated from major national policy debates, actionable with the input of relatively few stakeholder entities, and well aligned with preexisting policy-making structures and decision trends. Republican proposals to cap or reduce federal funding for Medicaid, if enacted, would compel states to contain program costs. In this context, states' established decision-making processes for updating Medicaid fee schedules, which we elucidate in this study, may shape the future of the Medicaid program. Copyright © 2018 by Duke University Press 2018.

Synthetic biology regulation and governance: Lessons from TAPIC for the United States, European Union, and Singapore.

PubMed

Trump, Benjamin D

2017-11-01

Synthetic biology is an emerging technology with potential benefits to various fields, yet also contains potential risks to human and environmental health. The field remains in an emerging state with limited quantitative guidance and a small but growing population of international researchers that conduct work within this field. Given the uncertain nature of this technology, an adaptive and anticipatory governance framework may be necessary to balance the potential benefits that may accrue from the technology's continued research alongside a desire to reduce or eliminate potential risks that may arise. However, such developments must account for the unique political and institutional factors that form a government's risk culture - something that can facilitate or impede the development of adaptive synthetic biology governance moving forward. The TAPIC framework helps illustrate those factors that are essential to develop good governance for emerging technologies like synthetic biology. Specifically, an application of TAPIC to synthetic biology governance indicates that the factors of accountability, participation, and integrity must be bolstered to improve technology governance in governments like with the United States, European Union, and Singapore. Copyright © 2017. Published by Elsevier B.V.

Clinician and manager perceptions of factors leading to ward patient clinical deterioration.

PubMed

Allen, Joshua; Jones, Daryl; Currey, Judy

2017-11-16

Improving the timely recognition and response to clinical deterioration is a critical challenge for clinicians, educators, administrators and researchers. Clinical deterioration leading to Rapid Response Team review is associated with poor patient outcomes. A range of factors associated with clinical deterioration and its outcomes have been identified, and may help with early identification of deteriorating patients. However, the relative importance of each factor on the development of clinical deterioration is unknown. To identify the relative importance of factors contributing to the development of clinical deterioration in ward patients, as perceived by health professionals who have experience in recognising or responding to clinical deterioration, or in the management, administration or governance of RRSs. A written questionnaire containing 12 pre-determined factors was provided to participants. Participants were asked to rank the items from most to least important contributors to ward patient deterioration. The study took place during a session of the Australia and New Zealand Intensive Care Society Rapid Response Team conference. A final sample of 233 (83% response rate), returned the questionnaire. The sample comprised specialist ICU registered nurses with direct patient contact (64%), ICU consultant doctors (17%), ICU nurse managers (7%), hospital administrators (2%), ICU registrars (2%), quality coordinators (2%) and non-hospital staff (4%). The patient's presenting illness/main diagnosis was the highest ranked factor, followed by pre-existing co-morbidities, seniority of nursing ward staff, medical documentation, senior medical staff, and interdisciplinary communication. Almost two-thirds of participants ranked patient characteristics as the most important contributor to clinical deterioration. Health professionals who have experience in recognising or responding to clinical deterioration, or in the management, administration or governance of RRSs perceive that patient characteristics such as the patient's primary diagnosis and comorbidities to be the most important contributors to clinical deterioration. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Iraqi primary care system in Kurdistan region: providers' perspectives on problems and opportunities for improvement.

PubMed

Shabila, Nazar P; Al-Tawil, Namir G; Al-Hadithi, Tariq S; Sondorp, Egbert; Vaughan, Kelsey

2012-09-27

As part of a comprehensive study on the primary health care system in Iraq, we sought to explore primary care providers' perspectives about the main problems influencing the provision of primary care services and opportunities to improve the system. A qualitative study based on four focus groups involving 40 primary care providers from 12 primary health care centres was conducted in Erbil governorate in the Iraqi Kurdistan region between July and October 2010. A topic guide was used to lead discussions and covered questions on positive aspects of and current problems with the primary care system in addition to the priority needs for its improvement. The discussions were fully transcribed and the qualitative data was analyzed by content analysis, followed by a thematic analysis. Problems facing the primary care system included inappropriate health service delivery (irrational use of health services, irrational treatment, poor referral system, poor infrastructure and poor hygiene), health workforce challenges (high number of specialists, uneven distribution of the health workforce, rapid turnover, lack of training and educational opportunities and discrepancies in the salary system), shortage in resources (shortage and low quality of medical supplies and shortage in financing), poor information technology and poor leadership/governance. The greatest emphasis was placed on poor organization of health services delivery, particularly the irrational use of health services and the related overcrowding and overload on primary care providers and health facilities. Suggestions for improving the system included application of a family medicine approach and ensuring effective planning and monitoring. This study has provided a comprehensive understanding of the factors that negatively affect the primary care system in Iraq's Kurdistan region from the perspective of primary care providers. From their experience, primary care providers have a role in informing the community and policy makers about the main problems affecting this system, though improvements to the health care system must be taken up at the national level and involve other key stakeholders.

What if the Faculty Really Do Assume Responsibility for the Educational Program?

ERIC Educational Resources Information Center

Gaff, Jerry G.

2007-01-01

The governance of most colleges and universities is shared among the board of trustees, the administration, and the faculty. Most four-year institutions endorse the American Association of University Professors (AAUP) Statement on Government of Colleges and Universities (1966), which asserts that the faculty has "primary" authority over the…

Public Investment in Children's Early and Elementary Years (Birth to Age 11)

ERIC Educational Resources Information Center

Macomber, Jennifer; Isaacs, Julia; Vericker, Tracy; Kent, Adam

2010-01-01

How government spends money, and who benefits, reveals the priorities. How, then, do children fare in the competition for public resources? While families have long been the primary caregivers of children, all levels of government--local, state, and federal--invest in the growth and development of children, whether through education, family…

Innovative Financing for Out-of-School Children and Youth

ERIC Educational Resources Information Center

UNESCO Bangkok, 2015

2015-01-01

Despite government commitments to Education for All (EFA) and Millennium Development Goals (MDGs) to improve access to education, more than 18 million primary-aged children remain out of school in the Asia-Pacific (UNESCO, 2014). Given the impact of education on individuals, societies, and economies, there is great urgency for governments to…

Child Care and Equal Opportunity for Women. Clearinghouse Publication No. 67.

ERIC Educational Resources Information Center

Levine, James A.; And Others

This report examines the relationship between the federal government's child care programs and policies and the federal government's goal of equal opportunity for women. Specifically, the report reviews three dimensions of federal child care activities: programs and policies whose primary purpose is to assist families with child care; the…

What Is Literacy? Thirty Years of Australian Literacy Debates (1975-2005)

ERIC Educational Resources Information Center

Edwards, Debra; Potts, Anthony

2008-01-01

Australia is a federation of six states and two territories. Each state and territory has its own legislature, which may not be of the same political persuasion as the Commonwealth (Federal) Government. Under the Australian Constitution primary control of school education is with the State and Territory Governments, with the Australian…

77 FR 2550 - Office for State, Tribal, Local and Territorial Support (OSTLTS)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-18

... in October of 2005 with the primary purpose of providing guidance across the agency to work.../AN access to CDC resources and programs. In November of 2006, an Agency Advisory Committee (the CDC... government-to-government consultation activities rests within the CDC Office of the Director (OD), other CDC...

Evaluating and Terminating Existing Instructional Programs: The Controversial Role of Statewide Coordinating/Governing Agencies.

ERIC Educational Resources Information Center

Johnson, Elizabeth H.

Structures for governing and coordinating higher education are changing. However, the primary responsibility for education rests with the state. The coordinating agency, which occupies the middle-ground between the institutions and the political decision-makers, should have 5 minimum abilities: (1) to engage in continuous planning, both long-range…

The Effectiveness of Using Technology in English Language Classrooms in Government Primary Schools in Bangladesh

ERIC Educational Resources Information Center

Parvin, Ruxana Hossain; Salam, Shaikh Flint

2015-01-01

Across the globe, governments of different countries have recognized the importance and value of digital technologies in language learning. This article is based on the pilot project of Save the Children using information and communication technology (ICT) in education. Through this initiative, interactive multimedia software based on national…

76 FR 39367 - Migratory Bird Permits; Changes in the Regulations Governing Raptor Propagation

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-06

...-0020; 91200-1231-9BPP] RIN 1018-AX78 Migratory Bird Permits; Changes in the Regulations Governing... primary responsibility for managing migratory birds. Our authority is based on the Migratory Bird Treaty... take and possession of migratory birds for many purposes. The BGEPA allows bald eagles and golden...

A Review of the Literature Related to Government Relations in Higher Education

ERIC Educational Resources Information Center

Brumfield, Randall; Miller, Michael T.

2008-01-01

This review of literature identifies the primary writings and research related to how higher education institutions operate government relations offices. These offices are defined by their mission and role of interfacing between institutional needs and officers and public officials. The review first reports the literature related to public…

Higher Education Governance and University Autonomy in China

ERIC Educational Resources Information Center

Wang, Li

2010-01-01

The primary aim of the paper is to examine the scope of university autonomy and extent of government control on higher education (HE) through mapping out the complexity of centralised decentralisation of HE. It consists of three major parts. University autonomy is critically analysed in the first section by examining regulative rules and opinions…

48 CFR 227.673 - Foreign license and technical assistance agreements between the Government and domestic concerns.

Code of Federal Regulations, 2010 CFR

2010-10-01

... GENERAL CONTRACTING REQUIREMENTS PATENTS, DATA, AND COPYRIGHTS Foreign License and Technical Assistance... concerns. (a) Contracts between the Government and a primary source to provide technical assistance or... extent practicable, specify the rights in patents and data and any other rights to be supplied to the...

7 CFR 7.27 - Political activity.

Code of Federal Regulations, 2010 CFR

2010-01-01

... opposing any candidate or any political organization in any primary, general, or special election for... party organizations; (2) A candidate for political office in any primary, general, or special election... the county governing body or hold a Federal, State, or county office filled by an election held...

CHEMICAL PUBLICATIONS, THEIR NATURE AND USE.

ERIC Educational Resources Information Center

MELLON, M.G.

THIS PUBLICATION CONTAINS AN ANALYSIS OF TYPES OF CHEMICAL LITERATURE, WHERE THEY MAY BE OBTAINED, AND HOW THEY SHOULD BE USED. PRIMARY, SECONDARY, AND TERTIARY SOURCES OF INFORMATION ARE ANALYZED. PRIMARY SOURCES INCLUDE PERIODICALS, UNITED STATES AND FOREIGN GOVERNMENT PUBLICATIONS, UNITED NATIONS PUBLICATIONS, REPORTS OF NON-GOVERNMENTAL…

The Perceived Stress Levels of Primary and Secondary Principals.

ERIC Educational Resources Information Center

Savery, Lawson K.; Detiuk, Michael

1986-01-01

Research conducted in Western Australian government schools indicates perceived stress among principals, particularly role overload and role conflict. Primary principals experienced greater stress than secondary principals. Suggestions on how the education department can reduce employee stress include altering leadership styles and offering stress…

48 CFR 227.671 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... patents, data, or know-how reflecting the primary source's investment in developing and engineering and... DEFENSE GENERAL CONTRACTING REQUIREMENTS PATENTS, DATA, AND COPYRIGHTS Foreign License and Technical..., referred to in this subpart as a “primary source,” agrees to furnish to a foreign concern or government...

The development of sasi laut in the preservation of sea in Kei community

NASA Astrophysics Data System (ADS)

Ananingsih, Sri Wahyu

2018-02-01

"Sasi laut" is a local wisdom of Kei society that prohibits community members to take natural resources in a particular area over a period of time. Sasi laut has an important role in the preservation of the sea. This article is based on research. The purpose of the research is to analyze causal factors of sasi laut are not practiced anymore in Kei kecil society, and the efforts to revitalize sasi laut as a local wisdom to preserve sea. This article uses socio-legal approach and the analysis is qualitative. The data consist of primary and secondary data. The results of the research show that sasi laut in several villages of Kei kecil is not practiced anymore because of the damage to sea and ecosystem, market problem, the society problem and adat institution problem. The efforts to revitalize sasi laut are improve the quality of the sea environment, legal awareness Kei society and the participation of local government. This article can be a recommendation for the local government of Southeast Maluku in order to determine the policy of sasi laut.

RhoB controls coordination of adult angiogenesis and lymphangiogenesis following injury by regulating VEZF1-mediated transcription

NASA Astrophysics Data System (ADS)

Gerald, Damien; Adini, Irit; Shechter, Sharon; Perruzzi, Carole; Varnau, Joseph; Hopkins, Benjamin; Kazerounian, Shiva; Kurschat, Peter; Blachon, Stephanie; Khedkar, Santosh; Bagchi, Mandrita; Sherris, David; Prendergast, George C.; Klagsbrun, Michael; Stuhlmann, Heidi; Rigby, Alan C.; Nagy, Janice A.; Benjamin, Laura E.

2013-11-01

Mechanisms governing the distinct temporal dynamics that characterize post-natal angiogenesis and lymphangiogenesis elicited by cutaneous wounds and inflammation remain unclear. RhoB, a stress-induced small GTPase, modulates cellular responses to growth factors, genotoxic stress and neoplastic transformation. Here we show, using RhoB null mice, that loss of RhoB decreases pathological angiogenesis in the ischaemic retina and reduces angiogenesis in response to cutaneous wounding, but enhances lymphangiogenesis following both dermal wounding and inflammatory challenge. We link these unique and opposing roles of RhoB in blood versus lymphatic vasculatures to the RhoB-mediated differential regulation of sprouting and proliferation in primary human blood versus lymphatic endothelial cells. We demonstrate that nuclear RhoB-GTP controls expression of distinct gene sets in each endothelial lineage by regulating VEZF1-mediated transcription. Finally, we identify a small-molecule inhibitor of VEZF1-DNA interaction that recapitulates RhoB loss in ischaemic retinopathy. Our findings establish the first intra-endothelial molecular pathway governing the phased response of angiogenesis and lymphangiogenesis following injury.

Realisation of a joint consumer engagement strategy in the Nepean Blue Mountains region.

PubMed

Blignault, Ilse; Aspinall, Diana; Reay, Lizz; Hyman, Kay

2017-02-15

Ensuring consumer engagement at different levels of the health system - direct care, organisational design and governance and policy - has become a strategic priority. This case study explored, through interviews with six purposively selected 'insiders' and document review, how one Medicare Local (now a Primary Health Network, PHN) and Local Health District worked together with consumers, to establish a common consumer engagement structure and mechanisms to support locally responsive, integrated and consumer-centred services. The two healthcare organisations worked as partners across the health system, sharing ownership and responsibility. Critical success factors included a consumer champion working with other highly motivated consumers concerned with improving the health system, a budget, and ongoing commitment from the Medicare Local or PHN and the Local Health District at executive and board level. Shared boundaries were an enormous advantage. Activities were jointly planned and executed, with consumer participation paramount. Training and mentoring enhanced consumer capacity and confidence. Bringing everyone on board and building on existing structures required time, effort and resources. The initiative produced immediate and lasting benefits, with consumer engagement now embedded in organisational governance and practice.

Life prediction and constitutive behavior

NASA Technical Reports Server (NTRS)

Halford, G. R.

1983-01-01

One of the primary drivers that prompted the initiation of the hot section technology (HOST) program was the recognized need for improved cyclic durability of costly hot section components. All too frequently, fatigue in one form or another was directly responsible for the less than desired durability, and prospects for the future weren't going to improve unless a significant effort was mounted to increase our knowledge and understanding of the elements governing cyclic crack initiation and propagation lifetime. Certainly one of the important factors is the ability to perform accurate structural stress-strain analyses on a routine basis to determine the magnitudes of the localized stresses and strains since it is these localized conditions that govern the initiation and crack growth processes. Developing the ability to more accurately predict crack initiation lifetimes and cyclic crack growth rates for the complex loading conditions found in turbine engine hot sections is of course the ultimate goal of the life prediction research efforts. It has been found convenient to divide the research efforts into those dealing with nominally isotropic and anisotropic alloys; the latter for application to directionally solidified and single crystal turbine blades.

Regulatory approaches to obesity prevention: A systematic overview of current laws addressing diet-related risk factors in the European Union and the United States.

PubMed

Sisnowski, Jana; Handsley, Elizabeth; Street, Jackie M

2015-06-01

High prevalence of overweight and obesity remains a significant international public health problem. Law has been identified as a tool for obesity prevention and selected high-profile measures have been reported. However, the nature and extent of enacted legislation internationally are unclear. This research provides an overview of regulatory approaches enacted in the United States, the European Union, and EU Member States since 2004. To this end, relevant databases of primary and secondary legislation were systematically searched to identify and explore laws addressing dietary risk factors for obesity. Across jurisdictions, current regulatory approaches to obesity prevention are limited in reach and scope. Target groups are rarely the general population, but instead sub-populations in government-supported settings. Consumer information provision is preferred over taxation and marketing restrictions other than the regulation of health and nutrition claims. In the EU in particular, product reformulation with industry consent has also emerged as a popular small-scale measure. While consistent and widespread use of law is lacking, governments have employed a range of regulatory measures in the name of obesity prevention, indicating that there is, in principle, political will. Results from this study may serve as a starting point for future research and policy development. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Independent practice association physician groups in California.

PubMed

Grumbach, K; Coffman, J; Vranizan, K; Blick, N; O'Neil, E H

1998-01-01

We surveyed independent practice association (IPA) physician groups in California about their approaches to staffing, physician payment, and governance. Most IPAs desired more primary care physicians but not more specialists. Capitation was the major mode of remuneration for primary care physicians in 77 percent of IPAs, and for specialists in 30 percent of IPAs. Most IPAs also used financial incentives related to use of referral or ancillary services. Boards of directors were dominated by physicians, but governance tended to be centralized rather than highly democratic. We found that IPAs mirror many of the broader trends in physician staffing and physician payment that exist in managed care organizations.

Regional scale groundwater resource assessment in the Australian outback - Geophysics is the only way.

NASA Astrophysics Data System (ADS)

Munday, T. J.; Davis, A. C.; Gilfedder, M.; Annetts, D.

2015-12-01

Resource development, whether in agriculture, mining and/or energy, is set to have significant consequences for the groundwater resources of Australia in the short to medium term. These industry sectors are of significant economic value to the country and consequently their support remains a priority for State and Federal Governments alike. The scale of potential developments facilitated in large part by the Government Programs, like the West Australian (WA) Government's "Water for Food" program, and the South Australian's Government's PACE program, will result in an increase in infrastructure requirements, including access to water resources and Aboriginal lands to support these developments. However, the increased demand for water, particularly groundwater, is likely to be compromised by the limited information we have about these resources. This is particularly so for remote parts of the country which are targeted as primary development areas. There is a recognised need to expand this knowledge so that water availability is not a limiting factor to development. Governments of all persuasions have therefore adopted geophysical technologies, particularly airborne electromagnetics (AEM), as a basis for extending the hydrogeological knowledge of data poor areas. In WA, the State Government has employed regional-scale AEM surveys as a basis for defining groundwater resources to support mining, regional agricultural developments whilst aiming to safeguard regional population centres, and environmental assets. A similar approach is being employed in South Australia. These surveys are being used to underpin conceptual hydrogeological frameworks, define basin-scale hydrogeological models, delimit the extent of saltwater intrusion in coastal areas, and to determine the groundwater resource potential of remote alluvial systems aimed at supporting new, irrigation-based, agricultural developments in arid parts of the Australian outback. In the absence of conventional hydrogeological information, geophysical methods are demonstrably a cost and time effective approach to upscaling local hydrogeological information, thereby fast tracking groundwater resource assessments that would otherwise take decades to complete.

The relation between invertebrate drift and two primary controls, discharge and benthic densities, in a large regulated river

USGS Publications Warehouse

Kennedy, Theodore A.; Yackulic, Charles B.; Cross, Wyatt F.; Grams, Paul E.; Yard, Michael D.; Copp, Adam J.

2014-01-01

1. Invertebrate drift is a fundamental process in streams and rivers. Studies from laboratory experiments and small streams have identified numerous extrinsic (e.g. discharge, light intensity, water quality) and intrinsic factors (invertebrate life stage, benthic density, behaviour) that govern invertebrate drift concentrations (# m−3), but the factors that govern invertebrate drift in larger rivers remain poorly understood. For example, while large increases or decreases in discharge can lead to large increases in invertebrate drift, the role of smaller, incremental changes in discharge is poorly described. In addition, while we might expect invertebrate drift concentrations to be proportional to benthic densities (# m−2), the benthic–drift relation has not been rigorously evaluated. 2. Here, we develop a framework for modelling invertebrate drift that is derived from sediment transport studies. We use this framework to guide the analysis of high-resolution data sets of benthic density and drift concentration for four important invertebrate taxa from the Colorado River downstream of Glen Canyon Dam (mean daily discharge 325 m3 s−1) that were collected over 18 months and include multiple observations within days. Ramping of regulated flows on this river segment provides an experimental treatment that is repeated daily and allowed us to describe the functional relations between invertebrate drift and two primary controls, discharge and benthic densities. 3. Twofold daily variation in discharge resulted in a >10-fold increase in drift concentrations of benthic invertebrates associated with pools and detritus (i.e. Gammarus lacustris and Potamopyrgus antipodarum). In contrast, drift concentrations of sessile blackfly larvae (Simuliium arcticum), which are associated with high-velocity cobble microhabitats, decreased by over 80% as discharge doubled. Drift concentrations of Chironomidae increased proportional to discharge. 4. Drift of all four taxa was positively related to benthic density. Drift concentrations of Gammarus, Potamopyrgus and Chironomidae were proportional to benthic density. Drift concentrations of Simulium were positively related to benthic density, but the benthic–drift relation was less than proportional (i.e. a doubling of benthic density only led to a 40% increase in drift concentrations). 5. Our study demonstrates that invertebrate drift concentrations in the Colorado River are jointly controlled by discharge and benthic densities, but these controls operate at different timescales. Twofold daily variation in discharge associated with hydropeaking was the primary control on within-day variation in invertebrate drift concentrations. In contrast, benthic density, which varied 10- to 1000-fold among sampling dates, depending on the taxa, was the primary control on invertebrate drift concentrations over longer timescales (weeks to months).

Neighbourhood socioeconomic status and maternal factors at birth as moderators of the association between birth characteristics and school attainment: a population study of children attending government schools in Western Australia.

PubMed

Malacova, E; Li, J; Blair, E; Mattes, E; de Klerk, N; Stanley, F

2009-10-01

This article investigates whether reading and writing skills among children of equivalent perinatal characteristics differ by neighbourhood socioeconomic status and maternal factors. Notifications of births for all non-Aboriginal singletons born in 1990-7 in Western Australia subsequently attending government primary schools were linked to the State literacy tests in grade three and with information on socioeconomic status of the school and the residential area. Using multilevel modelling, the associations between birth characteristics (gestational age, intrauterine growth, birth order and Apgar score at 5 minutes) and literacy attainment in grade three were examined in models that included socioeconomic and demographic factors of the child, mother and community. Higher percentages of optimal head circumference and birth length and term birth were positively and independently associated with literacy scores. A higher percentage of optimal birth weight was associated with higher reading scores especially for children born to mothers residing in educationally advantaged areas. First birth was positively associated with reading and writing attainment: this association was stronger for children born to single mothers and additional advantage in writing was also associated with first birth in children living in disadvantaged areas. These findings suggest that having suboptimal growth in utero or an older sibling at birth increases vulnerability to poor literacy attainment especially among children born to single mothers or those in disadvantaged neighbourhoods. These data provide evidence for advocating lifestyles compatible with optimum fetal growth and socioeconomic conditions conducive to healthy lifestyles, particularly during pregnancy.

A systematic policy approach to changing the food system and physical activity environments to prevent obesity.

PubMed

Sacks, Gary; Swinburn, Boyd A; Lawrence, Mark A

2008-06-05

As obesity prevention becomes an increasing health priority in many countries, including Australia and New Zealand, the challenge that governments are now facing is how to adopt a systematic policy approach to increase healthy eating and regular physical activity. This article sets out a structure for systematically identifying areas for obesity prevention policy action across the food system and full range of physical activity environments. Areas amenable to policy intervention can be systematically identified by considering policy opportunities for each level of governance (local, state, national, international and organisational) in each sector of the food system (primary production, food processing, distribution, marketing, retail, catering and food service) and each sector that influences physical activity environments (infrastructure and planning, education, employment, transport, sport and recreation). Analysis grids are used to illustrate, in a structured fashion, the broad array of areas amenable to legal and regulatory intervention across all levels of governance and all relevant sectors. In the Australian context, potential regulatory policy intervention areas are widespread throughout the food system, e.g., land-use zoning (primary production within local government), food safety (food processing within state government), food labelling (retail within national government). Policy areas for influencing physical activity are predominantly local and state government responsibilities including, for example, walking and cycling environments (infrastructure and planning sector) and physical activity education in schools (education sector). The analysis structure presented in this article provides a tool to systematically identify policy gaps, barriers and opportunities for obesity prevention, as part of the process of developing and implementing a comprehensive obesity prevention strategy. It also serves to highlight the need for a coordinated approach to policy development and implementation across all levels of government in order to ensure complementary policy action.

Effects of Training Programme on HIV/AIDS Prevention among Primary Health Care Workers in Oyo State, Nigeria

ERIC Educational Resources Information Center

Ajuwon, Ademola; Funmilayo, Fawole; Oladepo, Oladimeji; Osungbade, Kayode; Asuzu, Michael

2008-01-01

Purpose: The purpose of this paper is to train primary health care workers to be trainers and implementers of community-based AIDS prevention activities in Oyo State, Nigeria, by describing an evaluation of the project. Design/methodology/approach: A total of 148 primary health care workers recruited from the 33 local government areas (LGA) of the…

Primary Health Care in Undergraduate Medical Education. Report on a World Health Organization Meeting (Exeter, England, July 18-22, 1983).

ERIC Educational Resources Information Center

World Health Organization, Copenhagen (Denmark). Regional Office for Europe.

Ways to improve the training of undergraduate medical students in primary health care are identified, based on a seminar organized by the World Health Organization Regional Office for Europe and the Government of the United Kingdom. Primary health care is concerned with preventing and treating illness and promoting health, based on applying…

Investigating Provision and Impact of the Primary Physical Education and Sport Premium: A West Midlands Case Study

ERIC Educational Resources Information Center

Griggs, Gerald

2018-01-01

In March 2013, the UK government announced that it was to award the Primary Physical Education and Sport Premium funding to all English state-funded primary schools to improve provision of Physical Education and sport following the London 2012 Olympic Games. This study reports on seven schools in close geographical proximity to each other within…

What Informs Primary School Principals' Decision-Making in Relation to Teacher Placement in Class Levels?

ERIC Educational Resources Information Center

Carlyon, Tracey; Fisher, Anthony

2012-01-01

One of the most challenging decisions for primary school principals is to decide what class level each of their teachers will teach. It seems there is very little research on the way principals go about making these decisions. Government reforms have had significant impact on the role of the primary school principal in New Zealand, and a trend has…

Parental Choice and Learner Achievement in Primary Education in Rachuonyo Sub County, Kenya: Focusing on Quality of Education

ERIC Educational Resources Information Center

Oyier, Charles Richard; Odundo, Paul Amollo; Obat, Rispa Atieno; Lilian, Ganira Khavugwi; Akondo, Joseph Ochieng

2015-01-01

Kenyan government launched Free Primary Education (FPE) in 2003 to make schooling affordable to all parents, but less attention has been paid to the quality assurance and equity of the education system. Studies have indicated that the FPE policy sacrificed the quality of education and this led to parents avoiding FPE offered in primary schools and…

Instructional Leadership in Primary and Secondary Schools in Western Australia.

ERIC Educational Resources Information Center

Wildy, Helen; Dimmock, Clive

1993-01-01

Investigates teachers' and principals' perceptions of instructional leadership in a sample of Western Australian government primary and secondary schools, using the Instructional Leadership Questionnaire. Instructional leadership was viewed as a shared responsibility; teachers felt principals were less involved than principals felt they were.…

Reperfusion therapy of myocardial infarction in Mexico: A challenge for modern cardiology.

PubMed

Martínez-Sánchez, Carlos; Arias-Mendoza, Alexandra; González-Pacheco, Héctor; Araiza-Garaygordobil, Diego; Marroquín-Donday, Luis Alfonso; Padilla-Ibarra, Jorge; Sierra-Fernández, Carlos; Altamirano-Castillo, Alfredo; Álvarez-Sangabriel, Amada; Azar-Manzur, Francisco Javier; Briseño-de la Cruz, José Luis; Mendoza-García, Salvador; Piña-Reyna, Yigal; Martínez-Ríos, Marco Antonio

Mexico has been positioned as the country with the highest mortality attributed to myocardial infarction among the members of the Organization for Economic Cooperation and Development. This rate responds to multiple factors, including a low rate of reperfusion therapy and the absence of a coordinated system of care. Primary angioplasty is the reperfusion method recommended by the guidelines, but requires multiple conditions that are not reached at all times. Early pharmacological reperfusion of the culprit coronary artery and early coronary angiography (pharmacoinvasive strategy) can be the solution to the logistical problem that primary angioplasty rises. Several studies have demonstrated pharmacoinvasive strategy as effective and safe as primary angioplasty ST-elevation myocardial infarction, which is postulated as the choice to follow in communities where access to PPCI is limited. The Mexico City Government together with the National Institute of Cardiology have developed a pharmaco-invasive reperfusion treatment program to ensure effective and timely reperfusion in STEMI. The model comprises a network of care at all three levels of health, including a system for early pharmacological reperfusion in primary care centers, a digital telemedicine system, an inter-hospital transport network to ensure primary angioplasty or early percutaneous coronary intervention after fibrinolysis and a training program with certification of the health care personal. This program intends to reduce morbidity and mortality associated with myocardial infarction. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

Private sector participation in solid waste collection in Addis Ababa (Ethiopia) by involving micro-enterprises.

PubMed

Tilaye, Mesfin; van Dijk, Meine Pieter

2014-01-01

Privatization of urban services focuses often on the involvement of foreign enterprises. This contribution deals with micro-privatization, the partial transfer of government responsibility for solid waste collection to micro-enterprises. It tries to shed light on whether the current private sector participation (PSP) of micro-enterprises in solid waste collection service is the best way to capture the expected advantages of private sector involvement. The article examines the relations of the micro-enterprises with beneficiaries and the public sector by focusing on the contract procedure, the tariff-setting process, the cost recovery mechanism and institutionalizing of market principles for micro-enterprises. The research was carried out using secondary and primary data sources. Primary data were collected through the interviewing of public sector officials at different levels, focus group discussions with community groups and micro-enterprises, and observation. A survey was conducted among 160 micro-enterprises in the city of Addis Ababa, Ethiopia, using a standard questionnaire. What are some of the factors contributing to the results of PSP in Addis Ababa, the capital of Ethiopia? Policies at higher levels of government definitely produced an overall climate conducive to micro-privatization and recognized the need to develop micro-enterprises, but it is not clear what role the micro-enterprises are to play in solid waste management. New opportunities were created by formalization and taken up by communities and micro-enterprises. Coverage and waste collected both increased. The initiation and institutionalization of the formalization process was not without problems. The public sector over-stressed the autonomy of micro-enterprises. The fate of the micro-enterprises is largely determined by the reforms undertaken at local government level. The rapid changes in policies at the local level made waste-collecting micro-enterprises lose confidence and more dependent on the public sector. The study shows the continued power of the state and its agents in shaping developments in this domain.

Clinical Data Systems to Support Public Health Practice: A National Survey of Software and Storage Systems Among Local Health Departments.

PubMed

McCullough, J Mac; Goodin, Kate

2016-01-01

Numerous software and data storage systems are employed by local health departments (LHDs) to manage clinical and nonclinical data needs. Leveraging electronic systems may yield improvements in public health practice. However, information is lacking regarding current usage patterns among LHDs. To analyze clinical and nonclinical data storage and software types by LHDs. Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County and City Health Officials. A total of 324 LHDs from all 50 states completed the survey (response rate: 50%). Outcome measures included LHD's primary clinical service data system, nonclinical data system(s) used, and plans to adopt electronic clinical data system (if not already in use). Predictors of interest included jurisdiction size and governance type, and other informatics capacities within the LHD. Bivariate analyses were performed using χ and t tests. Up to 38.4% of LHDs reported using an electronic health record (EHR). Usage was common especially among LHDs that provide primary care and/or dental services. LHDs serving smaller populations and those with state-level governance were both less likely to use an EHR. Paper records were a common data storage approach for both clinical data (28.9%) and nonclinical data (59.4%). Among LHDs without an EHR, 84.7% reported implementation plans. Our findings suggest that LHDs are increasingly using EHRs as a clinical data storage solution and that more LHDs are likely to adopt EHRs in the foreseeable future. Yet use of paper records remains common. Correlates of electronic system usage emerged across a range of factors. Program- or system-specific needs may be barriers or facilitators to EHR adoption. Policy makers can tailor resources to address barriers specific to LHD size, governance, service portfolio, existing informatics capabilities, and other pertinent characteristics.

Increasing a Community College Governing Board's Engagement in Accountability for Student Success: What Are the Principal Influences?

ERIC Educational Resources Information Center

Welsh, Linda Susan Anderson

2010-01-01

Understanding the factors that influence a community college governing board to increase its engagement in accountability for student success was the purpose of this grounded theory case study. A further aim was to develop a model that described how these factors interact. A highly engaged community college governing board, as defined by a focus,…

How College Pricing Undermines Financial Aid

ERIC Educational Resources Information Center

Martin, Robert E.; Gillen, Andrew

2011-01-01

The primary purpose of government provided student financial aid is to increase college access by bringing the out-of-pocket price of attendance within reach of more students. The basic idea is quite straightforward. If a good or service costs $100 to buy and the government gives consumers a $50 subsidy, then consumers need only spend $50 of their…

To Segregate or to Integrate: Education Politics and Democracy. NBER Working Paper No. 13319

ERIC Educational Resources Information Center

de la Croix, David; Doepke, Matthias

2007-01-01

The governments of nearly all countries are major providers of primary and secondary education to their citizens. In some countries, however, public schools coexist with private schools, while in others the government is the sole provider of education. In this study, we ask why different societies make different choices regarding the mix of…

Mental Health Services for Children and Youth: Strengthening the Promise of the Future. Human Services Series.

ERIC Educational Resources Information Center

Craig, Rebecca T.

1988-01-01

Many mentally ill children, especially those who are seriously disturbed, are not receiving the mental health care they need. Although the federal government offers financing to the states for child and adolescent mental health programming, the primary responsibility for financing mental health services has been assumed by state governments. At…

Categorical Funds: The Intersection of School Finance and Governance

ERIC Educational Resources Information Center

Smith, Joanna; Gasparian, Hovanes; Perry, Nicholas; Capinpin, Fatima

2013-01-01

How a state chooses to design its system of funding schools is ultimately a question of education governance, determining who--state policymakers, school districts, or school principals--gets to make the decisions about how and where funding is spent. States have two primary ways of funding schools: the foundation, or base funding that is intended…

Who Governs? Academic Decision-Making in US Four-Year Colleges and Universities, 2000-2012

ERIC Educational Resources Information Center

Apkarian, Jacob; Mulligan, Kerry; Rotondi, Matthew B.; Brint, Steven

2014-01-01

This study compares the explanatory power of two models of academic governance: dual and managerial control. The research is based on characterizations by chief academic officers of the primary decision-makers involved in 13 types of recurrent academic decisions. We examine change between responses to surveys fielded to US four-year colleges and…

Workforce Development for Communities in Crisis and Transition: A Case Study of the Windward Islands.

ERIC Educational Resources Information Center

Whittington, L. Alfons

The Windward Islands (Dominica, Grenada, St. Lucia, and St. Vincent and the Grenadines) have taken several approaches to educate the work force and prepare for the technology-driven society of the future. These approaches include government initiatives, such as the governments' commitment to primary education and more recently to secondary…

A School District Financial Condition Assessment System and Its Application to Pennsylvania School Districts

ERIC Educational Resources Information Center

Bruck, W. Earl; Miltenberger, Lauren

2013-01-01

The funding of public education in America has been a primary concern for government officials at the federal, state, and local levels for several generations. According to the National Center for Education Statistics, this expenditure accounts for the single largest allocation in most state and local government operating budgets (Stanley and…

Helminthiasis and Hygiene Conditions of Schools in Ikenne, Ogun State, Nigeria

PubMed Central

Ekpo, Uwem Friday; Odoemene, Simon Nnayere; Mafiana, Chiedu Felix; Sam-Wobo, Sammy Olufemi

2008-01-01

Background A study of the helminth infection status of primary-school children and the hygiene condition of schools in Ikenne Local Government Area of Ogun State, Nigeria was undertaken between November 2004 and February 2005 to help guide the development of a school-based health programme. Methods and Findings Three primary schools were randomly selected: two government-owned schools (one urban and the other rural) and one urban private school. No rural private schools existed to survey. A total of 257 schoolchildren aged 4–15 y, of whom 146 (56.8%) were boys and 111 (43.2%) were girls, took part in the survey. A child survey form, which included columns for name, age, sex, and class level, was used in concert with examination of stool samples for eggs of intestinal helminths. A school survey form was used to assess the conditions of water supply, condition of latrines, presence of soap for handwashing, and presence of garbage around the school compound. The demographic data showed that the number of schoolchildren gradually decreased as their ages increased in all three schools. The sex ratio was proportional in the urban school until primary level 3, after which the number of female pupils gradually decreased, whereas in the private school, sexes were proportionally distributed even in higher classes. The prevalence of helminth infection was 54.9% of schoolchildren in the urban government school, 63.5% in the rural government school, and 28.4% in the urban private school. Ascaris lumbricoides was the most prevalent species, followed by Trichuris trichiura, Taenia species, and hookworm in the three schools. Prevalence of infection in the government-owned schools was significantly higher than in the private school (χ 2 = 18.85, df = 2, p<0.0005). A survey of hygiene conditions in the three schools indicated that in the two government schools tapwater was unavailable, sanitation of latrines was poor, handwashing soap was unavailable, and garbage was present around school compounds. In the private school, in contrast, all hygiene indices were satisfactory. Conclusions These results indicate that burden of parasite infections and poor sanitary conditions are of greater public health importance in government-owned schools than in privately owned schools. School health programmes in government-owned schools, including deworming, health education, and improvement of hygiene conditions are recommended. PMID:18357338

Key factors that influence government policies and decision making about healthcare priorities: Lessons for the field of eating disorders.

PubMed

Whiteford, Harvey; Weissman, Ruth Striegel

2017-03-01

Worldwide, the demand for healthcare exceeds what individuals and governments are able to afford. Priority setting is therefore inevitable, and mental health services have often been given low priority in the decision-making process. Drawing on established economic criteria, and specifically the work of Philip Musgrove, key factors which influence government decision-making about health priorities are reviewed. These factors include the size of the health burden, the availability of cost-effective interventions to reduce the burden, whether private markets can provide the necessary treatment efficiently, whether there are "catastrophic costs" incurred in accessing treatment, whether negative externalities arise from not providing care, and if the "rule of rescue" applies. Beyond setting priorities for resource allocation, governments also become involved where there is a need for regulation to maintain quality in the delivery of healthcare. By providing field-specific examples for each factor, we illustrate how advocates in the eating disorder field may use evidence to inform government policy about resource allocation and regulation in support of individuals with an eating disorder. © 2017 Wiley Periodicals, Inc.

Primary Humanities: A Perspective from Wales

ERIC Educational Resources Information Center

Jones, Mark; Whitehouse, Sarah

2017-01-01

How the humanities subjects are represented in primary schools in Wales has been influenced by curriculum developments including Curriculum Cymraeg, the Skills Framework and the Foundation Phase. A central tenet of Welsh Government policy has been to actively encourage schools to promote a sense of "Welshness" through curriculum content,…

Compulsory "Foreign Language Activities" in Japanese Primary Schools

ERIC Educational Resources Information Center

Hashimoto, Kayoko

2011-01-01

From 2011, the new curriculum for introducing English to Japanese primary schools will be fully implemented in the form of "foreign language activities". This innovation forms part of the government's plan to cultivate "Japanese with English abilities", a development based on the awareness, particularly in the business sector,…

Examining Preservice Teachers' Preparedness for Teaching Art

ERIC Educational Resources Information Center

Hudson, Peter; Hudson, Sue

2007-01-01

The Australian Federal Government's call for another teacher education inquiry aims to investigate preservice teacher preparedness for teaching. Art education was selected for this study as the teaching of art education in primary schools occurs in less than ideal conditions and may often be avoided by generalist primary teachers (Russell-Bowie,…

Creative Primary Schools: Developing and Maintaining Pedagogy for Creativity

ERIC Educational Resources Information Center

Craft, Anna; Cremin, Teresa; Hay, Penny; Clack, James

2014-01-01

This micro-ethnographic study investigated pedagogy in two English primary schools, following a change of government and challenges posed by economic austerity. Unlike the previous decade's emphasis on children's curiosity and agency and valuing arts and partnership, emphasis on knowledge and attainment was now foregrounded. A two-stage National…

Pushed to the Margins--Sex and Relationships in Greek Primary Textbooks

ERIC Educational Resources Information Center

Gerouki, Margarita

2008-01-01

In 2001, the Greek Government introduced sex and gender relationships education as a thematic unit for interdisciplinary Health Education activities. However, the diffusion of such programmes remains extremely limited. The present paper discusses how sex and relationships issues are presented in contemporary Greek primary school textbooks since…

Links in the Chain: Bringing Together Literacy and Science

ERIC Educational Resources Information Center

Taylor, Neil; Hansford, Diane; Rizk, Nadya; Taylor, Subhashni

2017-01-01

In Australia, the Federal Government and the Australian Academy of Science have developed a programme entitled "Primary Connections" (primaryconnections.org. au), aimed at supporting the teaching of science in the primary sector. The programme makes strong and explicit links between science and literacy through the use of word walls,…

Educating Girls: Strategies To Increase Access, Persistence, and Achievement.

ERIC Educational Resources Information Center

Tietjen, Karen; Prather, Cynthia, Ed.

This document reviews the interventions, such as policies, programs, and projects, that have been implemented by governments, donors, and other institutions to increase girls' access, persistence, and achievement at the primary school level. It examines both the formal system of primary education and nontraditional, alternative approaches to reach…

48 CFR 227.675-2 - Review of agreements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... request shall be made to the primary source— (1) To identify the patents, data, and other technical... identify any such patents and data in which, to the knowledge of the primary source, the Government may..., DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS PATENTS, DATA, AND COPYRIGHTS Foreign License and...

Do Local Contributions Affect the Efficacy of Public Primary Schools?

ERIC Educational Resources Information Center

Jimenez, Emmanuel; Paqueo, Vicente

1996-01-01

Uses cost, financial sources, and student achievement data from Philippine primary schools (financed primarily from central sources) to discover if financial decentralization leads to more efficient schools. Schools that rely more heavily on local sources (contributions from local school boards, municipal government, parent-teacher associations,…

Scientific governance and the process for exposure scenario development in REACH.

PubMed

Money, Chris D; Van Hemmen, Joop J; Vermeire, Theo G

2007-12-01

The primary process established by the European Commission to address the science needed to define key REACH concepts and to help rationally implement REACH's ambitions is enshrined in a series of activities known as the REACH Implementation Projects (RIPs). These are projects that aim to define the methodology that could be used, and present the basis for guidance on the actual principles and procedures that may be (are proposed to be) followed in the development of the required documentation that ensures the safe use of chemicals. In order to develop soundly based and equitable regulation, it is necessary that science governance using established and accepted scientific principles must take a leading role. The extent to which such governance is embraced will be determined by many factors, but notably the process adopted to enable scientific discussion to take place. This article addresses the issues of science as they have impacted on the exemplification of the Exposure Scenario concept under REACH. The current RIP activities have created a non-adversarial process in which the key stakeholders are able to discuss the key REACH challenges. But the RIP activities will be finalised before REACH comes into force. A suitable mechanism should perhaps now be identified to ensure that this positive spirit of scientific discussion and collaboration can continue to benefit REACH and those that it serves well into the future.

Primary Healthcare-based Diabetes Registry in Puducherry: Design and Methods

PubMed Central

Lakshminarayanan, Subitha; Kar, Sitanshu Sekhar; Gupta, Rajeev; Xavier, Denis; Bhaskar Reddy, S. Vijaya

2017-01-01

Background: Diabetes registries monitor the population prevalence and incidence of diabetes, monitor diabetes control program, provide information of quality of care to health service providers, and provide a sampling frame for interventional studies. This study documents the process of establishing a prospective diabetes registry in a primary health-care setting in Puducherry. Methods: This is a facility-based prospective registry conducted in six randomly selected urban health centers in Puducherry, with enrollment of all known patients with diabetes attending chronic disease clinics. Administrative approvals were obtained from Government Health Services. Manuals for training of medical officers, health-care workers, and case report forms were developed. Diabetes registry was prepared using Epi Info software. Results: In the first phase, demographic characteristics, risk factors, complications, coexisting chronic conditions, lifestyle and medical management, and clinical outcomes were recorded. Around 2177 patients with diabetes have been registered in six Primary Health Centres out of a total of 2948 participants seeking care from chronic disease clinic. Registration coverage ranges from 61% to 105% in these centers. Conclusion: This study has documented methodological details, and learning experiences gained while developing a diabetes registry at the primary health care level and the scope for upscaling to a Management Information System for Diabetes and a State-wide Registry. Improvement in patient care through needs assessment and quality assurance in service delivery is an important theme envisioned by this registry. PMID:28553589

[Economic aspects of prevention: an international perspective].

PubMed

Suhrcke, M

2009-10-01

This article provides an overview of selected economic aspects of primary prevention, from an international perspective. It starts by qualifying two widely held myths about the economics of prevention. It then discusses two core components of the economic argument for (or against) prevention: first, this involves providing a very basic, efficiency-based rationale for a role of government in prevention; second, we review the existing evidence on the cost-effectiveness of primary prevention. While a fair amount of encouraging evidence exists, there has definitely been far more cost-effectiveness research on clinical than on non-clinical primary prevention (e. g., health promotion). The article seeks to explain this comparative shortage, which carries over to pure effectiveness research on prevention. It concludes by arguing the economic case for a role of government not only in prevention but also, and even more so, in research on non-clinical prevention. Copyright Georg Thieme Verlag KG Stuttgart . New York.

[Primary health care: challenges for implementation in Latin America].

PubMed

Giraldo Osorio, Alexandra; Vélez Álvarez, Consuelo

2013-01-01

A development process, marked by the re-appearance of the primary health care as the core of health systems, has emerged in Latin America. Governments have made a commitment to renew this strategy as the basis of their health systems. However, these health systems are mainly faced with re-introducing equity values, and there are common challenges such as providing the health systems with trained human resources in sufficient numbers, overcoming the fragmentation/segmentation of the systems, ensuring financial sustainability, improving governance, quality of care and information systems, expanding coverage, preparing to face the consequences of an aging population, the changing epidemiological profile, and increase in the response capacity of the public health system. This article is intended to provide a comprehensive view of the progress and challenges of the inclusion of primary care health systems in Latin American countries. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Factors influencing evidence-based practice in prosthetics and orthotics.

PubMed

Andrysek, Jan; Christensen, James; Dupuis, Annie

2011-03-01

The importance of evidence-based practice is being recognized across a broad range of healthcare disciplines as a means for improving patient outcomes and also efficiently managing healthcare resources. The objective of this work was to obtain information from clinicians about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Cross sectional survey. An internet survey was developed and distributed to 300 prosthetists and orthotists currently practicing in Canada. A principal component factor analysis of the survey results revealed ten primary factors affecting evidence-based practice. These include time constraints, workload and system demands, limited relevant evidence from research, and gaps in skills and knowledge required to perform evidence-based practice. Clinicians value research as a means of improving clinical practice, but they are faced with a number of practical barriers in performing evidence-based practice. This study provides empirical data about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Such data are essential in order to inform those involved in improving existing clinical practices, including educators, professional organizations, and governing bodies.

Suicide Risk Documented During Veterans' Last Veterans Affairs Health Care Contacts Prior to Suicide.

PubMed

Denneson, Lauren M; Kovas, Anne E; Britton, Peter C; Kaplan, Mark S; McFarland, Bentson H; Dobscha, Steven K

2016-06-01

A total of 295 veterans who died by suicide in 2009 across 11 states and received Veterans Affairs (VA) health care in the 6 months prior to death were identified. The suicide risk factors documented and the care received at these veterans' last VA contacts are described, and the study explores whether veterans present differently to VA care (i.e., different risk factors documented or different care settings accessed) based on the proximity of their last contact to suicide. Many veterans were seen in primary care (n = 136; 46%) for routine follow-up (n = 168; 57%). Fifty-three (18%) were assessed for suicidal thoughts; 20 (38%) of whom endorsed such thoughts. Although higher frequencies of some risk factors at last contacts more proximal to suicide compared to those more distal were observed, findings overall highlight the challenges clinicians face detecting enhanced risk prior to suicide. © Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Kinematic properties of the helicopter in coordinated turns

NASA Technical Reports Server (NTRS)

Chen, R. T. N.; Jeske, J. A.

1981-01-01

A study on the kinematic relationship of the variables of helicopter motion in steady, coordinated turns involving inherent sideslip is described. A set of exact kinematic equations which govern a steady coordinated helical turn about an Earth referenced vertical axis is developed. A precise definition for the load factor parameter that best characterizes a coordinated turn is proposed. Formulas are developed which relate the aircraft angular rates and pitch and roll attitudes to the turn parameters, angle of attack, and inherent sideslip. A steep, coordinated helical turn at extreme angles of attack with inherent sideslip is of primary interest. The bank angle of the aircraft can differ markedly from the tilt angle of the normal load factor. The normal load factor can also differ substantially from the accelerometer reading along the vertical body axis of the aircraft. Sideslip has a strong influence on the pitch attitude and roll rate of the helicopter. Pitch rate is independent of angle of attack in a coordinated turn and in the absence of sideslip, angular rates about the stability axes are independent of the aerodynamic characteristics of the aircraft.

Hospital networks: how to make them work in Belgium? Facilitators and barriers of different governance models.

PubMed

De Pourcq, Kaat; De Regge, Melissa; Van den Heede, Koen; Van de Voorde, Carine; Gemmel, Paul; Eeckloo, Kristof

2018-03-29

Objectives This study aims to identify the facilitators and barriers to governance models of hospital collaborations. The country-specific characteristics of the Belgian healthcare system and legislation are taken into account. Methods A case study was carried out in six Belgian hospital collaborations. Different types of governance models were selected: two health systems, two participant-governed networks, and two lead-organization-governed networks. Within these collaborations, 43 people were interviewed. Results All structures have both advantages and disadvantages. It is important that the governance model fits the network. However, structural, procedural, and especially contextual factors also affect the collaborations, such as alignment of hospitals' and professionals' goals, competition, distance, level of integrated care, time needed for decision-making, and legal and financial incentives. Conclusion The fit between the governance model and the collaboration can facilitate the functioning of a collaboration. The main barriers we identified are contextual factors. The Belgian government needs to play a major role in facilitating collaboration.

Classroom Listening Conditions in Indian Primary Schools: A Survey of Four Schools

PubMed Central

Sundaravadhanan, Gayathri; Selvarajan, Heramba G.; McPherson, Bradley

2017-01-01

Introduction: Background noise affects the listening environment inside classrooms, especially for younger children. High background noise level adversely affects not only student speech perception but also teacher vocal hygiene. The current study aimed to give an overview of the classroom listening conditions in selected government primary schools in India. Materials and Methods: Noise measurements were taken in 23 classrooms of four government primary schools in southern India, using a type 2 sound level meter. In each classroom measurements were taken in occupied and unoccupied conditions. Teacher voice level was measured in the same classrooms. In addition, the classroom acoustical conditions were observed and the reverberation time for each classroom was calculated. Results: The mean occupied noise level was 62.1 dBA and 65.6 dBC, and the mean unoccupied level was 62.2 dBA and 65 dBC. The mean unamplified teacher speech-to-noise ratio was 10.6 dBA. Both the occupied and unoccupied noise levels exceeded national and international recommended levels and the teacher speech-to-noise ratio was also found to be inadequate in most classrooms. The estimated reverberation time in all classrooms was greater than 2.6 seconds, which is almost double the duration of accepted standards. In addition, observation of classrooms revealed insufficient acoustical treatment to effectively reduce internal and external noise and minimize reverberation. Conclusion: The results of this study point out the need to improve the listening environment for children in government primary schools in India. PMID:28164937

Classroom Listening Conditions in Indian Primary Schools: A Survey of Four Schools.

PubMed

Sundaravadhanan, Gayathri; Selvarajan, Heramba G; McPherson, Bradley

2017-01-01

Background noise affects the listening environment inside classrooms, especially for younger children. High background noise level adversely affects not only student speech perception but also teacher vocal hygiene. The current study aimed to give an overview of the classroom listening conditions in selected government primary schools in India. Noise measurements were taken in 23 classrooms of four government primary schools in southern India, using a type 2 sound level meter. In each classroom measurements were taken in occupied and unoccupied conditions. Teacher voice level was measured in the same classrooms. In addition, the classroom acoustical conditions were observed and the reverberation time for each classroom was calculated. The mean occupied noise level was 62.1 dBA and 65.6 dBC, and the mean unoccupied level was 62.2 dBA and 65 dBC. The mean unamplified teacher speech-to-noise ratio was 10.6 dBA. Both the occupied and unoccupied noise levels exceeded national and international recommended levels and the teacher speech-to-noise ratio was also found to be inadequate in most classrooms. The estimated reverberation time in all classrooms was greater than 2.6 seconds, which is almost double the duration of accepted standards. In addition, observation of classrooms revealed insufficient acoustical treatment to effectively reduce internal and external noise and minimize reverberation. The results of this study point out the need to improve the listening environment for children in government primary schools in India.

Factor Configurations with Governance as Conditions for Low HIV/AIDS Prevalence in HIV/AIDS Recipient Countries: Fuzzy-set Analysis

PubMed Central

Lee, Hwa-Young; Kang, Minah

2015-01-01

This paper aims to investigate whether good governance of a recipient country is a necessary condition and what combinations of factors including governance factor are sufficient for low prevalence of HIV/AIDS in HIV/AIDS aid recipient countries during the period of 2002-2010. For this, Fuzzy-set Qualitative Comparative Analysis (QCA) was used. Nine potential attributes for a causal configuration for low HIV/AIDS prevalence were identified through a review of previous studies. For each factor, full membership, full non-membership, and crossover point were specified using both author's knowledge and statistical information of the variables. Calibration and conversion to a fuzzy-set score were conducted using Fs/QCA 2.0 and probabilistic tests for necessary and sufficiency were performed by STATA 11. The result suggested that governance is the necessary condition for low prevalence of HIV/AIDS in a recipient country. From sufficiency test, two pathways were resulted. The low level of governance can lead to low level of HIV/AIDS prevalence when it is combined with other favorable factors, especially, low economic inequality, high economic development and high health expenditure. However, strengthening governance is a more practical measure to keep low prevalence of HIV/AIDS because it is hard to achieve both economic development and economic quality. This study highlights that a comprehensive policy measure is the key for achieving low prevalence of HIV/AIDS in recipient country. PMID:26617451

Factor Configurations with Governance as Conditions for Low HIV/AIDS Prevalence in HIV/AIDS Recipient Countries: Fuzzy-set Analysis.

PubMed

Lee, Hwa-Young; Yang, Bong-Min; Kang, Minah

2015-11-01

This paper aims to investigate whether good governance of a recipient country is a necessary condition and what combinations of factors including governance factor are sufficient for low prevalence of HIV/AIDS in HIV/AIDS aid recipient countries during the period of 2002-2010. For this, Fuzzy-set Qualitative Comparative Analysis (QCA) was used. Nine potential attributes for a causal configuration for low HIV/AIDS prevalence were identified through a review of previous studies. For each factor, full membership, full non-membership, and crossover point were specified using both author's knowledge and statistical information of the variables. Calibration and conversion to a fuzzy-set score were conducted using Fs/QCA 2.0 and probabilistic tests for necessary and sufficiency were performed by STATA 11. The result suggested that governance is the necessary condition for low prevalence of HIV/AIDS in a recipient country. From sufficiency test, two pathways were resulted. The low level of governance can lead to low level of HIV/AIDS prevalence when it is combined with other favorable factors, especially, low economic inequality, high economic development and high health expenditure. However, strengthening governance is a more practical measure to keep low prevalence of HIV/AIDS because it is hard to achieve both economic development and economic quality. This study highlights that a comprehensive policy measure is the key for achieving low prevalence of HIV/AIDS in recipient country.

GEOCHEMICAL FACTORS GOVERNING METHYL MERCURY PRODUCTION IN MERCURY CONTAMINATED SEDIMENTS

EPA Science Inventory

Bench scale experiments were conducted to improve our understanding of aquatic mercury transformation processes (biotic and abiotic), specifically those factors which govern the production of methyl mercury (MeHg) in sedimentary environments. The greatest cause for concern regar...

Primary Education, Teachers' Professionalism and Social Class about Motivation and Demotivation of Government School Teachers in India

ERIC Educational Resources Information Center

Mooij, Jos

2008-01-01

Since the early 1990s, significant progress has been made with regard to education in India. This positive development stands, however, in sharp contrast with the way in which government teachers themselves think and talk about education. Instead of feeling pride and satisfaction, many teachers are unhappy, and often self-critical. Based on focus…

What does "local" firewood buy you? Managing the risk of invasive species introduction

Treesearch

Patrick C. Tobin; Andrea Diss-Torrance; Laura M. Blackburn; Brian D. Brown

2011-01-01

Firewood can serve as a primary vector in the transport of non-native species, particularly of wood boring insects that can be transported surreptitiously in firewood. State and Federal governments have enacted limitations on the movement of firewood as a means to limit accidental introduction of invasive species. However, it can be challenging for governments to...

The costs of public primary health care services in rural Indonesia.

PubMed Central

Berman, P.; Brotowasisto; Nadjib, M.; Sakai, S.; Gani, A.

1989-01-01

Described are the results of a cost study of national rural health services carried out in Indonesia between November 1986 and March 1987. Detailed costings of government inputs to all public health services below the district hospital level were made for 41 subdistricts in five provinces that were representative of the different regions of the country. The total costs of services as well as the average costs for specific service functions were estimated for the whole country as well as for the different provinces. The results indicate a low overall level of government spending on rural primary health care. Regional differences in this respect were not significant, suggesting that the government policy of encouraging regional balance in allocations has been successful. The average costs for most services were much greater than the charges made to patients, and this provided information on the current level of government subsidies. There was a large variability in the average costs, indicating that the existing system is inefficient, that some districts were able to attain much higher levels of efficiency than others within the existing constraints, and that improvements in this respect are possible. PMID:2517412

Effects of implementing electronic medical records on primary care billings and payments: a before-after study.

PubMed

Jaakkimainen, R Liisa; Shultz, Susan E; Tu, Karen

2013-09-01

Several barriers to the adoption of electronic medical records (EMRs) by family physicians have been discussed, including the costs of implementation, impact on work flow and loss of productivity. We examined billings and payments received before and after implementation of EMRs among primary care physicians in the province of Ontario. We also examined billings and payments before and after switching from a fee-for-service to a capitation payment model, because EMR implementation coincided with primary care reform in the province. We used information from the Electronic Medical Record Administrative Data Linked Database (EMRALD) to conduct a retrospective before-after study. The EMRALD database includes EMR data extracted from 183 community-based family physicians in Ontario. We included EMRALD physicians who were eligible to bill the Ontario Health Insurance Plan at least 18 months before and after the date they started using EMRs and had completed a full 18-month period before Mar. 31, 2011, when the study stopped. The main outcome measures were physicians' monthly billings and payments for office visits and total annual payments received from all government sources. Two index dates were examined: the date physicians started using EMRs and were in a stable payment model (n = 64) and the date physicians switched from a fee-for-service to a capitation payment model (n = 42). Monthly billings and payments for office visits did not decrease after the implementation of EMRs. The overall weighted mean annual payment from all government sources increased by 27.7% after the start of EMRs among EMRALD physicians; an increase was also observed among all other primary care physicians in Ontario, but it was not as great (14.4%). There was a decline in monthly billings and payments for office visits after physicians changed payment models, but an increase in their overall annual government payments. Implementation of EMRs by primary care physicians did not result in decreased billings or government payments for office visits. Further economic analyses are needed to measure the effects of EMR implementation on productivity and the costs of implementing an EMR system, including the costs of nonclinical work by physicians and their staff.

13 CFR 121.402 - What size standards are applicable to Federal Government Contracting programs?

Code of Federal Regulations, 2010 CFR

2010-01-01

... Size Eligibility Requirements for Government Procurement § 121.402 What size standards are applicable... being purchased. Other factors considered include previous Government procurement classifications of the... to Federal Government Contracting programs? 121.402 Section 121.402 Business Credit and Assistance...

How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature.

PubMed

Kok, Maryse C; Kane, Sumit S; Tulloch, Olivia; Ormel, Hermen; Theobald, Sally; Dieleman, Marjolein; Taegtmeyer, Miriam; Broerse, Jacqueline E W; de Koning, Korrie A M

2015-03-07

Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs. We searched six databases for quantitative, qualitative, and mixed-methods studies that included CHWs working in promotional, preventive or curative primary health care services in LMICs. We differentiated CHW performance outcome measures at two levels: CHW level and end-user level. Ninety-four studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programmes. Thematic coding was conducted and evidence on five main categories of contextual factors influencing CHW performance was synthesized. Few studies had the influence of contextual factors on CHW performance as their primary research focus. Contextual factors related to community (most prominently), economy, environment, and health system policy and practice were found to influence CHW performance. Socio-cultural factors (including gender norms and values and disease related stigma), safety and security and education and knowledge level of the target group were community factors that influenced CHW performance. Existence of a CHW policy, human resource policy legislation related to CHWs and political commitment were found to be influencing factors within the health system policy context. Health system practice factors included health service functionality, human resources provisions, level of decision-making, costs of health services, and the governance and coordination structure. All contextual factors can interact to shape CHW performance and affect the performance of CHW interventions or programmes. Research on CHW programmes often does not capture or explicitly discuss the context in which CHW interventions take place. This synthesis situates and discusses the influence of context on CHW and programme performance. Future health policy and systems research should better address the complexity of contextual influences on programmes. This insight can help policy makers and programme managers to develop CHW interventions that adequately address and respond to context to optimise performance.

Opening Real Science: Evaluation of an Online Module on Statistical Literacy for Pre-Service Primary Teachers

ERIC Educational Resources Information Center

Bilgin, Ayse Aysin Bombaci; Date-Huxtable, Elizabeth; Coady, Carmel; Geiger, Vincent; Cavanagh, Michael; Mulligan, Joanne; Petocz, Peter

2017-01-01

Opening Real Science (ORS) is a three-year government initiative developed as part of the Mathematics and Science Teachers program. It is a collaboration across universities involving teacher educators, scientists, mathematicians, statisticians and educational designers aimed at improving primary and secondary pre-service teachers' competence and…

78 FR 45540 - Agency Information Collection Activities: Proposed Collection: Public Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-29

... education nurses through the AENT Program. The AENT Program is governed by Title VIII, Section 811(a)(2) of... of primary care nurse practitioners and nurse midwives who plan to practice in rural, underserved, or... provision of primary care nurse practitioner and nurse midwifery programs accredited by a national nurse...

Report on Educational Developments, 1974-1976. Mauritius.

ERIC Educational Resources Information Center

Ministry of Education and Cultural Affairs (Mauritius).

Educational development in Mauritius is directed by a Minister of Education and Cultural Affairs in conjunction with a government appointed advisory board. Education is the largest single item in the national budget and comprises 25% of estimated annual expenditure for 1977-8. The primary education system serves 92% of the primary school age…

Achieving Universal Primary Education by 2015: A Chance for Every Child.

ERIC Educational Resources Information Center

Bruns, Barbara; Mingat, Alain; Rakotomalala, Ramahatra

Achievement of the second of the Millennium Development Goals (MDG)--universal primary education by 2015--is crucial, as education is one of the most powerful instruments for reducing poverty and inequality and for laying the foundation for sustained economic growth, effective institutions, and sound governance. This study assesses whether…

The Promotion of Critical Thinking Skills in School-Based Assessment (SBA)

ERIC Educational Resources Information Center

Kamarulzaman, Wirawani; Kamarulzaman, Wirawahida

2016-01-01

The new curriculum introduced in the Malaysian primary students; the Primary School Standard Curriculum (Kurikulum Standard Sekolah Rendah-KSSR) together with the school-based assessment (SBA) is a step taken by the Malaysian government to encourage thinking skills to students, specifically critical thinking skills. The study explores teachers'…

The "New" Science Specialists: Promoting and Improving the Teaching of Science in Primary Schools

ERIC Educational Resources Information Center

Campbell, Coral; Chittleborough, Gail

2014-01-01

A Victorian government initiative called "The Primary Science Specialists Professional Learning Program" is designed to tackle students' falling interest in science by investing in the building of teacher capacity. The aims of the initiative are: to improve the science knowledge base of all teachers and therefore increase teachers'…

Effective Practical Work in Primary Science: The Role of Empathy

ERIC Educational Resources Information Center

Abrahams, Ian; Reiss, Michael

2010-01-01

"Getting Practical-Improving practical work in science" is a government-funded programme intended to improve the effectiveness and affective value of practical work in school science in England. In order to evaluate the effectiveness of the programme in terms of achieving its aims, ten primary and twenty secondary schools have been…

Stressors and Stressor Response Levels of Hong Kong Primary School Music Teachers

ERIC Educational Resources Information Center

Wong, Marina Wai-yee; Chik, Maria Pik-yuk; Chan, Edmund Sze Shing

2018-01-01

Responses from 309 randomly sampled Hong Kong primary school music teachers to the shortened version of the Chinese Teacher Stress Questionnaire were subjected to a descriptive percentage analysis, one-way ANOVA and independent t test. Obtained results identify five key stressors: "changing education policy of the government";…

Federalization of Education in Chihuahua

ERIC Educational Resources Information Center

Marak, Andrae M.

2005-01-01

This article examines the politics behind the initial centralization of primary education in Chihuahua, Mexico during the 1920s and 1930s. The article argues that the centralization of primary education was one of many tools used by the federal government to consolidate its power in the wake of the Mexican Revolution (1910-1917) and create a…

School Environment and Satisfaction with Schooling among Primary School Pupils in Ondo State, Nigeria

ERIC Educational Resources Information Center

Aina, Stephen Ileoye

2015-01-01

Modern school environments put emphasis on adequate and qualitative facilities to promote conducive teaching and learning environments, the deplorable conditions of the primary schools has become worrisome to the state government and education stakeholders. The study investigated the school environment and pupils' satisfaction with schooling in…

Guidance Counselling as a Whole School Responsibility in the Irish Post Primary Sector

ERIC Educational Resources Information Center

Hearne, Lucy; Geary, Tom; Martin, Noelle

2017-01-01

This paper will deliberate upon the relevance of guidance counselling as a "whole school" responsibility in the context of recent policy and practice changes in the Irish post primary sector since the Government of Ireland Budget 2012. Pertinent issues including the complexities of delivering a whole school approach to guidance…

Community Group Practices in Canada: Are They Ready to Reform Their Practice?

ERIC Educational Resources Information Center

Murray, Suzanne; Silver, Ivan; Patel, Dilip; Dupuis, Martin; Hayes, Sean M.; Davis, Dave

2008-01-01

Introduction: Governments and healthcare organizations in Canada are reforming the clinical practice structures and policies to deliver primary care to the population. A key component of primary healthcare reform is the establishment of an interdisciplinary, community-based team approach to patient care. This study was undertaken to provide…

English Clubs: Introducing English to Young Learners

ERIC Educational Resources Information Center

Afia, Jawida Ben

2006-01-01

This article introduces an approach taken in Tunisia to introduce English as a foreign language to children in primary school classrooms. The author states that in Tunisia, children in primary schools are first taught Arabic and then French. The government does not want to overburden the students with English learning. Then, the author describes…

Primary data collection in health technology assessment.

PubMed

McIsaac, Michelle L; Goeree, Ron; Brophy, James M

2007-01-01

This study discusses the value of primary data collection as part of health technology assessment (HTA). Primary data collection can help reduce uncertainty in HTA and better inform evidence-based decision making. However, methodological issues such as choosing appropriate study design and practical concerns such as the value of collecting additional information need to be addressed. The authors emphasize the conditions required for successful primary data collection in HTA: experienced researchers, sufficient funding, and coordination among stakeholders, government, and researchers. The authors conclude that, under specific conditions, primary data collection is a worthwhile endeavor in the HTA process.

The Effects of Home-Based Lunch Provision on Child Retention in Primary Schools in Mbita Sub-County Kenya

ERIC Educational Resources Information Center

Abonyo, Nelson; Onderi, Henry; Ayodo, T. M. O.

2014-01-01

Despite the introduction of Free Primary Education in 2003 by the Kenya government in its quest to increasing access, retention and equity in education provision, child survival rate in primary schools in Mbita Sub-county is still 85.2% and is below the national survival rate of 97.1%. It was due to this low retention rate that the study was set…

What are the similarities and differences in structure and function among the three main models of community health centers in China: a systematic review.

PubMed

Li, Haitao; Qian, Dongfu; Griffiths, Sian; Chung, Roger Yat-Nork; Wei, Xiaolin

2015-11-10

There are three major models of primary care providers (Community Health Centers, CHCs) in China, i.e., government managed, hospital managed and privately owned CHCs. We performed a systematic review of structures and health care delivery patterns of the three models of CHCs. Studies from relevant English and Chinese databases for the period of 1997-2011 were searched. Two independent researchers extracted data from the eligible studies using a standardized abstraction form. Methodological quality of included articles was assessed with the Mixed Methods Appraisal Tool (MMAT). A total of 13 studies was included in the final analysis. Compared with the other two models, private CHCs had a smaller health workforce and lower share of government funding in their total revenues. Private CHCs also had fewer training opportunities, were less recognized by health insurance schemes and tended to provide primary care services of poor quality. Hospital managed CHCs attracted patients through their higher quality of clinical care, while private CHCs attracted users through convenience and medical equipment. Our study suggested that government and hospital managed CHCs were more competent and provided better primary care than privately owned CHCs. Further studies are warranted to comprehensively compare performances among different models of CHCs.

An overview of future EU health systems. An insight into governance, primary care, data collection and citizens' participation.

PubMed

Quaglio, Gianluca; Figueras, Josep; Mantoan, Domenico; Dawood, Amr; Karapiperis, Theodoros; Costongs, Caroline; Bernal-Delgado, Enrique

2018-03-26

Health systems in the European Union (EU) are being questioned over their effectiveness and sustainability. In pursuing both goals, they have to conciliate coexisting, not always aligned, realities. This paper originated from a workshop entitled 'Health systems for the future' held at the European Parliament. Experts and decision makers were asked to discuss measures that may increase the effectiveness and sustainability of health systems, namely: (i) increasing citizens' participation; (ii) the importance of primary care in providing integrated services; (iii) improving the governance and (iv) fostering better data collection and information channels to support the decision making process. In the parliamentary debate, was discussed the concept that, in the near future, health systems' effectiveness and sustainability will very much depend on effective access to integrated services where primary care is pivotal, a clearer shift from care-oriented systems to health promotion and prevention, a profound commitment to good governance, particularly to stakeholders participation, and a systematic reuse of data meant to build health data-driven learning systems. Many health issues, such as future health systems in the EU, are potentially transformative and hence an intense political issue. It is policy-making leadership that will mostly determine how well EU health systems are prepared to face future challenges.

“One man one job”: the marriage ban and the employment of women teachers in Irish primary schools.

PubMed

Redmond, Jennifer; Harford, Judith

2010-01-01

In 1932, the Irish government, facing an economic downturn, introduced a marriage ban which required that female primary school teachers were required to resign on marriage. This followed a series of restrictive legislative measures adopted by Irish governments throughout the 1920s which sought to limit women's participation in public life and the public sector. Such a requirement emerged in several countries in response to high unemployment and applied principally to women's white-collar occupations, leading some commentators to argue that it stemmed from a social consensus rather than an economic rationale. Despite opposition to the ban from the Irish National Teachers' Organisation (INTO) on the basis that it was unconstitutional, would lead to fewer marriages and that married women were in fact more suited to teaching children, it remained in place until 1958. Although the ban is much referred to as part of the gender ideology that informed legislation in the early years of independent Ireland, the particular history of married women teachers has been little researched in the academic context. Over 50 years since the rescinding of the ban, this article examines its impact through an analysis of primary sources, including government cabinet minutes and the public commentary of the INTO and positions this history within the international context.

Public-private partnerships to improve primary healthcare surgeries: clarifying assumptions about the role of private provider activities.

PubMed

Mudyarabikwa, Oliver; Tobi, Patrick; Regmi, Krishna

2017-07-01

Aim To examine assumptions about public-private partnership (PPP) activities and their role in improving public procurement of primary healthcare surgeries. PPPs were developed to improve the quality of care and patient satisfaction. However, evidence of their effectiveness in delivering health benefits is limited. A qualitative study design was employed. A total of 25 interviews with public sector staff (n=23) and private sector managers (n=2) were conducted to understand their interpretations of assumptions in the activities of private investors and service contractors participating in Local Improvement Finance Trust (LIFT) partnerships. Realist evaluation principles were applied in the data analysis to interpret the findings. Six thematic areas of assumed health benefits were identified: (i) quality improvement; (ii) improved risk management; (iii) reduced procurement costs; (iv) increased efficiency; (v) community involvement; and (vi) sustainable investment. Primary Care Trusts that chose to procure their surgeries through LIFT were expected to support its implementation by providing an environment conducive for the private participants to achieve these benefits. Private participant activities were found to be based on a range of explicit and tacit assumptions perceived helpful in achieving government objectives for LIFT. The success of PPPs depended upon private participants' (i) capacity to assess how PPP assumptions added value to their activities, (ii) effectiveness in interpreting assumptions in their expected activities, and (iii) preparedness to align their business principles to government objectives for PPPs. They risked missing some of the expected benefits because of some factors constraining realization of the assumptions. The ways in which private participants preferred to carry out their activities also influenced the extent to which expected benefits were achieved. Giving more discretion to public than private participants over critical decisions may help in ensuring that assumptions in PPP activities result in outcomes that match the anticipated health benefits.

Characteristics of Indigenous primary health care models of service delivery: a scoping review protocol.

PubMed

Harfield, Stephen; Davy, Carol; Kite, Elaine; McArthur, Alexa; Munn, Zachary; Brown, Ngiare; Brown, Alex

2015-11-01

The objective of the scoping review is to identify and describe within the existing literature the characteristics (values, principles, components and suggest practical applications) of primary health care models of service delivery for Indigenous people. More specifically, the review question is:What are the characteristics (values, principles, components and suggested practical applications) of primary health care models of service delivery for Indigenous people?Findings from this scoping review will inform two systematic reviews. One of these will explore the acceptability and the other the effectiveness of identified characteristics. The scoping review will follow the JBI Scoping Review methodology as outlined in the 2015 Joanna Briggs Institute Reviewers' Manual. Indigenous populations in colonized countries experience worse health outcomes relative to their non-Indigenous counterparts. In Australia, in the period 2010 to 2012 the estimated gap in life expectancy between Aboriginal and Torres Strait Islander Australians compared to non-Indigenous Australians was 10 years Similar gaps in life expectancy between Indigenous and non-Indigenous have been demonstrated in other countries, such as New Zealand, Canada and the United StatesThe gap in life expectancy and the health disadvantage experienced by Indigenous people is in part the result of mainstream health services not adequately meeting the health needs of Indigenous people and Indigenous people's inability to access mainstream services Part of the solution has been the establishment of primary health care services for and in many cases run by Indigenous people. Indigenous primary health services have been developed to provide culturally appropriate services that meet the needs of local Indigenous communities.In Australia, the first Aboriginal medical service was established in 1971 in Redfern, New South Wales, by "community activists in response to ongoing discrimination against Aboriginal people within mainstream health services to address the poor health and premature deaths of Aboriginal people, and to provide a culturally appropriate system of health care". There are now over 150 Aboriginal Community Controlled Health Services in Australia. Aboriginal Community Controlled Health Services are underpinned by common values such as culture, cultural respect, integrity, inclusion, self-determination, community control, sovereignty and leadership.Similar models of Indigenous health services exist in other countries, such as Māori health providers in New Zealand, First Nations and Inuit Health Authorities in Canada, and the Indian Health Services in the US. In New Zealand, Māori health providers deliver health and disability services to Māori and non-Māori clients. The difference between Māori health providers and mainstream services in New Zealand is that Māori health services are based on kaupapa, a plan or set of principles and ideas that informs behavior and customs, and the delivery framework which is distinctively Māori. First Nations and Inuit Health Authorities in Canada coordinate and integrate health programs and services to achieve better health outcomes for First Nations people. These community-based services largely focus on health promotion and prevention. First Nations and Inuit Health Authorities work under a unique health governance structure that includes local First Nations' leadership, based on the philosophy of self-governance and self-determination, which represent and address the health needs of First Nation communities. The Indian Health Service (IHS) in the US is responsible for providing comprehensive health services to American Indians and Alaska Natives. The IHS aims to raise the physical, mental, social and spiritual health of American Indians and Alaska Natives to the highest level, and its goal is "to ensure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people". The IHS "grew out of a special government-to-government relationship between the federal government and Indian Tribes".Evidence suggests that "a strong primary health care sector is essential to the health and wellbeing of a population, and that a strong primary health care sector is associated with better population health, reduced costs of health care provision, and greater efficiency within the system". A study of Aboriginal Canadians shows that poor access and ineffective primary health care services were directly related to increased avoidable hospital admissions. In addition, a recent study in Australia focusing on the costs and the health outcomes associated with primary care use by Indigenous people with diabetes in remote communities in the Northern Territory demonstrates that improved access to primary health care which is responsive to the needs of Aboriginal and Torres Strait Islander people is both cost-effective and associated with better health outcomes.Given the strong link between primary health care and health outcomes and the significant contribution Indigenous health services make towards reducing the health disadvantage experienced by Indigenous people, it is important to understand the characteristics that support the delivery of health provided by Indigenous health services and their unique models. While there is not a clear definition in the literature about what a model of care or model of service delivery is, for the purpose of this review, it will encompass all factors involved in the delivery of care including but not limited to the vision, values and strategies that underpin the delivery of care, healthcare services and programs, governance and leadership, workforce, organization and supply, and infrastructure and other resources.The aim of this scoping review is to determine the characteristics of Indigenous primary health care models of service delivery by drawing on existing literature that look at the way in which services are delivered in this setting.An initial search of literature was conducted to establish whether there are studies with findings available to answer the review question, and whether there is a systematic or scoping review addressing the knowledge gap currently underway or published. There are no systematic or scoping reviews published or underway that address the question proposed by this review.

A Conceptual Model of Counterinsurgency: Understanding Elements, Factors, and Probability of Success

DTIC Science & Technology

2011-05-03

the counterinsurgent. Galula is critical of Mao Tse -tung in the regard that Mao‘s ―laws of revolutionary warfare‖ are only applicable for the side...Algerian Independence 1954 1962 Government Loses Eritrea 1960 1993 Government Loses Laos 1960 1975 Government Loses Namibia 1960 1989 Government

Modeling environmental influences on child growth in the MAL-ED cohort study: opportunities and challenges.

PubMed

Richard, Stephanie A; McCormick, Benjamin J J; Miller, Mark A; Caulfield, Laura E; Checkley, William

2014-11-01

Although genetics, maternal undernutrition and low birth weight status certainly play a role in child growth, dietary insufficiency and infectious diseases are key risk factors for linear growth faltering during early childhood. A primary goal of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study is to identify specific risk factors associated with growth faltering during the first 2 years of life; however, growth in early childhood is challenging to characterize because growth may be inherently nonlinear with age. In this manuscript, we describe some methods for analyzing longitudinal growth to evaluate both short- and long-term associations between risk factors and growth trajectories over the first 2 years of life across 8 resource-limited settings using harmonized protocols. We expect there will be enough variability within and between sites in the prevalence of risk factors and burden of linear growth faltering to allow us to distinguish some of the key pathways to linear growth faltering in the MAL-ED study. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Governing the quality and safety of healthcare: A conceptual framework.

PubMed

Brown, Alison; Dickinson, Helen; Kelaher, Margaret

2018-04-01

Recent research has advanced understanding of corporate governance of healthcare quality, highlighting the need for future empirical work to develop beyond a focus on board composition to a more detailed exploration of the internal workings of governance that influence board engagement and activities. This paper proposes a conceptual framework to guide empirical research examining the work of board and senior management in governing healthcare quality. To generate this framework, existing conceptual approaches and key constructs influencing effectiveness are identified in the governance literature. Commonalities between governance and team effectiveness literature are mapped and suggest a number of key constructs in the team effectiveness literature are applicable to, but not yet fully explored, within the governance literature. From these we develop a healthcare governance conceptual framework encompassing both literatures, that outlines input and mediating factors influencing governance. The mapping process highlights gaps in research related to board dynamics and external influences that require further investigation. Organizing the multiple complex factors that influence governance of healthcare quality in a conceptual framework brings a new perspective to structuring theory-led research and informing future policy initiatives. Copyright © 2018 Elsevier Ltd. All rights reserved.

Debt profiles of new grads.

PubMed

Hiscott, R D

1996-03-01

The economic climate in Ontario in particular and Canada in general (especially, severe problems with government budget deficits and accumulated long-term debt) has led to increasing pressures to off-load financial responsibilities for postsecondary education from governments to those who reap the primary benefits of such education--namely, the students. As a result, there have been sizable increases in tuition fees for postsecondary programs in recent years. It is reasonable to assume that cash-strapped governments will continue to expect students in university and community college programs to pay an increasing share of their education. In fact, this is one of the major options set out in the recent federal government paper for reform of social programs.

Meeting the needs of children and young people with speech, language and communication difficulties.

PubMed

Lindsay, Geoff; Dockrell, Julie; Desforges, Martin; Law, James; Peacey, Nick

2010-01-01

The UK government set up a review of provision for children and young people with the full range of speech, language and communication needs led by a Member of Parliament, John Bercow. A research study was commissioned to provide empirical evidence to inform the Bercow Review. To examine the efficiency and effectiveness of different arrangements for organizing and providing services for children and young people with needs associated with primary speech, language and communication difficulties. Six Local Authorities in England and associated Primary Care Trusts were selected to represent a range of locations reflecting geographic spread, urban/rural and prevalence of children with speech, language and communication difficulties. In each case study, interviews were held with the senior Local Authority manager for special educational needs and a Primary Care Trust senior manager for speech and language therapy. A further 23 head teachers or heads of specialist provision for speech, language and communication difficulties were also interviewed and policy documents were examined. A thematic analysis of the interviews produced four main themes: identification of children and young people with speech, language and communication difficulties; meeting their needs; monitoring and evaluation; and research and evaluation. There were important differences between Local Authorities and Primary Care Trusts in the collection, analysis and use of data, in particular. There were also differences between Local Authority/Primary Care Trust pairs, especially in the degree to which they collaborated in developing policy and implementing practice. This study has demonstrated a lack of consistency across Local Authorities and Primary Care Trusts. Optimizing provision to meet the needs of children and young people with speech, language and communication difficulties will require concerted action, with leadership from central government. The study was used by the Bercow Review whose recommendations have been addressed by central government and a funded action plan has been implemented as a result.

The views of key leaders in South Africa on implementation of family medicine: critical role in the district health system.

PubMed

Moosa, Shabir; Mash, Bob; Derese, Anselme; Peersman, Wim

2014-06-25

Integrated team-based primary care is an international imperative. This is required more so in Africa, where fragmented verticalised care dominates. South Africa is trying to address this with health reforms, including Primary Health Care Re-engineering. Family physicians are already contributing to primary care despite family medicine being only fully registered as a full specialty in South Africa in 2008. However the views of leaders on family medicine and the role of family physicians is not clear, especially with recent health reforms. The aim of this study was to understand the views of key government and academic leaders in South Africa on family medicine, roles of family physicians and human resource issues. This was a qualitative study with academic and government leaders across South Africa. In-depth interviews were conducted with sixteen purposively selected leaders using an interview guide. Thematic content analysis was based on the framework method. Whilst family physicians were seen as critical to the district health system there was ambivalence on their leadership role and 'specialist' status. National health reforms were creating both threats and opportunities for family medicine. Three key roles for family physicians emerged: supporting referrals; clinical governance/quality improvement; and providing support to community-oriented care. Respondents' urged family physicians to consolidate the development and training of family physicians, and shape human resource policy to include family physicians. Family physicians were seen as critical to the district health system in South Africa despite difficulties around their precise role. Whilst their role was dominated by filling gaps at district hospitals to reduce referrals it extended to clinical governance and developing community-oriented primary care - a tall order, requiring strong teamwork. Innovative team-based service delivery is possible despite human resource challenges, but requires family physicians to proactively develop team-based models of care, reform education and advocate for clearer policy, based on the views of these respondents.

The views of key leaders in South Africa on implementation of family medicine: critical role in the district health system

PubMed Central

2014-01-01

Background Integrated team-based primary care is an international imperative. This is required more so in Africa, where fragmented verticalised care dominates. South Africa is trying to address this with health reforms, including Primary Health Care Re-engineering. Family physicians are already contributing to primary care despite family medicine being only fully registered as a full specialty in South Africa in 2008. However the views of leaders on family medicine and the role of family physicians is not clear, especially with recent health reforms. The aim of this study was to understand the views of key government and academic leaders in South Africa on family medicine, roles of family physicians and human resource issues. Methods This was a qualitative study with academic and government leaders across South Africa. In-depth interviews were conducted with sixteen purposively selected leaders using an interview guide. Thematic content analysis was based on the framework method. Results Whilst family physicians were seen as critical to the district health system there was ambivalence on their leadership role and ‘specialist’ status. National health reforms were creating both threats and opportunities for family medicine. Three key roles for family physicians emerged: supporting referrals; clinical governance/quality improvement; and providing support to community-oriented care. Respondents’ urged family physicians to consolidate the development and training of family physicians, and shape human resource policy to include family physicians. Conclusions Family physicians were seen as critical to the district health system in South Africa despite difficulties around their precise role. Whilst their role was dominated by filling gaps at district hospitals to reduce referrals it extended to clinical governance and developing community-oriented primary care - a tall order, requiring strong teamwork. Innovative team-based service delivery is possible despite human resource challenges, but requires family physicians to proactively develop team-based models of care, reform education and advocate for clearer policy, based on the views of these respondents. PMID:24961449

[Relaunching primary healthcaree].

PubMed

Marcolongo, Adriano; Talarico, Francesco

2014-01-01

The health environment today is characterized by diffuse inequalities, the emergence of chronic diseases, and the introduction of new technologies, all of which, together with other factors are leading to a healthcare system that is becoming increasingly less sustainable from a financial point of view. Primary healthcare, public health and hospitals should work together to define a comprehensive healthcare delivery model characterized by continuity of care, information and management. The proposed model of disease management, in particular of chronic diseases, must reorganize health services around the needs of citizens and the community and involve patients and their families in the disease management process, by promoting self-help groups and patient organizations that cooperate with health services. In order to put this change into effect, evidence-based medicine and evidence-based practice need to be adopted. From an organizational point of view, it will be important to change wage rules, so as to implement a new payment system based upon performance. In this new contest, physicians specialized in hygiene and public health can play an important role that includes leadership, governance and coordination. By integrating the concepts of accountability, community intervention and training, we can acquire the tools to change the current hospital-based system to a new model of primary healthcare that works together with the community to move the focus from healthcare provider to patient.

The role of virologic and immunologic factors in mother-to-child transmission of HIV-1.

PubMed

Colognesi, C; Halapi, E; Jansson, M; Hodara, V; Steuer, G; Tresoldi, E; Leitner, T; Scarlatti, G

1997-09-01

More than 90% of human immunodeficiency virus type 1 (HIV-1) infection in children is acquired by mother-to-child transmission. However, infection of the child occurs in between 14 and 35% of cases. To understand the mechanisms involved in HIV-1 transmission, we have investigated the antigenic, molecular, and phenotypic characteristics of the virus harbored in infected mothers and their children. A clear correlation was observed between the transmission of the virus and the isolation of viral variants with a rapidly replicating and syncytium-inducing phenotype from the mother. Furthermore, non-transmitting mothers were able to neutralize several primary isolates more frequently than transmitting mothers. The comparison of the viral phenotype and genotype of mother-child pairs showed that the transmitted virus did not have common features, suggesting that transmission is usually not a selective process. This study suggests that transmission is governed by an interaction of both viral and immunological factors. The results obtained indicate that different strategies can be applied for the prevention of transmission.

Synthesis from Design Requirements of a Hybrid System for Transport Aircraft Longitudinal Control. Volume 1

NASA Technical Reports Server (NTRS)

Hynes, Charles S.; Hardy, Gordon H.; Sherry, Lance

2007-01-01

Volume I of this report presents a new method for synthesizing hybrid systems directly from design requirements, and applies the method to design of a hybrid system for longitudinal control of transport aircraft. The resulting system satisfies general requirement for safety and effectiveness specified a priori, enabling formal validation to be achieved. Volume II contains seven appendices intended to make the report accessible to readers with backgrounds in human factors, fli ght dynamics and control. and formal logic. Major design goals are (1) system desi g n integrity based on proof of correctness at the design level, (2), significant simplification and cost reduction in system development and certification, and (3) improved operational efficiency, with significant alleviation of human-factors problems encountered by pilots in current transport aircraft. This report provides for the first time a firm technical basis for criteria governing design and certification of avionic systems for transport aircraft. It should be of primary interest to designers of next-generation avionic systems.

Synthesis from Design Requirements of a Hybrid System for Transport Aircraft Longitudinal Control. Volume 2

NASA Technical Reports Server (NTRS)

Hynes, Charles S.; Hardy, Gordon H.; Sherry, Lance

2007-01-01

Volume I of this report presents a new method for synthesizing hybrid systems directly from desi gn requirements, and applies the method to design of a hybrid system for longitudinal control of transport aircraft. The resulting system satisfies general requirement for safety and effectiveness specified a priori, enabling formal validation to be achieved. Volume II contains seven appendices intended to make the report accessible to readers with backgrounds in human factors, flight dynamics and control, and formal logic. Major design goals are (1) system design integrity based on proof of correctness at the design level, (2) significant simplification and cost reduction in system development and certification, and (3) improved operational efficiency, with significant alleviation of human-factors problems encountered by pilots in current transport aircraft. This report provides for the first time a firm technical basis for criteria governing design and certification of avionic systems for transport aircraft. It should be of primary interest to designers of next-generation avionic systems.

Obesity framing for health policy development in Australia, France and Switzerland.

PubMed

Patchett, Annabelle D; Yeatman, Heather R; Johnson, Keryn M

2016-03-01

The obesity epidemic is a consequence of the interaction of cultural, environmental, genetic and behavioural factors; framing the issue is central to determining appropriate solutions. This study used content and thematic framing analysis to explore portrayal of responsibility for obesity in policy documents in Australia, France and Switzerland. For Australia and France, obesity causality was a combination of individual and environmental factors, but for Switzerland, it was predominantly individual. The primary solutions for all countries were health promotion strategies and children's education. Industry groups proposed more school education while health advocates advised government intervention. Where France emphasized cultural attitudes towards taste, Australia focused on sport. The French were most keen on legislating against unhealthy foods compared with Switzerland where there was opposition towards regulation of individual's choices. To curb the increasing prevalence of obesity, allocation of responsibility needs to be considered and initiatives enacted accordingly. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Developing effective policy and practice for health promotion in Scotland.

PubMed

Wimbush, Erica; Young, Ian; Robertson, Graham

2007-01-01

Scotland has recently embarked on a new phase of policy and infrastructure development for improving population health and reducing health inequalities that broadly conforms to the Ottawa Charter and WHO's strategic framework for the prevention and control of non-communicable diseases. The new phase is characterised by an integrated, cross-government approach to improving health with strengthened political and Scottish Executive leadership and investment since devolution. A comprehensive policy framework for improving young people's health and reducing inequalities has been developed across education, health, environment and social justice. It builds on an earlier phase of relative stability and continuity in the health promotion infrastructure with policy focused on CVD and cancer prevention and tackling the behavioural risk factors (smoking, alcohol, diet, physical activity) as well as sexual health and mental health and wellbeing. These national strategies are currently being implemented across Scotland. They combine promotion, prevention, treatment and protection goals and target both population-level and high-risk groups. Crosscutting government objectives and headline targets for addressing poverty, disadvantage and health inequalities now supplement the NHS health improvement targets on smoking, alcohol, physical activity, teenage pregnancy and child immunization. Within the health service, prevention efforts are largely concerned with primary care development (anticipatory care) and health system reform to maximize their impact on reducing health inequalities. Efforts to tackle the social determinants of health and reduce inequalities in health outcomes are beginning to be connected and mainstreamed across local government with Community Planning Partnerships as the main vehicle. National level mechanisms for integrated funding, planning and performance reporting to deliver shared priority outcomes have yet to be developed. The development of health improvement strategies has been founded upon a rich source of population health data to monitor changes and improvements, epidemiological studies and evaluation work. The key issues have been to find ways of intervening to accelerate the rate of improvement and to stem the growing health inequalities. A further challenge is to ensure that the lessons from reviews and evaluations of past programmes and strategies are not lost, but help to guide improvements in the complex delivery system and to inform future policy direction. Within the health service, prevention efforts are largely concerned with primary care development and health system reform. Efforts to reduce inequalities in health outcomes are beginning to be connected and mainstreamed across local government.

What systemic factors contribute to collaboration between primary care and public health sectors? An interpretive descriptive study.

PubMed

Wong, Sabrina T; MacDonald, Marjorie; Martin-Misener, Ruth; Meagher-Stewart, Donna; O'Mara, Linda; Valaitis, Ruta K

2017-12-01

Purposefully building stronger collaborations between primary care (PC) and public health (PH) is one approach to strengthening primary health care. The purpose of this paper is to report: 1) what systemic factors influence collaborations between PC and PH; and 2) how systemic factors interact and could influence collaboration. This interpretive descriptive study used purposive and snowball sampling to recruit and conduct interviews with PC and PH key informants in British Columbia (n = 20), Ontario (n = 19), and Nova Scotia (n = 21), Canada. Other participants (n = 14) were knowledgeable about collaborations and were located in various Canadian provinces or working at a national level. Data were organized into codes and thematic analysis was completed using NVivo. The frequency of "sources" (individual transcripts), "references" (quotes), and matrix queries were used to identify potential relationships between factors. We conducted a total of 70 in-depth interviews with 74 participants working in either PC (n = 33) or PH (n = 32), both PC and PH (n = 7), or neither sector (n = 2). Participant roles included direct service providers (n = 17), senior program managers (n = 14), executive officers (n = 11), and middle managers (n = 10). Seven systemic factors for collaboration were identified: 1) health service structures that promote collaboration; 2) funding models and financial incentives supporting collaboration; 3) governmental and regulatory policies and mandates for collaboration; 4) power relations; 5) harmonized information and communication infrastructure; 6) targeted professional education; and 7) formal systems leaders as collaborative champions. Most themes were discussed with equal frequency between PC and PH. An assessment of the system level context (i.e., provincial and regional organization and funding of PC and PH, history of government in successful implementation of health care reform, etc) along with these seven system level factors could assist other jurisdictions in moving towards increased PC and PH collaboration. There was some variation in the importance of the themes across provinces. British Columbia participants more frequently discussed system structures that could promote collaboration, power relations, harmonized information and communication structures, formal systems leaders as collaboration champions and targeted professional education. Ontario participants most frequently discussed governmental and regulatory policies and mandates for collaboration.

School Governance, Teacher Incentives, and Pupil-Teacher Ratios: Experimental Evidence from Kenyan Primary Schools. NBER Working Paper No. 17939

ERIC Educational Resources Information Center

Duflo, Esther; Dupas, Pascaline; Kremer, Michael

2012-01-01

We examine a program that enabled Parent-Teacher Associations (PTAs) in Kenya to hire novice teachers on short-term contracts, reducing class sizes in grade one from 82 to 44 on average. PTA teachers earned approximately one-quarter as much as teachers operating under central government civil-service institutions but were absent one day per week…

Understanding Return on Investment for Data Center Consolidation

DTIC Science & Technology

2013-09-01

Channel over Ethernet FDCCI Federal Data Center Consolidation Initiative GAO Government Accountability Office GDA Government Directed Actions GIG ...to judge how each stakeholder group will benefit from it. Such measures as lower risk, greater control, better economies of scale, better utilization...NMS product by Kratos Networks called Neural Star to manage the Global Information Grid ( GIG ) (Kratos, 2013). DISA uses Neural Star as the primary

Zebrafish as a Model to Study NF1-Associated Learning Deficits

DTIC Science & Technology

2016-07-01

characterized by attention deficit and learning disabilities . The NF1 protein govern distinct aspects of cognitive behavior: the NF1- GRD attenuates Ras...most prominently scholastic under-performance characterized by attention deficit and learning disabilities . The NF1 protein govern distinct...disorder associated with attention deficits and learning disabilities . The primary known function of neurofibromin, encoded by the NF1 gene, is to

The Role of Parent Governors in School Governance in Zimbabwe: Perceptions of School Heads, Teachers and Parent Governors

ERIC Educational Resources Information Center

Chikoko, Vitallis

2008-01-01

This paper reports on a study of the role of parent governors in five neighbouring rural primary schools in Zimbabwe. The study proposed that despite the presence of a legal decentralised school governance structure in which parents form the majority, they did not have the capacity to function effectively therein, and were still marginalised in…

Teaching About Basic Legal Concepts in the Senior High School. Module IV--The System: Keeping Officials in Line.

ERIC Educational Resources Information Center

Campbell, A. Bruce; And Others

The primary focus of this legal education module, fourth of five to be integrated into an 11th grade American history course, is on the problems of maintaining a system of government in which officials who make, change, enforce, and apply laws do not unreasonably interfere with fundamental values and interests of the governed. Understandings, or…

A novel regulation mechanism of DNA repair by damage-induced and RAD23-dependent stabilization of xeroderma pigmentosum group C protein

PubMed Central

Ng, Jessica M.Y.; Vermeulen, Wim; van der Horst, Gijsbertus T.J.; Bergink, Steven; Sugasawa, Kaoru; Vrieling, Harry; Hoeijmakers, Jan H.J.

2003-01-01

Primary DNA damage sensing in mammalian global genome nucleotide excision repair (GG-NER) is performed by the xeroderma pigmentosum group C (XPC)/HR23B protein complex. HR23B and HR23A are human homologs of the yeast ubiquitin-domain repair factor RAD23, the function of which is unknown. Knockout mice revealed that mHR23A and mHR23B have a fully redundant role in NER, and a partially redundant function in embryonic development. Inactivation of both genes causes embryonic lethality, but appeared still compatible with cellular viability. Analysis of mHR23A/B double-mutant cells showed that HR23 proteins function in NER by governing XPC stability via partial protection against proteasomal degradation. Interestingly, NER-type DNA damage further stabilizes XPC and thereby enhances repair. These findings resolve the primary function of RAD23 in repair and reveal a novel DNA-damage-dependent regulation mechanism of DNA repair in eukaryotes, which may be part of a more global damage-response circuitry. PMID:12815074

X-linked primary ciliary dyskinesia due to mutations in the cytoplasmic axonemal dynein assembly factor PIH1D3

PubMed Central

Olcese, Chiara; Patel, Mitali P.; Shoemark, Amelia; Kiviluoto, Santeri; Legendre, Marie; Williams, Hywel J.; Vaughan, Cara K.; Hayward, Jane; Goldenberg, Alice; Emes, Richard D.; Munye, Mustafa M.; Dyer, Laura; Cahill, Thomas; Bevillard, Jeremy; Gehrig, Corinne; Guipponi, Michel; Chantot, Sandra; Duquesnoy, Philippe; Thomas, Lucie; Jeanson, Ludovic; Copin, Bruno; Tamalet, Aline; Thauvin-Robinet, Christel; Papon, Jean- François; Garin, Antoine; Pin, Isabelle; Vera, Gabriella; Aurora, Paul; Fassad, Mahmoud R.; Jenkins, Lucy; Boustred, Christopher; Cullup, Thomas; Dixon, Mellisa; Onoufriadis, Alexandros; Bush, Andrew; Chung, Eddie M. K.; Antonarakis, Stylianos E.; Loebinger, Michael R.; Wilson, Robert; Armengot, Miguel; Escudier, Estelle; Hogg, Claire; Al-Turki, Saeed; Anderson, Carl; Antony, Dinu; Barroso, Inês; Beales, Philip L.; Bentham, Jamie; Bhattacharya, Shoumo; Carss, Keren; Chatterjee, Krishna; Cirak, Sebahattin; Cosgrove, Catherine; Allan, Daly; Durbin, Richard; Fitzpatrick, David; Floyd, Jamie; Foley, A. Reghan; Franklin, Chris; Futema, Marta; Humphries, Steve E.; Hurles, Matt; McCarthy, Shane; Muddyman, Dawn; Muntoni, Francesco; Parker, Victoria; Payne, Felicity; Plagnol, Vincent; Raymond, Lucy; Savage, David B.; Scambler, Peter J.; Schmidts, Miriam; Semple, Robert; Serra, Eva; Stalker, Jim; van Kogelenberg, Margriet; Vijayarangakannan, Parthiban; Walter, Klaudia; Amselem, Serge; Sun, Zhaoxia; Bartoloni, Lucia; Blouin, Jean-Louis; Mitchison, Hannah M.

2017-01-01

By moving essential body fluids and molecules, motile cilia and flagella govern respiratory mucociliary clearance, laterality determination and the transport of gametes and cerebrospinal fluid. Primary ciliary dyskinesia (PCD) is an autosomal recessive disorder frequently caused by non-assembly of dynein arm motors into cilia and flagella axonemes. Before their import into cilia and flagella, multi-subunit axonemal dynein arms are thought to be stabilized and pre-assembled in the cytoplasm through a DNAAF2–DNAAF4–HSP90 complex akin to the HSP90 co-chaperone R2TP complex. Here, we demonstrate that large genomic deletions as well as point mutations involving PIH1D3 are responsible for an X-linked form of PCD causing disruption of early axonemal dynein assembly. We propose that PIH1D3, a protein that emerges as a new player of the cytoplasmic pre-assembly pathway, is part of a complementary conserved R2TP-like HSP90 co-chaperone complex, the loss of which affects assembly of a subset of inner arm dyneins. PMID:28176794

X-linked primary ciliary dyskinesia due to mutations in the cytoplasmic axonemal dynein assembly factor PIH1D3.

PubMed

Olcese, Chiara; Patel, Mitali P; Shoemark, Amelia; Kiviluoto, Santeri; Legendre, Marie; Williams, Hywel J; Vaughan, Cara K; Hayward, Jane; Goldenberg, Alice; Emes, Richard D; Munye, Mustafa M; Dyer, Laura; Cahill, Thomas; Bevillard, Jeremy; Gehrig, Corinne; Guipponi, Michel; Chantot, Sandra; Duquesnoy, Philippe; Thomas, Lucie; Jeanson, Ludovic; Copin, Bruno; Tamalet, Aline; Thauvin-Robinet, Christel; Papon, Jean-François; Garin, Antoine; Pin, Isabelle; Vera, Gabriella; Aurora, Paul; Fassad, Mahmoud R; Jenkins, Lucy; Boustred, Christopher; Cullup, Thomas; Dixon, Mellisa; Onoufriadis, Alexandros; Bush, Andrew; Chung, Eddie M K; Antonarakis, Stylianos E; Loebinger, Michael R; Wilson, Robert; Armengot, Miguel; Escudier, Estelle; Hogg, Claire; Amselem, Serge; Sun, Zhaoxia; Bartoloni, Lucia; Blouin, Jean-Louis; Mitchison, Hannah M

2017-02-08

By moving essential body fluids and molecules, motile cilia and flagella govern respiratory mucociliary clearance, laterality determination and the transport of gametes and cerebrospinal fluid. Primary ciliary dyskinesia (PCD) is an autosomal recessive disorder frequently caused by non-assembly of dynein arm motors into cilia and flagella axonemes. Before their import into cilia and flagella, multi-subunit axonemal dynein arms are thought to be stabilized and pre-assembled in the cytoplasm through a DNAAF2-DNAAF4-HSP90 complex akin to the HSP90 co-chaperone R2TP complex. Here, we demonstrate that large genomic deletions as well as point mutations involving PIH1D3 are responsible for an X-linked form of PCD causing disruption of early axonemal dynein assembly. We propose that PIH1D3, a protein that emerges as a new player of the cytoplasmic pre-assembly pathway, is part of a complementary conserved R2TP-like HSP90 co-chaperone complex, the loss of which affects assembly of a subset of inner arm dyneins.

An analysis of lateral stability in power-off flight with charts for use in design

NASA Technical Reports Server (NTRS)

Zimmerman, Charles H

1937-01-01

The aerodynamic and mass factors governing lateral stability are discussed and formulas are given for their estimation. Relatively simple relationships between the governing factors and the resulting stability characteristics are presented. A series of charts is included with which approximate stability characteristics may be rapidly estimated. The effects of the various governing factors upon the stability characteristics are discussed in detail. It is pointed out that much additional research is necessary both to correlate stability characteristics with riding, flying, and handling qualities and to provide suitable data for accurate estimates of those characteristics of an airplane while it is in the design stage.

Understanding performance management in primary care.

PubMed

Rogan, Lisa; Boaden, Ruth

2017-02-13

Purpose Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care. Design/methodology/approach Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management. Findings There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation. Originality/value The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.

Strengthening decentralized primary healthcare planning in Nigeria using a quality improvement model: how contexts and actors affect implementation.

PubMed

Eboreime, Ejemai Amaize; Nxumalo, Nonhlanhla; Ramaswamy, Rohit; Eyles, John

2018-05-08

Quality improvement models have been applied across various levels of health systems with varying success leading to scepticisms about effectiveness. Health systems are complex, influenced by contexts and characterized by numerous interests. Thus, a shift in focus from examining whether improvement models work, to understanding why, when and where they work most effectively is essential. Nigeria introduced DIVA (Diagnose-Intervene-Verify-Adjust) as a model to strengthen decentralized PHC planning. However, implementation has been poorly sustained. This article explores the role of actors and context in implementation and sustainability of DIVA in two local government areas (LGAs) in Nigeria. We employed an integrated mixed method approach in which qualitative data was used in conjunction with quantitative to understand effects of actors and contexts on implementation outcomes. We analysed policy documents and conducted interviews with PHC managers. Then using the Model for Understanding Success in Quality (MUSIQ), we measured contextual factors affecting implementation of DIVA in the selected LGAs. The LGAs scored 117.42 and 104.67 out of 168 points on the MUSIQ scale, respectively, indicating contextual barriers exist. Both have strong DIVA team attributes, but these could not independently ensure quality implementation. Although external support accounted for the greatest contextual disparities, the utmost implementation challenges relate to subnational government leadership, management, financial and technical support. Although higher levels of government may set visionary goals for PHC, interventions are potentially skewed towards donor interests at lower (implementation) levels. Thus, subnational political will is a key determinant of quality implementation. Consequently, advocacy for responsible and accountable political governance is essential in comparable decentralized contexts.

Factors Influencing the Design, Establishment, Administration, and Governance of Correctional Education for Females

ERIC Educational Resources Information Center

Ellis, Johnica; McFadden, Cheryl; Colaric, Susan

2008-01-01

This article summarizes the results of a study conducted to investigate factors influencing the organizational design, establishment, administration, and governance of correctional education for females. The research involved interviews with correctional and community college administrators and practitioners representing North Carolina female…

Initial perceptions of key stakeholders in Ontario regarding independent prescriptive authority for pharmacists.

PubMed

Pojskic, Nedzad; MacKeigan, Linda; Boon, Heather; Austin, Zubin

2014-01-01

A number of jurisdictions, both in Canada and internationally, have recently expanded pharmacists' scope of practice to allow prescriptive authority. To ascertain the initial perceptions of the Ontario government and health professional stakeholder groups regarding the prospect of prescriptive authority for pharmacists. Qualitative research methods were used; data sources were policy documents and semi-structured interviews with key informants from the Ontario government and pharmacy and medical professional organizations. Purposive and snowball sampling strategies were used to identify 17 key informants. Fifty-one relevant policy documents were retrieved through searches of organizational websites and interviewee suggestions. Interview transcripts and documents were content analyzed independently by 2 researchers; and once consensus was achieved on key themes, the primary investigator analyzed the remainder. Pharmacy organizations and Ontario government representatives both expressed support for pharmacist prescriptive authority, suggesting that it would enhance patient access to primary care. Medical organizations were opposed to this expanded pharmacist role, arguing that pharmacists' lack of training and experience in diagnosis and prescribing would endanger patient safety. Other concerns were fragmentation of care and pharmacists' lack of access to patient clinical information. Some government and pharmacy informants felt that pharmacist prescribing would decrease health system costs through substitution of cheaper health professionals for physicians, while others felt that costs would increase due to increased utilization of services. Medical organizations preferred delegated medical authority as the policy alternative to pharmacist prescribing. Widely different views were expressed by the Ontario government and pharmacy organizations on the one hand and medical professional organizations on the other hand, regarding the potential impact of pharmacist prescribing on patient safety and access to primary care. This is likely due, at least in part, to the lack of evidence on the expected impact of this expanded pharmacist role. More research is needed to help inform discussions regarding this issue. Copyright © 2014 Elsevier Inc. All rights reserved.

The Cost of Public Primary Education in Indonesia: Do Schools Need More Money?

ERIC Educational Resources Information Center

Lewis, Blane D.; Pattinasarany, Daan; Sahn, David E.

2011-01-01

In the international context, the quality of public primary education in Indonesia is sub-standard. The assumption of officials at all levels of government is that a significant increase in funding will be required to improve education performance. The analysis in this paper shows that money does indeed matter for the attainment of primary…

The Professional Development Needs of Special Needs Assistants in Irish Post-Primary Schools

ERIC Educational Resources Information Center

Kerins, Pauline; Casserly, Ann Marie; Deacy, Evelyn; Harvey, Deirdre; McDonagh, Dolores; Tiernan, Bairbre

2018-01-01

According to government policy in Ireland, special needs assistants (SNAs) may be employed in post-primary schools to support students deemed to have chronic and serious care needs. There is currently no national policy regarding the continuing professional development (CPD) of SNAs, to meet the requirements of their role. This study investigated…

Infrastructure Availability in the Public Sector Schools: A Case Study of Sindh Province

ERIC Educational Resources Information Center

Mujahid, Nooreen; Noman, Muhammad

2015-01-01

This focus of this study is confined to primary and secondary education in Sindh province. This paper provides a comprehensive review of the facilities available at the primary and secondary schools especially within the context of rural and urban areas. This study investigates 48,865 Government schools in terms of efficient and well-organized…

School Governors and the Religious Ethos of C of E Voluntary Aided Primary Schools.

ERIC Educational Resources Information Center

Francis, Leslie J.; Stone, Ernest A.

1995-01-01

Charts attitudes of the first generation of governors appointed to the Church of England voluntary aided primary schools in the Chichester (England) diocese, following the new Instruments of Government implemented in 1985. The foundation governors remain highly committed to maintaining a distinctive church-related ethos in these schools. (60…

Digital Media in Primary Schools: Literacy or Technology? Analyzing Government and Media Discourses

ERIC Educational Resources Information Center

Pereira, Sara; Pereira, Luís

2015-01-01

This article examines the political and the media discourses concerning the Portuguese governmental program responsible for delivering a laptop named "Magalhães" to all primary school children. The analysis is based on the official documents related to the launch and development of the initiative as well as the press coverage of this…

Changing Practice in Malaysian Primary Schools: Learning from Student Teachers' Reports of Using Action, Reflection and Modelling (ARM)

ERIC Educational Resources Information Center

Dickerson, Claire; Thomas, Kit; Jarvis, Joy; Levy, Roger

2018-01-01

Curricular and pedagogical reforms are complex inter-linked processes such that curricular reform can only be enacted through teachers teaching differently. This article reports the perspective of emergent Malaysian primary teachers who were expected to implement a Government reform that promoted active learning. The 120 student teachers were…

Critical Perspectives on Free Primary Education in Kenya: Towards an Anti-Colonial Pedagogy

ERIC Educational Resources Information Center

Milu, Esther

2013-01-01

This paper is a reading of the "Free Primary Education" (FPE) policy in Kenya through the lenses of critical theory/pedagogy. The study critiques the National Alliance Rainbow Coalition (NARC) government for adoption of the Freirian banking model to design and implement the policy. The paper argues that such a model has ended up…

New Horizons for Primary Schools in Jamaica: Inputs, Outcomes and Impact. Revised

ERIC Educational Resources Information Center

Lockheed, Marlaine; Harris, Abigail; Gammill, Paul; Barrow, Karima; Jayasundera, Tamara

2006-01-01

The New Horizons for Primary Schools (NHP) was implemented in 72 government schools in Jamaica, from 1998-2005. The program provided support to schools on the basis of needs identified through the preparation of a School Development Plan (also called a School Improvement Plan). This independent evaluation report first compares the schools in the…

Implementing Free Primary Education Policy in Malawi and Ghana: Equity and Efficiency Analysis

ERIC Educational Resources Information Center

Inoue, Kazuma; Oketch, Moses

2008-01-01

Malawi and Ghana are among the numerous Sub-Saharan Africa countries that have in recent years introduced Free Primary Education (FPE) policy as a means to realizing the 2015 Education for All and Millennium Development Goals international targets. The introduction of FPE policy is, however, a huge challenge for any national government that has…

Teachers' Involvement in Implementing the Basic Science and Technology Curriculum of the Nine-Year Basic Education

ERIC Educational Resources Information Center

Odili, John Nwanibeze; Ebisine, Sele Sylvester; Ajuar, Helen Nwakaife

2011-01-01

The study investigated teachers' involvement in implementing the basic science and technology curriculum in primary schools in WSLGA (Warri South Local Government Area) of Delta State. It sought to identify the availability of the document in primary schools and teachers' knowledge of the objectives and activities specified in the curriculum.…

Introducing National Tests in Swedish Primary Education: Implications for Test Anxiety

ERIC Educational Resources Information Center

Nyroos, Mikaela; Wiklund-Hornqvist, Carola

2011-01-01

Introduction: The Swedish government has decided to introduce national tests in primary education. Swedish pupils in general have few tests and a recognised possible adverse effect of testing is test anxiety among pupils, which may have a negative impact on examination performance. However, there has been little research on effects of testing on…

Evidence, Rhetoric and Collateral Damage: The Problematic Pursuit of "World Class" Standards

ERIC Educational Resources Information Center

Alexander, Robin

2011-01-01

Drawing initially on evidence assembled by the Cambridge Primary Review, and acknowledging Maurice Galton's trenchant critiques of recent educational policy, this paper tracks the rise and decline of the flagship standards agenda which was launched by the Blair government in 1997 and came to dominate the work of England's primary schools during…

Responsibility for Financial Management in Primary Schools: Evidence from an English Local Authority

ERIC Educational Resources Information Center

Fitzgerald, Sarah; Drake, Julie

2013-01-01

Financial management in primary schools has changed in the UK with the introduction of the Schools Financial Value Standard (SFVS). There is increasing delegation of financial responsibility to the management team in the school, increasing the role of the head teacher and the governing body as part of overall responsibility for the strategic…

The National Singing Programme for Primary Schools in England: An Initial Baseline Study

ERIC Educational Resources Information Center

Welch, G. F.; Himonides, E.; Papageorgi, I.; Saunders, J.; Rinta, T.; Stewart, C.; Preti, C.; Lani, J.; Vraka, M.; Hill, J.

2009-01-01

The "Sing Up" National Singing Programme for primary schools in England was launched in November 2007 under the UK government's "Music Manifesto". "Sing Up" is a four-year programme whose overall aim is to raise the status of singing and increase opportunities for children throughout the country to enjoy singing as…

Politics and Preschool: The Political Economy of Investment in Pre-Primary Education. Policy Research Working Paper 5647

ERIC Educational Resources Information Center

Kosec, Katrina

2011-01-01

What drives governments with similar revenues to publicly provide very different amounts of goods for which private substitutes are available? Key examples are education and health care. This paper compares spending by Brazilian municipalities on pre-primary education--a good that is also provided privately--with spending on public infrastructure…

Organisational Communication and Its Relationships with Job Satisfaction and Organisational Commitment of Primary School Staff in Western Australia

ERIC Educational Resources Information Center

De Nobile, John

2017-01-01

The aim of this study was to investigate the relationships between aspects of organisational communication and dimensions of job satisfaction and general organisational commitment. Participants were 358 staff members from 35 government primary schools in the state of Western Australia, who completed a survey comprising the Organisational…

Primary and Intermediate Schools in 2013: Main Findings from the NZCER National Survey

ERIC Educational Resources Information Center

Wylie, Cathy; Bonne, Linda

2014-01-01

This report presents the main findings from the NZCER national survey of primary and intermediate schools, conducted in July and August 2013. It reports on the views of principals, teachers, boards of trustees and parents. It covers many aspects of school experience, including school resources, school interactions with government agencies, the…

Constitutional Debates on Freedom of Religion: A Documentary History. Primary Documents in American History and Contemporary Issues.

ERIC Educational Resources Information Center

Patrick, John J., Ed.; Long, Gerald P., Ed.

Debates over the separation or accommodation of religion and government have divided the United States since its founding. This collection of over 70 primary documents represents the ideas and issues on the interpretation of the United States Constitution's First Amendment clauses pertaining to establishment and free exercise of religion. The…

A Review of Technology Education in Ireland; a Changing Technological Environment Promoting Design Activity

ERIC Educational Resources Information Center

Leahy, Keelin; Phelan, Pat

2014-01-01

In Ireland, Technology Education's structure and organisation across the levels of education is not delivered or governed in a coherent manner. Technology Education in primary level education, for students between 5 and 12 years of age, does not explicitly exist as a separate subject. In primary level education, Social, Environmental and…

Health worker posting and transfer at primary level in Tamil Nadu: Governance of a complex health system function

PubMed Central

Garimella, Surekha; Sheikh, Kabir

2016-01-01

Background: Posting and transfer (PT) of health personnel – placing the right health workers in the right place at the right time – is a core function of any large-scale health service. In the context of government health services, this may be seen as a simple process of bureaucratic governance and implementation of the rule of law. However the literature from India and comparable low and middle-income country health systems suggests that in reality PT is a contested domain, driven by varied expressions of private and public interest throughout the chain of implementation. Objective: To investigate policymaking for PT in the government health sector and implementation of policies as experienced by different health system actors and stakeholders at primary health care level. Methodology: We undertook an empirical case study of a PT reform policy at primary health care level in Tamil Nadu State, to understand how different groups of health systems actors experience PT. In-depth qualitative methods were undertaken to study processes of implementation of PT policies enacted through ‘counselling’ of health workers (individualized consultations to determine postings and transfers). Results: PT emerges as a complex phenomenon, shaped partially by the laws of the state and partially as a parallel system of norms and incentives requiring consideration and coordination of the interests of different groups. Micro-practices of governance represent homegrown coping mechanisms of health administrators that reconcile public and private interests and sustain basic health system functions. Beyond a functional perspective of PT, it also reflects justice and fairness as it plays out in the health system. It signifies how well a system treats its employees, and by inference, is an index of the overall health of the system. Conclusions: For a complex governance function such as PT, the roles of private actors and private interests are not easily separable from the public, but rather are intertwined within the complexities of delivery of a public service. This complexity blurs conventional boundaries of private and public ownership and behaviour, and raises critical questions for the interpretation of coordinated governance. Hence, the imperative of enforcing rules may need to be complemented with bottom-up policy approaches, including treating PT not merely as system dysfunction, but also as a potential instrument of governance innovations, procedural justice and the accountability of health services to communities they seek to serve. PMID:28217602

Factors contributing to men’s reluctance to seek HIV counselling and testing at Primary Health Care facilities in Vhembe District of South Africa

PubMed Central

Sirwali, Robert N.; Tshitangano, Takalani

2016-01-01

Background Voluntary HIV antibody Counselling and Testing (HCT) is a cornerstone of HIV prevention in South Africa because it has the potential to prevent HIV transmission. The government of South Africa has for a long time been investing heavily in fighting the spread of HIV and/or AIDS. However, men rarely utilise this service. Aim The aim of this study was to explore the factors contributing to the reluctance of men to seek HCT in the primary health facilities in Vhembe District. Setting The study was conducted at Vhembe District health offices in Limpopo, South Africa. Methods A qualitative research design, anchored on semi-structured interviews as a method of data collection, was used. Fifteen men working at Vhembe health offices were purposively sampled. Data were analysed using the TECHS’s 8 steps method. The approval from Polokwane Provincial offices was guaranteed with participants being protected and respected throughout the study. Results The response rate per question was 100% with all 15 participants willing to answer all the raised questions, though with different views and opinions. The majority of the interviewees indicated that they were aware of HCT services. Stigma as a societal reaction to disease, governmental policies, and attitudinal factors made men refrain from seeking counselling and testing from public health facilities. Conclusion There was a high level of HCT awareness among men in Vhembe District. However, attitudinal and political barriers, stigma, and cultural practices such as circumcision were cited as the reasons for the low level utilisation of HCT services. PMID:27380851

YAP1 Is a Driver of Myofibroblast Differentiation in Normal and Diseased Fibroblasts.

PubMed

Piersma, Bram; de Rond, Saskia; Werker, Paul M N; Boo, Stellar; Hinz, Boris; van Beuge, Marike M; Bank, Ruud A

2015-12-01

Dupuytren disease is a fibrotic disorder characterized by contraction of myofibroblast-rich cords and nodules in the hands. The Hippo member Yes-associated protein 1 (YAP1) is activated by tissue stiffness and the profibrotic transforming growth factor-β1, but its role in cell fibrogenesis is yet unclear. We hypothesized that YAP1 regulates the differentiation of dermal fibroblasts into highly contractile myofibroblasts and that YAP1 governs the maintenance of a myofibroblast phenotype in primary Dupuytren cells. Knockdown of YAP1 in transforming growth factor-β1-stimulated dermal fibroblasts decreased the formation of contractile smooth muscle α-actin stress fibers and the deposition of collagen type I, which are hallmark features of myofibroblasts. Translating our findings to a clinically relevant model, we found that YAP1 deficiency in Dupuytren disease myofibroblasts resulted in decreased expression of ACTA2, COL1A1, and CCN2 mRNA, but this did not result in decreased protein levels. YAP1-deficient Dupuytren myofibroblasts showed decreased contraction of a collagen hydrogel. Finally, we showed that YAP1 levels and nuclear localization were elevated in affected Dupuytren disease tissue compared with matched control tissue and partly co-localized with smooth muscle α-actin-positive cells. In conclusion, our data show that YAP1 is a regulator of myofibroblast differentiation and contributes to the maintenance of a synthetic and contractile phenotype, in both transforming growth factor-β1-induced myofibroblast differentiation and primary Dupuytren myofibroblasts. Copyright © 2015 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

African leaders' views on critical human resource issues for the implementation of family medicine in Africa.

PubMed

Moosa, Shabir; Downing, Raymond; Essuman, Akye; Pentz, Stephen; Reid, Stephen; Mash, Robert

2014-01-17

The World Health Organisation has advocated for comprehensive primary care teams, which include family physicians. However, despite (or because of) severe doctor shortages in Africa, there is insufficient clarity on the role of the family physician in the primary health care team. Instead there is a trend towards task shifting without thought for teamwork, which runs the risk of dangerous oversimplification. It is not clear how African leaders understand the challenges of implementing family medicine, especially in human resource terms. This study, therefore, sought to explore the views of academic and government leaders on critical human resource issues for implementation of family medicine in Africa. In this qualitative study, key academic and government leaders were purposively selected from sixteen African countries. In-depth interviews were conducted using an interview guide. All interviews were audio-recorded, transcribed and thematically analysed. There were 27 interviews conducted with 16 government and 11 academic leaders in nine Sub-Saharan African countries: Botswana, Democratic Republic of Congo, Ghana, Kenya, Malawi, Nigeria, Rwanda, South Africa and Uganda. Respondents spoke about: educating doctors in family medicine suited to Africa, including procedural skills and holistic care, to address the difficulty of recruiting and retaining doctors in rural and underserved areas; planning for primary health care teams, including family physicians; new supervisory models in primary health care; and general human resource management issues. Important milestones in African health care fail to specifically address the human resource issues of integrated primary health care teamwork that includes family physicians. Leaders interviewed in this study, however, proposed organising the district health system with a strong embrace of family medicine in Africa, especially with regard to providing clinical leadership in team-based primary health care. Whilst these leaders focussed positively on entry and workforce issues, in terms of the 2006 World Health Report on human resources for health, they did not substantially address retention of family physicians. Family physicians need to respond to the challenge by respondents to articulate human resource policies appropriate to Africa, including the organisational development of the primary health care team with more sophisticated skills and teamwork.

Perceptions of the health system and public trust in government in low- and middle-income countries: evidence from the World Health Surveys.

PubMed

Rockers, Peter C; Kruk, Margaret E; Laugesen, Miriam J

2012-06-01

In low- and middle-income countries, health care systems are an important means by which individuals interact with their government. As such, aspects of health systems in these countries may be associated with public trust in government. Greater trust in government may in turn improve governance and government effectiveness. We identify health system and non-health system factors hypothesized to be associated with trust in government and fit several multilevel regression models to cross-national data from 51,300 respondents in thirty-eight low- and middle-income countries participating in the World Health Surveys. We find that health system performance factors are associated with trust in government while controlling for a range of non-health system covariates. Taken together, higher technical quality of health services, more responsive service delivery, fair treatment, better health outcomes, and financial risk protection accounted for a 13 percentage point increase in the probability of having trust in government. Health system performance and good governance may be more inter-related than previously thought. This finding is particularly important for low-income and fragile states, where health systems and governments tend to be weakest. Future research efforts should focus on determining the causal mechanisms that underlie the observed associations between health system performance and trust in government.

Transboundary Water: Improving Methodologies and Developing Integrated Tools to Support Water Security

NASA Technical Reports Server (NTRS)

Hakimdavar, Raha; Wood, Danielle; Eylander, John; Peters-Lidard, Christa; Smith, Jane; Doorn, Brad; Green, David; Hummel, Corey; Moore, Thomas C.

2018-01-01

River basins for which transboundary coordination and governance is a factor are of concern to US national security, yet there is often a lack of sufficient data-driven information available at the needed time horizons to inform transboundary water decision-making for the intelligence, defense, and foreign policy communities. To address this need, a two-day workshop entitled Transboundary Water: Improving Methodologies and Developing Integrated Tools to Support Global Water Security was held in August 2017 in Maryland. The committee that organized and convened the workshop (the Organizing Committee) included representatives from the National Aeronautics and Space Administration (NASA), the US Army Corps of Engineers Engineer Research and Development Center (ERDC), and the US Air Force. The primary goal of the workshop was to advance knowledge on the current US Government and partners' technical information needs and gaps to support national security interests in relation to transboundary water. The workshop also aimed to identify avenues for greater communication and collaboration among the scientific, intelligence, defense, and foreign policy communities. The discussion around transboundary water was considered in the context of the greater global water challenges facing US national security.

Educating girls.

PubMed

Bellew, R; Raney, L; Subbarao, K

1992-03-01

20 years of research has established that the economic and social benefits of women's primary and secondary schooling are far reaching. The more educated a population's women are, the fewer children they have, and the ones they do have are healthier. However, social tradition and other economic considerations often force families to exclude young girls from education in favor of boys. The safety of young girls is one consideration as well as their value as household labor. There is also a false impression that the good of the community is served if boys are educated, but not so the same for girls. Evidence has been complied to show that in populations where women are more educated, the level of poverty is lower. Because society gains by educating its girls, how can governments change the traditions that have educating its girls, how can governments change the traditions that have previously kept girls under educated? The government of Bangladesh and Guatemala have been very successful with scholarship programs at the primary and secondary level. In Bangladesh the enrollment of females in secondary school almost doubled. The program is also credited with increasing attendance of primary schools, increasing labor force participation, postponing the age of marriage and reducing fertility. Between 1972-80 there were 105 Bank assisted primary and secondary school programs. Of these 20% identified the presence of genderissues, but only 10% included significant actions to improve females enrollment. Between 1981-1991 about half of the Bank assisted programs identified the presence of gender issues, and a quarter included significant actions to improve female enrollment.

Do governance choices matter in health care networks?: an exploratory configuration study of health care networks.

PubMed

Willem, Annick; Gemmel, Paul

2013-06-24

Health care networks are widely used and accepted as an organizational form that enables integrated care as well as dealing with complex matters in health care. However, research on the governance of health care networks lags behind. The research aim of our study is to explore the type and importance of governance structure and governance mechanisms for network effectiveness. The study has a multiple case study design and covers 22 health care networks. Using a configuration view, combinations of network governance and other network characteristics were studied on the level of the network. Based on interview and questionnaire data, network characteristics were identified and patterns in the data looked for. Neither a dominant (or optimal) governance structure or mechanism nor a perfect fit among governance and other characteristics were revealed, but a number of characteristics that need further study might be related to effective networks such as the role of governmental agencies, legitimacy, and relational, hierarchical, and contractual governance mechanisms as complementary factors. Although the results emphasize the situational character of network governance and effectiveness, they give practitioners in the health care sector indications of which factors might be more or less crucial for network effectiveness.

Embracing value co-creation in primary care services research: a framework for success.

PubMed

Janamian, Tina; Crossland, Lisa; Jackson, Claire L

2016-04-18

Value co-creation redresses a key criticism of researcher-driven approaches to research - that researchers may lack insight into the end users' needs and values across the research journey. Value co-creation creates, in a step-wise way, value with, and for, multiple stakeholders through regular, ongoing interactions leading to innovation, increased productivity and co-created outcomes of value to all parties - thus creating a "win more-win more" environment. The Centre of Research Excellence (CRE) in Building Primary Care Quality, Performance and Sustainability has co-created outcomes of value that have included robust and enduring partnerships, research findings that have value to end users (such as the Primary Care Practice Improvement Tool and the best-practice governance framework), an International Implementation Research Network in Primary Care and the International Primary Health Reform Conference. Key lessons learned in applying the strategies of value co-creation have included the recognition that partnership development requires an investment of time and effort to ensure meaningful interactions and enriched end user experiences, that research management systems including governance, leadership and communication also need to be "co-creative", and that openness and understanding is needed to work across different sectors and cultures with flexibility, fairness and transparency being essential to the value co-creation process.

The marine diatom and diazotroph under future climate: Role of Iron

NASA Astrophysics Data System (ADS)

Li, Xuefeng; Fonseca-batista, Debany; Brouwers, Julie; Roevros, Nathalie; Dehairs, Frank; Chou, Lei

2016-04-01

Diatoms constitute a major group of phytoplankton, accounting for one quarter of the world's net primary productivity. Diazotrophs provide the largest input of new nitrogen (N) to the ocean and control the marine N budgets. It has been shown that iron (Fe) can be the limiting factor for diatom growth, in particular, in the HNLC (High Nutrient Low Chlorophyll) regions. This trace element can also govern the development of marine diazotrophs due to the high Fe demand necessary for biological N2 fixation. Iron plays thus an essential role in governing the marine primary productivity and the efficiency of biological carbon pump. Ocean systems are undergoing continuous modifications at varying rates and magnitudes as a result of changing climate. The objectives of our research is to evaluate 1) how climate change (dust deposition, ocean warming and acidification) can affect Fe biogeochemistry and the growth of diatoms and diazotrophs, and 2) the role of Fe in the control of biological N2 fixation under future climate scenarios. Laboratory culture experiments using Chaetoceros socialis were examined at two temperatures (13°C and 18°C) and two CO2 conditions (400 μatm and 800 μatm). The present study demonstrates clearly the influence of ocean acidification on the release of Fe upon dust deposition. It also shows that dust particles could provide a readily utilizable source of Fe and other macronutrients (dissolved phosphate and silicate) for phytoplankton growth. Elevated pCO2 concentrations may have adverse impact on the diatom growth; seawater warming may cause poleward shifts in the biogeographic distribution of diatoms. The impact of Fe on the natural N2 fixation was tested via field incubation experiments using natureal phytoplankton assemblage in the Bay of Biscay and along the Iberian Margin. N2 fixation rates in oligotrophic waters were greatly stimulated through the addition of dissolved Fe compared to the control, demonstrating the limitation of N2 fixation by Fe. Numerous factors can affect the extent of N2 fixation, but a better understanding of the major controlling factors is highly required. Semi-continuous dilution culture experiments were conducted on Trichodesmium IMS-101 under future high pCO2 and warming seawater conditions. Additionally, special attention has been given to studying the effects of mineral dust deposition which is believed to promote N2 fixation through increasing Fe availability.

48 CFR 1352.215-75 - Evaluation criteria.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Evaluation Factors. Factor 1—TECHNICAL APPROACH. The proposal will be evaluated on how the offeror intends to... as an example only.] In determining which proposal provides the best value to the Government, non... integrated assessment of the technical and cost/price proposals, the Government may make an award to other...

48 CFR 14.201-8 - Price-related factors.

Code of Federal Regulations, 2010 CFR

2010-10-01

... delays to the Government resulting from such factors as differences in inspection, locations of supplies... be for the items or combinations of items that result in the lowest aggregate cost to the Government... supplies, and, if foreign, the application of the Buy American Act or any other prohibition on foreign...

Teacher Governance Factors and Social Cohesion: Insights from Pakistan

ERIC Educational Resources Information Center

Halai, Anjum; Durrani, Naureen

2016-01-01

This paper explores teacher governance factors, particularly recruitment and deployment of teachers, in relation to inequalities and social cohesion. Pakistan introduced major reforms in education in the post 9/11 context of escalating conflict. These include a merit and needs-based policy on teacher recruitment to eliminate corruption in…

Measured and modeled interactive effects of potassium deficiency and water deficit on gross primary productivity and light-use efficiency in Eucalyptus grandis plantations.

PubMed

Christina, Mathias; Le Maire, Guerric; Battie-Laclau, Patricia; Nouvellon, Yann; Bouillet, Jean-Pierre; Jourdan, Christophe; de Moraes Gonçalves, José Leonardo; Laclau, Jean-Paul

2015-05-01

Global climate change is expected to increase the length of drought periods in many tropical regions. Although large amounts of potassium (K) are applied in tropical crops and planted forests, little is known about the interaction between K nutrition and water deficit on the physiological mechanisms governing plant growth. A process-based model (MAESPA) parameterized in a split-plot experiment in Brazil was used to gain insight into the combined effects of K deficiency and water deficit on absorbed radiation (aPAR), gross primary productivity (GPP), and light-use efficiency for carbon assimilation and stem biomass production (LUEC and LUEs ) in Eucalyptus grandis plantations. The main-plot factor was the water supply (undisturbed rainfall vs. 37% of throughfall excluded) and the subplot factor was the K supply (with or without 0.45 mol K m(-2 ) K addition). Mean GPP was 28% lower without K addition over the first 3 years after planting whether throughfall was partly excluded or not. K deficiency reduced aPAR by 20% and LUEC by 10% over the whole period of growth. With K addition, throughfall exclusion decreased GPP by 25%, resulting from a 21% decrease in LUEC at the end of the study period. The effect of the combination of K deficiency and water deficit was less severe than the sum of the effects of K deficiency and water deficit individually, leading to a reduction in stem biomass production, gross primary productivity and LUE similar to K deficiency on its own. The modeling approach showed that K nutrition and water deficit influenced absorbed radiation essentially through changes in leaf area index and tree height. The changes in gross primary productivity and light-use efficiency were, however, driven by a more complex set of tree parameters, especially those controlling water uptake by roots and leaf photosynthetic capacities. © 2014 John Wiley & Sons Ltd.

Blood cigarettes: cigarette smuggling and war economies in central and eastern Africa.

PubMed

Titeca, Kristof; Joossens, Luk; Raw, Martin

2011-05-01

To analyse cigarette smuggling practices in central and eastern Africa. Primary data were gathered during long-term qualitative field research in which about 400 interviews were conducted. Analysis of secondary sources included academic literature and reports from non-government organisations, multilateral organisations and the press. Our research suggests that the following factors play an important role in cigarette smuggling in eastern and central Africa: (1) government officials encounter difficulties monitoring the long and porous borders; (2) there is a general problem of corrupt government officials and particularly those who allow large-scale smugglers to operate; (3) criminal elements also play an important role in smuggling--cigarette smuggling has helped rebel groups to finance their activities, something illustrated through examples from the war economy in the eastern part of the Democratic Republic of Congo. Our research suggests that cigarette smuggling in this region is not primarily the result of different taxation levels in neighbouring states, but rather the outcome of weak state capacity, high levels of corruption and the activities of rebel groups. Under these conditions smuggling cigarettes becomes an attractive option as taxation is so easily avoided. This explains why in the low-income countries in this study there are high levels of smuggling in spite of low cigarette prices. Comprehensive supply control and enforcement legislation, and cooperation at national, regional and global level are needed to tackle fraudulent practices facilitated by corruption at state level, and to effectively punish interaction between cigarette traders and rebel groups.

Outreach services to improve access to health care in South Africa: lessons from three community health worker programmes.

PubMed

Nxumalo, Nonhlanhla; Goudge, Jane; Thomas, Liz

2013-01-24

In South Africa, there are renewed efforts to strengthen primary health care and community health worker (CHW) programmes. This article examines three South African CHW programmes, a small local non-governmental organisation (NGO), a local satellite of a national NGO, and a government-initiated service, that provide a range of services from home-based care, childcare, and health promotion to assist clients in overcoming poverty-related barriers to health care. The comparative case studies, located in Eastern Cape and Gauteng, were investigated using qualitative methods. Thematic analysis was used to identify factors that constrain and enable outreach services to improve access to care. The local satellite (of a national NGO), successful in addressing multi-dimensional barriers to care, provided CHWs with continuous training focused on the social determinants of ill-health, regular context-related supervision, and resources such as travel and cell-phone allowances. These workers engaged with, and linked their clients to, agencies in a wide range of sectors. Relationships with participatory structures at community level stimulated coordinated responses from service providers. In contrast, an absence of these elements curtailed the ability of CHWs in the small NGO and government-initiated service to provide effective outreach services or to improve access to care. Significant investment in resources, training, and support can enable CHWs to address barriers to care by negotiating with poorly functioning government services and community participation structures.

Publications as an indicator of increased tobacco control research productivity (quantity and quality) in New Zealand.

PubMed

Kira, Anette; Glover, Marewa; Bullen, Chris; Viehbeck, Sarah

2011-06-01

Tobacco control (TC) research capacity and productivity are critical for developing evidence-informed interventions that will reduce the harmful effects of smoking. The aim of this paper was to investigate New Zealand's (NZ) TC research capacity along with the quantity and quality of publications, following two government initiatives aimed, in part, at improving the quantity and quality of NZ TC research. Scopus was searched for articles with at least one NZ author and where the topic was of primary relevance to TC. Publications were organized into two time periods, following the government initiatives, 1993-2003 and 2004-2009. We analyzed the number of publications, publication journals, type of publications, impact (using the impact factor), and authorship. There has been an increase in number and impact of publications and number of authors. The number of publications has increased from an average of 14 (1994-2003) to 38 per year (2004-2009). The number of journals published increased from 64 to 86. The impact during 2004-2009 was almost threefold than in 1993-2003. The number of authors increased from 212 to 345, and the number of authors who had at least one first-authored publication increased from 80 to 124. These results show an encouraging trend in NZ TC research, with an increase in research productivity, quality, and in research capacity. It is possible that government-initiated and -funded infrastructural support contributed to increasing needed TC research, which supports the worth of such initiatives.

Flying qualities and control system characteristics for superaugmented aircraft

NASA Technical Reports Server (NTRS)

Myers, T. T.; Mcruer, D. T.; Johnston, D. E.

1984-01-01

Aircraft-alone dynamics and superaugmented control system fundamental regulatory properties including stability and regulatory responses of the basic closed-loop systems; fundamental high and low frequency margins and governing factors; and sensitivity to aircraft and controller parameters are addressed. Alternative FCS mechanizations, and mechanizational side effects are also discussed. An overview of flying qualities considerations encompasses general pilot operations as a controller in unattended, intermittent and trim, and full-attention regulatory or command control; effective vehicle primary and secondary response properties to pilot inputs and disturbances; pilot control architectural possibilities; and comparison of superaugmented and conventional aircraft path responses for different forms of pilot control. Results of a simple experimental investigation into pilot dynamic behavior in attitude control of superaugmented aircraft configurations with high frequency time laps and time delays are presented.

The impact of H2S emissions on future geothermal power generation - The Geysers region, California

NASA Technical Reports Server (NTRS)

Leibowitz, L. P.

1977-01-01

The future potential for geothermal power generation in the Geysers region of California is as much as 10 times the current 502 MW(e) capacity. However, environmental factors such as H2S emissions and institutional considerations may play the primary role in determining the rate and ultimate level of development. In this paper a scenario of future geothermal generation capacity and H2S emissions in the Geysers region is presented. Problem areas associated with H2S emissions, H2S abatement processes, plant operations, and government agency resources are described. The impact of H2S emissions on future development and the views of effected organizations are discussed. Potential actions needed to remove these constraints are summarized.

Internal and external resorption in a lower molar with an associated endodontic-periodontic lesion: a case report.

PubMed

Komabayashi, Takashi; Zhu, Qiang

2012-08-01

This article describes a unique case in which both internal and external inflammatory resorption and endodontic-periodontic lesions were present at the same time in the patient's left mandibular first molar. Based on clinical and radiographic findings, it was determined that the nature of this case was a pulpal infection-induced inflammatory resorption and furcation lesion. After root canal therapy, the furcation lesion and external inflammatory resorption were completely resolved. This case indicates that the correct diagnosis of the stimulating factor for tooth resorption and determination of the primary origin of endodontic-periodontic lesions are critical for clinical management and success. Published 2011. This article is a U.S. Government work and is in the public domain in the USA.

IRBs and Security Research: Myths, Facts and Mission Creep

DTIC Science & Technology

2008-04-07

discovering the US Government’s regula- tions that govern human subject research. This paper dis- cusses those regulations, their application to research on...ity and other human factors issues, many are surprised to discover that they must comply with regulations govern- ing the use of human beings as...security researchers are discovering the US Government?s regulations that govern human subject research. This paper discusses those regulations, their

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

PubMed

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

2014-08-01

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

Data-mining analysis of the global distribution of soil carbon in observational databases and Earth system models

NASA Astrophysics Data System (ADS)

Hashimoto, Shoji; Nanko, Kazuki; Ťupek, Boris; Lehtonen, Aleksi

2017-03-01

Future climate change will dramatically change the carbon balance in the soil, and this change will affect the terrestrial carbon stock and the climate itself. Earth system models (ESMs) are used to understand the current climate and to project future climate conditions, but the soil organic carbon (SOC) stock simulated by ESMs and those of observational databases are not well correlated when the two are compared at fine grid scales. However, the specific key processes and factors, as well as the relationships among these factors that govern the SOC stock, remain unclear; the inclusion of such missing information would improve the agreement between modeled and observational data. In this study, we sought to identify the influential factors that govern global SOC distribution in observational databases, as well as those simulated by ESMs. We used a data-mining (machine-learning) (boosted regression trees - BRT) scheme to identify the factors affecting the SOC stock. We applied BRT scheme to three observational databases and 15 ESM outputs from the fifth phase of the Coupled Model Intercomparison Project (CMIP5) and examined the effects of 13 variables/factors categorized into five groups (climate, soil property, topography, vegetation, and land-use history). Globally, the contributions of mean annual temperature, clay content, carbon-to-nitrogen (CN) ratio, wetland ratio, and land cover were high in observational databases, whereas the contributions of the mean annual temperature, land cover, and net primary productivity (NPP) were predominant in the SOC distribution in ESMs. A comparison of the influential factors at a global scale revealed that the most distinct differences between the SOCs from the observational databases and ESMs were the low clay content and CN ratio contributions, and the high NPP contribution in the ESMs. The results of this study will aid in identifying the causes of the current mismatches between observational SOC databases and ESM outputs and improve the modeling of terrestrial carbon dynamics in ESMs. This study also reveals how a data-mining algorithm can be used to assess model outputs.

Negotiating and managing partnership in primary care.

PubMed

Charlesworth, J

2001-09-01

In the UK public service organisations are increasingly working together in new partnerships, networks and alliances, largely stimulated by government legislation, which aims to encourage 'joined-up' policy-making. This is particularly prevalent in health-care where local government, health authorities and trusts, voluntary and community groups are extending existing, and developing new, forms of partnership, particularly around Health Improvement Programmes and new primary care organisations. This paper explores two main aspects of how these new interorganizational relationships are being developed and managed and is based on research conducted in one case study locality. First, the new structures of partnership in primary care are mapped out, together with discussion on why these particular patterns of relationship between statutory and voluntary sector organisations have emerged, exploring both centrally and locally determined influences. Secondly, the paper explores the tensions associated with working within new policy-making and management structures, and how the additional demands of audit, performance measurement and the sheer pace of change, pose a potential threat to the partnership process.

Access to and Exclusion from Primary Education in Slums of Dhaka, Bangladesh. CREATE Pathways to Access. Research Monograph No. 45

ERIC Educational Resources Information Center

Cameron, Stuart

2010-01-01

Bangladesh's urban population is rising fast. In the capital, Dhaka, some 4 million people live in slums. They are lacking in wealth, power and social connections; probably under-counted in national surveys; and under-served by both government and non-government organisations, many of whom still see poverty as a rural issue or see the urban poor…

"If the Child Cannot Come to the School, Then the School Must Go to the Child": The Railway Station Platform Schools in Odisha, India

ERIC Educational Resources Information Center

Datta, Dipankar; Banik, Deviuma

2014-01-01

Despite its constitutional obligation of ensuring universal primary education, the Indian Government has not been able to find a way to educate its 18 million street children. It is widely accepted that the government lacks the capacity--financial, managerial and human resource--to provide meaningful education to those who are left out of the…

[Governance of PHC development in Rosario, Argentina].

PubMed

Báscolo, Ernesto; Yavich, Natalia

2010-01-01

Describing the development of PHC policy as promoted by Rosario Municipality (Argentina). A case-study was carried out during 2007 and 2008. Data was collected from secondary and primary sources (interviews, organisational census and observations). PHC development stages were identified by recognising the social norms which produced institutional change and transformation in municipal health services structure and health care and management models. The prevailing modes of governance in each stage were reconognised and characterised (clan, hierarchy and/or incentives). Four stages were identified between 1990 and 2008: 1990-1995/hierarchical mode: primary health care level organisation autonomied from hospitals. 1995-2000/ clan mode: developing of participatory managerial boards and community participation. 2000-2004/ clan mode: maturation of the "PHC movement" in competition with hospitals. 2004-2008/ clan-hierarchical mode: "movement's" crisis and constructions of norms tending towards enhancing an integrated network. Strengthening and empowering first-level health-care produced innovation favouring: the consolidation of a "PHC movement" having strong social commitment and improved services performance. The clan governance mode (regulating collective action via voluntary adhesion to shared values) was crucial for developing PHC between 1995 and 2004. Later on, the movement's fragmentation and the challenges of integrating the health system required developing hierarchical regulation mechanisms to complement the governance clan mode regulation.

Accounting for abortion: Accomplishing transnational reproductive governance through post-abortion care in Senegal.

PubMed

Suh, Siri

2018-06-01

Reproductive governance operates through calculating demographic statistics that offer selective truths about reproductive practices, bodies, and subjectivities. Post-abortion care, a global reproductive health intervention, represents a transnational reproductive regime that establishes motherhood as women's primary legitimate reproductive status. Drawing on ethnographic fieldwork conducted in Senegal between 2010 and 2011, I illustrate how post-abortion care accomplishes reproductive governance in a context where abortion is prohibited altogether and the US is the primary bilateral donor of population aid. Reproductive governance unfolds in hospital gynecological wards and the national health information system through the mobilization and interpretation of post-abortion care data. Although health workers search women's bodies and behavior for signs of illegal abortion, they minimize police intervention in the hospital by classifying most post-abortion care cases as miscarriage. Health authorities deploy this account of post-abortion care to align the intervention with national and global maternal health policies that valorize motherhood. Although post-abortion care offers life-saving care to women with complications of illegal abortion, it institutionalizes abortion stigma by scrutinizing women's bodies and masking induced abortion within and beyond the hospital. Post-abortion care reinforces reproductive inequities by withholding safe, affordable obstetric care from women until after they have resorted to unsafe abortion.

Optimising the use of observational electronic health record data: Current issues, evolving opportunities, strategies and scope for collaboration.

PubMed

Liaw, Siaw-Teng; Powell-Davies, Gawaine; Pearce, Christopher; Britt, Helena; McGlynn, Lisa; Harris, Mark F

2016-03-01

With increasing computerisation in general practice, national primary care networks are mooted as sources of data for health services and population health research and planning. Existing data collection programs - MedicinesInsight, Improvement Foundation, Bettering the Evaluation and Care of Health (BEACH) - vary in purpose, governance, methodologies and tools. General practitioners (GPs) have significant roles as collectors, managers and users of electronic health record (EHR) data. They need to understand the challenges to their clinical and managerial roles and responsibilities. The aim of this article is to examine the primary and secondary use of EHR data, identify challenges, discuss solutions and explore directions. Representatives from existing programs, Medicare Locals, Local Health Districts and research networks held workshops on the scope, challenges and approaches to the quality and use of EHR data. Challenges included data quality, interoperability, fragmented governance, proprietary software, transparency, sustainability, competing ethical and privacy perspectives, and cognitive load on patients and clinicians. Proposed solutions included effective change management; transparent governance and management of intellectual property, data quality, security, ethical access, and privacy; common data models, metadata and tools; and patient/community engagement. Collaboration and common approaches to tools, platforms and governance are needed. Processes and structures must be transparent and acceptable to GPs.

Cost-Savings Analysis of the Better Beginnings, Better Futures Community-Based Project for Young Children and Their Families: A 10-Year Follow-up.

PubMed

Peters, Ray DeV; Petrunka, Kelly; Khan, Shahriar; Howell-Moneta, Angela; Nelson, Geoffrey; Pancer, S Mark; Loomis, Colleen

2016-02-01

This study examined the long-term cost-savings of the Better Beginnings, Better Futures (BBBF) initiative, a community-based early intervention project for young children living in socioeconomically disadvantaged neighborhoods during their transition to primary school. A quasi-experimental, longitudinal two-group design was used to compare costs and outcomes for children and families in three BBBF project neighborhoods (n = 401) and two comparison neighborhoods (n = 225). A cost-savings analysis was conducted using all project costs for providing up to 4 years of BBBF programs when children were in junior kindergarten (JK) (4 years old) to grade 2 (8 years old). Data on 19 government service cost measures were collected from the longitudinal research sample from the time the youth were in JK through to grade 12 (18 years old), 10 years after ending project participation. The average family incremental net savings to government of providing the BBBF project was $6331 in 2014 Canadian dollars. When the BBBF monetary return to government as a ratio of savings to costs was calculated, for every dollar invested by the government, a return of $2.50 per family was saved. Findings from this study have important implications for government investments in early interventions focused on a successful transition to primary school as well as parenting programs and community development initiatives in support of children's development.

What Factors Influence Smoking Prevalence and Smoke Free Policy Enactment across the European Union Member States

PubMed Central

Bogdanovica, Ilze; McNeill, Ann; Murray, Rachael; Britton, John

2011-01-01

Background Smoking prevention should be a primary public health priority for all governments, and effective preventive policies have been identified for decades. The heterogeneity of smoking prevalence between European Union (EU) Member States therefore reflects, at least in part, a failure by governments to prioritise public health over tobacco industry or possibly other financial interests, and hence potentially government corruption. The aims of this study were to test the hypothesis that smoking prevalence is higher in countries with high levels of public sector corruption, and explore the ecological association between smoking prevalence and a range of other national characteristics in current EU Member States. Methods Ecological data from 27 EU Member States were used to estimate univariate and multivariate correlations between smoking prevalence and the Transparency International Corruption Perceptions Index, and a range of other national characteristics including economic development, social inclusion, quality of life and importance of religion. We also explored the association between the Corruption Perceptions Index and measures of the extent to which smoke-free policies have been enacted and are enforced. Results In univariate analysis, smoking prevalence was significantly higher in countries with higher scores for corruption, material deprivation, and gender inequality; and lower in countries with higher per capita Gross Domestic Product, social spending, life satisfaction and human development scores. In multivariate analysis, only the corruption perception index was independently related to smoking prevalence. Exposure to tobacco smoke in the workplace was also correlated with corruption, independently from smoking prevalence, but not with the measures of national smoke-free policy implementation. Conclusions Corruption appears to be an important risk factor for failure of national tobacco control activity in EU countries, and the extent to which key tobacco control policies have been implemented. Further research is needed to assess the causal relationships involved. PMID:21909375

Spall behavior of cast iron with varying microstructures

NASA Astrophysics Data System (ADS)

Plume, Gifford; Rousseau, Carl-Ernst

2014-07-01

The spall strength of cast iron with varying microstructures has been investigated using plate impact at moderate speed. Stress history measurements were made with manganin stress gauges embedded between the back face of the specimen and a low impedance polycarbonate backing. Five separate cast irons were tested. Four of these consisted of gray cast iron with graphite in flake form, with three classified as Type VII A2 and the fourth containing a bimodal distribution of Types VII A4 and VII D8. The fifth casting consisted of ductile cast iron with graphite in nodular form, classified as Type I, size class 5. The spall strength for the Type VII A2 gray cast irons varied between 40 and 370 MPa, and that of the additional gray cast iron, between 410 and 490 MPa. The spall strength of the ductile cast iron fell within the range of 0.94-1.2 GPa. It is shown that the spall strength is linked to the damage level at the spall plane, where an increased level of tensile stress is required to generate higher levels of damage. Post mortem analysis was performed on the recovered samples, revealing the graphite phase to be the primary factor governing the spall fracture of cast irons, where crack nucleation is directly correlated to the debonding of graphite from the metal matrix. The average length of graphite found within a casting is linked to the material's strength, where strength increases as a function of decreasing length. The morphology and mean free path of graphite precipitates further govern the subsequent coalescence of initiated cracks to form a complete fracture plane. In cases where graphite spacing is large, increased energy level is required to complete the fracture process. A secondary factor governing the spall fracture of cast irons has also been linked to the microstructure of the metal matrix, with pearlite yielding higher spall strengths than free ferrite.

Do socioeconomic factors influence breast cancer screening practices among Arab women in Qatar?

PubMed

Donnelly, Tam Truong; Al Khater, Al-Hareth; Al Kuwari, Mohamed Ghaith; Al-Bader, Salha Bujassoum; Al-Meer, Nabila; Abdulmalik, Mariam; Singh, Rajvir; Chaudhry, Sofia; Fung, Tak

2015-01-22

Breast cancer incidence rates are rising in Qatar. Although the Qatari government provides subsidised healthcare and screening programmes that reduce cost barriers for residents, breast cancer screening (BCS) practices among women remain low. This study explores the influence of socioeconomic status on BCS among Arab women in Qatar. A multicentre, cross-sectional quantitative survey was conducted with 1063 Arab women (87.5% response rate) in Qatar from March 2011 to July 2011. Women who were 35 years or older and had lived in Qatar for at least 10 years were recruited from seven primary healthcare centres and women's health clinics in urban and semiurban regions of Qatar. Associations between socioeconomic factors and BCS practice were estimated using χ(2) tests and multivariate logistic regression analyses. Findings indicate that less than one-third of the participants practised BCS appropriately, whereas less than half of the participants were familiar with recent BCS guidelines. Married women and women with higher education and income levels were significantly more likely to be aware of and to practise BCS than women who had lower education and income levels. Findings indicate low levels of awareness and low participation rates in BCS among Arab women in Qatar. Socioeconomic factors influence these women's participation in BCS activities. The strongest predictors for BCS practice are higher education and higher income levels. Additional research is needed to explore the impact of economic factors on healthcare seeking behaviours in the Middle Eastern countries that have a high national gross domestic product where healthcare services are free or heavily subsidised by the government; promotion of BCS and intervention strategies in these countries should focus on raising awareness about breast cancer, the cost and benefit of early screening for this disease, particularly among low-income women. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.