Integrating Community Resources.

ERIC Educational Resources Information Center

Courtney, Linda J., Ed.

This manual is designed to provide resource managers, advocates, and social service personnel with information about the integration of community services for persons with traumatic brain injury (TBI). The materials encompass the values of independence, productivity, and integration in the delivery of resources and services to persons with TBI.…

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

PubMed Central

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

2015-01-01

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

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

PubMed Central

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

2017-01-01

Abstract Drawing on rich data from the Integra evaluation of integrated HIV and reproductive-health services, we explored the interaction of systems hardware and software factors to explain why some facilities were able to implement and sustain integrated service delivery while others were not. This article draws on detailed mixed-methods data for four case-study facilities offering reproductive-health and HIV services between 2009 and 2013 in Kenya: (i) time-series client flow, tracking service uptake for 8841 clients; (ii) structured questionnaires with 24 providers; (iii) in-depth interviews with 17 providers; (iv) workload and facility data using a periodic activity review and cost-instruments; and (v) contextual data on external activities related to integration in study sites. Overall, our findings suggested that although structural factors like stock-outs, distribution of staffing and workload, rotation of staff can affect how integrated care is provided, all these factors can be influenced by staff themselves: both frontline and management. Facilities where staff displayed agency of decision making, worked as a team to share workload and had management that supported this, showed better integration delivery and staff were able to overcome some structural deficiencies to enable integrated care. Poor-performing facilities had good structural integration, but staff were unable to utilize this because they were poorly organized, unsupported or teams were dysfunctional. Conscientious objection and moralistic attitudes were also barriers. Integra has demonstrated that structural integration is not sufficient for integrated service delivery. Rather, our case studies show that in some cases excellent leadership and peer-teamwork enabled facilities to perform well despite resource shortages. The ability to provide support for staff to work flexibly to deliver integrated services and build resilient health systems to meet changing needs is particularly relevant as health systems face challenges of changing burdens of disease, climate change, epidemic outbreaks and more. PMID:29194544

Medicaid integrity program; limitation on contractor liability. Final rule.

PubMed

2007-11-30

The Medicaid Integrity Program (the Program) provides that the Secretary promote the integrity of the Medicaid program by entering into contracts with contractors that will review the actions of individuals or entities furnishing items or services (whether fee-for-service, risk, or other basis) for which payment may be made under an approved State plan and/or any waiver of the plan approved under section 1115 of the Social Security Act; audit claims for payment of items or services furnished, or administrative services furnished, under a State plan; identify overpayments of individuals or entities receiving Federal funds; and educate providers of services, managed care entities, beneficiaries, and other individuals with respect to payment integrity and quality of care. This final rule will provide for limitations on a contractor's liability while performing these services under the Program. The final rule will, to the extent possible, employ the same or comparable standards and other substantive and procedural provisions as are contained in section 1157 (Limitation on Liability) of the Social Security Act.

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

NASA Astrophysics Data System (ADS)

Yamada, Hiroshi; Kawaguchi, Akira

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

Exploring the Feasibility of Service Integration in a Low-Income Setting: A Mixed Methods Investigation into Different Models of Reproductive Health and HIV Care in Swaziland

PubMed Central

Church, Kathryn; Wringe, Alison; Lewin, Simon; Ploubidis, George B.; Fakudze, Phelele; Mayhew, Susannah H.

2015-01-01

Integrating reproductive health (RH) with HIV care is a policy priority in high HIV prevalence settings, despite doubts surrounding its feasibility and varying evidence of effects on health outcomes. The process and outcomes of integrated RH-HIV care were investigated in Swaziland, through a comparative case study of four service models, ranging from fully integrated to fully stand-alone HIV services, selected purposively within one town. A client exit survey (n=602) measured integrated care received and unmet family planning (FP) needs. Descriptive statistics were used to assess the degree of integration per clinic and client demand for services. Logistic regression modelling was used to test the hypothesis that clients at more integrated sites had lower unmet FP needs than clients in a stand-alone site. Qualitative methods included in-depth interviews with clients and providers to explore contextual factors influencing the feasibility of integrated RH-HIV care delivery; data were analysed thematically, combining deductive and inductive approaches. Results demonstrated that clinic models were not as integrated in practice as had been claimed. Fragmentation of HIV care was common. Services accessed per provider were no higher at the more integrated clinics compared to stand-alone models (p>0.05), despite reported demand. While women at more integrated sites received more FP and pregnancy counselling than stand-alone models, they received condoms (a method of choice) less often, and there was no statistical evidence of difference in unmet FP needs by model of care. Multiple contextual factors influenced integration practices, including provider de-skilling within sub-specialist roles; norms of task-oriented routinised HIV care; perceptions of heavy client loads; imbalanced client-provider interactions hindering articulation of RH needs; and provider motivation challenges. Thus, despite institutional support, factors related to the social context of care inhibited provision of fully integrated RH-HIV services in these clinics. Programmes should move beyond simplistic training and equipment provision if integrated care interventions are to be sustained. PMID:25978632

Bringing Wellness to Schools: Opportunities for and Challenges to Mental Health Integration in School-Based Health Centers.

PubMed

Lai, Karen; Guo, Sisi; Ijadi-Maghsoodi, Roya; Puffer, Maryjane; Kataoka, Sheryl H

2016-12-01

School-based health centers (SBHCs) reduce access barriers to mental health care and improve educational outcomes for youths. This qualitative study evaluated the innovations and challenges of a unique network of SBHCs in a large, urban school district as the centers attempted to integrate health, mental health, and educational services. The 43 participants sampled included mental health providers, primary care providers, and care coordinators at 14 SBHCs. Semistructured interviews with each participant were audio recorded and transcribed. Themes were identified and coded by using Atlas.ti 5.1 and collapsed into three domains: operations, partnership, and engagement. Interviews revealed provider models ranging from single agencies offering both primary care and mental health services to colocated services. Sites where the health agency provided at least some mental health services reported more mental health screenings. Many sites used SBHC wellness coordinators and coordination team meetings to facilitate relationships between schools and health agency and community mental health clinic providers. Partnership challenges included confidentiality policies and staff turnover. Participants also highlighted student and parent engagement through culturally sensitive services, peer health advocates, and "drop-in" lunches. Staffing and operational models are critical in the success of integrating primary care, mental health care, and education. Among the provider models observed, the combined primary care and mental health provider model offered the most integrated services. Despite barriers, providers and schools have begun to implement novel solutions to operational problems and family engagement in mental health services.

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

PubMed

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

2007-03-01

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

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

PubMed Central

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

2007-01-01

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

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

ERIC Educational Resources Information Center

Crews, Moody E.; Hemby, K. Virginia

2009-01-01

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

14 CFR 1214.105 - Apportionment and/or assignment of services.

Code of Federal Regulations, 2010 CFR

2010-01-01

... and/or assignment of Shuttle services may take place outside the payload. (b) Integration of... assistance in such integration will be provided as an optional service. (c) Customers intending to apportion...

Integrating Space Communication Network Capabilities via Web Portal Technologies

NASA Technical Reports Server (NTRS)

Johnston, Mark D.; Lee, Carlyn-Ann; Lau, Chi-Wung; Cheung, Kar-Ming; Levesque, Michael; Carruth, Butch; Coffman, Adam; Wallace, Mike

2014-01-01

We have developed a service portal prototype as part of an investigation into the feasibility of using Java portlet technology as a means of providing integrated access to NASA communications network services. Portal servers provide an attractive platform for this role due to the various built-in collaboration applications they can provide, combined with the possibility to develop custom inter-operating portlets to extent their functionality while preserving common presentation and behavior. This paper describes various options for integration of network services related to planning and scheduling, and results based on use of a popular open-source portal framework. Plans are underway to develop an operational SCaN Service Portal, building on the experiences reported here.

The Integration of Health and Counseling Services on College Campuses: Is There a Risk in Maintaining Student Patients' Privacy?

ERIC Educational Resources Information Center

Davenport, Robin G.

2017-01-01

The formation of integrated centers on college campuses that combine health services and counseling provide clear advantages for students. There is currently no "best practices" model that informs integrated centers' operational procedures. The "continuity of care" requirement of medical providers can conflict with the strict…

Survey of Federal, National, and International standards applicable to the NASA applications data services

NASA Technical Reports Server (NTRS)

Kuch, T.; Sakamoto, R.

1981-01-01

An applications data service (ADS) was developed to meet the challenges in the data access and integration. The ADS provides a common service to locate and access applications data electronically and integrate the cross correlative data sets required by multiple users. Its catalog and network services increase data visibility as well as provide the data in a more rapid manner and a usable form.

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

PubMed

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

2017-08-01

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

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

PubMed

Walsh, A M

1998-01-01

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

Divergent modes of integration: the Canadian way.

PubMed

Jiwani, Izzat; Fleury, Marie-Josée

2011-01-01

The paper highlights key trajectories and outcomes of the recent policy developments toward integrated health care delivery systems in Quebec and Ontario in the primary care sector and in the development of regional networks of health and social services. It particularly explores how policy legacies, interests and cultures may be mitigated to develop and sustain different models of integrated health care that are pertinent to the local contexts. In Quebec, three decades of iterative developments in health and social services evolved in 2005 into integrated centres for health and social services at the local levels (CSSSs). Four integrated university-based health care networks provide ultra-specialised services. Family Medicine Groups and network clinics are designed to enhance access and continuity of care. Ontario's Family Health Teams (2004) constitute an innovative public funding for private delivery model that is set up to enhance the capacity of primary care and to facilitate patient-based care. Ontario's Local Health Integration Networks (LHINs) with autonomous boards of provider organisations are intended to coordinate and integrate care. Integration strategies in Quebec and Ontario yield clinical autonomy and power to physicians while simultaneously making them key partners in change. Contextual factors combined with increased and varied forms of physician remunerations and incentives mitigated some of the challenges from policy legacies, interests and cultures. Virtual partnerships and accountability agreements between providers promise positive but gradual movement toward integrated health service systems.

A novel virtual hub approach for multisource downstream service integration

NASA Astrophysics Data System (ADS)

Previtali, Mattia; Cuca, Branka; Barazzetti, Luigi

2016-08-01

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

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

PubMed

Washington-Brown, Linda; Ritchie, Arlene

2014-01-01

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

Consuming Web Services: A Yahoo! Newsfeed Reader

ERIC Educational Resources Information Center

Dadashzadeh, Mohammad

2010-01-01

Service Oriented Architecture (SOA) shows demonstrable signs of simplifying software integration. It provides the necessary framework for building applications that can be integrated and can reduce the cost of integration significantly. Organizations are beginning to architect new integration solutions following the SOA approach. As such,…

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

NASA Astrophysics Data System (ADS)

Wang, Xi Vincent; Wang, Lihui

2017-08-01

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

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2017-03-14

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

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

PubMed

Sutherland, Ross

2012-01-01

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

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

PubMed

Lin, Y J; Wan, T T

2001-02-01

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

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

ERIC Educational Resources Information Center

Center for Rural Pennsylvania, Harrisburg.

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

Agent-based paradigm for integration of interactive cable television operations and business support systems

NASA Astrophysics Data System (ADS)

Wattawa, Scott

1995-11-01

Offering interactive services and data in a hybrid fiber/coax cable system requires the coordination of a host of operations and business support systems. New service offerings and network growth and evolution create never-ending changes in the network infrastructure. Agent-based enterprise models provide a flexible mechanism for systems integration of service and support systems. Agent models also provide a mechanism to decouple interactive services from network architecture. By using the Java programming language, agents may be made safe, portable, and intelligent. This paper investigates the application of the Object Management Group's Common Object Request Brokering Architecture to the integration of a multiple services metropolitan area network.

Interoperable Data Access Services for NOAA IOOS

NASA Astrophysics Data System (ADS)

de La Beaujardiere, J.

2008-12-01

The Integrated Ocean Observing System (IOOS) is intended to enhance our ability to collect, deliver, and use ocean information. The goal is to support research and decision-making by providing data on our open oceans, coastal waters, and Great Lakes in the formats, rates, and scales required by scientists, managers, businesses, governments, and the public. The US National Oceanic and Atmospheric Administration (NOAA) is the lead agency for IOOS. NOAA's IOOS office supports the development of regional coastal observing capability and promotes data management efforts to increase data accessibility. Geospatial web services have been established at NOAA data providers including the National Data Buoy Center (NDBC), the Center for Operational Oceanographic Products and Services (CO-OPS), and CoastWatch, and at regional data provider sites. Services established include Open-source Project for a Network Data Access Protocol (OpenDAP), Open Geospatial Consortium (OGC) Sensor Observation Service (SOS), and OGC Web Coverage Service (WCS). These services provide integrated access to data holdings that have been aggregated at each center from multiple sources. We wish to collaborate with other groups to improve our service offerings to maximize interoperability and enhance cross-provider data integration, and to share common service components such as registries, catalogs, data conversion, and gateways. This paper will discuss the current status of NOAA's IOOS efforts and possible next steps.

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

PubMed

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

2018-06-01

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

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

PubMed

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

2017-11-01

Drawing on rich data from the Integra evaluation of integrated HIV and reproductive-health services, we explored the interaction of systems hardware and software factors to explain why some facilities were able to implement and sustain integrated service delivery while others were not. This article draws on detailed mixed-methods data for four case-study facilities offering reproductive-health and HIV services between 2009 and 2013 in Kenya: (i) time-series client flow, tracking service uptake for 8841 clients; (ii) structured questionnaires with 24 providers; (iii) in-depth interviews with 17 providers; (iv) workload and facility data using a periodic activity review and cost-instruments; and (v) contextual data on external activities related to integration in study sites. Overall, our findings suggested that although structural factors like stock-outs, distribution of staffing and workload, rotation of staff can affect how integrated care is provided, all these factors can be influenced by staff themselves: both frontline and management. Facilities where staff displayed agency of decision making, worked as a team to share workload and had management that supported this, showed better integration delivery and staff were able to overcome some structural deficiencies to enable integrated care. Poor-performing facilities had good structural integration, but staff were unable to utilize this because they were poorly organized, unsupported or teams were dysfunctional. Conscientious objection and moralistic attitudes were also barriers.Integra has demonstrated that structural integration is not sufficient for integrated service delivery. Rather, our case studies show that in some cases excellent leadership and peer-teamwork enabled facilities to perform well despite resource shortages. The ability to provide support for staff to work flexibly to deliver integrated services and build resilient health systems to meet changing needs is particularly relevant as health systems face challenges of changing burdens of disease, climate change, epidemic outbreaks and more. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

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

PubMed

Cisse, C

2017-06-01

The objective of this study was to assess the level of integration of prevention of mother-to-child HIV transmission (PMTCT) in facilities providing services for maternal, newborn, and child health (MNCH) and reproductive health (RH) in Senegal. The survey, conducted from August through November, 2014, comprised five parts : a literature review to assess the place of this integration in the health policies, standards, and protocols in effect in Senegal; an analysis by direct observation of attitudes and practices of 25 healthcare providers at 5 randomly-selected obstetrics and gynecology departments representative of different levels of the health pyramid; a questionnaire evaluating knowledge and attitudes of 10 providers about the integration of PMTCT services into MNCH/RH facilities; interviews to collect the opinions of 70 clients, including 16 HIV-positive, about the quality of PMTCT services they received; and a questionnaire evaluating knowledge and opinions of 14 policy-makers/managers of health programs focusing on mothers and children about this integration. The literature review revealed several constraints impeding this integration : the policy documents, standards, and protocols of each of the programs involved do not clearly indicate the modalities of this integration; the programs are housed in two different divisions while the national Program against the Human Immunodeficiency Virus reports directly to the Prime Minister; program operations remains generally vertical; the resources for the different programs are not sufficiently shared; there is no integrated training module covering integrated management of pregnancy and delivery; and supervision for each of the different programs is organized separately.The observation of the providers supporting women during pregnancy, during childbirth, and in the postpartum period, showed an effort to integrate PMTCT into the MNCH/RH services delivered daily to clients. But this desire is hampered by many problems, including the inconsistent availability of HIV testing and antiretroviral drugs at program sites and the deficit in training and supervision for PMTCT. Clients interviewed after their contact with providers often complained about the lack of information received about PMTCT. They considered that effective integration of these services would provide them with better quality care while reducing their waiting time, costs, and trips to health facilities. The responses of policymakers and program managers interviewed mostly revealed gaps in their understanding and implementation of the integration. There is an effort to integrate MNCH/RH and PMTCT services at the healthcare facilities we visited. But our investigation revealed many shortcomings in both the screening and support of new or expectant HIV+ mothers. To improve this situation it is necessary to improve the skills and motivation of PMTCT providers, enhance the level of equipment, and empower local maternity wards.

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

PubMed Central

2014-01-01

Background There is growing interest in integration of HIV and sexual and reproductive health (SRH) services as a way to improve the efficiency of human resources (HR) for health in low- and middle-income countries. Although this is supported by a wealth of evidence on the acceptability and clinical effectiveness of service integration, there is little evidence on whether staff in general health services can easily absorb HIV services. Methods We conducted a descriptive analysis of HR integration through task shifting/sharing and staff workload in the context of the Integra Initiative - a large-scale five-year evaluation of HIV/SRH integration. We describe the level, characteristics and changes in HR integration in the context of wider efforts to integrate HIV/SRH, and explore the impact of HR integration on staff workload. Results Improvements in the range of services provided by staff (HR integration) were more likely to be achieved in facilities which also improved other elements of integration. While there was no overall relationship between integration and workload at the facility level, HIV/SRH integration may be most influential on staff workload for provider-initiated HIV testing and counselling (PITC) and postnatal care (PNC) services, particularly where HIV care and treatment services are being supported with extra SRH/HIV staffing. Our findings therefore suggest that there may be potential for further efficiency gains through integration, but overall the pace of improvement is slow. Conclusions This descriptive analysis explores the effect of HIV/SRH integration on staff workload through economies of scale and scope in high- and medium-HIV prevalence settings. We find some evidence to suggest that there is potential to improve productivity through integration, but, at the same time, significant challenges are being faced, with the pace of productivity gain slow. We recommend that efforts to implement integration are assessed in the broader context of HR planning to ensure that neither staff nor patients are negatively impacted by integration policy. PMID:25103923

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

PubMed

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

2014-08-07

There is growing interest in integration of HIV and sexual and reproductive health (SRH) services as a way to improve the efficiency of human resources (HR) for health in low- and middle-income countries. Although this is supported by a wealth of evidence on the acceptability and clinical effectiveness of service integration, there is little evidence on whether staff in general health services can easily absorb HIV services. We conducted a descriptive analysis of HR integration through task shifting/sharing and staff workload in the context of the Integra Initiative - a large-scale five-year evaluation of HIV/SRH integration. We describe the level, characteristics and changes in HR integration in the context of wider efforts to integrate HIV/SRH, and explore the impact of HR integration on staff workload. Improvements in the range of services provided by staff (HR integration) were more likely to be achieved in facilities which also improved other elements of integration. While there was no overall relationship between integration and workload at the facility level, HIV/SRH integration may be most influential on staff workload for provider-initiated HIV testing and counselling (PITC) and postnatal care (PNC) services, particularly where HIV care and treatment services are being supported with extra SRH/HIV staffing. Our findings therefore suggest that there may be potential for further efficiency gains through integration, but overall the pace of improvement is slow. This descriptive analysis explores the effect of HIV/SRH integration on staff workload through economies of scale and scope in high- and medium-HIV prevalence settings. We find some evidence to suggest that there is potential to improve productivity through integration, but, at the same time, significant challenges are being faced, with the pace of productivity gain slow. We recommend that efforts to implement integration are assessed in the broader context of HR planning to ensure that neither staff nor patients are negatively impacted by integration policy.

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

ERIC Educational Resources Information Center

Stöbe-Blossey, Sybille

2013-01-01

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

Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: summary guidance from CDC and the U.S. Department of Health and Human Services.

PubMed

2012-11-09

This report summarizes current (as of 2011) guidelines or recommendations published by multiple agencies of the U.S. Department of Health and Human Services (DHHS) for prevention and control of human immunodeficiency virus (HIV) infection, viral hepatitis, sexually transmitted diseases (STDs), and tuberculosis (TB) for persons who use drugs illicitly. It also summarizes existing evidence of effectiveness for practices to support delivery of integrated prevention services. Implementing integrated services for prevention of HIV infection, viral hepatitis, STDs, and TB is intended to provide persons who use drugs illicitly with increased access to services, to improve timeliness of service delivery, and to increase effectiveness of efforts to prevent infectious diseases that share common risk factors, behaviors, and social determinants. This guidance is intended for use by decision makers (e.g., local and federal agencies and leaders and managers of prevention and treatment services), health-care providers, social service providers, and prevention and treatment support groups. Consolidated guidance can strengthen efforts of health-care providers and public health providers to prevent and treat infectious diseases and substance use and mental disorders, use resources efficiently, and improve health-care services and outcomes in persons who use drugs illicitly. An integrated approach to service delivery for persons who use drugs incorporates recommended science-based public health strategies, including 1) prevention and treatment of substance use and mental disorders; 2) outreach programs; 3) risk assessment for illicit use of drugs; 4) risk assessment for infectious diseases; 5) screening, diagnosis, and counseling for infectious diseases; 6) vaccination; 7) prevention of mother-to-child transmission of infectious diseases; 8) interventions for reduction of risk behaviors; 9) partner services and contact follow-up; 10) referrals and linkage to care; 11) medical treatment for infectious diseases; and 12) delivery of integrated prevention services. These strategies are science-based, public health strategies to prevent and treat infectious diseases, substance use disorders, and mental disorders. Treatment of infectious diseases and treatment of substance use and mental disorders contribute to prevention of transmission of infectious diseases. Integrating prevention services can increase access to and timeliness of prevention and treatment.

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

PubMed

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

2018-02-01

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

Integrated care

PubMed Central

Gröne, Oliver; Garcia-Barbero, Mila

2001-01-01

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

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

PubMed

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

1999-08-01

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

Identity Management and Trust Services: Foundations for Cloud Computing

ERIC Educational Resources Information Center

Suess, Jack; Morooney, Kevin

2009-01-01

Increasingly, IT organizations will move from providing IT services locally to becoming an integrator of IT services--some provided locally and others provided outside the institution. As a result, institutions must immediately begin to plan for shared services and must understand the essential role that identity management and trust services play…

The HIV epidemic and sexual and reproductive health policy integration: views of South African policymakers.

PubMed

Cooper, Diane; Mantell, Joanne E; Moodley, Jennifer; Mall, Sumaya

2015-03-04

Integration of sexual and reproductive health (SRH) and HIV policies and services delivered by the same provider is prioritised worldwide, especially in sub-Saharan Africa where HIV prevalence is highest. South Africa has the largest antiretroviral treatment (ART) programme in the world, with an estimated 2.7 million people on ART, elevating South Africa's prominence as a global leader in HIV treatment. In 2011, the Southern African HIV Clinicians Society published safer conception guidelines for people living with HIV (PLWH) and in 2013, the South African government published contraceptive guidelines highlighting the importance of SRH and fertility planning services for people living with HIV. Addressing unintended pregnancies, safer conception and maternal health issues is crucial for improving PLWH's SRH and combatting the global HIV epidemic. This paper explores South African policymakers' perspectives on public sector SRH-HIV policy integration, with a special focus on the need for national and regional policies on safer conception for PLWH and contraceptive guidelines implementation. It draws on 42 in-depth interviews with national, provincial and civil society policymakers conducted between 2008-2009 and 2011-2012, as the number of people on ART escalated. Interviews focused on three key domains: opinions on PLWH's childbearing; the status of SRH-HIV integration policies and services; and thoughts and suggestions on SRH-HIV integration within the restructuring of South African primary care services. Data were coded and analysed according to themes. Participants supported SRH-HIV integrated policy and services. However, integration challenges identified included a lack of policy and guidelines, inadequately trained providers, vertical programming, provider work overload, and a weak health system. Participants acknowledged that SRH-HIV integration policies, particularly for safer conception, contraception and cervical cancer, had been neglected. Policymakers supported public sector adoption of safer conception policy and services. Participants interviewed after expanded ART were more positive about safer conception policies for PLWH than participants interviewed earlier. The past decade's HIV policy changes have increased opportunities for SRH-HIV integration. The findings provide important insights for international, regional and national SRH-HIV policy and service integration initiatives.

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

PubMed

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

2017-04-10

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

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2012-12-01

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

Using Integrated Student Supports to Keep Kids in School: A Quasi-Experimental Evaluation of Communities in Schools

ERIC Educational Resources Information Center

Somers, Marie-Andrée; Haider, Zeest

2017-01-01

The Communities In Schools (CIS) Model of Integrated Student Supports aims to reduce dropout rates by providing students with integrated and tiered support services based on their levels of need. The model includes preventive services that are available to all students (Level 1 services) as well as intensive, targeted, and sustained services…

Using Integrated Student Supports to Keep Kids in School: A Quasi-Experimental Evaluation of Communities in Schools. Executive Summary

ERIC Educational Resources Information Center

Somers, Marie-Andrée; Haider, Zeest

2017-01-01

The Communities In Schools (CIS) Model of Integrated Student Supports aims to reduce dropout rates by providing students with integrated and tiered support services based on their levels of need. The model includes preventive services that are available to all students (Level 1 services) as well as intensive, targeted, and sustained services…

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

PubMed

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

2012-12-01

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

The Massachusetts HIV, hepatitis, addiction services integration (HHASI) experience: responding to the comprehensive needs of individuals with co-occurring risks and conditions.

PubMed

Hoffman, Heidi L; Castro-Donlan, Carolyn A; Johnson, Victoria M; Church, Daniel R

2004-01-01

Categorical funding mechanisms traditionally used to fund public health programs are a challenge to providers serving individuals with complex needs that often span multiple service areas. Integration--a formalized, collaborative process among service systems--responds to the challenge by decreasing fragmentation of care and improving coordination. In 2000, the Massachusetts Department of Public Health (MDPH) received a one-year planning grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to evaluate opportunities for integrating HIV/AIDS programs and substance abuse treatment programs. The project was later expanded to include viral hepatitis programming. Outcomes include the development of a strategic plan, joint procurement initiatives, and an ongoing commitment to sustain inter-bureau integration efforts, even in the face of substantial budget reductions. Integrated approaches can promote greater efficiency, improving communication and coordination among clients, providers, and government funding agencies.

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

PubMed

Bates, Jason; Sharratt, Martin; King, John

2014-01-01

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

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

ERIC Educational Resources Information Center

Stoops, Jack W.; Hull, Janis L.

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

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

ERIC Educational Resources Information Center

Robinson, Mark; Atkinson, Mary; Downing, Dick

2008-01-01

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

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

PubMed Central

2014-01-01

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

Integration of post-abortion care: the role of township medical officers and midwives in Myanmar.

PubMed

Htay, Thein Thein; Sauvarin, Josephine; Khan, Saba

2003-05-01

Complications of unsafe abortion are a significant cause of maternal morbidity and mortality in Myanmar, and are recognised by the Ministry of Health as a priority. The Department of Health developed a strategy to address the problem of abortion complications by integrating post-abortion care and contraceptive services into the existing township health system. The quality of post-abortion care was assessed by the Department of Health in 2000, using a baseline survey of health providers and post-abortion women in Bago Division. The integration of post-abortion care was led by the Township Medical Officers, who provided monthly in-service training and supervision of health care workers in each township. Hospital-based doctors and nurses, clinic midwives, village midwives and other volunteer health providers, including traditional birth attendants, were all trained. The role of the local clinic midwife was extended to make follow-up home visits to the women with post-abortion complications and provide them with contraception when requested. Preliminary results show positive outcomes. However, donor-funded projects may have a destabilizing effect on township services by diverting attention and resources; donors need to work with government to support its priorities for health care. The future nationwide integration of post-abortion care services into township services should be planned in consultation with Township Medical Officers and midwives, the key providers of these services.

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

PubMed

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

2016-05-10

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

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

ERIC Educational Resources Information Center

Baillie, Susan; And Others

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

A comparative study of tuberculosis patients initiated on ART and receiving different models of TB-HIV care.

PubMed

Schulz, S A; Draper, H R; Naidoo, P

2013-12-01

Although health policy in South Africa calls for the integration of services, the effectiveness of different models of integration on patient outcomes has not been well demonstrated. To evaluate the outcomes of coinfected patients starting antiretroviral treatment (ART) in a tuberculosis (TB) hospital who received different models of ongoing care. This cohort study compared outcomes for 271 coinfected patients who started ART in a TB hospital in the Western Cape. After discharge, one group of patients received anti-tuberculosis treatment and ART from different providers, in the same or in different clinics (vertical care). The other group received anti-tuberculosis treatment and ART at the same visit from the same service provider (integrated care). Demographic and clinical data and TB and ART outcomes were compared. The vertical care model had more unfavourable outcomes for anti-tuberculosis treatment (28.7% vs. 5.9%, P < 0.001) and ART (30.1% vs. 7.4%, P < 0.001) than the integrated care model. The vertical care model showed no difference whether services were provided by two service providers in the same or in geographically separate primary health care clinics. Patient outcomes were better when TB and HIV care was received from the same service provider at the same visit.

Early Experiences with Mobile Electronic Health Records Application in a Tertiary Hospital in Korea

PubMed Central

Park, Minah; Hong, Eunseok; Kim, Sunhyu; Ahn, Ryeok; Hong, Jungseok; Song, Seungyeol; Kim, Tak; Kim, Jeongkeun; Yeo, Seongwoon

2015-01-01

Objectives Recent advances in mobile technology have opened up possibilities to provide strongly integrated mobile-based services in healthcare and telemedicine. Although the number of mobile Electronic Health Record (EHR) applications is large and growing, there is a paucity of evidence demonstrating the usage patterns of these mobile applications by healthcare providers. This study aimed to illustrate the deployment process for an integrated mobile EHR application and to analyze usage patterns after provision of the mobile EHR service. Methods We developed an integrated mobile application that aimed to enhance the mobility of healthcare providers by improving access to patient- and hospital-related information during their daily medical activities. The study included mobile EHR users who accessed patient healthcare records between May 2013 and May 2014. We performed a data analysis using a web server log file analyzer from the integrated EHR system. Cluster analysis was applied to longitudinal user data based on their application usage pattern. Results The mobile EHR service named M-UMIS has been in service since May 2013. Every healthcare provider in the hospital could access the mobile EHR service and view the medical charts of their patients. The frequency of using services and network packet transmission on the M-UMIS increased gradually during the study period. The most frequently accessed service in the menu was the patient list. Conclusions A better understanding regarding the adoption of mobile EHR applications by healthcare providers in patient-centered care provides useful information to guide the design and implementation of future applications. PMID:26618036

45 CFR 1634.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... legal services. The purposes of such a competitive system are to: (a) Encourage the effective and... Services to the Poor through an integrated system of legal services providers; (b) Provide opportunities... Regulations Relating to Public Welfare (Continued) LEGAL SERVICES CORPORATION COMPETITIVE BIDDING FOR GRANTS...

Integration of Geographical Information Systems and Geophysical Applications with Distributed Computing Technologies.

NASA Astrophysics Data System (ADS)

Pierce, M. E.; Aktas, M. S.; Aydin, G.; Fox, G. C.; Gadgil, H.; Sayar, A.

2005-12-01

We examine the application of Web Service Architectures and Grid-based distributed computing technologies to geophysics and geo-informatics. We are particularly interested in the integration of Geographical Information System (GIS) services with distributed data mining applications. GIS services provide the general purpose framework for building archival data services, real time streaming data services, and map-based visualization services that may be integrated with data mining and other applications through the use of distributed messaging systems and Web Service orchestration tools. Building upon on our previous work in these areas, we present our current research efforts. These include fundamental investigations into increasing XML-based Web service performance, supporting real time data streams, and integrating GIS mapping tools with audio/video collaboration systems for shared display and annotation.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2014-03-01

Current service delivery systems do not reach all people in need of antiretroviral therapy (ART). In order to inform the operational and service delivery section of the WHO 2013 consolidated antiretroviral guidelines, our objective was to summarize systematic reviews on integrating ART delivery into maternal, newborn, and child health (MNCH) care settings in countries with generalized epidemics, tuberculosis (TB) treatment settings in which the burden of HIV and TB is high, and settings providing opiate substitution therapy (OST); and decentralizing ART into primary health facilities and communities. A summary of systematic reviews. The reviewers searched PubMed, Embase, PsycINFO, Web of Science, CENTRAL, and the WHO Index Medicus databases. Randomized controlled trials and observational cohort studies were included if they compared ART coverage, retention in HIV care, and/or mortality in MNCH, TB, or OST facilities providing ART with MNCH, TB, or OST facilities providing ART services separately; or primary health facilities or communities providing ART with hospitals providing ART. The reviewers identified 28 studies on integration and decentralization. Antiretroviral therapy integration into MNCH facilities improved ART coverage (relative risk [RR] 1.37, 95% confidence interval [CI] 1.05-1.79) and led to comparable retention in care. ART integration into TB treatment settings improved ART coverage (RR 1.83, 95% CI 1.48-2.23) and led to a nonsignificant reduction in mortality (RR 0.55, 95% CI 0.29-1.05). The limited data on ART integration into OST services indicated comparable rates of ART coverage, retention, and mortality. Partial decentralization into primary health facilities improved retention (RR 1.05, 95% CI 1.01-1.09) and reduced mortality (RR 0.34, 95% CI 0.13-0.87). Full decentralization improved retention (RR 1.12, 95% CI 1.08-1.17) and led to comparable mortality. Community-based ART led to comparable rates of retention and mortality. Integrating ART into MNCH, TB, and OST services was often associated with improvements in ART coverage, and decentralization of ART into primary health facilities and communities was often associated with improved retention. Neither integration nor decentralization was associated with adverse outcomes. These data contributed to recommendations in the WHO 2013 consolidated antiretroviral guidelines to integrate ART delivery into MNCH, TB, and OST services and to decentralize ART.

[Consideration of national policies to support the development of medical services for dementia].

PubMed

Awata, Shuichi

2014-01-01

To consider national policies to support the development of medical services for dementia, we conducted three studies. Study 1: We evaluated the dementia management capacity of clinics using a questionnaire on medical services for dementia 1) Clinics that employed doctors who had attended a lecture on dementia management had a superior capacity to provide primary care services, make diagnoses, manage behavioral and psychological symptoms of dementia (BPSD), provide home healthcare for dementia, and promote community integration compared to clinics that did not employ such doctors. 2)Clinics that employed"dementia support doctors"had a superior capacity to provide such dementia management as mentioned above compared to clinics employing doctors who had attended a lecture on dementia management. However, 3) the questionnaire data suggested that only some clinics that employed "dementia support doctors" could provide such medical services as diagnosis of dementia, management of BPSD, and promotion of community integration in their regular clinical practice. Study 2: We evaluated the current activities of Medical Centers for Dementia (MCDs). 1) MCDs had more efficient activities in general compared to Dementia Centers for the Elderly (DCEs) established in 1989 and suspended in 2007. However, there was a large disparity among the facilities in terms of their activities. 2) Many MCDs thought that they could not provide adequate services due to the size of their catchment area. 3) Emergency services for dementia patients with concurrent medical conditions were supported by staff of many MCDs located in general hospitals without the designation of a special MCD for providing emergency services. 4) Inpatient stays tended to be longer in psychiatric hospitals where MCDs were located. Study 3: We conducted a preliminary investigation on activities in possible "dementia support clinics". These clinics had an inferior capacity to provide inpatient services but a similar capacity to make diagnoses, provide management of BPSD, and promote community integration compared to MCDs. From these findings, we made recommendations as follows: (1) It is necessary to not only increase the number of "dementia support doctors", but also to develop adequate numbers of "dementia support clinics" that provide such medical services as diagnosis of dementia, management of BPSD, and promotion of community integration in cooperation with community general support centers in regular clinical practice. (2) It is necessary to monitor the level of activities and develop adequate numbers of MCDs based on the size of the area and population. MCDs should take part in establishing community-based, integrated care systems in cooperation with the local government. Equipping "dementia support teams" might be indispensable in general hospitals that provide emergency medical services for dementia patients. (3) It would be significant to arrange "dementia support clinics" as a medical resource to make diagnoses, provide management of BPSD, and promote community integration for dementia in local dementia planning by a municipality.

Integration of mobile satellite and cellular systems

NASA Technical Reports Server (NTRS)

Drucker, Elliott H.; Estabrook, Polly; Pinck, Deborah; Ekroot, Laura

1993-01-01

By integrating the ground based infrastructure component of a mobile satellite system with the infrastructure systems of terrestrial 800 MHz cellular service providers, a seamless network of universal coverage can be established. Users equipped for both cellular and satellite service can take advantage of a number of features made possible by such integration, including seamless handoff and universal roaming. To provide maximum benefit at lowest posible cost, the means by which these systems are integrated must be carefully considered. Mobile satellite hub stations must be configured to efficiently interface with cellular Mobile Telephone Switching Offices (MTSO's), and cost effective mobile units that provide both cellular and satellite capability must be developed.

Integration of mobile satellite and cellular systems

NASA Astrophysics Data System (ADS)

Drucker, Elliott H.; Estabrook, Polly; Pinck, Deborah; Ekroot, Laura

By integrating the ground based infrastructure component of a mobile satellite system with the infrastructure systems of terrestrial 800 MHz cellular service providers, a seamless network of universal coverage can be established. Users equipped for both cellular and satellite service can take advantage of a number of features made possible by such integration, including seamless handoff and universal roaming. To provide maximum benefit at lowest posible cost, the means by which these systems are integrated must be carefully considered. Mobile satellite hub stations must be configured to efficiently interface with cellular Mobile Telephone Switching Offices (MTSO's), and cost effective mobile units that provide both cellular and satellite capability must be developed.

Integrated multimedia information system on interactive CATV network

NASA Astrophysics Data System (ADS)

Lee, Meng-Huang; Chang, Shin-Hung

1998-10-01

In the current CATV system architectures, they provide one- way delivery of a common menu of entertainment to all the homes through the cable network. Through the technologies evolution, the interactive services (or two-way services) can be provided in the cable TV systems. They can supply customers with individualized programming and support real- time two-way communications. With a view to the service type changed from the one-way delivery systems to the two-way interactive systems, `on demand services' is a distinct feature of multimedia systems. In this paper, we present our work of building up an integrated multimedia system on interactive CATV network in Shih Chien University. Besides providing the traditional analog TV programming from the cable operator, we filter some channels to reserve them as our campus information channels. In addition to the analog broadcasting channel, the system also provides the interactive digital multimedia services, e.g. Video-On- Demand (VOD), Virtual Reality, BBS, World-Wide-Web, and Internet Radio Station. These two kinds of services are integrated in a CATV network by the separation of frequency allocation for the analog broadcasting service and the digital interactive services. Our ongoing work is to port our previous work of building up a VOD system conformed to DAVIC standard (for inter-operability concern) on Ethernet network into the current system.

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

PubMed

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

2015-03-24

Integration of services for Prevention of Mother-To-Child Transmission of HIV (PMTCT) into routine maternal and child health care is promoted as a priority strategy by the WHO to facilitate the implementation of PMTCT. Integration of services emphasizes inter-sectoral coordination in the health systems to provide convenient services for clients. China has been integrating prenatal HIV, syphilis and hepatitis B testing services since 2009. However, as the individual health systems are complex, effective coordination among different health agencies is challenging. Few studies have examined the factors that affect the coordination of such complex systems. The aim of this study is to assess the effectiveness of and examine challenges for integrated service delivery. Findings will provide the basis for strategy development to enhance the effective delivery of integrated services. The research was conducted in Guangdong province in 2013 using a needs assessment approach that includes qualitative and quantitative methods. Quantitative data was collected through a survey and from routine monitoring for PMTCT and qualitative data was collected through stakeholder interviews. Routine monitoring data used to assess key indicators of coordination suggested numerous coordination problems. The rates of prenatal HIV (95%), syphilis (47%) and hepatitis B (47%) test were inconsistent. An average of only 20% of the HIV positive mothers was referred in the health systems. There were no regular meetings among different health agencies and the clients indicated complicated service processes. The major obstacles to the coordination of delivering these integrated services are lack of service resource integration; and lack of a mechanism for coordination of the health systems, with no uniform guidelines, clear roles or consistent evaluation. The key obstacles that have been identified in this study hinder the coordination of the delivery of integrated services. Our recommendations include: 1) Facilitate integration of the funding and information systems by fully combining the service resources of different health agencies into one unit; 2) Establish regular meetings to facilitate exchange of information and address problems; 3) Establish a client referral network between different health agencies with agreed guidelines, clear roles and consistent evaluation.

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

NASA Astrophysics Data System (ADS)

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

2009-04-01

1. INTRODUCTION Early warning systems are long living and evolving: New sensor-systems and -types may be developed and deployed, sensors will be replaced or redeployed on other locations and the functionality of analyzing software will be improved. To ensure a continuous operability of those systems their architecture must be evolution-enabled. From a computer science point of view an evolution-enabled architecture must fulfill following criteria: • Encapsulation of and functionality on data in standardized services. Access to proprietary sensor data is only possible via these services. • Loose coupling of system constituents which easily can be achieved by implementing standardized interfaces. • Location transparency of services what means that services can be provided everywhere. • Separation of concerns that means breaking a system into distinct features which overlap in functionality as little as possible. A Service Oriented Architecture (SOA) as e. g. realized in the German Indonesian Tsunami Early Warning System (GITEWS) and the advantages of functional integration on the basis of services described below adopt these criteria best. 2. SENSOR INTEGRATION Integration of data from (distributed) data sources is just a standard task in computer science. From few well known solution patterns, taking into account performance and security requirements of early warning systems only functional integration should be considered. Precondition for this is that systems are realized compliant to SOA patterns. Functionality is realized in form of dedicated components communicating via a service infrastructure. These components provide their functionality in form of services via standardized and published interfaces which could be used to access data maintained in - and functionality provided by dedicated components. Functional integration replaces the tight coupling at data level by a dependency on loosely coupled services. If the interfaces of the service providing components remain unchanged, components can be maintained and evolved independently on each other and service functionality as a whole can be reused. In GITEWS the functional integration pattern was adopted by applying the principles of an Enterprise Service Bus (ESB) as a backbone. Four services provided by the so called Tsunami Service Bus (TSB) which are essential for early warning systems are realized compliant to services specified within the Sensor Web Enablement (SWE) initiative of the Open Geospatial Consortium (OGC). 3. ARCHITECTURE The integration platform was developed to access proprietary, heterogeneous sensor data and to provide them in a uniform manner for further use. Its core, the TSB provides both a messaging-backbone and -interfaces on the basis of a Java Messaging Service (JMS). The logical architecture of GITEWS consists of four independent layers: • A resource layer where physical or virtual sensors as well as data or model storages provide relevant measurement-, event- and analysis-data: Utilizable for the TSB are any kind of data. In addition to sensors databases, model data and processing applications are adopted. SWE specifies encoding both to access and to describe these data in a comprehensive way: 1. Sensor Model Language (SensorML): Standardized description of sensors and sensor data 2. Observations and Measurements (O&M): Model and encoding of sensor measurements • A service layer to collect and conduct data from heterogeneous and proprietary resources and provide them via standardized interfaces: The TSB enables interaction with sensors via the following services: 1. Sensor Observation Service (SOS): Standardized access to sensor data 2. Sensor Planning Service (SPS): Controlling of sensors and sensor networks 3. Sensor Alert Service (SAS): Active sending of data if defined events occur 4. Web Notification Service (WNS): Conduction of asynchronous dialogues between services • An orchestration layer where atomic services are composed and arranged to high level processes like a decision support process: One of the outstanding features of service-oriented architectures is the possibility to compose new services from existing ones, which can be done programmatically or via declaration (workflow or process design). This allows e. g. the definition of new warning processes which could be adapted easily to new requirements. • An access layer which may contain graphical user interfaces for decision support, monitoring- or visualization-systems: To for example visualize time series graphical user interfaces request sensor data simply via the SOS. 4.BENEFIT The integration platform is realized on top of well known and widely used open source software implementing industrial standards. New sensors could be added easily to the infrastructure. Client components don't need to be adjusted if new sensor-types or -individuals are added to the system, because they access the sensors via standardized services. With implementing SWE fully compatible to the OGC specification it is possible to establish the "detection" and integration of sensors via the Web. Thus realizing a system of systems that combines early warning system functionality at different levels of detail (distant early warning systems, monitoring systems and any sensor system) is feasible.

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

PubMed

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

2016-01-01

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

Evaluation of How Integrative Oncology Services Are Valued between Hematology/Oncology Patients and Hematologists/Oncologists at a Tertiary Care Center.

PubMed

Hansra, D M; McIntyre, K; Ramdial, J; Sacks, S; Patrick, C S; Cutler, J; McIntyre, B; Feister, K; Miller, M; Taylor, A K; Farooq, F; de Mayolo, J Antunez; Ahn, E

2018-01-01

Evidence regarding opinions on integrative modalities by patients and physicians is lacking. Methods . A survey study was conducted assessing how integrative modalities were valued among hematology/oncology patients and hematologists and oncologists at a major tertiary medical center. Results. 1008 patients and 55 physicians were surveyed. With the exception of support groups, patients valued nutrition services, exercise therapy, spiritual/religious counseling, supplement/herbal advice, support groups, music therapy, and other complimentary medicine services significantly more than physicians ( P ≤ 0.05). Conclusion . With the exception of support groups, patients value integrative modalities more than physicians. Perhaps with increasing education, awareness, and acceptance by providers and traditional institutions, integrative modalities could be equally valued between patients and providers. It is possible that increased availability and utilization of integrative oncology modalities at tertiary hospital sites could improve patient satisfaction, quality of life, and other clinical endpoints.

Integrated AUTODIN System Architecture Report. Part 1.

DTIC Science & Technology

1977-12-01

necessary standards; (2) identify the roles and relationships of components of the Integrated AUTODIN System; (3) establish an Inter -Service/Agency ANPE...provide a network access element now designated the Inter -Service/Agency AMPE (I-S/A AMPE). The AUTODIN I ASCs will be phased out by "phasing in...further access area needs provided by an Inter -Service/Agency AMPE, which can serve all DoD users in an area and interface either AUTODIN I or AUTODIN

Bringing ecosystem services into integrated water resources management.

PubMed

Liu, Shuang; Crossman, Neville D; Nolan, Martin; Ghirmay, Hiyoba

2013-11-15

In this paper we propose an ecosystem service framework to support integrated water resource management and apply it to the Murray-Darling Basin in Australia. Water resources in the Murray-Darling Basin have been over-allocated for irrigation use with the consequent degradation of freshwater ecosystems. In line with integrated water resource management principles, Australian Government reforms are reducing the amount of water diverted for irrigation to improve ecosystem health. However, limited understanding of the broader benefits and trade-offs associated with reducing irrigation diversions has hampered the planning process supporting this reform. Ecosystem services offer an integrative framework to identify the broader benefits associated with integrated water resource management in the Murray-Darling Basin, thereby providing support for the Government to reform decision-making. We conducted a multi-criteria decision analysis for ranking regional potentials to provide ecosystem services at river basin scale. We surveyed the wider public about their understanding of, and priorities for, managing ecosystem services and then integrated the results with spatially explicit indicators of ecosystem service provision. The preliminary results of this work identified the sub-catchments with the greatest potential synergies and trade-offs of ecosystem service provision under the integrated water resources management reform process. With future development, our framework could be used as a decision support tool by those grappling with the challenge of the sustainable allocation of water between irrigation and the environment. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

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

PubMed Central

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

2016-01-01

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

Service-oriented infrastructure for scientific data mashups

NASA Astrophysics Data System (ADS)

Baru, C.; Krishnan, S.; Lin, K.; Moreland, J. L.; Nadeau, D. R.

2009-12-01

An important challenge in informatics is the development of concepts and corresponding architecture and tools to assist scientists with their data integration tasks. A typical Earth Science data integration request may be expressed, for example, as “For a given region (i.e. lat/long extent, plus depth), return a 3D structural model with accompanying physical parameters of density, seismic velocities, geochemistry, and geologic ages, using a cell size of 10km.” Such requests create “mashups” of scientific data. Currently, such integration is hand-crafted and depends heavily upon a scientist’s intimate knowledge of how to process, interpret, and integrate data from individual sources. In most case, the ultimate “integration” is performed by overlaying output images from individual processing steps using image manipulation software such as, say, Adobe Photoshop—leading to “Photoshop science”, where it is neither easy to repeat the integration steps nor to share the data mashup. As a result, scientists share only the final images and not the mashup itself. A more capable information infrastructure is needed to support the authoring and sharing of scientific data mashups. The infrastructure must include services for data discovery, access, and transformation and should be able to create mashups that are interactive, allowing users to probe and manipulate the data and follow its provenance. We present an architectural framework based on a service-oriented architecture for scientific data mashups in a distributed environment. The framework includes services for Data Access, Data Modeling, and Data Interaction. The Data Access services leverage capabilities for discovery and access to distributed data resources provided by efforts such as GEON and the EarthScope Data Portal, and services for federated metadata catalogs under development by projects like the Geosciences Information Network (GIN). The Data Modeling services provide 2D, 3D, and 4D modeling services based on standards such as WFS, WMS, WCS, and GeoSciML that allow integration of disparate data in a distributed, Web-based environment. Along these lines, we introduce the notion of a Web Volume Service (WVS) for modeling and manipulating 3D data. The Data Interaction Services provide services for rich interactions with the integrated 3D data. To provide efficient interactions with large-scale data in a distributed environment the architecture must include capabilities for caching and reuse of data, use of multi-level indexing, and the ability to orchestrate and coordinate execution of data processing and transformation routines as part of the data access and integration steps. The data mashup infrastructure is based on a service-oriented architecture. A range of alternatives are available for implementing these mashup services in a scalable fashion, using the cloud computing paradigm. We will describe the tradeoffs of each approach and provide an evaluation of which options are best suited to which types of services. We will describe security, privacy, performance, and price/performance issues and considerations in implementing services on dedicated servers versus private as well as public clouds, including systems such as Amazon Web Services.

Software as a service approach to sensor simulation software deployment

NASA Astrophysics Data System (ADS)

Webster, Steven; Miller, Gordon; Mayott, Gregory

2012-05-01

Traditionally, military simulation has been problem domain specific. Executing an exercise currently requires multiple simulation software providers to specialize, deploy, and configure their respective implementations, integrate the collection of software to achieve a specific system behavior, and then execute for the purpose at hand. This approach leads to rigid system integrations which require simulation expertise for each deployment due to changes in location, hardware, and software. Our alternative is Software as a Service (SaaS) predicated on the virtualization of Night Vision Electronic Sensors (NVESD) sensor simulations as an exemplary case. Management middleware elements layer self provisioning, configuration, and integration services onto the virtualized sensors to present a system of services at run time. Given an Infrastructure as a Service (IaaS) environment, enabled and managed system of simulations yields a durable SaaS delivery without requiring user simulation expertise. Persistent SaaS simulations would provide on demand availability to connected users, decrease integration costs and timelines, and benefit the domain community from immediate deployment of lessons learned.

CERNBox + EOS: end-user storage for science

NASA Astrophysics Data System (ADS)

Mascetti, L.; Gonzalez Labrador, H.; Lamanna, M.; Mościcki, JT; Peters, AJ

2015-12-01

CERNBox is a cloud synchronisation service for end-users: it allows syncing and sharing files on all major mobile and desktop platforms (Linux, Windows, MacOSX, Android, iOS) aiming to provide offline availability to any data stored in the CERN EOS infrastructure. The successful beta phase of the service confirmed the high demand in the community for an easily accessible cloud storage solution such as CERNBox. Integration of the CERNBox service with the EOS storage back-end is the next step towards providing “sync and share” capabilities for scientific and engineering use-cases. In this report we will present lessons learnt in offering the CERNBox service, key technical aspects of CERNBox/EOS integration and new, emerging usage possibilities. The latter includes the ongoing integration of “sync and share” capabilities with the LHC data analysis tools and transfer services.

An Examination of New York State's Integrated Primary and Mental Health Care Services for Adults with Serious Mental Illness.

PubMed

Scharf, Deborah M; Breslau, Joshua; Hackbarth, Nicole Schmidt; Kusuke, Daniela; Staplefoote, B Lynette; Pincus, Harold Alan

2014-12-30

The poor physical health of adults with serious mental illnesses is a public health crisis. Greater integration of mental health and primary medical care services at the clinic and system levels could address this need. In New York state, there are several ongoing initiatives that promote integrated care for adults with serious mental illness, provided or coordinated by community mental health center staff. This study examines three initiatives. Data were collected by RAND through site visits and surveys of mental health clinic administrators and associated professionals. Results showed that Primary and Behavioral Health Care Integration grantees developed infrastructure that supported a broad scope of primary and preventive health care services; these broad changes appeared to contribute to clinic-wide culture shifts toward integration and shared accountability for consumers' "whole person" health. Clinics participating in the Medicaid Incentive tended to implement only those services for which they could bill, which resulted in newly identified consumer physical health care needs but did not help consumers to connect to physical health care services. Finally, while administrators and providers were optimistic that Medicaid Health Homes have potential to improve access to care for adults with serious mental illness, the newness of the initiative made it difficult to assess the degree to which Health Home networks would meet these goals. We conclude with recommendations to state policymakers, clinical providers, and technical assistance providers and recommendations for future research, all designed to strengthen New York state's integrated care initiatives for adults with serious mental illness.

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

ERIC Educational Resources Information Center

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

2017-01-01

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

Applications integration in a hybrid cloud computing environment: modelling and platform

NASA Astrophysics Data System (ADS)

Li, Qing; Wang, Ze-yuan; Li, Wei-hua; Li, Jun; Wang, Cheng; Du, Rui-yang

2013-08-01

With the development of application services providers and cloud computing, more and more small- and medium-sized business enterprises use software services and even infrastructure services provided by professional information service companies to replace all or part of their information systems (ISs). These information service companies provide applications, such as data storage, computing processes, document sharing and even management information system services as public resources to support the business process management of their customers. However, no cloud computing service vendor can satisfy the full functional IS requirements of an enterprise. As a result, enterprises often have to simultaneously use systems distributed in different clouds and their intra enterprise ISs. Thus, this article presents a framework to integrate applications deployed in public clouds and intra ISs. A run-time platform is developed and a cross-computing environment process modelling technique is also developed to improve the feasibility of ISs under hybrid cloud computing environments.

From NHS Choices to the integrated customer service platform.

PubMed

Gann, Bob; Grant, Maria J

2013-03-01

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

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

PubMed Central

2012-01-01

Background In the majority of China, the Centre for Disease Control (CDC) at the county level provides both clinical and public health care for TB cases, with hospitals and other health facilities referring suspected TB cases to the CDC. In recent years, an integrated model has emerged, where the CDC remains the basic management unit for TB control, while a general hospital is designated to provide clinical care for TB patients. This study aims to explore the factors that influence the integration of TB services in general hospitals and generate knowledge to aid the scale-up of integration of TB services in China. Methods This study adopted a qualitative approach using interviews from sites in East and West China. Analysis was conducted using a thematic framework approach. Results The more prosperous site in East China was more coordinated and thus had a better method of resource allocation and more patient-orientated service, compared with the poorer site in the West. The development of public health organizations appeared to influence how effectively integration occurred. An understanding from staff that hospitals had better capacity to treat TB patients than CDCs was a strong rationale for integration. However, the economic and political interests might act as a barrier to effective integration. Both sites shared the same challenges of attracting and retaining a skilled workforce for the TB services. The role of the health bureau was more directive in the Western site, while a more participatory and collaborative approach was adopted in the Eastern site. Conclusion The process of integration identifies similarities and differences between sites in more affluent East China and poorer West China. Integration of TB services in the hospitals needs to address the challenges of stakeholder motivations and resource allocation. Effective inter-organizational collaboration could help to improve the efficiency and quality of TB service. Key words: TB control, service delivery, integration, hospitals, China. PMID:22276746

International organizations to enable world-wide mobile satellite services

NASA Technical Reports Server (NTRS)

Anglin, Richard L., Jr.

1993-01-01

Numbers of systems exist or have been proposed to provide world-wide mobile satellite services (MSS). Developers of these systems have formulated institutional structures they consider most appropriate for profitable delivery of these services. MSS systems provide niche services and complement traditional telecommunications networks; they are not integrated into world-wide networks. To be successful, MSS system operators must be able to provide an integrated suite of services to support the increasing globalization, interconnectivity, and mobility of business. The critical issue to enabling 'universal roaming' is securing authority to provide MSS in all of the nations of the world. Such authority must be secured in the context of evolving trends in international telecommunications, and must specifically address issues of standardization, regulation and organization. Today, only one existing organization has such world-wide authority. The question is how proponents of new MSS systems and services can gain similar authority. Securing the appropriate authorizations requires that these new organizations reflect the objectives of the nations in which services are to be delivered.

Connecting Body and Mind: A Resource Guide to Integrated Health Care in Texas and the United States

ERIC Educational Resources Information Center

Lopez, Molly; Coleman-Beattie, Brenda; Jahnke, Lauren; Sanchez, Katherine

2008-01-01

There is a call across the country and in Texas to improve health care systems through integrated care. Integrated health care is the systematic coordination of physical and behavioral health services. The idea is that physical and behavioral health problems often occur at the same time and that integrating services will provide the best results…

Indian Employment Training and Related Services Demonstration Act of 1991. Joint Hearing on S. 1530 To Authorize the Integration of Employment, Training, and Related Services Provided by Indian Tribes before the Select Committee on Indian Affairs, United States Senate and the Committee on Labor and Human Resources, Subcommittee on Employment and Productivity. One Hundred Second Congress, First Session (July 25, 1991).

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Select Committee on Indian Affairs.

This report documents statements from Senators, agency representatives, and tribal representatives concerning Senate bill S. 1530. The purposes of S. 1530 are to demonstrate how Indian tribal governments can integrate the employment, training and related services they provide in order to improve the effectiveness of those services, reduce…

Service Management Database for DSN Equipment

NASA Technical Reports Server (NTRS)

Zendejas, Silvino; Bui, Tung; Bui, Bach; Malhotra, Shantanu; Chen, Fannie; Wolgast, Paul; Allen, Christopher; Luong, Ivy; Chang, George; Sadaqathulla, Syed

2009-01-01

This data- and event-driven persistent storage system leverages the use of commercial software provided by Oracle for portability, ease of maintenance, scalability, and ease of integration with embedded, client-server, and multi-tiered applications. In this role, the Service Management Database (SMDB) is a key component of the overall end-to-end process involved in the scheduling, preparation, and configuration of the Deep Space Network (DSN) equipment needed to perform the various telecommunication services the DSN provides to its customers worldwide. SMDB makes efficient use of triggers, stored procedures, queuing functions, e-mail capabilities, data management, and Java integration features provided by the Oracle relational database management system. SMDB uses a third normal form schema design that allows for simple data maintenance procedures and thin layers of integration with client applications. The software provides an integrated event logging system with ability to publish events to a JMS messaging system for synchronous and asynchronous delivery to subscribed applications. It provides a structured classification of events and application-level messages stored in database tables that are accessible by monitoring applications for real-time monitoring or for troubleshooting and analysis over historical archives.

Integrating Multilevel Command and Control into a Service Oriented Architecture to Provide Cross Domain Capability

DTIC Science & Technology

2006-06-01

Horizontal Fusion, the JCDX team developed two web services, a Classification Policy Decision Service (cPDS), and a Federated Search Provider (FSP...The cPDS web service primarily provides other systems with methods for handling labeled data such as label comparison. The federated search provider...level domains. To provide defense-in-depth, cPDS and the Federated Search Provider are implemented on a separate server known as the JCDX Web

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

PubMed

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

2016-03-01

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

IAServ: an intelligent home care web services platform in a cloud for aging-in-place.

PubMed

Su, Chuan-Jun; Chiang, Chang-Yu

2013-11-12

As the elderly population has been rapidly expanding and the core tax-paying population has been shrinking, the need for adequate elderly health and housing services continues to grow while the resources to provide such services are becoming increasingly scarce. Thus, increasing the efficiency of the delivery of healthcare services through the use of modern technology is a pressing issue. The seamless integration of such enabling technologies as ontology, intelligent agents, web services, and cloud computing is transforming healthcare from hospital-based treatments to home-based self-care and preventive care. A ubiquitous healthcare platform based on this technological integration, which synergizes service providers with patients' needs to be developed to provide personalized healthcare services at the right time, in the right place, and the right manner. This paper presents the development and overall architecture of IAServ (the Intelligent Aging-in-place Home care Web Services Platform) to provide personalized healthcare service ubiquitously in a cloud computing setting to support the most desirable and cost-efficient method of care for the aged-aging in place. The IAServ is expected to offer intelligent, pervasive, accurate and contextually-aware personal care services. Architecturally the implemented IAServ leverages web services and cloud computing to provide economic, scalable, and robust healthcare services over the Internet.

IAServ: An Intelligent Home Care Web Services Platform in a Cloud for Aging-in-Place

PubMed Central

Su, Chuan-Jun; Chiang, Chang-Yu

2013-01-01

As the elderly population has been rapidly expanding and the core tax-paying population has been shrinking, the need for adequate elderly health and housing services continues to grow while the resources to provide such services are becoming increasingly scarce. Thus, increasing the efficiency of the delivery of healthcare services through the use of modern technology is a pressing issue. The seamless integration of such enabling technologies as ontology, intelligent agents, web services, and cloud computing is transforming healthcare from hospital-based treatments to home-based self-care and preventive care. A ubiquitous healthcare platform based on this technological integration, which synergizes service providers with patients’ needs to be developed to provide personalized healthcare services at the right time, in the right place, and the right manner. This paper presents the development and overall architecture of IAServ (the Intelligent Aging-in-place Home care Web Services Platform) to provide personalized healthcare service ubiquitously in a cloud computing setting to support the most desirable and cost-efficient method of care for the aged-aging in place. The IAServ is expected to offer intelligent, pervasive, accurate and contextually-aware personal care services. Architecturally the implemented IAServ leverages web services and cloud computing to provide economic, scalable, and robust healthcare services over the Internet. PMID:24225647

Integrated musculoskeletal service design by GP consortia

PubMed Central

2011-01-01

Background Musculoskeletal conditions are common in primary care and are associated with significant co-morbidity and impairment of quality of life. Traditional care pathways combined community-based physiotherapy with GP referral to hospital for a consultant opinion. Locally, this model led to only 30% of hospital consultant orthopaedic referrals being listed for surgery, with the majority being referred for physiotherapy. The NHS musculoskeletal framework proposed the use of interface services to provide expertise in diagnosis, triage and management of musculoskeletal problems not requiring surgery. The White Paper Equity and Excellence: Liberating the NHS has replaced PCT commissioning with GP consortia, who will lead future service development. Setting Primary and community care, integrated with secondary care, in the NHS in England. Question How can GP consortia lead the development of integrated musculoskeletal services? Review: The Ealing experience We explore here how Ealing implemented a ‘See and Treat’ interface clinic model to improve surgical conversion rates, reduce unnecessary hospital referrals and provide community treatment more efficiently than a triage model. A high-profile GP education programme enabled GPs to triage in their practices and manage patients without referral. Conclusion In Ealing, we demonstrated that most patients with musculoskeletal conditions can be managed in primary care and community settings. The integrated musculoskeletal service provides clear and fast routes to secondary care. This is both clinically effective and cost-effective, reserving hospital referral for patients most likely to need surgery. GP consortia, in conjunction with strong clinical leadership, inbuilt organisational and professional learning, and a GP champion, are well placed to deliver service redesign by co-ordinating primary care development, local commissioning of community services and the acute commissioning vehicles responsible for secondary care. The immediate priority for GP consortia is to develop a truly integrated service by facilitating consultant opinions within a community setting. PMID:25949643

MAPPING WATERSHED INTEGRITY FOR THE CONTERMINOUS UNITED STATES.

EPA Science Inventory

Watersheds provide a variety of ecosystem services valued by society. Production of these services is sensitive to watershed alteration by human activities. Flotemersch and others (2015), defined watershed integrity (WI) as the “capacity of a watershed to support and maint...

Mapping Watershed Integrity for the Conterminous United States

EPA Science Inventory

Watersheds provide a variety of ecosystem services valued by society. Production of these services is partially a function of the degree to which watersheds are altered by human activities. In a recent manuscript, Flotemersch and others (in preparation), defined watershed integr...

Lynx web services for annotations and systems analysis of multi-gene disorders.

PubMed

Sulakhe, Dinanath; Taylor, Andrew; Balasubramanian, Sandhya; Feng, Bo; Xie, Bingqing; Börnigen, Daniela; Dave, Utpal J; Foster, Ian T; Gilliam, T Conrad; Maltsev, Natalia

2014-07-01

Lynx is a web-based integrated systems biology platform that supports annotation and analysis of experimental data and generation of weighted hypotheses on molecular mechanisms contributing to human phenotypes and disorders of interest. Lynx has integrated multiple classes of biomedical data (genomic, proteomic, pathways, phenotypic, toxicogenomic, contextual and others) from various public databases as well as manually curated data from our group and collaborators (LynxKB). Lynx provides tools for gene list enrichment analysis using multiple functional annotations and network-based gene prioritization. Lynx provides access to the integrated database and the analytical tools via REST based Web Services (http://lynx.ci.uchicago.edu/webservices.html). This comprises data retrieval services for specific functional annotations, services to search across the complete LynxKB (powered by Lucene), and services to access the analytical tools built within the Lynx platform. © The Author(s) 2014. Published by Oxford University Press on behalf of Nucleic Acids Research.

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

ERIC Educational Resources Information Center

Berney, Tomi D.; Carey, Cecilia

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

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

ERIC Educational Resources Information Center

Anderson, Richard T.

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

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

PubMed

2005-03-01

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

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

NASA Technical Reports Server (NTRS)

Bai, Haowei; Atiquzzaman, Mohammed; Ivancic, William

2001-01-01

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

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

NASA Technical Reports Server (NTRS)

Bai, Haowei; Atiquzzaman, Mohammed; Ivancic, William

2001-01-01

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

76 FR 20534 - Program Integrity Issues

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-13

... Code of Federal Regulations is available via the Federal Digital System at: http://www.gpo.gov/fdsys... educational programs or those that provide marketing, advertising, recruiting, or admissions services. We have... the institution to provide services, such as food service, other than educational programs, marketing...

Medicaid Integrity Program; eligible entity and contracting requirements for the Medicaid Integrity audit program. Final rule.

PubMed

2008-09-26

Section 1936 of the Social Security Act (the Act) (as added by section 6034 of the Deficit Reduction Act of 2005 (DRA) established the Medicaid Integrity Program to promote the integrity of the Medicaid program by requiring CMS to enter into contracts with eligible entities to: (1) Review the actions of individuals or entities furnishing items or services (whether on a fee-for-service, risk, or other basis) for which payment may be made under an approved State plan and/or any waiver of such plan approved under section 1115 of the Act; (2) audit claims for payment of items or services furnished, or administrative services rendered, under a State plan; (3) identify overpayments to individuals or entities receiving Federal funds; and (4) educate providers of services, managed care entities, beneficiaries, and other individuals with respect to payment integrity and quality of care. This final rule will provide requirements for an eligible entity to enter into a contract under the Medicaid integrity audit program. The final rule will also establish the contracting requirements for eligible entities. The requirements will include procedures for identifying, evaluating, and resolving organizational conflicts of interest that are generally applicable to Federal acquisition and procurement; competitive procedures to be used; and procedures under which a contract may be renewed.

The Complexity of Health Service Integration: A Review of Reviews.

PubMed

Heyeres, Marion; McCalman, Janya; Tsey, Komla; Kinchin, Irina

2016-01-01

The aim of health service integration is to provide a sustainable and integrated health system that better meets the needs of the end user. Yet, definitions of health service integration, methods for integrating health services, and expected outcomes are varied. This review was commissioned by Queensland Health, the government department responsible for health service delivery in Queensland, Australia, to inform efforts to integrate their mental health services. This review reports on the characteristics, reported outcomes, and design quality of studies included in systematic reviews of health service integration research. The review was developed by systematically searching nine electronic databases to find peer-reviewed Australian and international systematic reviews with a focus on health service integration. Reviews were included if they were in the English language and published between 2000 and 2015. A standardized assessment tool was used to analyze the study design quality of included reviews. Data relating to the integration types, methods, and reported outcomes of integration were synthesized. Seventeen publications met the inclusion criteria. Eleven (65%) reviews were published during the past 5 years, which may indicate a trend for increased awareness of the need for service integration. The majority of reviews were published by researchers in the UK (8/47%), USA (3/18%), and Australia (3/18%). Included reviews focused on a variety of integration types, including integrated care pathways, governance models, integration of interventions, collaborative/integrated care models, and integration of different types of health care. Most (53%) of the reviews reported on the cost-effectiveness of service integration, e.g., positive results, no effect, or inconclusive. Only one of the reviews reported on the importance of consumer involvement. The overall design of 70% of the reviews was high, 18% medium, and 12% low. There is no "one size fits all" approach to health service integration. Instead, this literature review highlighted the complexity of service integration, which in most primary studies involved a range of strategies. Rigorous assessments of cost-effectiveness and reporting on consumer involvement are required in future research.

EIDA Next Generation: ongoing and future developments

NASA Astrophysics Data System (ADS)

Strollo, Angelo; Quinteros, Javier; Sleeman, Reinoud; Trani, Luca; Clinton, John; Stammler, Klaus; Danecek, Peter; Pedersen, Helle; Ionescu, Constantin

2015-04-01

The European Integrated Data Archive (EIDA; http://www.orfeus-eu.org/eida/eida.html) is the distributed Data Centre system within ORFEUS, providing transparent access and services to high quality, seismic data across (currently) 9 large data archives in Europe. EIDA is growing, in terms of the number of participating data centres, the size of the archives, the variability of the data in the archives, the number of users, and the volume of downloads. The on-going success of EIDA is thus providing challenges that are the driving force behind the design of the next generation (NG) of EIDA, which is expected to be implemented within EPOS IP. EIDA ORFEUS must cope with further expansion of the system and more complex user requirements by developing new techniques and extended services. The EIDA NG is being designed to work on standard FDSN web services and two additional new web services: Routing Service and QC (quality controlled) service. This presentation highlights the challenges EIDA needs to address during the EPOS IP and focuses on these 2 new services. The Routing Service can be considered as the core of EIDA NG. It was designed to assist users and clients to locate data within a federated, decentralized data centre (e.g. EIDA). A detailed, FDSN-compliant specification of the service has been developed. Our implementation of this service will run at every EIDA node, but is also capable of running on a user's computer, allowing anyone to define virtual or integrate existing data centres. This (meta)service needs to be queried in order to locate the data. Some smart clients (in a beta status) have been also provided to offer the user an integrated view of the whole EIDA, hiding the complexity of its internal structure. The service is open and able to be queried by anyone without the need of credentials or authentication. The QC Service is developed to cope with user requirements to query for relevant data only. The web service provides detailed information on the contents of the waveform data in an archive and in particular the following features and quality parameters are provided: gaps, statistical values, availability, overlaps, quality flags and more. It is a tool to be used for quickly exploring the contents of the waveform files before downloading them, or by clients to fulfill user specific requirements. The API reflects almost identically the FDSN dataselect service with some additional features. The characteristics are computed on fixed daily intervals (day boundaries) and in case of gaps the service can additionally provide the above features for each continuous data segment in the day interval. The newly developed services and the mediator service being designed and implemented in the near future, will facilitate interoperability and sustainability of the EIDA system and ensure a smooth integration with other Thematic (TCS) and Integrated (ICS) Core Services within EPOS.

A Pilot Study of a Criminal Justice Service-Learning Course: The Value of a Multicultural Approach

ERIC Educational Resources Information Center

Hirschinger-Blank, Nancy; Simons, Lori; Finley, Laura; Clearly, Joseph; Thoerig, Michael

2013-01-01

This article provides a description and evaluation of a service-learning juvenile justice course designed to broaden university students' attitudes toward diversity issues. Diversity service learning integrates academic learning with community service by providing students with opportunities to learn about social disparities associated with…

Flexible Web services integration: a novel personalised social approach

NASA Astrophysics Data System (ADS)

Metrouh, Abdelmalek; Mokhati, Farid

2018-05-01

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

IMS: a new technology to develop a telemedicine system.

PubMed

Uceda, J D; Elena, M; Blasco, S; Tarrida, C L; Quero, J M

2008-01-01

The emergent IMS (Internet Protocol Multimedia Subsystem) technology appears to improve the current communication technologies. Its characteristics, such as Quality of Service (QoS), make it an advantageous system for innovative applications. Providing integrated services to users is one of the main reasons for the existence of IMS. Operators provide the technology as an open source, to be able to use services developed by researchers. Combining and integrating them, users will receive completely new services. Our proposal of use for IMS is the development of a telemedicine platform, designed to support not only remote biological signal monitoring, but value-added services for diagnosis and medical care, both of these working in real time.

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

NASA Astrophysics Data System (ADS)

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

2007-06-01

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

Including safety-net providers in integrated delivery systems: issues and options for policymakers.

PubMed

Witgert, Katherine; Hess, Catherine

2012-08-01

Health care reform legislation has spurred efforts to develop integrated health care delivery systems that seek to coordinate the continuum of health services. These systems may be of particular benefit to patients who face barriers to accessing care or have multiple health conditions. But it remains to be seen how safety-net providers, including community health centers and public hospitals--which have long experience in caring for these vulnerable populations--will be included in integrated delivery systems. This issue brief explores key considerations for incorporating safety-net providers into integrated delivery systems and discusses the roles of state and federal agencies in sup­porting and testing models of integrated care delivery. The authors conclude that the most important principles in creating integrated delivery systems for vulnerable populations are: (1) an emphasis on primary care; (2) coordination of all care, including behavioral, social, and public health services; and (3) accountability for population health outcomes.

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

PubMed

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

2008-12-01

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

Effects of antenatal care and HIV treatment integration on elements of the PMTCT cascade: Results from the SHAIP cluster-randomized controlled trial in Kenya

PubMed Central

Turan, Janet M.; Onono, Maricianah; Steinfeld, Rachel L.; Shade, Starley B.; Owuor, Kevin; Washington, Sierra; Bukusi, Elizabeth A.; Ackers, Marta L.; Kioko, Jackson; Interis, Evelyn C.; Cohen, Craig R.

2015-01-01

Background Integrating antenatal care (ANC) and HIV care may improve uptake and retention in services along the prevention of mother-to-child transmission (PMTCT) cascade. The current study aimed to determine if integration of HIV services into ANC settings improves PMTCT service utilization outcomes. Methods ANC clinics in rural Kenya were randomized to integrated (6 clinics, 569 women) or non-integrated (6 clinics, 603 women) services. Intervention clinics provided all HIV services, including highly active antiretroviral therapy (HAART), while control clinics provided PMTCT services but referred women to HIV care clinics within the same facility. PMTCT utilization outcomes among HIV-infected women (maternal HIV care enrollment, HAART initiation, and 3-month infant HIV testing uptake) were compared using generalized estimating equations and Cox regression. Results HIV care enrollment was higher in intervention compared to control clinics (69% versus 36%, Odds Ratio (OR)=3.94, 95% Confidence Interval (CI): 1.14–13.63). Median time to enrollment was significantly shorter among intervention arm women (0 versus 8 days, Hazard Ratio (HR)=2.20, 95% CI: 1.62–3.01). Eligible women in the intervention arm were more likely to initiate HAART (40% versus 17%, OR=3.22, 95% CI: 1.81–5.72). Infant testing was more common in the intervention arm (25% versus 18%), however not statistically different. No significant differences were detected in postnatal service uptake or maternal retention. Conclusions Service integration increased maternal HIV care enrollment and HAART uptake. However, PMTCT utilization outcomes were still suboptimal, and postnatal service utilization remained poor in both study arms. Further improvements in the PMTCT cascade will require additional research and interventions. PMID:25967269

Industry structures in private dental markets in Finland.

PubMed

Widström, E; Mikkola, H

2012-12-01

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

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

PubMed Central

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

2009-01-01

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

Wearable Internet of Things - from human activity tracking to clinical integration.

PubMed

Kumari, Poonam; Lopez-Benitez, Miguel; Gyu Myoung Lee; Tae-Seong Kim; Minhas, Atul S

2017-07-01

Wearable devices for human activity tracking have been emerging rapidly. Most of them are capable of sending health statistics to smartphones, smartwatches or smart bands. However, they only provide the data for individual analysis and their data is not integrated into clinical practice. Leveraging on the Internet of Things (IoT), edge and cloud computing technologies, we propose an architecture which is capable of providing cloud based clinical services using human activity data. Such services could supplement the shortage of staff in primary healthcare centers thereby reducing the burden on healthcare service providers. The enormous amount of data created from such services could also be utilized for planning future therapies by studying recovery cycles of existing patients. We provide a prototype based on our architecture and discuss its salient features. We also provide use cases of our system in personalized and home based healthcare services. We propose an International Telecommunication Union based standardization (ITU-T) for our design and discuss future directions in wearable IoT.

Strengthening Health Systems at Facility-Level: Feasibility of Integrating Antiretroviral Therapy into Primary Health Care Services in Lusaka, Zambia

PubMed Central

Topp, Stephanie M.; Chipukuma, Julien M.; Giganti, Mark; Mwango, Linah K.; Chiko, Like M.; Tambatamba-Chapula, Bushimbwa; Wamulume, Chibesa S.; Reid, Stewart

2010-01-01

Introduction HIV care and treatment services are primarily delivered in vertical antiretroviral (ART) clinics in sub-Saharan Africa but there have been concerns over the impact on existing primary health care services. This paper presents results from a feasibility study of a fully integrated model of HIV and non-HIV outpatient services in two urban Lusaka clinics. Methods Integration involved three key modifications: i) amalgamation of space and patient flow; ii) standardization of medical records and iii) introduction of routine provider initiated testing and counseling (PITC). Assessment of feasibility included monitoring rates of HIV case-finding and referral to care, measuring median waiting and consultation times and assessing adherence to clinical care protocols for HIV and non-HIV outpatients. Qualitative data on patient/provider perceptions was also collected. Findings Provider and patient interviews at both sites indicated broad acceptability of the model and highlighted a perceived reduction in stigma associated with integrated HIV services. Over six months in Clinic 1, PITC was provided to 2760 patients; 1485 (53%) accepted testing, 192 (13%) were HIV positive and 80 (42%) enrolled. Median OPD patient-provider contact time increased 55% (6.9 vs. 10.7 minutes; p<0.001) and decreased 1% for ART patients (27.9 vs. 27.7 minutes; p = 0.94). Median waiting times increased by 36 (p<0.001) and 23 minutes (p<0.001) for ART and OPD patients respectively. In Clinic 2, PITC was offered to 1510 patients, with 882 (58%) accepting testing, 208 (24%) HIV positive and 121 (58%) enrolled. Median OPD patient-provider contact time increased 110% (6.1 vs. 12.8 minutes; p<0.001) and decreased for ART patients by 23% (23 vs. 17.7 minutes; p<0.001). Median waiting times increased by 47 (p<0.001) and 34 minutes (p<0.001) for ART and OPD patients, respectively. Conclusions Integrating vertical ART and OPD services is feasible in the low-resource and high HIV-prevalence setting of Lusaka, Zambia. Integration enabled shared use of space and staffing that resulted in increased HIV case finding, a reduction in stigma associated with vertical ART services but resulted in an overall increase in patient waiting times. Further research is urgently required to assess long-term clinical outcomes and cost effectiveness in order to evaluate scalability and generalizability. PMID:20644629

The Study of HIV and Antenatal Care Integration in Pregnancy in Kenya: Design, Methods, and Baseline Results of a Cluster-Randomized Controlled Trial

PubMed Central

Turan, Janet M.; Steinfeld, Rachel L.; Onono, Maricianah; Bukusi, Elizabeth A.; Woods, Meghan; Shade, Starley B.; Washington, Sierra; Marima, Reson; Penner, Jeremy; Ackers, Marta L.; Mbori-Ngacha, Dorothy; Cohen, Craig R.

2012-01-01

Background Despite strong evidence for the effectiveness of anti-retroviral therapy for improving the health of women living with HIV and for the prevention of mother-to-child transmission (PMTCT), HIV persists as a major maternal and child health problem in sub-Saharan Africa. In most settings antenatal care (ANC) services and HIV treatment services are offered in separate clinics. Integrating these services may result in better uptake of services, reduction of the time to treatment initiation, better adherence, and reduction of stigma. Methodology/Principal Findings A prospective cluster randomized controlled trial design was used to evaluate the effects of integrating HIV treatment into ANC clinics at government health facilities in rural Kenya. Twelve facilities were randomized to provide either fully integrated services (ANC, PMTCT, and HIV treatment services all delivered in the ANC clinic) or non-integrated services (ANC clinics provided ANC and basic PMTCT services and referred clients to a separate HIV clinic for HIV treatment). During June 2009– March 2011, 1,172 HIV-positive pregnant women were enrolled in the study. The main study outcomes are rates of maternal enrollment in HIV care and treatment, infant HIV testing uptake, and HIV-free infant survival. Baseline results revealed that the intervention and control cohorts were similar with respect to socio-demographics, male partner HIV testing, sero-discordance of the couple, obstetric history, baseline CD4 count, and WHO Stage. Challenges faced while conducting this trial at low-resource rural health facilities included frequent staff turnover, stock-outs of essential supplies, transportation challenges, and changes in national guidelines. Conclusions/Significance This is the first randomized trial of ANC and HIV service integration to be conducted in rural Africa. It is expected that the study will provide critical evidence regarding the implementation and effectiveness of this service delivery strategy, with important implications for programs striving to eliminate vertical transmission of HIV and improve maternal health. Trial Registration ClinicalTrials.gov NCT00931216 NCT00931216. PMID:22970177

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

ERIC Educational Resources Information Center

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

2004-01-01

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

Virtual healthcare delivery: defined, modeled, and predictive barriers to implementation identified.

PubMed

Harrop, V M

2001-01-01

Provider organizations lack: 1. a definition of "virtual" healthcare delivery relative to the products, services, and processes offered by dot.coms, web-compact disk healthcare content providers, telemedicine, and telecommunications companies, and 2. a model for integrating real and virtual healthcare delivery. This paper defines virtual healthcare delivery as asynchronous, outsourced, and anonymous, then proposes a 2x2 Real-Virtual Healthcare Delivery model focused on real and virtual patients and real and virtual provider organizations. Using this model, provider organizations can systematically deconstruct healthcare delivery in the real world and reconstruct appropriate pieces in the virtual world. Observed barriers to virtual healthcare delivery are: resistance to telecommunication integrated delivery networks and outsourcing; confusion over virtual infrastructure requirements for telemedicine and full-service web portals, and the impact of integrated delivery networks and outsourcing on extant cultural norms and revenue generating practices. To remain competitive provider organizations must integrate real and virtual healthcare delivery.

Virtual healthcare delivery: defined, modeled, and predictive barriers to implementation identified.

PubMed Central

Harrop, V. M.

2001-01-01

Provider organizations lack: 1. a definition of "virtual" healthcare delivery relative to the products, services, and processes offered by dot.coms, web-compact disk healthcare content providers, telemedicine, and telecommunications companies, and 2. a model for integrating real and virtual healthcare delivery. This paper defines virtual healthcare delivery as asynchronous, outsourced, and anonymous, then proposes a 2x2 Real-Virtual Healthcare Delivery model focused on real and virtual patients and real and virtual provider organizations. Using this model, provider organizations can systematically deconstruct healthcare delivery in the real world and reconstruct appropriate pieces in the virtual world. Observed barriers to virtual healthcare delivery are: resistance to telecommunication integrated delivery networks and outsourcing; confusion over virtual infrastructure requirements for telemedicine and full-service web portals, and the impact of integrated delivery networks and outsourcing on extant cultural norms and revenue generating practices. To remain competitive provider organizations must integrate real and virtual healthcare delivery. PMID:11825189

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

PubMed

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

2000-07-01

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

ITOHealth: a multimodal middleware-oriented integrated architecture for discovering medical entities.

PubMed

Alor-Hernández, Giner; Sánchez-Cervantes, José Luis; Juárez-Martínez, Ulises; Posada-Gómez, Rubén; Cortes-Robles, Guillermo; Aguilar-Laserre, Alberto

2012-03-01

Emergency healthcare is one of the emerging application domains for information services, which requires highly multimodal information services. The time of consuming pre-hospital emergency process is critical. Therefore, the minimization of required time for providing primary care and consultation to patients is one of the crucial factors when trying to improve the healthcare delivery in emergency situations. In this sense, dynamic location of medical entities is a complex process that needs time and it can be critical when a person requires medical attention. This work presents a multimodal location-based system for locating and assigning medical entities called ITOHealth. ITOHealth provides a multimodal middleware-oriented integrated architecture using a service-oriented architecture in order to provide information of medical entities in mobile devices and web browsers with enriched interfaces providing multimodality support. ITOHealth's multimodality is based on the use of Microsoft Agent Characters, the integration of natural language voice to the characters, and multi-language and multi-characters support providing an advantage for users with visual impairments.

Look Who's Under the Same Roof Now

ERIC Educational Resources Information Center

Green, Alan C.

1973-01-01

Discusses emerging steps toward integration and coordination of public services including using excess school and college space for community purposes; building extra space in order to provide room for other services; providing for education and social services through cooperative building ventures; joining schools and housing or commercial…

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

NASA Astrophysics Data System (ADS)

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

2012-05-01

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

LEOPACK The integrated services communications system based on LEO satellites

NASA Astrophysics Data System (ADS)

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

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

A Service Portal for the Integrated SCaN Network

NASA Technical Reports Server (NTRS)

Marx, Sarah R.

2012-01-01

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

Progress of Geomagnetism towards integration of data and services in EPOS

NASA Astrophysics Data System (ADS)

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

2017-04-01

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

An Open Service Provider Concept for Enterprise Complex Automation

NASA Astrophysics Data System (ADS)

Ivaschenko, A. V.; Sitnikov, P. V.; Tanonykhina, M. O.

2017-01-01

The paper introduces a solution for IT services representation and management in the integrated information space of distributed enterprises. It is proposed to develop an Open Service Provider as a software platform for interaction between IT services providers and their users. Implementation of the proposed concept and approach is illustrated by an after-sales customer support system for a large manufacturing corporation delivered by SEC “Open Code”.

Provider Experiences with Prison Care and Aftercare for Women with Co-occurring Mental Health and Substance Use Disorders: Treatment, Resource, and Systems Integration Challenges.

PubMed

Johnson, Jennifer E; Schonbrun, Yael Chatav; Peabody, Marlanea E; Shefner, Ruth T; Fernandes, Karen M; Rosen, Rochelle K; Zlotnick, Caron

2015-10-01

Incarcerated women with co-occurring mental health and substance use disorders (COD) face complex psychosocial challenges at community reentry. This study used qualitative methods to evaluate the perspectives of 14 prison and aftercare providers about service delivery challenges and treatment needs of reentering women with COD. Providers viewed the needs of women prisoners with COD as distinct from those of women with substance use alone and from men with COD. Providers described optimal aftercare for women with COD as including contact with the same provider before and after release, access to services within 24-72 hours after release, assistance with managing multiple social service agencies, assistance with relationship issues, and long-term follow-up. Providers also described larger service system and societal issues, including systems integration and ways in which a lack of prison and community aftercare resources impacted quality of care and reentry outcomes. Practice and policy implications are provided.

Provider Experiences with Prison Care and Aftercare for Women with Co-occurring Mental Health and Substance Use Disorders: Treatment, Resource, and Systems Integration Challenges

PubMed Central

Johnson, Jennifer E.; Schonbrun, Yael Chatav; Peabody, Marlanea E.; Shefner, Ruth T.; Fernandes, Karen M.; Rosen, Rochelle K.; Zlotnick, Caron

2014-01-01

Incarcerated women with co-occurring mental health and substance use disorders (COD) face complex psychosocial challenges at community reentry. This study used qualitative methods to evaluate the perspectives of 14 prison and aftercare providers about service delivery challenges and treatment needs of reentering women with COD. Providers viewed the needs of women prisoners with COD as distinct from those of women with substance use alone and from men with COD. Providers described optimal aftercare for women with COD as including contact with the same provider before and after release, access to services within 24–72 hours after release, assistance with managing multiple social service agencies, assistance with relationship issues, and long-term follow-up. Providers also described larger service system and societal issues, including systems integration and ways in which a lack of prison and community aftercare resources impacted quality of care and reentry outcomes. Practice and policy implications are provided. PMID:24595815

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

NASA Astrophysics Data System (ADS)

Lu, Xiaodong; Mori, Kinji

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

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

PubMed Central

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

2009-01-01

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

How size matters: exploring the association between quality of mental health services and catchment area size.

PubMed

Ala-Nikkola, Taina; Sadeniemi, Minna; Kaila, Minna; Saarni, Samuli; Kontio, Raija; Pirkola, Sami; Joffe, Grigori; Oranta, Olli; Wahlbeck, Kristian

2016-08-12

The diversity of mental health and substance abuse services (MHS) available to service users is seen as an indicator of the quality of the service system. In most countries MHS are provided by a mix of public, private and third sector providers. In Finland, officially, the municipalities are responsible for organizing the services needed, but the real extent and roles of private and third sector service providers are not known. Our previous study showed that the catchment area population size was strongly associated with diversity of mental health services. It is not known whether this was due to some types of services or some provider types being more sensitive to the size effect than others. The aim of this study was to investigate the association between area population size and diversity of mental health services, i.e. which types of services and which service providers' contributions are sensitive to population size. To map and classify services, we used the ESMS-R. The diversity of services was defined as the count of main types of care. Providers were classified as public, private or third sectors. The diversity of outpatient, residential and voluntary services correlated positively with catchment area population size. The strongest positive correlation between the size of population and services available was found in third sector activities followed by public providers, but no correlation was found for diversity of private services. The third sector and public corporations each provided 44 % of the service units. Third sector providers produced all self-help services and most of the day care services. Third sector and private companies provided a significant part (59 %) of the residential care service units. Significant positive correlations were found between size of catchment area population and diversity of residential, outpatient and voluntary services, indicating that these services concentrate on areas with larger population bases. The third sector seems to significantly complement the public sector in providing different services. Thus the third sector be needs to be functionally integrated with other MHS services to achieve a diversified and integrated service system.

Integrating Communication Skills into Functional Routines & Activities.

ERIC Educational Resources Information Center

Stremel, Kathleen

This training module on integrating communication skills into functional routines and activities is from the Mississippi Early Education Program for Children with Multiple Disabilities, a program designed to train Individuals with Disabilities Education Act Part H service coordinators and service providers to use family centered strategies. The…

Does integration of HIV and sexual and reproductive health services improve technical efficiency in Kenya and Swaziland? An application of a two-stage semi parametric approach incorporating quality measures

PubMed Central

Obure, Carol Dayo; Jacobs, Rowena; Guinness, Lorna; Mayhew, Susannah; Vassall, Anna

2016-01-01

Theoretically, integration of vertically organized services is seen as an important approach to improving the efficiency of health service delivery. However, there is a dearth of evidence on the effect of integration on the technical efficiency of health service delivery. Furthermore, where technical efficiency has been assessed, there have been few attempts to incorporate quality measures within efficiency measurement models particularly in sub-Saharan African settings. This paper investigates the technical efficiency and the determinants of technical efficiency of integrated HIV and sexual and reproductive health (SRH) services using data collected from 40 health facilities in Kenya and Swaziland for 2008/2009 and 2010/2011. Incorporating a measure of quality, we estimate the technical efficiency of health facilities and explore the effect of integration and other environmental factors on technical efficiency using a two-stage semi-parametric double bootstrap approach. The empirical results reveal a high degree of inefficiency in the health facilities studied. The mean bias corrected technical efficiency scores taking quality into consideration varied between 22% and 65% depending on the data envelopment analysis (DEA) model specification. The number of additional HIV services in the maternal and child health unit, public ownership and facility type, have a positive and significant effect on technical efficiency. However, number of additional HIV and STI services provided in the same clinical room, proportion of clinical staff to overall staff, proportion of HIV services provided, and rural location had a negative and significant effect on technical efficiency. The low estimates of technical efficiency and mixed effects of the measures of integration on efficiency challenge the notion that integration of HIV and SRH services may substantially improve the technical efficiency of health facilities. The analysis of quality and efficiency as separate dimensions of performance suggest that efficiency may be achieved without sacrificing quality. PMID:26803655

Does integration of HIV and sexual and reproductive health services improve technical efficiency in Kenya and Swaziland? An application of a two-stage semi parametric approach incorporating quality measures.

PubMed

Obure, Carol Dayo; Jacobs, Rowena; Guinness, Lorna; Mayhew, Susannah; Vassall, Anna

2016-02-01

Theoretically, integration of vertically organized services is seen as an important approach to improving the efficiency of health service delivery. However, there is a dearth of evidence on the effect of integration on the technical efficiency of health service delivery. Furthermore, where technical efficiency has been assessed, there have been few attempts to incorporate quality measures within efficiency measurement models particularly in sub-Saharan African settings. This paper investigates the technical efficiency and the determinants of technical efficiency of integrated HIV and sexual and reproductive health (SRH) services using data collected from 40 health facilities in Kenya and Swaziland for 2008/2009 and 2010/2011. Incorporating a measure of quality, we estimate the technical efficiency of health facilities and explore the effect of integration and other environmental factors on technical efficiency using a two-stage semi-parametric double bootstrap approach. The empirical results reveal a high degree of inefficiency in the health facilities studied. The mean bias corrected technical efficiency scores taking quality into consideration varied between 22% and 65% depending on the data envelopment analysis (DEA) model specification. The number of additional HIV services in the maternal and child health unit, public ownership and facility type, have a positive and significant effect on technical efficiency. However, number of additional HIV and STI services provided in the same clinical room, proportion of clinical staff to overall staff, proportion of HIV services provided, and rural location had a negative and significant effect on technical efficiency. The low estimates of technical efficiency and mixed effects of the measures of integration on efficiency challenge the notion that integration of HIV and SRH services may substantially improve the technical efficiency of health facilities. The analysis of quality and efficiency as separate dimensions of performance suggest that efficiency may be achieved without sacrificing quality. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Service-Learning and Learning Communities: Tools for Integration and Assessment.

ERIC Educational Resources Information Center

Oates, Karen K.; Leavitt, Lynn H.

This publication attempts to provide fundamental theory about service-learning and learning communities, along with descriptions of best practices, lessons learned, and assessment strategies. The text is designed to provide resources to help readers offer service-learning experiences for their students. Learning communities are now commonly…

Scheduling multimedia services in cloud computing environment

NASA Astrophysics Data System (ADS)

Liu, Yunchang; Li, Chunlin; Luo, Youlong; Shao, Yanling; Zhang, Jing

2018-02-01

Currently, security is a critical factor for multimedia services running in the cloud computing environment. As an effective mechanism, trust can improve security level and mitigate attacks within cloud computing environments. Unfortunately, existing scheduling strategy for multimedia service in the cloud computing environment do not integrate trust mechanism when making scheduling decisions. In this paper, we propose a scheduling scheme for multimedia services in multi clouds. At first, a novel scheduling architecture is presented. Then, We build a trust model including both subjective trust and objective trust to evaluate the trust degree of multimedia service providers. By employing Bayesian theory, the subjective trust degree between multimedia service providers and users is obtained. According to the attributes of QoS, the objective trust degree of multimedia service providers is calculated. Finally, a scheduling algorithm integrating trust of entities is proposed by considering the deadline, cost and trust requirements of multimedia services. The scheduling algorithm heuristically hunts for reasonable resource allocations and satisfies the requirement of trust and meets deadlines for the multimedia services. Detailed simulated experiments demonstrate the effectiveness and feasibility of the proposed trust scheduling scheme.

Improving sexual health for HIV patients by providing a combination of integrated public health and hospital care services; a one-group pre- and post test intervention comparison.

PubMed

Dukers-Muijrers, Nicole Htm; Somers, Carlijn; Hoebe, Christian Jpa; Lowe, Selwyn H; Niekamp, Anne-Marie Ejwm; Oude Lashof, Astrid; Bruggeman, Cathrien Amvh; Vrijhoef, Hubertus Jm

2012-12-27

Hospital HIV care and public sexual health care (a Sexual Health Care Centre) services were integrated to provide sexual health counselling and sexually transmitted infections (STIs) testing and treatment (sexual health care) to larger numbers of HIV patients. Services, need and usage were assessed using a patient perspective, which is a key factor for the success of service integration. The study design was a one-group pre-test and post-test comparison of 447 HIV-infected heterosexual individuals and men who have sex with men (MSM) attending a hospital-based HIV centre serving the southern region of the Netherlands. The intervention offered comprehensive sexual health care using an integrated care approach. The main outcomes were intervention uptake, patients' pre-test care needs (n=254), and quality rating. Pre intervention, 43% of the patients wanted to discuss sexual health (51% MSM; 30% heterosexuals). Of these patients, 12% to 35% reported regular coverage, and up to 25% never discussed sexual health topics at their HIV care visits. Of the patients, 24% used our intervention. Usage was higher among patients who previously expressed a need to discuss sexual health. Most patients who used the integrated services were new users of public health services. STIs were detected in 13% of MSM and in none of the heterosexuals. The quality of care was rated good. The HIV patients in our study generally considered sexual health important, but the regular counselling and testing at the HIV care visit was insufficient. The integration of public health and hospital services benefited both care sectors and their patients by addressing sexual health questions, detecting STIs, and conducting partner notification. Successful sexual health care uptake requires increased awareness among patients about their care options as well as a cultural shift among care providers.

Improving sexual health for HIV patients by providing a combination of integrated public health and hospital care services; a one-group pre- and post test intervention comparison

PubMed Central

2012-01-01

Background Hospital HIV care and public sexual health care (a Sexual Health Care Centre) services were integrated to provide sexual health counselling and sexually transmitted infections (STIs) testing and treatment (sexual health care) to larger numbers of HIV patients. Services, need and usage were assessed using a patient perspective, which is a key factor for the success of service integration. Methods The study design was a one-group pre-test and post-test comparison of 447 HIV-infected heterosexual individuals and men who have sex with men (MSM) attending a hospital-based HIV centre serving the southern region of the Netherlands. The intervention offered comprehensive sexual health care using an integrated care approach. The main outcomes were intervention uptake, patients’ pre-test care needs (n=254), and quality rating. Results Pre intervention, 43% of the patients wanted to discuss sexual health (51% MSM; 30% heterosexuals). Of these patients, 12% to 35% reported regular coverage, and up to 25% never discussed sexual health topics at their HIV care visits. Of the patients, 24% used our intervention. Usage was higher among patients who previously expressed a need to discuss sexual health. Most patients who used the integrated services were new users of public health services. STIs were detected in 13% of MSM and in none of the heterosexuals. The quality of care was rated good. Conclusions The HIV patients in our study generally considered sexual health important, but the regular counselling and testing at the HIV care visit was insufficient. The integration of public health and hospital services benefited both care sectors and their patients by addressing sexual health questions, detecting STIs, and conducting partner notification. Successful sexual health care uptake requires increased awareness among patients about their care options as well as a cultural shift among care providers. PMID:23270463

Globus | Informatics Technology for Cancer Research (ITCR)

Cancer.gov

Globus software services provide secure cancer research data transfer, synchronization, and sharing in distributed environments at large scale. These services can be integrated into applications and research data gateways, leveraging Globus identity management, single sign-on, search, and authorization capabilities. Globus Genomics integrates Globus with the Galaxy genomics workflow engine and Amazon Web Services to enable cancer genomics analysis that can elastically scale compute resources with demand.

A starting point for delivery reform. Catholic healthcare providers can receive guidance from "A Time to Be Old, a Time to Flourish".

PubMed

1992-03-01

The ideal healthcare delivery system is client focused and ensures that the individual and the family receive the appropriate mix of services to meet their needs. Healthcare delivery should be presented as a coordinated continuum of care. Key integrating elements are essential to provide healthcare services on a day-by-day basis as a continuum of care. Integrating elements that form the bridge between clients and services include planning, care management, a management information system, financing, and an appropriate administrative structure. Many Catholic healthcare providers are expanding by acquiring a variety of services. However, many of these acquisitions are in response to today's competitive environment, whereas a true continuum of care must focus on the client's range of functional needs. Catholic providers must keep in mind that not all services they provide will be profitable. Although Catholic healthcare providers will be pressured to focus on fiscal strength and market position, they must put the client's holistic needs first. By doing so, they can help create a client-centered healthcare system in their communities.

A Comparison of Medical Birth Register Outcomes between Maternity Health Clinics and Integrated Maternity and Child Health Clinics in Southwest Finland

PubMed Central

Kaljonen, Anne; Ahonen, Pia; Mäkinen, Juha; Rautava, Päivi

2016-01-01

Introduction: Primary maternity care services are globally provided according to various organisational models. Two models are common in Finland: a maternity health clinic and an integrated maternity and child health clinic. The aim of this study was to clarify whether there is a relation between the organisational model of the maternity health clinics and the utilisation of maternity care services, and certain maternal and perinatal health outcomes. Methods: A comparative, register-based cross-sectional design was used. The data of women (N = 2741) who had given birth in the Turku University Hospital area between 1 January 2009 and 31 December 2009 were collected from the Finnish Medical Birth Register. Comparisons were made between the women who were clients of the maternity health clinics and integrated maternity and child health clinics. Results: There were no clinically significant differences between the clients of maternity health clinics and integrated maternity and child health clinics regarding the utilisation of maternity care services or the explored health outcomes. Conclusions: The organisational model of the maternity health clinic does not impact the utilisation of maternity care services or maternal and perinatal health outcomes. Primary maternity care could be provided effectively when integrated with child health services. PMID:27761106

A Comparison of Medical Birth Register Outcomes between Maternity Health Clinics and Integrated Maternity and Child Health Clinics in Southwest Finland.

PubMed

Tuominen, Miia; Kaljonen, Anne; Ahonen, Pia; Mäkinen, Juha; Rautava, Päivi

2016-07-08

Primary maternity care services are globally provided according to various organisational models. Two models are common in Finland: a maternity health clinic and an integrated maternity and child health clinic. The aim of this study was to clarify whether there is a relation between the organisational model of the maternity health clinics and the utilisation of maternity care services, and certain maternal and perinatal health outcomes. A comparative, register-based cross-sectional design was used. The data of women (N = 2741) who had given birth in the Turku University Hospital area between 1 January 2009 and 31 December 2009 were collected from the Finnish Medical Birth Register. Comparisons were made between the women who were clients of the maternity health clinics and integrated maternity and child health clinics. There were no clinically significant differences between the clients of maternity health clinics and integrated maternity and child health clinics regarding the utilisation of maternity care services or the explored health outcomes. The organisational model of the maternity health clinic does not impact the utilisation of maternity care services or maternal and perinatal health outcomes. Primary maternity care could be provided effectively when integrated with child health services.

New Zealand's health providers in an emerging market.

PubMed

Malcolm, L; Barnett, P

1994-01-01

Services have almost completely replaced hospitals as the organisational units in the reformed New Zealand health care system. Within the secondary service provider sector service management, the decentralisation of general management to budget-holding clinical groupings has been an important factor in achieving a population focus, cost containment, accountability and integration. It is being further developed within the 23 newly formed Crown health enterprises (CHEs), the main providers of secondary, hospital and related services. The CHEs are evolving roles beyond a narrow definition of 'providers', taking initiatives to collaborate with other providers, or rejecting those elements of competition that might interfere with effective local co-ordination of services. Service management is also being extended to the demand-driven, fee-for-service primary care sector, where inflation-adjusted expenditure over the last decade has grown at more than 6%, compared with zero growth in the capitation-financed secondary sector. This is being achieved in both general practice and community budget-holder groupings through what might be called managed primary health care. The current health reform process has also created four regional health authorities (RHAs), responsible, within capped and capitated budgets, for the fully integrated purchasing of services from both primary and secondary providers. The success of these innovative arrangements, which could be of international significance, will depend upon the quality of the developing relationships between providers and their purchasing RHAs.

Issues in the Linkage and Integration of Treatment and Rehabilitation Services for Chronically Mentally Ill Persons.

ERIC Educational Resources Information Center

Woy, J. Richard; Dellario, Donald J.

1985-01-01

Compares and contrasts characteristics of the mental health system and the Vocational Rehabilitation (VR) service system; examines environmental, intraorganizational, and interorganizational variables as they pertain to potential for linkages between mental health and VR providers; and discusses implications for improved integration of treatment…

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

ERIC Educational Resources Information Center

Saba, Farhad; Twitchell, David

1989-01-01

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

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

ERIC Educational Resources Information Center

Chiatula, Victoria Oliaku

2015-01-01

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

The Implementation of Integrated Behavioral Health Protocols In Primary Care Settings in Project Care.

PubMed

Padwa, Howard; Teruya, Cheryl; Tran, Elise; Lovinger, Katherine; Antonini, Valerie P; Overholt, Colleen; Urada, Darren

2016-03-01

The majority of adults with mental health (MH) and substance use (SU) disorders in the United States do not receive treatment. The Affordable Care Act will create incentives for primary care centers to begin providing behavioral health (MH and SU) services, thus promising to address the MH and SU treatment gaps. This paper examines the implementation of integrated care protocols by three primary care organizations. The Behavioral Health Integration in Medical Care (BHIMC) tool was used to evaluate the integrated care capacity of primary care organizations that chose to participate in the Kern County (California) Mental Health Department's Project Care annually for 3years. For a subsample of clinics, change over time was measured. Informed by the Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors, inner and outer contextual factors impacting implementation were identified and analyzed using multiple data sources and qualitative analytic methods. The primary care organizations all offered partially integrated (PI) services throughout the study period. At baseline, organizations offered minimally integrated/partially integrated (MI/PI) services in the Program Milieu, Clinical Process - Treatment, and Staffing domains of the BHIMC, and scores on all domains were at the partially integrated (PI) level or higher in the first and second follow-ups. Integrated care services emphasized the identification and management of MH more than SU in 52.2% of evaluated domains, but did not emphasize SU more than MH in any of them. Many of the gaps between MH and SU emphases were associated with limited capacities related to SU medications. Several outer (socio-political context, funding, leadership) and inner (organizational characteristics, individual adopter characteristics, leadership, innovation-values fit) contextual factors impacted the development of integrated care capacity. This study of a small sample of primary care organizations showed that it is possible to improve their integrated care capacity as measured by the BHIMC, though it may be difficult or unfeasible for them to provide fully integrated behavioral health services. Integrated services emphasized MH more than SU, and enhancing primary care clinic capacities related to SU medications may help close this gap. Both inner and outer contextual factors may impact integrated service capacity development in primary care clinics. Study findings may be used to inform future research on integrated care and inform the implementation of efforts to enhance integrated care capacity in primary care clinics. Copyright © 2015 Elsevier Inc. All rights reserved.

Toward multidomain integrated network management for ATM and SDH networks

NASA Astrophysics Data System (ADS)

Galis, Alex; Gantenbein, Dieter; Covaci, Stefan; Bianza, Carlo; Karayannis, Fotis; Mykoniatis, George

1996-12-01

ACTS Project AC080 MISA has embarked upon the task of realizing and validating via European field trials integrated end-to-end management of hybrid SDH and ATM networks in the framework of open network provision. This paper reflects the initial work of the project and gives an overview of the proposed MISA system architecture and initial design. We describe our understanding of the underlying enterprise model in the network management context, including the concept of the MISA Global Broadband Connectivity Management service. It supports Integrated Broadband Communication by defining an end-to-end broadband connection service in a multi-domain business environment. Its implementation by the MISA consortium within trials across Europe aims for an efficient management of network resources of the SDH and ATM infrastructure, considering optimum end-to-end quality of service and the needs of a number of telecommunication actors: customers, value-added service providers, and network providers.

Development of an integrated medical supply information system

NASA Astrophysics Data System (ADS)

Xu, Eric; Wermus, Marek; Blythe Bauman, Deborah

2011-08-01

The integrated medical supply inventory control system introduced in this study is a hybrid system that is shaped by the nature of medical supply, usage and storage capacity limitations of health care facilities. The system links demand, service provided at the clinic, health care service provider's information, inventory storage data and decision support tools into an integrated information system. ABC analysis method, economic order quantity model, two-bin method and safety stock concept are applied as decision support models to tackle inventory management issues at health care facilities. In the decision support module, each medical item and storage location has been scrutinised to determine the best-fit inventory control policy. The pilot case study demonstrates that the integrated medical supply information system holds several advantages for inventory managers, since it entails benefits of deploying enterprise information systems to manage medical supply and better patient services.

Metadata-Driven SOA-Based Application for Facilitation of Real-Time Data Warehousing

NASA Astrophysics Data System (ADS)

Pintar, Damir; Vranić, Mihaela; Skočir, Zoran

Service-oriented architecture (SOA) has already been widely recognized as an effective paradigm for achieving integration of diverse information systems. SOA-based applications can cross boundaries of platforms, operation systems and proprietary data standards, commonly through the usage of Web Services technology. On the other side, metadata is also commonly referred to as a potential integration tool given the fact that standardized metadata objects can provide useful information about specifics of unknown information systems with which one has interest in communicating with, using an approach commonly called "model-based integration". This paper presents the result of research regarding possible synergy between those two integration facilitators. This is accomplished with a vertical example of a metadata-driven SOA-based business process that provides ETL (Extraction, Transformation and Loading) and metadata services to a data warehousing system in need of a real-time ETL support.

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

PubMed Central

2011-01-01

Background The complexity and inter-related nature of biological data poses a difficult challenge for data and tool integration. There has been a proliferation of interoperability standards and projects over the past decade, none of which has been widely adopted by the bioinformatics community. Recent attempts have focused on the use of semantics to assist integration, and Semantic Web technologies are being welcomed by this community. Description SADI - Semantic Automated Discovery and Integration - is a lightweight set of fully standards-compliant Semantic Web service design patterns that simplify the publication of services of the type commonly found in bioinformatics and other scientific domains. Using Semantic Web technologies at every level of the Web services "stack", SADI services consume and produce instances of OWL Classes following a small number of very straightforward best-practices. In addition, we provide codebases that support these best-practices, and plug-in tools to popular developer and client software that dramatically simplify deployment of services by providers, and the discovery and utilization of those services by their consumers. Conclusions SADI Services are fully compliant with, and utilize only foundational Web standards; are simple to create and maintain for service providers; and can be discovered and utilized in a very intuitive way by biologist end-users. In addition, the SADI design patterns significantly improve the ability of software to automatically discover appropriate services based on user-needs, and automatically chain these into complex analytical workflows. We show that, when resources are exposed through SADI, data compliant with a given ontological model can be automatically gathered, or generated, from these distributed, non-coordinating resources - a behaviour we have not observed in any other Semantic system. Finally, we show that, using SADI, data dynamically generated from Web services can be explored in a manner very similar to data housed in static triple-stores, thus facilitating the intersection of Web services and Semantic Web technologies. PMID:22024447

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

PubMed

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

2011-10-24

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

Managed care, vertical integration strategies and hospital performance.

PubMed

Wang, B B; Wan, T T; Clement, J; Begun, J

2001-09-01

The purpose of this study is to examine the association of managed care with hospital vertical integration strategies, as well as to observe the relationships of different types of vertical integration with hospital efficiency and financial performance. The sample consists of 363 California short-term acute care hospitals in 1994. Linear structure equation modeling is used to test six hypotheses derived from the strategic adaptation model. Several organizational and market factors are controlled statistically. Results suggest that managed care is a driving force for hospital vertical integration. In terms of performance, hospitals that are integrated with physician groups and provide outpatient services (backward integration) have better operating margins, returns on assets, and net cash flows (p < 0.01). These hospitals are not, however, likely to show greater productivity. Forward integration with a long-term-care facility, on the other hand, is positively and significantly related to hospital productivity (p < 0.001). Forward integration is negatively related to financial performance (p < 0.05), however, opposite to the direction hypothesized. Health executives should be responsive to the growth of managed care in their local market and should probably consider providing more backward integrated services rather than forward integrated services in order to improve the hospital's financial performance in today's competitive health care market.

Evolving technologies drive the new roles of Biomedical Engineering.

PubMed

Frisch, P H; St Germain, J; Lui, W

2008-01-01

Rapidly changing technology coupled with the financial impact of organized health care, has required hospital Biomedical Engineering organizations to augment their traditional operational and business models to increase their role in developing enhanced clinical applications utilizing new and evolving technologies. The deployment of these technology based applications has required Biomedical Engineering organizations to re-organize to optimize the manner in which they provide and manage services. Memorial Sloan-Kettering Cancer Center has implemented a strategy to explore evolving technologies integrating them into enhanced clinical applications while optimally utilizing the expertise of the traditional Biomedical Engineering component (Clinical Engineering) to provide expanded support in technology / equipment management, device repair, preventive maintenance and integration with legacy clinical systems. Specifically, Biomedical Engineering is an integral component of the Medical Physics Department which provides comprehensive and integrated support to the Center in advanced physical, technical and engineering technology. This organizational structure emphasizes the integration and collaboration between a spectrum of technical expertise for clinical support and equipment management roles. The high cost of clinical equipment purchases coupled with the increasing cost of service has driven equipment management responsibilities to include significant business and financial aspects to provide a cost effective service model. This case study details the dynamics of these expanded roles, future initiatives and benefits for Biomedical Engineering and Memorial Sloan Kettering Cancer Center.

HIV Services Provided by STD Programs in State and Local Health Departments - United States, 2013-2014.

PubMed

Cuffe, Kendra M; Esie, Precious; Leichliter, Jami S; Gift, Thomas L

2017-04-07

The incidence of human immunodeficiency virus (HIV) infection in the United States is higher among persons with other sexually transmitted diseases (STDs), and the incidence of other STDs is increased among persons with HIV infection (1). Because infection with an STD increases the risk for HIV acquisition and transmission (1-4), successfully treating STDs might help reduce the spread of HIV among persons at high risk (1-4). Because health department STD programs provide services to populations who are at risk for HIV, ensuring service integration and coordination could potentially reduce the incidence of STDs and HIV. Program integration refers to the combining of STD and HIV prevention programs through structural, service, or policy-related changes such as combining funding streams, performing STD and HIV case matching, or integrating staff members (5). Some STD programs in U.S. health departments are partially or fully integrated with an HIV program (STD/HIV program), whereas other STD programs are completely separate. To assess the extent of provision of HIV services by state and local health department STD programs, CDC analyzed data from a sample of 311 local health departments and 56 state and directly funded city health departments derived from a national survey of STD programs. CDC found variation in the provision of HIV services by STD programs at the state and local levels. Overall, 73.1% of state health departments and 16.1% of local health departments matched STD case report data with HIV data to analyze possible syndemics (co-occurring epidemics that exacerbate the negative health effects of any of the diseases) and overlaps. Similarly, 94.1% of state health departments and 46.7% of local health departments performed site visits to HIV care providers to provide STD information or public health updates. One fourth of state health departments and 39.4% of local health departments provided HIV testing in nonclinical settings (field testing) for STD contacts, and all of these programs linked HIV cases to care. STD programs are providing some HIV services; however, delivery of certain specific services could be improved.

34 CFR 361.49 - Scope of vocational rehabilitation services for groups of individuals with disabilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... is used to provide vocational rehabilitation services that promote integration and competitive..., which may not exceed 6 months. (iv) If the designated State unit provides for these services, it must... groups of individuals, it must— (1) Develop and maintain written policies covering the nature and scope...

34 CFR 361.49 - Scope of vocational rehabilitation services for groups of individuals with disabilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... is used to provide vocational rehabilitation services that promote integration and competitive..., which may not exceed 6 months. (iv) If the designated State unit provides for these services, it must... groups of individuals, it must— (1) Develop and maintain written policies covering the nature and scope...

34 CFR 361.49 - Scope of vocational rehabilitation services for groups of individuals with disabilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

... is used to provide vocational rehabilitation services that promote integration and competitive..., which may not exceed 6 months. (iv) If the designated State unit provides for these services, it must... groups of individuals, it must— (1) Develop and maintain written policies covering the nature and scope...

Integrated Air Surveillance Concept of Operations

DTIC Science & Technology

2011-11-01

information, intelligence, weather data, and other situational awareness-related information. 4.2.4 Shared Services Automated processing of sensor and...other surveillance information will occur through shared services , accessible through an enterprise network infrastructure, that provide for collecting...also be provided, such as information discovery and translation. The IS architecture effort will identify specific shared services . Shared

Pre-Service Teachers Designing Virtual World Learning Environments

ERIC Educational Resources Information Center

Jacka, Lisa; Booth, Kate

2012-01-01

Integrating Information Technology Communications in the classroom has been an important part of pre-service teacher education for over a decade. The advent of virtual worlds provides the pre-service teacher with an opportunity to study teaching and learning in a highly immersive 3D computer-based environment. Virtual worlds also provide a place…

Oregon School-Based Health Centers 1996-1997 Services Report.

ERIC Educational Resources Information Center

Alexander, Tammis; Nystrom, Robert J.; Spitz, Lauren

School based health centers (SBHC) are effective providers of health services and education because they are easy for students to access, they take an integrated and developmentally appropriate approach to meeting health needs, and they are prevention-oriented. This report describes the 1996-1997 services provided in 15 of 19 state-supported…

Family planning and health: the Narangwal experiment.

PubMed

Faruqee, R

1983-06-01

The findings of a 7-year field experiment conducted in the Indian Punjab show that integrating family planning with health services is more effective and efficient than providing family planning separately. The field experiment was conducted between 1968 and 1974 at Narangwal in the Indian State of Punjab. It involved 26 villages, with a total population of 35,000 in 1971-72. The demographic characteristics of the villages were found to be typical of the area. 5 groups of villages were provided with different combinations of services for health, nutrition and family planning. A control group received no project services. A population study was made of the effects of integrating family planning with maternal and child health services. A nutritional study looked at the results of integrating nutritional care and health services. The effectiveness of integration was evaluated by identifying it both with increased use of family planning and improved health. Efficiency was judged by relating effectiveness to input costs. Distribution of the benefits was also examined. The effectiveness of these different combinations of services on the use of family planning was measured: 1) by all changes in the use of modern methods of family planning, 2) by the number of new acceptors, 3) by the changes in the proportion of eligible women using contraceptives, and 4) by how many people started to use the more effective methods. Results showed the use of family planning increased substantially in the experimental groups, whereas the control group remained constant. It was also found that, though the services combining family planning with maternal health care stimulated more use of family planning, they were more costly than the more integrated srevices. The Narangwal experiment provides significant evidence in favor of combining the provision of family planning and health services, but its potential for replication on a large scale needs to be studied.

Development of a GIS-based integrated framework for coastal seiches monitoring and forecasting: A North Jiangsu shoal case study

NASA Astrophysics Data System (ADS)

Qin, Rufu; Lin, Liangzhao

2017-06-01

Coastal seiches have become an increasingly important issue in coastal science and present many challenges, particularly when attempting to provide warning services. This paper presents the methodologies, techniques and integrated services adopted for the design and implementation of a Seiches Monitoring and Forecasting Integration Framework (SMAF-IF). The SMAF-IF is an integrated system with different types of sensors and numerical models and incorporates the Geographic Information System (GIS) and web techniques, which focuses on coastal seiche events detection and early warning in the North Jiangsu shoal, China. The in situ sensors perform automatic and continuous monitoring of the marine environment status and the numerical models provide the meteorological and physical oceanographic parameter estimates. A model outputs processing software was developed in C# language using ArcGIS Engine functions, which provides the capabilities of automatically generating visualization maps and warning information. Leveraging the ArcGIS Flex API and ASP.NET web services, a web based GIS framework was designed to facilitate quasi real-time data access, interactive visualization and analysis, and provision of early warning services for end users. The integrated framework proposed in this study enables decision-makers and the publics to quickly response to emergency coastal seiche events and allows an easy adaptation to other regional and scientific domains related to real-time monitoring and forecasting.

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

PubMed

Page, Nivedita Dilip

2017-01-01

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

Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health?

PubMed

van Ryn, Michelle; Fu, Steven S

2003-02-01

There is extensive evidence of racial/ethnic disparities in receipt of health care. The potential contribution of provider behavior to such disparities has remained largely unexplored. Do health and human service providers behave in ways that contribute to systematic inequities in care and outcomes? If so, why does this occur? The authors build on existing evidence to provide an integrated, coherent, and sound approach to research on providers' contributions to racial/ethnic disparities. They review the evidence regarding provider contributions to disparities in outcomes and describe a causal model representing an integrated set of hypothesized mechanisms through which health care providers' behaviors may contribute to these disparities.

An Information Technology Framework for Strengthening Telehealthcare Service Delivery

PubMed Central

Chen, Chi-Wen; Weng, Yung-Ching; Shang, Rung-Ji; Yu, Hui-Chu; Chung, Yufang; Lai, Feipei

2012-01-01

Abstract Objective: Telehealthcare has been used to provide healthcare service, and information technology infrastructure appears to be essential while providing telehealthcare service. Insufficiencies have been identified, such as lack of integration, need of accommodation of diverse biometric sensors, and accessing diverse networks as different houses have varying facilities, which challenge the promotion of telehealthcare. This study designs an information technology framework to strengthen telehealthcare delivery. Materials and Methods: The proposed framework consists of a system architecture design and a network transmission design. The aim of the framework is to integrate data from existing information systems, to adopt medical informatics standards, to integrate diverse biometric sensors, and to provide different data transmission networks to support a patient's house network despite the facilities. The proposed framework has been evaluated with a case study of two telehealthcare programs, with and without the adoption of the framework. Results: The proposed framework facilitates the functionality of the program and enables steady patient enrollments. The overall patient participations are increased, and the patient outcomes appear positive. The attitudes toward the service and self-improvement also are positive. Conclusions: The findings of this study add up to the construction of a telehealthcare system. Implementing the proposed framework further assists the functionality of the service and enhances the availability of the service and patient acceptances. PMID:23061641

An information technology framework for strengthening telehealthcare service delivery.

PubMed

Chen, Li-Chin; Chen, Chi-Wen; Weng, Yung-Ching; Shang, Rung-Ji; Yu, Hui-Chu; Chung, Yufang; Lai, Feipei

2012-10-01

Telehealthcare has been used to provide healthcare service, and information technology infrastructure appears to be essential while providing telehealthcare service. Insufficiencies have been identified, such as lack of integration, need of accommodation of diverse biometric sensors, and accessing diverse networks as different houses have varying facilities, which challenge the promotion of telehealthcare. This study designs an information technology framework to strengthen telehealthcare delivery. The proposed framework consists of a system architecture design and a network transmission design. The aim of the framework is to integrate data from existing information systems, to adopt medical informatics standards, to integrate diverse biometric sensors, and to provide different data transmission networks to support a patient's house network despite the facilities. The proposed framework has been evaluated with a case study of two telehealthcare programs, with and without the adoption of the framework. The proposed framework facilitates the functionality of the program and enables steady patient enrollments. The overall patient participations are increased, and the patient outcomes appear positive. The attitudes toward the service and self-improvement also are positive. The findings of this study add up to the construction of a telehealthcare system. Implementing the proposed framework further assists the functionality of the service and enhances the availability of the service and patient acceptances.

Low earth orbit satellite/terrestrial mobile service compatibility

NASA Technical Reports Server (NTRS)

Sheriff, R. E.; Gardiner, J. G.

1993-01-01

Digital cellular mobile 'second generation' systems are now gradually being introduced into service; one such example is GSM, which will provide a digital voice and data service throughout Europe. Total coverage is not expected to be achieved until the mid '90's, which has resulted in several proposals for the integration of GSM with a geostationary satellite service. Unfortunately, because terrestrial and space systems have been designed to optimize their performance for their particular environment, integration between a satellite and terrestrial system is unlikely to develop further than the satellite providing a back-up service. This lack of system compatibility is now being addressed by system designers of third generation systems. The next generation of mobile systems, referred to as FPLMTS (future public land mobile telecommunication systems) by CCIR and UMTS (universal mobile telecommunication system) in European research programs, are intended to provide inexpensive, hand-held terminals that can operate in either satellite, cellular, or cordless environments. This poses several challenges for system designers, not least in terms of the choice of multiple access technique and power requirements. Satellite mobile services have been dominated by the geostationary orbital type. Recently, however, a number of low earth orbit configurations have been proposed, for example Iridium. These systems are likely to be fully operational by the turn of the century, in time for the implementation of FPLMTS. The developments in LEO mobile satellite service technology were recognized at WARC-92 with the allocation of specific frequency bands for 'big' LEO's, as well as a frequency allocation for FPLMTS which included a specific satellite allocation. When considering integrating a space service into the terrestrial network, LEO's certainly appear to have their attractions: they can provide global coverage, the round trip delay is of the order of tens of milliseconds, and good visibility to the satellite is usually possible. This has resulted in their detailed investigation in the European COST 227 program and in the work program of the European Telecommunications Standards Institute (ETSI). This paper will consider the system implications of integrating a LEO mobile service with a terrestrial service. Results will be presented from simulation software to show how a particular orbital configuration affects the performance of the system in terms of area coverage and visibility to a terminal for various locations and minimum elevation angle. Possible network topologies are then proposed for an integrated satellite/terrestrial network.

Quality effort decision in service supply chain with quality preference based on quantum game

NASA Astrophysics Data System (ADS)

Zhang, Cuihua; Xing, Peng; Wang, Jianwei

2015-04-01

Service quality preference behaviors of both members are considered in service supply chain (SSC) including a service integrator and a service provider with stochastic demand. Through analysis of service quality cost and revenue, the utility functions are established on service quality effort degree and service quality preference level in integrated and decentralized SSC. Nash equilibrium and quantum game are used to optimize the models. By comparing the different solutions, the optimal strategies are obtained in SSC with quality preference. Then some numerical examples are studied and the changing trend of service quality effort is further analyzed by the influence of the entanglement operator and quality preferences.

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

PubMed

Wijesinghe, Thushanthi S; Wijesinghe, Pushpa Ranjan

2013-01-01

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

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

PubMed Central

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

2017-01-01

Abstract The aim of this study was to investigate association between HIV and family planning integration and technical quality of care. The study focused on technical quality of client–provider consultation sessions. The cross-sectional study observed 366 client–provider consultation sessions and interviewed 37 health care providers in 12 public health facilities in Kenya. Multilevel random intercept and linear regression models were fitted to the matched data to investigate relationships between service integration and technical quality of care as well as associations between facility-level structural and provider factors and technical quality of care. A sensitivity analysis was performed to test for hidden bias. After adjusting for facility-level structural factors, HIV/family planning integration was found to have significant positive effect on technical quality of the consultation session, with average treatment effect 0.44 (95% CI: 0.63–0.82). Three of the 12 structural factors were significantly positively associated with technical quality of consultation session including: availability of family planning commodities (9.64; 95% CI: 5.07–14.21), adequate infrastructure (5.29; 95% CI: 2.89–7.69) and reagents (1.48; 95% CI: 1.02–1.93). Three of the nine provider factors were significantly positively associated with technical quality of consultation session: appropriate provider clinical knowledge (3.14; 95% CI: 1.92–4.36), job satisfaction (2.02; 95% CI: 1.21–2.83) and supervision (1.01; 95% CI: 0.35–1.68), while workload (−0.88; 95% CI: −1.75 to − 0.01) was negatively associated. Technical quality of the client–provider consultation session was also determined by duration of the consultation and type of clinic visit and appeared to depend on whether the clinic visit occurred early or later in the week. Integration of HIV care into family planning services can improve the technical quality of client–provider consultation sessions as measured by both health facility structural and provider factors. PMID:29194543

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

PubMed

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

2017-11-01

The aim of this study was to investigate association between HIV and family planning integration and technical quality of care. The study focused on technical quality of client-provider consultation sessions. The cross-sectional study observed 366 client-provider consultation sessions and interviewed 37 health care providers in 12 public health facilities in Kenya. Multilevel random intercept and linear regression models were fitted to the matched data to investigate relationships between service integration and technical quality of care as well as associations between facility-level structural and provider factors and technical quality of care. A sensitivity analysis was performed to test for hidden bias. After adjusting for facility-level structural factors, HIV/family planning integration was found to have significant positive effect on technical quality of the consultation session, with average treatment effect 0.44 (95% CI: 0.63-0.82). Three of the 12 structural factors were significantly positively associated with technical quality of consultation session including: availability of family planning commodities (9.64; 95% CI: 5.07-14.21), adequate infrastructure (5.29; 95% CI: 2.89-7.69) and reagents (1.48; 95% CI: 1.02-1.93). Three of the nine provider factors were significantly positively associated with technical quality of consultation session: appropriate provider clinical knowledge (3.14; 95% CI: 1.92-4.36), job satisfaction (2.02; 95% CI: 1.21-2.83) and supervision (1.01; 95% CI: 0.35-1.68), while workload (-0.88; 95% CI: -1.75 to - 0.01) was negatively associated. Technical quality of the client-provider consultation session was also determined by duration of the consultation and type of clinic visit and appeared to depend on whether the clinic visit occurred early or later in the week. Integration of HIV care into family planning services can improve the technical quality of client-provider consultation sessions as measured by both health facility structural and provider factors. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

[Complex chronic care situations and socio-health coordination].

PubMed

Morilla Herrera, Juan Carlos; Morales Asencio, José Miguel; Kaknani, Shakira; García Mayor, Silvia

2016-01-01

Patient-centered healthcare is currently one of the most pursued goals in health services. It is necessary to ensure a sufficient level of cooperative and coordinated work between different providers and settings, including family and social and community resources. Clinical integration occurs when the care provided by health professionals and providers is integrated into a single coherent process through different professions using shared guidelines and protocols. Such coordination can be developed at three levels: macro, which involves the integration of one or more of the three basic elements that support health care (the health plan, primary care and specialty care), with the aim of reducing fragmentation of care; meso, where health and social services are coordinated to provide comprehensive care to elderly and chronic patients; and micro, aimed to improve coordination in individual patients and caregivers. The implementation of new roles, such as Advanced Practice Nursing, along with improvements in family physicians' problem-solving capacity in certain processes, or modifying the place of provision of certain services are key to ensure services adapted to the requirements of chronic patients. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Bringing eCare platforms to the market.

PubMed

Vannieuwenborg, Frederic; Van der Auwermeulen, Thomas; Van Ooteghem, Jan; Jacobs, An; Verbugge, Sofie; Colle, Didier

2017-09-01

Due to changes in the demographic situation of most Western European countries, interest in Information and Communication Technologies (ICT)-supported care services is growing fast. eCare services that foster better care information exchange, social involvement, lifestyle monitoring services, etc., offered via ICT platforms, integrated in the homes of the elderly are believed to be cost-effective. Additionally, they could lead to an increased quality of life of both care receiver and (in)formal caregiver. Currently, adoption and integration of these eCare platforms (eCPs) is slowed down by several barriers such as unclear added value, a lack of regulations, or lack of sustainable financial models. In this work, the added value of eCPs is identified for the several involved key actors such as the care receiver, the (in)formal care providers, and the home care organizations. In a second step, several go-to-market strategies are formulated. Because the gap between the current way of providing home care and providing home care supported by a fully integrated eCP seems too big to bridge in one effort, a migration path is provided for stepwise integration and adoption of eCPs in the current way of home care provisioning.

Integrating care for individuals with FASD: results from a multi-stakeholder symposium.

PubMed

Masotti, Paul; Longstaffe, Sally; Gammon, Holly; Isbister, Jill; Maxwell, Breann; Hanlon-Dearman, Ana

2015-10-05

Fetal Alcohol Spectrum Disorder (FASD) has a significant impact on communities and systems such as health, education, justice and social services. FASD is a complex neurodevelopmental disorder that results in permanent disabilities and associated service needs that change across affected individuals' lifespans. There is a degree of interdependency among medical and non-medical providers across these systems that do not frequently meet or plan a coordinated continuum of care. Improving overall care integration will increase provider-specific and system capacity, satisfaction, quality of life and outcomes. We conducted a consensus generating symposium comprised of 60 experts from different stakeholder groups: Allied & Mental Health, Education, First Nations & Métis Health, Advocates, Primary Care, Government Health Policy, Regional FASD Coordinators, Social Services, and Youth Justice. Research questions addressed barriers and solutions to integration across systems and group-specific and system-wide research priorities. Solutions and consensus on prioritized lists were generated by combining the Electronic Meeting System approach with a modified 'Nominal Group Technique'. FASD capacity (e.g., training, education, awareness) needs to be increased in both medical and non-medical providers. Outcomes and integration will be improved by implementing: multidisciplinary primary care group practice models, FASD system navigators/advocates, and patient centred medical homes. Electronic medical records that are accessible to multiple medical and non-medical providers are a key tool to enhancing integration and quality. Eligibility criteria for services are a main barrier to integration across systems. There is a need for culturally and community-specific approaches for First Nations communities. There is a need to better integrate care for individuals and families living with FASD. Primary Care is well positioned to play a central and important role in facilitating and supporting increased integration. Research is needed to better address best practices (e.g., interventions, supports and programs) and long-term individual and family outcomes following a diagnosis of FASD.

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

NASA Astrophysics Data System (ADS)

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

2015-12-01

Serviced-oriented computing provides an opportunity to couple web service models using semantic web technology. Through this approach, models that are exposed as web services can be conserved in their own local environment, thus making it easy for modelers to maintain and update the models. In integrated modeling, the serviced-oriented loose-coupling approach requires (1) a set of models as web services, (2) the model metadata describing the external features of a model (e.g., variable name, unit, computational grid, etc.) and (3) a model integration framework. We present the architecture of coupling web service models that are self-describing by utilizing a smart modeling framework. We expose models that are encapsulated with CSDMS (Community Surface Dynamics Modeling System) Basic Model Interfaces (BMI) as web services. The BMI-enabled models are self-describing by uncovering models' metadata through BMI functions. After a BMI-enabled model is serviced, a client can initialize, execute and retrieve the meta-information of the model by calling its BMI functions over the web. Furthermore, a revised version of EMELI (Peckham, 2015), an Experimental Modeling Environment for Linking and Interoperability, is chosen as the framework for coupling BMI-enabled web service models. EMELI allows users to combine a set of component models into a complex model by standardizing model interface using BMI as well as providing a set of utilities smoothing the integration process (e.g., temporal interpolation). We modify the original EMELI so that the revised modeling framework is able to initialize, execute and find the dependencies of the BMI-enabled web service models. By using the revised EMELI, an example will be presented on integrating a set of topoflow model components that are BMI-enabled and exposed as web services. Reference: Peckham, S.D. (2014) EMELI 1.0: An experimental smart modeling framework for automatic coupling of self-describing models, Proceedings of HIC 2014, 11th International Conf. on Hydroinformatics, New York, NY.

Measuring the degree of integration for an integrated service network

PubMed Central

Ye, Chenglin; Browne, Gina; Grdisa, Valerie S; Beyene, Joseph; Thabane, Lehana

2012-01-01

Background Integration involves the coordination of services provided by autonomous agencies and improves the organization and delivery of multiple services for target patients. Current measures generally do not distinguish between agencies’ perception and expectation. We propose a method for quantifying the agencies’ service integration. Using the data from the Children’s Treatment Network (CTN), we aimed to measure the degree of integration for the CTN agencies in York and Simcoe. Theory and methods We quantified the integration by the agreement between perceived and expected levels of involvement and calculated four scores from different perspectives for each agency. We used the average score to measure the global network integration and examined the sensitivity of the global score. Results Most agencies’ integration scores were <65%. As measured by the agreement between every other agency’s perception and expectation, the overall integration of CTN in Simcoe and York was 44% (95% CI: 39%–49%) and 52% (95% CI: 48%–56%), respectively. The sensitivity analysis showed that the global scores were robust. Conclusion Our method extends existing measures of integration and possesses a good extent of validity. We can also apply the method in monitoring improvement and linking integration with other outcomes. PMID:23593050

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

PubMed

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

2017-03-11

In Bangladesh, abortion is restricted except to save the life of a woman, but menstrual regulation is allowed to induce menstruation and return to non-pregnancy after a missed period. MR services are typically provided through the Directorate General of Family Planning, while postabortion care services for incomplete abortion are provided by facilities under the Directorate General of Health Services. The bifurcated health system results in reduced quality of care, particularly for postabortion care patients whose procedures are often performed using sub-optimal uterine evacuation technology and typically do not receive postabortion contraceptive services. This study evaluated the success of a pilot project that aimed to integrate menstrual regulation, postabortion care and family planning services across six Directorate General of Health Services and Directorate General of Family Planning facilities by training providers on woman-centered abortion care and adding family planning services at sites offering postabortion care. A pre-post evaluation was conducted in the six large intervention facilities. Structured client exit interviews were administered to all uterine evacuation clients presenting in the 2-week data collection period for each facility at baseline (n = 105; December 2011-January 2012) and endline (n = 107; February-March 2013). Primary outcomes included service integration indicators such as provision of menstrual regulation, postabortion care and family planning services in both facility types, and quality of care indicators such as provision of pain management, provider communication and women's satisfaction with the services received. Outcomes were compared between baseline and endline for Directorate General of Family Planning and Directorate General of Health Services facilities, and chi-square tests and t-tests were used to test for differences between baseline and endline. At the end of the project there was an increase in menstrual regulation service provision in Directorate General of Health Services facilities, from none at baseline to 44.1% of uterine evacuation services at endline (p < 0.001). The proportion of women accepting a postabortion contraceptive method increased from 14.3% at baseline to 69.2% at endline in Directorate General of Health Services facilities (p = 0.006). Provider communication and women's rating of the care they received increased significantly in both Directorate General of Health Services and Directorate General of Family Planning facilities. Integration of menstrual regulation, postabortion care and family planning services is feasible in Bangladesh over a relatively short period of time. The intervention's focus on woman-centered abortion care also improved quality of care. This model can be scaled up through the public health system to ensure women's access to safe uterine evacuation services across all facility types in Bangladesh.

Overcoming Barriers to Integrating Behavioral Health and Primary Care Services

PubMed Central

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

2016-01-01

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

Relational systems change: implementing a model of change in integrating services for women with substance abuse and mental health disorders and histories of trauma.

PubMed

Markoff, Laurie S; Finkelstein, Norma; Kammerer, Nina; Kreiner, Peter; Prost, Carol A

2005-01-01

This article describes the "relational systems change" model developed by the Institute for Health and Recovery, and the implementation of the model in Massachusetts from 1998-2002 to facilitate systems change to support the delivery of integrated and trauma-informed services for women with co-occurring substance abuse and mental health disorders and histories of violence and empirical evidence of resulting systems changes. The federally funded Women Embracing Life and Living (WELL) Project utilized relational strategies to facilitate systems change within and across 3 systems levels: local treatment providers, community (or region), and state. The WELL Project demonstrates that a highly collaborative, inclusive, and facilitated change process can effect services integration within agencies (intra-agency), strengthen integration within a regional network of agencies (interagency), and foster state support for services integration.

48 CFR 25.703-2 - Iran Sanctions Act.

Code of Federal Regulations, 2011 CFR

2011-10-01

... integrity (see the Past Performance Information Retrieval System (including the Federal Awardee Performance.... (ii) Knowingly selling, leasing or providing to Iran goods, services, technology, information, or...) Knowingly selling, leasing, or providing to Iran goods, services, technology, information, or support with a...

48 CFR 25.703-2 - Iran Sanctions Act.

Code of Federal Regulations, 2010 CFR

2010-10-01

... integrity (see the Past Performance Information Retrieval System (including the Federal Awardee Performance.... (ii) Knowingly selling, leasing or providing to Iran goods, services, technology, information, or...) Knowingly selling, leasing, or providing to Iran goods, services, technology, information, or support with a...

The Computing and Data Grid Approach: Infrastructure for Distributed Science Applications

NASA Technical Reports Server (NTRS)

Johnston, William E.

2002-01-01

With the advent of Grids - infrastructure for using and managing widely distributed computing and data resources in the science environment - there is now an opportunity to provide a standard, large-scale, computing, data, instrument, and collaboration environment for science that spans many different projects and provides the required infrastructure and services in a relatively uniform and supportable way. Grid technology has evolved over the past several years to provide the services and infrastructure needed for building 'virtual' systems and organizations. We argue that Grid technology provides an excellent basis for the creation of the integrated environments that can combine the resources needed to support the large- scale science projects located at multiple laboratories and universities. We present some science case studies that indicate that a paradigm shift in the process of science will come about as a result of Grids providing transparent and secure access to advanced and integrated information and technologies infrastructure: powerful computing systems, large-scale data archives, scientific instruments, and collaboration tools. These changes will be in the form of services that can be integrated with the user's work environment, and that enable uniform and highly capable access to these computers, data, and instruments, regardless of the location or exact nature of these resources. These services will integrate transient-use resources like computing systems, scientific instruments, and data caches (e.g., as they are needed to perform a simulation or analyze data from a single experiment); persistent-use resources. such as databases, data catalogues, and archives, and; collaborators, whose involvement will continue for the lifetime of a project or longer. While we largely address large-scale science in this paper, Grids, particularly when combined with Web Services, will address a broad spectrum of science scenarios. both large and small scale.

Integrated care in rural health: Seeking sustainability.

PubMed

Peterson, Mary; Turgesen, Jeri; Fisk, Laura; McCarthy, Seamus

2017-06-01

The increased awareness of the financial impact associated with social determinants of health coincides with expectations of the Affordable Care Act (HR 3590) to improve care while reducing costs. The integration of behavioral health providers (BHPs) into primary care has demonstrated improved clinical outcomes. This study was designed with 2 aims, including the evaluation of the financial viability of an integrated care model in a rural setting and the demonstration of incorporating practice-based research into clinical work. A rural health plan caring for 22,000 members funded a pilot project placing BHPs in 3 clinics to provide integrated care. Patient utilization of medical services for 6 months following BHP services was compared with baseline utilization. The BHPs treated 256 unique patients, with a total of 459 consultations. The percentage of patients receiving BHP services varied between clinics (Clinic A = 1.4%, Clinic B = 2.7%, and Clinic C = 3.9%). A between-clinic analysis showed differences in medical claims data between baseline and post-BH services. The overall effect sizes for reduced medical utilization for patients at clinics B and C were very large, Hedge's g = -2.31 and -4.79, respectively. Utilization of 4 of the services (emergency, lab, outpatient, and primary care) showed the large reductions in their costs. In contrast, the data for Clinic A showed no change. Patients receiving behavioral health services within the integrated care model may decrease utilization of medical services following treatment, resulting in cost offset. Potential reasons for variability between clinics are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

An efficient protocol for providing integrated voice/data services to mobiles over power-limited satellite channels

NASA Astrophysics Data System (ADS)

Bose, Sanjay K.

1991-02-01

Various mobile satellite communication systems are being developed for providing integrated voice/data services over a shared satellite transponder which is power-limited in nature. A common strategy is to use slotted ALOHA request channels to request channel assignments for voice/data calls from a network management station. To maximize efficiency in a system with a power-limited satellite transponder, it is proposed that the bursty nature of voice sources be exploited by the NMS to 'over-assign' channels. This may cause problems of inefficiency and potential instability, as well as a degradation in the quality of service. Augmenting this with the introduction of simple state-dependent control procedures provides systems which exhibit more desirable operational features.

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

NASA Technical Reports Server (NTRS)

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

2017-01-01

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

Architecture and Concept of Operations for a Warfighter’s Internet. Volume 2: Appendices

DTIC Science & Technology

1998-01-28

National Technical Information Service , where it will be available to the general public, including foreign nationals. This technical report has been...SUPPORT INTEGRATED SERVICES IN A MOBILE CELLULAR SYSTEM ARCHITECTURE (FOR ARCHITECTURE OPT. 2) B-1 1. Introduction B-l 2. Warfighter’s...Internet Architecture and Concept of Operation B-2 3. Subnet Provider Interface (SNPI) B-5 4. Integrated Services Cell Multiplexing (ISCM) B-9 5. Mobile

An Integrated Approach to Forest Ecosystem Services

Treesearch

José Joaquin Campos; Francisco Alpizar; Bastiaan Louman; John A. Parrotta

2005-01-01

Forest ecosystem services (FES) are fundamental for the Earth’s life support systems. This chapter discusses the different services provided by forest ecosystems and the effects that land use and forest management practices have on their provision. It also discusses the role of markets in providing an enabling environment for a sustainable and equitable provision of...

Agile Integration of Complex Systems

DTIC Science & Technology

2010-11-01

touch screens for dismounted warfighters or first responders Laptops for mounted warfighters or first responders Multitouch would be useful for all...Messaging Service provides basic distribution support for the other SOAF services, as shown in Figure 3. This support includes interacting with the...entered with the details necessary to accomplish the respective interactions of consuming and providing services. The combination of additional

Small Payload Integration and Testing Project Development

NASA Technical Reports Server (NTRS)

Sorenson, Tait R.

2014-01-01

The National Aeronautics and Space Administration's (NASA) Kennedy Space Center (KSC) has mainly focused on large payloads for space flight beginning with the Apollo program to the assembly and resupply of the International Space Station using the Space Shuttle. NASA KSC is currently working on contracting manned Low Earth Orbit (LEO) to commercial providers, developing Space Launch System, the Orion program, deep space manned programs which could reach Mars, and providing technical expertise for the Launch Services Program for science mission payloads/satellites. KSC has always supported secondary payloads and smaller satellites as the launch provider; however, they are beginning to take a more active role in integrating and testing secondary payloads into future flight opportunities. A new line of business, the Small Payload Integration and Testing Services (SPLITS), has been established to provide a one stop shop that can integrate and test payloads. SPLITS will assist high schools, universities, companies and consortiums interested in testing or launching small payloads. The goal of SPLITS is to simplify and facilitate access to KSC's expertise and capabilities for small payloads integration and testing and to help grow the space industry. An effort exists at Kennedy Space Center to improve the external KSC website. External services has partnered with SPLITS as a content test bed for attracting prospective customers. SPLITS is an emerging effort that coincides with the relaunch of the website and has a goal of attracting external partnerships. This website will be a "front door" access point for all potential partners as it will contain an overview of KSC's services, expertise and includes the pertinent contact information.

Considerations for Providing Ambulatory Pharmacy Services for Pediatric Patients.

PubMed

Lampkin, Stacie J; Gildon, Brooke; Benavides, Sandra; Walls, Kelly; Briars, Leslie

2018-01-01

Pediatric clinical pharmacists are an integral part of the health care team. By practicing in an ambulatory care clinic, they can reduce the risk of medication errors, improve health outcomes, and enhance patient care. Unfortunately, because of limited data, misconceptions surrounding the role of pharmacists, and reimbursement challenges, there may be difficulty in establishing or expanding pediatric clinical pharmacy services to an ambulatory care setting. The purpose of this paper is to provide an overview of considerations for establishing or expanding pharmacy services in a pediatric ambulatory care clinic. The primer will discuss general and pediatric-specific pharmacy practice information, as well as potential barriers, and recommendations for identifying a practice site, creating a business plan, and integrating these services into a clinic setting.

Air ambulance services--integrated emergency care.

PubMed

Ferdinand, M

1994-10-01

In the name of cost-conscious care, air ambulance program directors and service contractors are seeing the dawn of integrated networks as a boon to their business. As integrated networks form, facilities will become increasingly specialized in the types of services they provide. Patients will need to be moved around the system, resulting in more frequent patient transport and more points of transfer. Many programs are considering aircraft replacement and additions, rather than leasing. Financial benefits could come on depreciation and the high resale value of aircraft. Unless reimbursement levels increase, more program mergers and affiliations may take place to spread and reduce cost. Air ambulance services will increasingly become part of a facility's strategic plan.

Remote Sensing: A valuable tool in the Forest Service decision making process. [in Utah

NASA Technical Reports Server (NTRS)

Stanton, F. L.

1975-01-01

Forest Service studies for integrating remotely sensed data into existing information systems highlight a need to: (1) re-examine present methods of collecting and organizing data, (2) develop an integrated information system for rapidly processing and interpreting data, (3) apply existing technological tools in new ways, and (4) provide accurate and timely information for making right management decisions. The Forest Service developed an integrated information system using remote sensors, microdensitometers, computer hardware and software, and interactive accessories. Their efforts substantially reduce the time it takes for collecting and processing data.

STRS Radio Service Software for NASA's SCaN Testbed

NASA Technical Reports Server (NTRS)

Mortensen, Dale J.; Bishop, Daniel Wayne; Chelmins, David T.

2012-01-01

NASAs Space Communication and Navigation(SCaN) Testbed was launched to the International Space Station in 2012. The objective is to promote new software defined radio technologies and associated software application reuse, enabled by this first flight of NASAs Space Telecommunications Radio System(STRS) architecture standard. Pre-launch testing with the testbeds software defined radios was performed as part of system integration. Radio services for the JPL SDR were developed during system integration to allow the waveform application to operate properly in the space environment, especially considering thermal effects. These services include receiver gain control, frequency offset, IQ modulator balance, and transmit level control. Development, integration, and environmental testing of the radio services will be described. The added software allows the waveform application to operate properly in the space environment, and can be reused by future experimenters testing different waveform applications. Integrating such services with the platform provided STRS operating environment will attract more users, and these services are candidates for interface standardization via STRS.

STRS Radio Service Software for NASA's SCaN Testbed

NASA Technical Reports Server (NTRS)

Mortensen, Dale J.; Bishop, Daniel Wayne; Chelmins, David T.

2013-01-01

NASA's Space Communication and Navigation(SCaN) Testbed was launched to the International Space Station in 2012. The objective is to promote new software defined radio technologies and associated software application reuse, enabled by this first flight of NASA's Space Telecommunications Radio System (STRS) architecture standard. Pre-launch testing with the testbed's software defined radios was performed as part of system integration. Radio services for the JPL SDR were developed during system integration to allow the waveform application to operate properly in the space environment, especially considering thermal effects. These services include receiver gain control, frequency offset, IQ modulator balance, and transmit level control. Development, integration, and environmental testing of the radio services will be described. The added software allows the waveform application to operate properly in the space environment, and can be reused by future experimenters testing different waveform applications. Integrating such services with the platform provided STRS operating environment will attract more users, and these services are candidates for interface standardization via STRS.

Integrating Parenting Support Within and Beyond the Pediatric Medical Home.

PubMed

Linton, Julie M; Stockton, Maria Paz; Andrade, Berta; Daniel, Stephanie

2018-01-01

Positive parenting programs, developmental support services, and evidence-based home visiting programs can effectively provide parenting support and improve health and developmental outcomes for at-risk children. Few models, however, have integrated referrals for on-site support and home visiting programs into the provision of routine pediatric care within a medical home. This article describes an innovative approach, through partnership with a community-based organization, to deliver on-site and home visiting support services for children and families within and beyond the medical home. Our model offers a system of on-site services, including parenting, behavior, and/or development support, with optional intensive home visiting services. Assessment included description of the population served, delineation of services provided, and qualitative identification of key themes of the impact of services, illustrated by case examples. This replicable model describes untapped potential of the pediatric medical home as a springboard to mitigate risk and optimize children's health and development.

Frail elderly patients. New model for integrated service delivery.

PubMed Central

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

2003-01-01

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

[Financing, organization, costs and services performance of the Argentinean health sub-systems.

PubMed

Yavich, Natalia; Báscolo, Ernesto Pablo; Haggerty, Jeannie

2016-01-01

To analyze the relationship between health system financing and services organization models with costs and health services performance in each of Rosario's health sub-systems. The financing and organization models were characterized using secondary data. Costs were calculated using the WHO/SHA methodology. Healthcare quality was measured by a household survey (n=822). Public subsystem:Vertically integrated funding and primary healthcare as a leading strategy to provide services produced low costs and individual-oriented healthcare but with weak accessibility conditions and comprehensiveness. Private subsystem: Contractual integration and weak regulatory and coordination mechanisms produced effects opposed to those of the public sub-system. Social security: Contractual integration and strong regulatory and coordination mechanisms contributed to intermediate costs and overall high performance. Each subsystem financing and services organization model had a strong and heterogeneous influence on costs and health services performance.

Design and implementation of a telecare information platform.

PubMed

Li, Shing-Han; Wang, Ching-Yao; Lu, Wen-Hui; Lin, Yuan-Yuan; Yen, David C

2012-06-01

For the aging population and for people with dominant chronic diseases, countries all over the world are promoting an "Aging in Place" program with its primary focus on the implementation of telecare. In 2009, Taiwan held a "Health Care Value-Added Platinum Program" with the goal of promoting the development of "Telecare" services by integrating medical treatment, healthcare, information communication, medical equipment and materials and by linking related cross-discipline professions to enable people to familiarize themselves with preventive healthcare services offered in their household and community environments. In addition, this program can be utilized to effectively provide diversified healthcare service benefitting society as a whole. This study aims to promote a diversified telecare service network in Taiwan's household and community environments, establish telecare information platforms, build an internal network of various healthcare service modes, standardize externally interfacing telecare information networks, effectively utilize related healthcare service resources, and complete reasonable service resource links forming an up-to-date health information exchange network. To this end, the telecare information platform based on service oriented architecture (SOA) is designed to promote an open telecare information interface and sharing environment to assist in such tasks as developing healthcare information exchange services, integrating service resources among various different healthcare service modes, accessing externally complex community affairs information, supporting remote physiological information transmissions, and providing diversified remote innovative services. Information system architecture and system monitoring indices of various types of healthcare service modes are used for system integrations for future development and/or expansions.

The Demonstrator for the European Plate Observing System (EPOS)

NASA Astrophysics Data System (ADS)

Hoffmann, T. L.; Euteneuer, F.; Ulbricht, D.; Lauterjung, J.; Bailo, D.; Jeffery, K. G.

2014-12-01

An important outcome of the 4-year Preparatory Phase of the ESFRI project European Plate Observing System (EPOS) was the development and first implementation of the EPOS Demonstrator by the project's ICT Working Group 7. The Demonstrator implements the vertical integration of the three-layer architectural scheme for EPOS, connecting the Integrated Core Services (ICS), Thematic Core Services (TCS) and the National Research Infrastructures (NRI). The demonstrator provides a single GUI with central key discovery and query functionalities, based on already existing services by the seismic, geologic and geodetic communities. More specifically the seismic services of the Demonstrator utilize webservices and APIs for data and discovery of raw seismic data (FDSN webservices by the EIDA Network), events (Geoportal by EMSC) and analytical data products (e.g., hazard maps by EFEHR via OGC WMS). For geologic services, the EPOS Demonstrator accesses OneGeology Europe which serves the community with geologic maps and point information via OGC webservices. The Demonstrator also provides access to raw geodetic data via a newly developed universal tool called GSAC. The Demonstrator itself resembles the future Integrated Core Service (ICS) and provides direct access to the end user. Its core functionality lies in a metadata catalogue, which serves as the central information hub and stores information about all RIs, related persons, projects, financial background and technical access information. The database schema of the catalogue is based on CERIF, which has been slightly adapted. Currently, the portal provides basic query functions as well as cross domain search. [www.epos.cineca.it

A theoretical framework to support research of health service innovation.

PubMed

Fox, Amanda; Gardner, Glenn; Osborne, Sonya

2015-02-01

Health service managers and policy makers are increasingly concerned about the sustainability of innovations implemented in health care settings. The increasing demand on health services requires that innovations are both effective and sustainable; however, research in this field is limited, with multiple disciplines, approaches and paradigms influencing the field. These variations prevent a cohesive approach, and therefore the accumulation of research findings, in the development of a body of knowledge. The purpose of this paper is to provide a thorough examination of the research findings and provide an appropriate theoretical framework to examine sustainability of health service innovation. This paper presents an integrative review of the literature available in relation to sustainability of health service innovation and provides the development of a theoretical framework based on integration and synthesis of the literature. A theoretical framework serves to guide research, determine variables, influence data analysis and is central to the quest for ongoing knowledge development. This research outlines the sustainability of innovation framework; a theoretical framework suitable for examining the sustainability of health service innovation. If left unaddressed, health services research will continue in an ad hoc manner, preventing full utilisation of outcomes, recommendations and knowledge for effective provision of health services. The sustainability of innovation theoretical framework provides an operational basis upon which reliable future research can be conducted.

Supporting Collaborative Model and Data Service Development and Deployment with DevOps

NASA Astrophysics Data System (ADS)

David, O.

2016-12-01

Adopting DevOps practices for model service development and deployment enables a community to engage in service-oriented modeling and data management. The Cloud Services Integration Platform (CSIP) developed the last 5 years at Colorado State University provides for collaborative integration of environmental models into scalable model and data services as a micro-services platform with API and deployment infrastructure. Originally developed to support USDA natural resource applications, it proved suitable for a wider range of applications in the environmental modeling domain. While extending its scope and visibility it became apparent community integration and adequate work flow support through the full model development and application cycle drove successful outcomes.DevOps provide best practices, tools, and organizational structures to optimize the transition from model service development to deployment by minimizing the (i) operational burden and (ii) turnaround time for modelers. We have developed and implemented a methodology to fully automate a suite of applications for application lifecycle management, version control, continuous integration, container management, and container scaling to enable model and data service developers in various institutions to collaboratively build, run, deploy, test, and scale services within minutes.To date more than 160 model and data services are available for applications in hydrology (PRMS, Hydrotools, CFA, ESP), water and wind erosion prediction (WEPP, WEPS, RUSLE2), soil quality trends (SCI, STIR), water quality analysis (SWAT-CP, WQM, CFA, AgES-W), stream degradation assessment (SWAT-DEG), hydraulics (cross-section), and grazing management (GRAS). In addition, supporting data services include soil (SSURGO), ecological site (ESIS), climate (CLIGEN, WINDGEN), land management and crop rotations (LMOD), and pesticides (WQM), developed using this workflow automation and decentralized governance.

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

NASA Astrophysics Data System (ADS)

Coyle, P. D.

2000-03-01

The goal of the National Ignition Facility (NIF) project is to provide an above ground experimental capability for maintaining nuclear competence and weapons effects simulation and to provide a facility capable of achieving fusion ignition using solid-state lasers as the energy driver. The facility will incorporate 192 laser beams, which will be focused onto a small target located at the center of a spherical target chamber-the energy from the laser beams will be deposited in a few billionths of a second. The target will then implode, forcing atomic nuclei to sufficiently high temperatures and densities necessary to achieve a miniature fusion reaction. The NIF is under construction, at Livermore, California, located approximately 50 miles southeast of San Francisco, California. The University of California, Lawrence Livermore National Laboratory (LLNL), operating under Prime Contract W-7405-ENG. 48 with the U.S. Department of Energy (DOE), shall subcontract for Integration Management and Installation (IMI) Services for the Beampath Infrastructure System (BIS). The BIS includes Beampath Hardware and Beampath Utilities. Conventional Facilities work for the NIF Laser and Target Area Building (LTAB) and Optics Assembly Building (OAB) is over 86 percent constructed. This Scope of Work is for Integration Management and Installation (IMI) Services corresponding to Management Services, Design Integration Services, Construction Services, and Commissioning Services for the NIB BIS. The BIS includes Beampath Hardware and Beampath Utilities. Beampath Hardware and Beampath Utilities include beampath vessels, enclosures, and beam tubes; auxiliary and utility systems; and support structures. A substantial amount of GFE will be provided by the University for installation as part of the infrastructure packages.

Common Data Servers as a Foundation for Specialized Services

NASA Astrophysics Data System (ADS)

Burger, E. F.; Schweitzer, R.; O'Brien, K.; Manke, A. B.; Smith, K. M.

2017-12-01

NOAA's Pacific Marine Environmental Laboratory (PMEL) hosts a broad range of research efforts that span many scientific and environmental research disciplines. Many of these research projects have their own data streams that are as diverse as the research. Data are collected using various platforms, including innovative new platforms such as Saildrones and autonomous profilers. With its requirements for public access to federally funded research results and data, the 2013 White House Office of Science and Technology memo on Public Access to Research Results (PARR) changed the data landscape for Federal agencies. In 2015, with support from the PMEL Director, the PMEL Science Data Integration Group (SDIG) initiated a multi-year effort to formulate and implement an integrated data-management strategy for PMEL research efforts. The PMEL integrated data management strategy will provide data access, visualization and some archive services to PMEL data and use existing and proven frameworks for this capability. In addition to these foundational data services, these data access and visualization frameworks are also leveraged to provide enhanced services to scientists. One enhanced service developed is a data management "dashboard". This application provides scientists with a snapshot of their data assets, access to these data, a map view of data locations, and information on the archival status. Ideally, information on the dashboard continually updates to accurately reflect the project's data asset status. This poster explains how frameworks such as ERDDAP and LAS were used as a foundation for the development of custom services, as well as an explanation of the PMEL data management dashboard functionality. We will also highlight accomplishments of the PMEL Integrated data management strategy implementation.

Chapter 4: Overview of the vegetation management treatment economic analysis module in the integrated landscape assessment project

Treesearch

Xiaoping Zhou; Miles A. Hemstrom

2014-01-01

Forest land provides various ecosystem services, including timber, biomass, and carbon sequestration. Estimating trends in these ecosystem services is essential for assessing potential outcomes of landscape management scenarios. However, the state-and transition models used in the Integrated Landscape Assessment Project for simulating landscape changes over time do not...

Frogs, fish and forestry: An integrated watershed network paradigm conserves biodiversity and ecological services

Treesearch

Hartwell H. Welsh Jr.

2011-01-01

Successfully addressing the multitude of stresses influencing forest catchments, their native biota, and the vital ecological services they provide humanity will require adapting an integrated view that incorporates the full range of natural and anthropogenic disturbances acting on these landscapes and their embedded fluvial networks. The concepts of dendritic networks...

Professional Development for Transformational Technology Integration: An Experimental Study of In-Service Teachers' Self-Perceptions of Technological Pedagogical and Content Knowledge

ERIC Educational Resources Information Center

Tachau, Elena M.

2017-01-01

Professional Development for Transformational Technology Integration: An Experimental Study of In-Service Teachers' Self-Perceptions of Technological Pedagogical and Content Knowledge Elena M. Tachau Drexel University Chairperson: Brian K. Smith, Ph.D. The rapid advancement of technology tasks K-12 schools with providing professional development…

Vertical integration and optimal reimbursement policy.

PubMed

Afendulis, Christopher C; Kessler, Daniel P

2011-09-01

Health care providers may vertically integrate not only to facilitate coordination of care, but also for strategic reasons that may not be in patients' best interests. Optimal Medicare reimbursement policy depends upon the extent to which each of these explanations is correct. To investigate, we compare the consequences of the 1997 adoption of prospective payment for skilled nursing facilities (SNF PPS) in geographic areas with high versus low levels of hospital/SNF integration. We find that SNF PPS decreased spending more in high integration areas, with no measurable consequences for patient health outcomes. Our findings suggest that integrated providers should face higher-powered reimbursement incentives, i.e., less cost-sharing. More generally, we conclude that purchasers of health services (and other services subject to agency problems) should consider the organizational form of their suppliers when choosing a reimbursement mechanism.

Vertical integration and optimal reimbursement policy

PubMed Central

Afendulis, Christopher C.

2011-01-01

Health care providers may vertically integrate not only to facilitate coordination of care, but also for strategic reasons that may not be in patients’ best interests. Optimal Medicare reimbursement policy depends upon the extent to which each of these explanations is correct. To investigate, we compare the consequences of the 1997 adoption of prospective payment for skilled nursing facilities (SNF PPS) in geographic areas with high versus low levels of hospital/SNF integration. We find that SNF PPS decreased spending more in high integration areas, with no measurable consequences for patient health outcomes. Our findings suggest that integrated providers should face higher-powered reimbursement incentives, i.e., less cost-sharing. More generally, we conclude that purchasers of health services (and other services subject to agency problems) should consider the organizational form of their suppliers when choosing a reimbursement mechanism. PMID:21850551

Videos as an Instructional Tool in Pre-Service Science Teacher Education

ERIC Educational Resources Information Center

Sonmez, Duygu; Hakverdi-Can, Meral

2012-01-01

Problem Statement: Student teaching is an integral part of teacher education. While it provides preservice teachers with real classroom experience, though, it is limited in that it does not provide shared experience. Used as instructional tools, videos provide a shared common experience in a controlled environment to pre-service teachers in…

Service-oriented model-encapsulation strategy for sharing and integrating heterogeneous geo-analysis models in an open web environment

NASA Astrophysics Data System (ADS)

Yue, Songshan; Chen, Min; Wen, Yongning; Lu, Guonian

2016-04-01

Earth environment is extremely complicated and constantly changing; thus, it is widely accepted that the use of a single geo-analysis model cannot accurately represent all details when solving complex geo-problems. Over several years of research, numerous geo-analysis models have been developed. However, a collaborative barrier between model providers and model users still exists. The development of cloud computing has provided a new and promising approach for sharing and integrating geo-analysis models across an open web environment. To share and integrate these heterogeneous models, encapsulation studies should be conducted that are aimed at shielding original execution differences to create services which can be reused in the web environment. Although some model service standards (such as Web Processing Service (WPS) and Geo Processing Workflow (GPW)) have been designed and developed to help researchers construct model services, various problems regarding model encapsulation remain. (1) The descriptions of geo-analysis models are complicated and typically require rich-text descriptions and case-study illustrations, which are difficult to fully represent within a single web request (such as the GetCapabilities and DescribeProcess operations in the WPS standard). (2) Although Web Service technologies can be used to publish model services, model users who want to use a geo-analysis model and copy the model service into another computer still encounter problems (e.g., they cannot access the model deployment dependencies information). This study presents a strategy for encapsulating geo-analysis models to reduce problems encountered when sharing models between model providers and model users and supports the tasks with different web service standards (e.g., the WPS standard). A description method for heterogeneous geo-analysis models is studied. Based on the model description information, the methods for encapsulating the model-execution program to model services and for describing model-service deployment information are also included in the proposed strategy. Hence, the model-description interface, model-execution interface and model-deployment interface are studied to help model providers and model users more easily share, reuse and integrate geo-analysis models in an open web environment. Finally, a prototype system is established, and the WPS standard is employed as an example to verify the capability and practicability of the model-encapsulation strategy. The results show that it is more convenient for modellers to share and integrate heterogeneous geo-analysis models in cloud computing platforms.

Paved With Good Intentions: Do Public Health and Human Service Providers Contribute to Racial/Ethnic Disparities in Health?

PubMed Central

van Ryn, Michelle; Fu, Steven S.

2003-01-01

There is extensive evidence of racial/ethnic disparities in receipt of health care. The potential contribution of provider behavior to such disparities has remained largely unexplored. Do health and human service providers behave in ways that contribute to systematic inequities in care and outcomes? If so, why does this occur? The authors build on existing evidence to provide an integrated, coherent, and sound approach to research on providers’ contributions to racial/ethnic disparities. They review the evidence regarding provider contributions to disparities in outcomes and describe a causal model representing an integrated set of hypothesized mechanisms through which health care providers’ behaviors may contribute to these disparities. PMID:12554578

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

PubMed

Thompson, Amibeth H; Knight, Tiffany M

2018-05-01

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

Collaboration Between Medical Providers and Dental Hygienists in Pediatric Health Care.

PubMed

Braun, Patricia A; Cusick, Allison

2016-06-01

Basic preventive oral services for children can be provided within the medical home through the collaborative care of medical providers and dental hygienists to expand access for vulnerable populations. Because dental caries is a largely preventable disease, it is untenable that it remains the most common chronic disease of childhood. Leveraging the multiple visits children have with medical providers has potential to expand access to early preventive oral services. Developing interprofessional relationships between dental providers, including dental hygienists, and medical providers is a strategic approach to symbiotically expand access to dental care. Alternative care delivery models that provide dental services in the medical home expand access to these services for vulnerable populations. The purpose of this article is to explore 4 innovative care models aimed to expand access to dental care. Current activities in Colorado and around the nation are described regarding the provision of basic preventive oral health services (eg, fluoride varnish) by medical providers with referral to a dentist (expanded coordinated care), the colocation of dental hygiene services into the medical home (colocated care), the integration of a dental hygienist into the medical care team (integrated care), and the expansion of the dental home into the community setting through telehealth-enabled teams (virtual dental home). Gaps in evidence regarding the impacts of these models are elucidated. Bringing preventive and restorative dental services to the patient both in the medical home and in the community has potential to reduce long-standing barriers to receive these services, improve oral health outcomes of vulnerable patients, and decrease oral health disparities. Copyright © 2016 Elsevier Inc. All rights reserved.

The climate4impact platform: Providing, tailoring and facilitating climate model data access

NASA Astrophysics Data System (ADS)

Pagé, Christian; Pagani, Andrea; Plieger, Maarten; Som de Cerff, Wim; Mihajlovski, Andrej; de Vreede, Ernst; Spinuso, Alessandro; Hutjes, Ronald; de Jong, Fokke; Bärring, Lars; Vega, Manuel; Cofiño, Antonio; d'Anca, Alessandro; Fiore, Sandro; Kolax, Michael

2017-04-01

One of the main objectives of climate4impact is to provide standardized web services and tools that are reusable in other portals. These services include web processing services, web coverage services and web mapping services (WPS, WCS and WMS). Tailored portals can be targeted to specific communities and/or countries/regions while making use of those services. Easier access to climate data is very important for the climate change impact communities. To fulfill this objective, the climate4impact (http://climate4impact.eu/) web portal and services has been developed, targeting climate change impact modellers, impact and adaptation consultants, as well as other experts using climate change data. It provides to users harmonized access to climate model data through tailored services. It features static and dynamic documentation, Use Cases and best practice examples, an advanced search interface, an integrated authentication and authorization system with the Earth System Grid Federation (ESGF), a visualization interface with ADAGUC web mapping tools. In the latest version, statistical downscaling services, provided by the Santander Meteorology Group Downscaling Portal, were integrated. An innovative interface to integrate statistical downscaling services will be released in the upcoming version. The latter will be a big step in bridging the gap between climate scientists and the climate change impact communities. The climate4impact portal builds on the infrastructure of an international distributed database that has been set to disseminate the results from the global climate model results of the Coupled Model Intercomparison project Phase 5 (CMIP5). This database, the ESGF, is an international collaboration that develops, deploys and maintains software infrastructure for the management, dissemination, and analysis of climate model data. The European FP7 project IS-ENES, Infrastructure for the European Network for Earth System modelling, supports the European contribution to ESGF and contributes to the ESGF open source effort, notably through the development of search, monitoring, quality control, and metadata services. In its second phase, IS-ENES2 supports the implementation of regional climate model results from the international Coordinated Regional Downscaling Experiments (CORDEX). These services were extended within the European FP7 Climate Information Portal for Copernicus (CLIPC) project, and some could be later integrated into the European Copernicus platform.

Facilitating Service Learning in the Online Technical Communication Classroom

ERIC Educational Resources Information Center

Nielsen, Danielle

2016-01-01

Drawing from the author's experience teaching online technical communication courses with an embedded service-learning component, this essay opens the discussion to the potential problems involved in designing online service-learning courses and provides practical approaches to integrating service learning into online coursework. The essay…

Benefit-Cost Analysis of Integrated Paratransit Systems : Volume 1. Executive Summary.

DOT National Transportation Integrated Search

1979-09-01

Integrated Paratransit (IP) is a concept which involves the integration of conventional fixed-route transit with flexibly routed paratransit services to provide the most effective area-wide transit coverage. The report estimates the benefits and cost...

Perceived Barriers and Facilitators to Integrating HIV Prevention and Treatment with Cross-Sex Hormone Therapy for Transgender Women in Lima, Peru.

PubMed

Reisner, Sari L; Perez-Brumer, Amaya G; McLean, Sarah A; Lama, Javier R; Silva-Santisteban, Alfonso; Huerta, Leyla; Sanchez, Jorge; Clark, Jesse L; Mimiaga, Matthew J; Mayer, Kenneth H

2017-12-01

Transgender women (TW) represent a vulnerable population at increased risk for HIV infection in Peru. A mixed-methods study with 48 TW and 19 healthcare professionals was conducted between January and February 2015 to explore barriers and facilitators to implementing a model of care that integrates HIV services with gender-affirmative medical care (i.e., hormone therapy) in Lima, Peru. Perceived acceptability of the integrated care model was high among TW and healthcare professionals alike. Barriers included stigma, lack of provider training or Peruvian guidelines regarding optimal TW care, and service delivery obstacles (e.g., legal documents, spatial placement of clinics, hours of operation). The hiring of TW staff was identified as a key facilitator for engagement in health care. Working in partnership with local TW and healthcare provider organizations is critical to overcoming existing barriers to successful implementation of an integrated HIV services and gender-affirmative medical care model for this key population in Peru.

Technical and economic feasibility of integrated video service by satellite

NASA Technical Reports Server (NTRS)

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

1992-01-01

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

42 CFR 455.19 - Provider's statement on check.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Provider's statement on check. 455.19 Section 455.19 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud Detection and...

42 CFR 455.18 - Provider's statements on claims forms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Provider's statements on claims forms. 455.18 Section 455.18 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud...

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

PubMed

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

2003-06-01

There is great concern about fragmentation of mental health service delivery, especially for dually diagnosed homeless people, and apprehension that such fragmentation adversely affects service access and outcomes. This study first seeks to articulate two alternative approaches to the integration of psychiatric and substance abuse services, one involving an integrated team model and the other a collaborative relationship between agencies. It then applies this conceptualization to a sample of dually diagnosed homeless people who participated in the ACCESS demonstration. Longitudinal outcome data were obtained through interviews at baseline, 3 months, and 12 months with homeless clients with a dual diagnosis (N = 1074) who received ACT-like case management services through the ACCESS demonstration. A survey of ACCESS case managers was conducted to obtain information on: (i) the proportion of clients who received substance abuse services directly from ACCESS case management teams, and the proportion who received services from other agencies; and (ii) the perceived quality of the relationship (i.e. communication, cooperation and trust) between providers--both within the same teams and between agencies. Hierarchical linear modeling was then used to examine the relationship of these two factors to service use and outcome with mixed-model regression analysis. Significant (p<.05) and positive relationships were observed in 4 of the 20 analyses of the association of service use and measures of communication, cooperation, and trust (either intrateam or inter-agency) while none were significant and negative. At 12 months, receipt of a higher proportion of services from agencies other than the ACCESS team was associated with fewer days homeless, and greater reduction of psychiatric symptoms, contradicting the hypothesis that integrated team care is more effective than interagency collaborations. This study broadens the conceptual framework for addressing service system fragmentation by considering both single team integration and interagency coordination, and by considering both program structure and the quality of relationships between providers. Data from a multi-site outcome study demonstrated suggestive associations between perceptions of communication, cooperation and measures of clinical service use. However, the proportion of clients treated entirely within a single team was associated with poorer housing and psychiatric outcomes. These empirical results must be regarded as illustrative rather than conclusive because of the use of a non-experimental study design, imperfections in the available measures, and the incomplete sampling of case managers. This study suggests that fragmentation of services for dually diagnosed clients may be reduced by improving the interactions within and between agencies providing these services. While primary emphasis has been placed on developing integrated teams, interagency approaches should not be prematurely excluded. Research on approaches to reducing system fragmentation have focused on either global efforts to integrate numerous agencies in a community or highly focused efforts to develop specialized teams. Future research should also focus on the possibility of fostering constructive relationships between selected pairs or subsets of agencies. Research in this area will also benefit from the further development measures of team integration and of both intra-team and inter-agency communication, collaboration, and trust.

Implementation of a SOA-Based Service Deployment Platform with Portal

NASA Astrophysics Data System (ADS)

Yang, Chao-Tung; Yu, Shih-Chi; Lai, Chung-Che; Liu, Jung-Chun; Chu, William C.

In this paper we propose a Service Oriented Architecture to provide a flexible and serviceable environment. SOA comes up with commercial requirements; it integrates many techniques over ten years to find the solution in different platforms, programming languages and users. SOA provides the connection with a protocol between service providers and service users. After this, the performance and the reliability problems are reviewed. Finally we apply SOA into our Grid and Hadoop platform. Service acts as an interface in front of the Resource Broker in the Grid, and the Resource Broker is middleware that provides functions for developers. The Hadoop has a file replication feature to ensure file reliability. Services provided on the Grid and Hadoop are centralized. We design a portal, in which users can use services on it directly or register service through the service provider. The portal also offers a service workflow function so that users can customize services according to the need of their jobs.

Association of Financial Integration Between Physicians and Hospitals With Commercial Health Care Prices.

PubMed

Neprash, Hannah T; Chernew, Michael E; Hicks, Andrew L; Gibson, Teresa; McWilliams, J Michael

2015-12-01

Financial integration between physicians and hospitals may help health care provider organizations meet the challenges of new payment models but also may enhance the bargaining power of provider organizations, leading to higher prices and spending in commercial health care markets. To assess the association between recent increases in physician-hospital integration and changes in spending and prices for outpatient and inpatient services. Using regression analysis, we estimated the relationship between changes in physician-hospital integration from January 1, 2008, through December 31, 2012, in 240 metropolitan statistical areas (MSAs) and concurrent changes in spending. Adjustments were made for patient, plan, and market characteristics, including physician, hospital, and insurer market concentration. The study population included a cohort of 7,391,335 nonelderly enrollees in preferred-provider organizations or point-of-service plans included in the Truven Health MarketScan Commercial Database during the study period. Data were analyzed from December 1, 2013, through July 13, 2015. Physician-hospital integration, measured using Medicare claims data as the share of physicians in an MSA who bill for outpatient services with a place-of-service code indicating employment or practice ownership by a hospital. Annual inpatient and outpatient spending per enrollee and associated use of health care services, with utilization measured by price-standardized spending (the sum of annual service counts multiplied by the national mean of allowed charges for the service). Among the 240 MSAs, physician-hospital integration increased from 2008 to 2012 by a mean of 3.3 percentage points, with considerable variation in increases across MSAs (interquartile range, 0.8-5.2 percentage points). For our study sample of 7,391,335 nonelderly enrollees, an increase in physician-hospital integration equivalent to the 75th percentile of changes experienced by MSAs was associated with a mean increase of $75 (95% CI, $38-$113) per enrollee in annual outpatient spending (P < .001) from 2008 to 2012, a 3.1% increase relative to mean outpatient spending in 2012 ($2407 [95% CI, $2400-$2414] per enrollee). This increase in outpatient spending was driven almost entirely by price increases because associated changes in utilization were minimal (corresponding change in price-standardized spending, $14 [95% CI, -$13 to $41] per enrollee; P = .32). Changes in physician-hospital integration were not associated with significant changes in inpatient spending ($22 [95% CI, -$1 to $46] per enrollee; P = .06) or utilization ($10 [95% CI, -$12 to $31] per enrollee; P = .37). Financial integration between physicians and hospitals has been associated with higher commercial prices and spending for outpatient care.

System and Method for Providing a Climate Data Analytic Services Application Programming Interface Distribution Package

NASA Technical Reports Server (NTRS)

Tamkin, Glenn S. (Inventor); Duffy, Daniel Q. (Inventor); Schnase, John L. (Inventor)

2016-01-01

A system, method and computer-readable storage devices for providing a climate data analytic services application programming interface distribution package. The example system can provide various components. The system provides a climate data analytic services application programming interface library that enables software applications running on a client device to invoke the capabilities of a climate data analytic service. The system provides a command-line interface that provides a means of interacting with a climate data analytic service by issuing commands directly to the system's server interface. The system provides sample programs that call on the capabilities of the application programming interface library and can be used as templates for the construction of new client applications. The system can also provide test utilities, build utilities, service integration utilities, and documentation.

Multipath for Agricultural and Rural Information Services in China

NASA Astrophysics Data System (ADS)

Ge, Ningning; Zang, Zhiyuan; Gao, Lingwang; Shi, Qiang; Li, Jie; Xing, Chunlin; Shen, Zuorui

Internet cannot provide perfect information services for farmers in rural regions in China, because farmers in rural regions can hardly access the internet by now. But the wide coverage of mobile signal, telephone line, and television network, etc. gave us a chance to solve the problem. The integrated pest management platform of Northern fruit trees were developed based on the integrated technology, which can integrate the internet, mobile and fixed-line telephone network, and television network, to provide integrated pest management(IPM) information services for farmers in rural regions in E-mail, telephone-voice, short message, voice mail, videoconference or other format, to users' telephone, cell phone, personal computer, personal digital assistant(PDA), television, etc. alternatively. The architecture and the functions of the system were introduced in the paper. The system can manage the field monitoring data of agricultural pests, deal with enquiries to provide the necessary information to farmers accessing the interactive voice response(IVR) in the system with the experts on-line or off-line, and issue the early warnings about the fruit tree pests when it is necessary according to analysis on the monitoring data about the pests of fruit trees in variety of ways including SMS, fax, voice and intersystem e-mail.The system provides a platform and a new pattern for agricultural technology extension with a high coverage rate of agricultural technology in rural regions, and it can solve the problem of agriculture information service 'last kilometer' in China. The effectiveness of the system was certified.

Preliminary construction of a service provider--informed domestic violence research agenda.

PubMed

Murray, Christine E; Welch, Metoka L

2010-12-01

This article presents the results of a statewide survey of domestic violence (DV) service providers that focused on the needs, background characteristics, and opinions of service providers related to research. The survey included an examination of service providers' motivation for working in the field, research background and training, and perceptions of research as well as the topics they believe are important for researchers to study, the resources they consult to learn about DV, and their suggestions to help researchers learn more about the nature of their work. The results are integrated into a preliminary agenda for future DV research that accounts for the needs and insight of service providers.

[Contribution of public health to paediatric physical disability rehabilitation units].

PubMed

Foley, Véronique; Camden, Chantal

2015-01-01

Approximately 4% of children in North America and Europe live with a chronic disability. Most countries have developed a range of specialized health services to meet the specific needs of these children. However, an increasing number of authors argue that more public health activities should be offered to children with disabilities in order to promote social participation and to ensure more efficient organization of these services. The objectives of this article are: 1) to describe the needs of children with physical disabilities that can be met bypublic health activities, 2) to present the Quebec health care system and discuss the inclusion of public health principles in paediatric rehabilitation services, and 3) to propose ways to improve integration of these principles. The needs of children with disabilities are described according to categories of needs from the Life Needs Model: basic skills; applied skills; needs support, education and information for children, family and community. The patterns of paediatric rehabilitation services and service organization in Quebec were analysed. Services for children with physical disabilities are primarily intended to develop basic and applied skills. The mandate of institutions delivering specialized services and waiting lists could limit the possibilities to provide services able to meet all of the needs of disabled children. Integration of public health activities would ensure greater complementarity and further promote social participation. Some approaches providing interesting avenues to further integrate public health in paediatric rehabilitation services are discussed.

14/12-GHz-band satellite communication services

NASA Astrophysics Data System (ADS)

Hayashi, Kunihiro; Nagaki, Kiyoaki; Mori, Yasuo

1990-01-01

Three new systems for integrated TV-relay services have been developed: Satellite Video Comunication Service (SVCS) and Satellite Digital Communication Service (SDCS), with Japan's 14/12-GHz-band commercial communication satellites. These systems have been in commercial use since May 1989. Usually SVCS and SDCS have been provided using Ka-band (30/20 GHz-band) of CS-2 and Cs-3. This paper provides an overview of the design, the performance, and the systems of the new 14/12-GHz-band satellite communication services.

FM 100-11 Force Integration

DTIC Science & Technology

1998-01-01

formed or available at an Army installation. It as- sesses both the quantity and quality of service deliv- ery, such as how much service is provided...34 That is, determining how much should it cost to provide services to cus- tomers to maintain a given level of quality and still satisfy their needs. d...ence, and ability to sustain the force (judgmental). (9) Quality of soldier and family support services (judgmental). (10) Civilian and military

Shepherds' local knowledge and scientific data on the scavenging ecosystem service: Insights for conservation.

PubMed

Morales-Reyes, Zebensui; Martín-López, Berta; Moleón, Marcos; Mateo-Tomás, Patricia; Olea, Pedro P; Arrondo, Eneko; Donázar, José A; Sánchez-Zapata, José A

2018-05-05

Integrating indigenous and local knowledge (ILK) and scientific knowledge (SK) in the evaluation of ecosystem services has been recommended by the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services. We examined the similarities and contradictions between shepherds' ILK and SK on the scavenging service provided by vertebrates in Spain. We conducted 73 face-to-face surveys with shepherds to evaluate their ILK. We collected scientific information on 20 scavenger species by monitoring the consumption of 45 livestock carcasses with camera traps. We found a high consistency between ILK and SK regarding the provision of the scavenging service by vertebrates, which was also consistent over the range of shepherd ages and experience. Our findings support the importance of ILK held by shepherds to better understand and to collect information on the scavenging service, particularly at the species level. The integration of ILK and SK into the management strategies of scavengers can benefit the conservation of globally endangered scavengers and the ecosystem services they provide.

Service Standards for the Mobile/Social Library

ERIC Educational Resources Information Center

Thomas, Lisa Carlucci

2010-01-01

Customer service is at the core of everything librarians do in libraries. They strive to create positive customer relationships and to provide added value to the library services offered to their patrons. Emerging technologies offer opportunities for creative integration with library services. Staff should be encouraged to explore, learn, and…

Implementation of Service-Learning in Business Education: Issues and Challenges

ERIC Educational Resources Information Center

Poon, Patrick; Chan, Tsang Sing; Zhou, Lianxi

2011-01-01

This paper examines the issues and challenges in the implementation of service-learning in undergraduate business education. It also provides an assessment of the students' learning efficacy and outcomes over time through the service-learning participation. Service-learning is a pedagogical approach that integrates academic learning and community…

Integration of Fixed and Flexible Route Public Transportation Systems, Phase II

DOT National Transportation Integrated Search

2012-01-01

Conventional bus service (with fixed routes and schedules) has lower average cost than flexible bus service (with : demand-responsive routes) at high demand densities. At low demand densities flexible bus service has lower : average costs and provide...

DS-MAC: differential service medium access control design for wireless medical information systems.

PubMed

Yuan, Xiaojing; Bagga, Sumegha; Shen, Jian; Balakrishnan, M; Benhaddou, D

2008-01-01

The integration of wireless networking technologies with medical information systems (telemedicine) have a significant impact on healthcare services provided to our society. Applications of telemedicine range from personalized medicine to affordable healthcare for underserved population. Though wireless technologies and medical informatics are individually progressing rapidly, wireless networking for healthcare systems is still at a very premature stage. In this paper we first present our open architecture for medical information systems that integrates both wired and wireless networked data acquisition systems. We then present the implementation at the physical layer and differential service MAC design that adapts channel provisioning based on the information criticality. Performance evaluation using analytical modeling and simulation shows that our DS-MAC provides differentiated services for emergency, warning, and normal traffic.

Kenya Hospices and Palliative Care Association: integrating palliative care in public hospitals in Kenya.

PubMed

Ali, Zipporah

2016-01-01

In Kenya, cancers as a disease group rank third as a cause of death after infectious and cardiovascular diseases. It is estimated that the annual incidence of cancer is about 37,000 new cases with an annual mortality of 28,000 cases (Kenya National Cancer Control Strategy 2010). The incidence of non-communicable diseases accounts for more than 50% of total hospital admissions and over 55% of hospital deaths (Kenya National Strategy for the Prevention and Control of Non Communicable Diseases 2015-2020). The prevalence of HIV is 6.8 (KIAS 2014). Most of these patients will benefit from palliative care services, hence the need to integrate palliative care services in the public healthcare system. The process of integrating palliative care in public hospitals involved advocacy both at the national level and at the institutional level, training of healthcare professionals, and setting up services within the hospitals that we worked with. Technical support was provided to each individual institution as needed. Eleven provincial hospitals across the country have now integrated palliative care services (Palliative Care Units) and are now centres of excellence. Over 220 healthcare providers have been trained, and approximately, over 30,000 patients have benefited from these services. Oral morphine is now available in the hospital palliative care units. As a success of the pilot project, Kenya Hospices and Palliative Care Association (KEHPCA) is now working with the Ministry of Health Kenya to integrate palliative care services in 30 other county hospitals across the country, thus ensuring more availability and access to more patients. Other developing countries can learn from Kenya's successful experience.

Interworking evolution of mobile satellite and terrestrial networks

NASA Technical Reports Server (NTRS)

Matyas, R.; Kelleher, P.; Moller, P.; Jones, T.

1993-01-01

There is considerable interest among mobile satellite service providers in interworking with terrestrial networks to provide a universal global network. With such interworking, subscribers may be provided a common set of services such as those planned for the Public Switched Telephone Network (PSTN), the Integrated Services Digital Network (ISDN), and future Intelligent Networks (IN's). This paper first reviews issues in satellite interworking. Next the status and interworking plans of terrestrial mobile communications service providers are examined with early examples of mobile satellite interworking including a discussion of the anticipated evolution towards full interworking between mobile satellite and both fixed and mobile terrestrial networks.

Integrated mental health atlas of the Western Sydney Local Health District: gaps and recommendations.

PubMed

Fernandez, Ana; Gillespie, James A; Smith-Merry, Jennifer; Feng, Xiaoqi; Astell-Burt, Thomas; Maas, Cailin; Salvador-Carulla, Luis

2017-03-01

Objective Australian mental health care remains hospital centric and fragmented; it is riddled with gaps and does little to promote recovery. Reform must be built on better knowledge of the shape of existing services. Mental health atlases are an essential part of this knowledge base, enabling comparison with other regions and jurisdictions, but must be based on a rigorous classification of services. The main aim of this study is to create an integrated mental health atlas of the Western Sydney LHD in order to help decision makers to better plan informed by local evidence. Methods The standard classification system, namely the Description and Evaluation of Services and Directories in Europe for Long-term Care model, was used to describe and classify adult mental health services in the Western Sydney Local Health District (LHD). This information provided the foundation for accessibility maps and the analysis of the provision of care for people with a lived experience of mental illness in Western Sydney LHD. All this data was used to create the Integrated Mental Health Atlas of Western Sydney LHD. Results The atlas identified four major gaps in mental health care in Western Sydney LHD: (1) a lack of acute and sub-acute community residential care; (2) an absence of services providing acute day care and non-acute day care; (3) low availability of specific employment services for people with a lived experience of mental ill-health; and (4) a lack of comprehensive data on the availability of supported housing. Conclusions The integrated mental health atlas of the Western Sydney LHD provides a tool for evidence-informed planning and critical analysis of the pattern of adult mental health care. What is known about the topic? Several reports have highlighted that the Australian mental health system is hospital based and fragmented. However, this knowledge has had little effect on actually changing the system. What does this paper add? This paper provides a critical analysis of the pattern of adult mental health care provided within the boundaries of the Western Sydney LHD using a standard, internationally validated tool to describe and classify the services. This provides a good picture of the availability of adult mental health care at the local level that was hitherto lacking. What are the implications for practitioners? The data presented herein provide a better understanding of the context in which mental health practitioners work. Managers and planners of services providing care for people with a lived experience of mental illness can use the information herein for better planning informed by local evidence.

Language Integrated Technology Project Final Evaluation Report.

ERIC Educational Resources Information Center

Stiegemeier, Lois

The goal of the Language Integrated Technology Grant Project (LIT) consortium was to help provide critical components of successful reading programs through a combination of proven computer/print programs and teacher training. Through leadership provided by the Educational Service District 113 (Olympia, Washington), the LIT consortium of schools…

Context-aware access control for pervasive access to process-based healthcare systems.

PubMed

Koufi, Vassiliki; Vassilacopoulos, George

2008-01-01

Healthcare is an increasingly collaborative enterprise involving a broad range of healthcare services provided by many individuals and organizations. Grid technology has been widely recognized as a means for integrating disparate computing resources in the healthcare field. Moreover, Grid portal applications can be developed on a wireless and mobile infrastructure to execute healthcare processes which, in turn, can provide remote access to Grid database services. Such an environment provides ubiquitous and pervasive access to integrated healthcare services at the point of care, thus improving healthcare quality. In such environments, the ability to provide an effective access control mechanism that meets the requirement of the least privilege principle is essential. Adherence to the least privilege principle requires continuous adjustments of user permissions in order to adapt to the current situation. This paper presents a context-aware access control mechanism for HDGPortal, a Grid portal application which provides access to workflow-based healthcare processes using wireless Personal Digital Assistants. The proposed mechanism builds upon and enhances security mechanisms provided by the Grid Security Infrastructure. It provides tight, just-in-time permissions so that authorized users get access to specific objects according to the current context. These permissions are subject to continuous adjustments triggered by the changing context. Thus, the risk of compromising information integrity during task executions is reduced.

Key Principles in Providing Integrated Behavioral Health Services for Young Children and Their Families: The "Starting Early Starting Smart" Experience.

ERIC Educational Resources Information Center

Hanson, Lori, Comp.; Deere, David, Comp.; Lee, Carol Amundson, Comp.; Lewin, Amy, Comp.; Seval, Carolyn, Comp.

This paper describes the Starting Early Starting Smart (SESS) project, an early intervention program that has been developed in the context of the national, multi-site program and evaluation. The emphasis in SESS is on the integration of behavioral health services into easily accessible, non-threatening settings where caregivers naturally and…

The integration of behavioral health interventions in children's health care: services, science, and suggestions.

PubMed

Kolko, David J; Perrin, Ellen

2014-01-01

Because the integration of mental or behavioral health services in pediatric primary care is a national priority, a description and evaluation of the interventions applied in the healthcare setting is warranted. This article examines several intervention research studies based on alternative models for delivering behavioral health care in conjunction with comprehensive pediatric care. This review describes the diverse methods applied to different clinical problems, such as brief mental health skills, clinical guidelines, and evidence-based practices, and the empirical outcomes of this research literature. Next, several key treatment considerations are discussed to maximize the efficiency and effectiveness of these interventions. Some practical suggestions for overcoming key service barriers are provided to enhance the capacity of the practice to deliver behavioral health care. There is moderate empirical support for the feasibility, acceptability, and clinical utility of these interventions for treating internalizing and externalizing behavior problems. Practical strategies to extend this work and address methodological limitations are provided that draw upon recent frameworks designed to simplify the treatment enterprise (e.g., common elements). Pediatric primary care has become an important venue for providing mental health services to children and adolescents due, in part, to its many desirable features (e.g., no stigma, local setting, familiar providers). Further adaptation of existing delivery models may promote the delivery of effective integrated interventions with primary care providers as partners designed to address mental health problems in pediatric healthcare.

The National Health Services of Brazil and Northern Europe: Universality, Equity, and Integrality-Time Has Come for the Latter.

PubMed

Gurgel, Garibaldi D; de Sousa, Islândia M Carvalho; de Araujo Oliveira, Sydia Rosana; de Assis da Silva Santos, Francisco; Diderichsen, Finn

2017-10-01

In 1990 the national health services in the United Kingdom and Sweden started to split up in internal markets with purchasers and providers. It was also the year when Brazil started to implement a national health service (SUS) inspired by the British national health service that aimed at principles of universality, equity, and integrality. While the reform in Brazil aimed at improving equity and effectiveness, reforms in Europe aimed at improving efficiency in order to contain costs. The European reforms increased supply and utilization but never provided the large increase in efficiency that was hoped for, and inequities have increased. The health sector reform in Brazil, on the other hand, contributed to great improvements in population health but never succeeded in changing the fact that more than half of health care spending was private. Demographic and epidemiological changes, with more elderly people having chronic disorders and very unequal comorbidities, bring the issue of integrality in the forefront in all 3 countries, and neither the public purchaser provider markets nor the 2-tier system in Brazil delivers on that front. It will demand political leadership and strategic planning with population responsibility to deal with such challenges.

The provision of surgical care by international organizations in developing countries: a preliminary report.

PubMed

McQueen, K A Kelly; Hyder, Joseph A; Taira, Breena R; Semer, Nadine; Burkle, Frederick M; Casey, Kathleen M

2010-03-01

Emerging data demonstrate that a large fraction of the global burden of disease is amenable to surgical intervention. There is a paucity of data related to delivery of surgical care in low- and middle-income countries, and no aggregate data describe the efforts of international organizations to provide surgical care in these settings. This study was designed to describe the roles and practices of international organizations delivering surgical care in developing nations with regard to surgical types and volume, outcomes tracking, and degree of integration with local health systems. Between October 2008 and December 2008, an Internet-based confidential questionnaire was distributed to 99 international organizations providing humanitarian surgical care to determine their size, scope, involvement in surgical data collection, and integration into local systems. Forty-six international organizations responded (response rate 46%). Findings reveal that a majority of organizations that provide surgery track numbers of cases performed and immediate outcomes, such as mortality. In general, these groups have mechanisms in place to track volume and outcomes, provide for postintervention follow-up, are committed to providing education, and work in conjunction with local health organizations and providers. Whereas most organizations surveyed provided fewer than 500 surgical procedures annually, more than half had the capacity to provide emergency services. In addition, a great diversity of specialized surgical care was provided, including obstetrics, orthopedic, plastic, and ophthalmologic surgery. International organizations providing surgical services are diverse in size and breadth of surgical services provided yet, with consistency, provide rudimentary analysis, postoperative follow-up care, and both education and integration of health services at the local level. The role of international organizations in the delivery of surgery is an important index, worthy of further evaluation.

Productivity and quality improvements in health care through airboss mobile messaging services.

PubMed

Shah, P J; Martinez, R; Cooney, E

1997-01-01

The US health care industry is in the midst of revolutionary changes. Under tremendous pressures from third-party payers and managed care programs to control costs while providing high quality medical services, health care entities are now looking at information technologies to help them achieve their goals. These goals typically include improved productivity, efficiency and decision-making capabilities among staff members. Moreover, hospitals and other health care facilities that provide a broad and integrated range of inpatient and outpatient care, wellness and home care services are in the best position to offer comprehensive packages to managed care and private insurers. Many health care providers and administrators are considered mobile employees. This mobility can range from intra-building and intra-campus to multi-site and metropolitan areas. This group often relies on a variety of information technologies such as personal computers, communicating laptops, pagers, cellular phones, wireline phones, cordless phones and fax machines to stay in touch and handle information needs. These health care professionals require mobile information access and messaging tools to improve communications, control accessibility and enhance decision-making capabilities. AirBoss mobile messaging services could address the health care industry's need for improved messaging capabilities for its mobile employees. The AirBoss family of services supports integrated voice services, data messaging, mobile facsimile and customized information delivery. This paper describes overview of the current mobile data networking capability, the AirBoss architecture, the health care-related applications it addresses and long-term benefits. In addition, a prototype application for mobile home health care workers is illustrated. This prototype application provides integrated e-mail, information services, web access, real-time access and update of patient records from wireline or wireless networks, and cross media delivery and notification. It provides seamless wide area access to patient data in a secure environment, thus providing a continuity of care from the hospital to home.

Integration of family planning with maternal health services: an opportunity to increase postpartum modern contraceptive use in urban Uttar Pradesh, India.

PubMed

Achyut, Pranita; Mishra, Anurag; Montana, Livia; Sengupta, Ranajit; Calhoun, Lisa M; Nanda, Priya

2016-04-01

Maternal health (MH) services provide an invaluable opportunity to inform and educate women about family planning (FP). It is expected that this would enable women to choose an appropriate method and initiate contraception early in the postpartum period. In this study we examined interactions with health providers for MH services, and the effect of FP information provision during these interactions on the postpartum use of modern contraceptive methods. This study used midline data collected from 990 women who had delivered a live birth between January 2010 and the date of the midline survey in 2012. These women were asked a series of questions about their last delivery, including interactions with health providers during pregnancy, delivery and the postpartum period, if they received FP information during these interactions, and their contraceptive use during the postpartum period. The study found that FP information provision as part of antenatal care in the third trimester, delivery and the postpartum period have a positive association with postpartum modern contraceptive use in urban Uttar Pradesh. However, health providers often miss these opportunities. Despite a high proportion of women coming into contact with health providers when utilising MH services, only a small proportion received FP information during these interactions. Integration of FP with MH services can increase postpartum modern contraceptive use. With the launch of the National Urban Health Mission, there now exists appropriate policy and programmatic environments for integration of FP and MH services in urban settings in India. However, this will require a concentrated effort both to enhance the capacity of health providers and encourage supportive supervision. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Semantic Web meets Integrative Biology: a survey.

PubMed

Chen, Huajun; Yu, Tong; Chen, Jake Y

2013-01-01

Integrative Biology (IB) uses experimental or computational quantitative technologies to characterize biological systems at the molecular, cellular, tissue and population levels. IB typically involves the integration of the data, knowledge and capabilities across disciplinary boundaries in order to solve complex problems. We identify a series of bioinformatics problems posed by interdisciplinary integration: (i) data integration that interconnects structured data across related biomedical domains; (ii) ontology integration that brings jargons, terminologies and taxonomies from various disciplines into a unified network of ontologies; (iii) knowledge integration that integrates disparate knowledge elements from multiple sources; (iv) service integration that build applications out of services provided by different vendors. We argue that IB can benefit significantly from the integration solutions enabled by Semantic Web (SW) technologies. The SW enables scientists to share content beyond the boundaries of applications and websites, resulting into a web of data that is meaningful and understandable to any computers. In this review, we provide insight into how SW technologies can be used to build open, standardized and interoperable solutions for interdisciplinary integration on a global basis. We present a rich set of case studies in system biology, integrative neuroscience, bio-pharmaceutics and translational medicine, to highlight the technical features and benefits of SW applications in IB.

Integrated primary care: patient perceptions and the role of mental health stigma.

PubMed

Miller-Matero, Lisa R; Khan, Shehryar; Thiem, Rachel; DeHondt, Tiffany; Dubaybo, Hala; Moore, Daniel

2018-06-19

Some patients are more willing to see a behavioral health provider within primary care. The purpose of this study was to evaluate the patients' perspectives of having access to a psychologist within primary care and to investigate whether mental health stigma affected preferences. In total, 36 patients completed questionnaires after seeing a psychologist in primary care. Patients were satisfied with having a primary care psychologist involved in their care. Most patients were more likely to see the psychologist in primary care and those who preferred this indicated higher levels of mental health stigma. The overarching theme for why patients saw a psychologist in primary care was convenience. Mental health stigma may also have played a role. Results suggest that providing integrated services may reach patients who may not have otherwise sought services in a behavioral health clinic. Findings from this study encourage the continued integration of behavioral health services.

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

PubMed

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

2011-12-01

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

NEP-ORD Collaborations on Quantifying the Ecosystem Goods and Services of Estuaries

EPA Science Inventory

Nature’s goods and services provided by estuarine ecosystems are integral to the economies and well-being of coastal communities. However, many valuable ecosystem goods and services (EGS), including their benefits to surrounding communities, are not explicitly considered i...

Software for Remote Monitoring of Space-Station Payloads

NASA Technical Reports Server (NTRS)

Schneider, Michelle; Lippincott, Jeff; Chubb, Steve; Whitaker, Jimmy; Gillis, Robert; Sellers, Donna; Sims, Chris; Rice, James

2003-01-01

Telescience Resource Kit (TReK) is a suite of application programs that enable geographically dispersed users to monitor scientific payloads aboard the International Space Station (ISS). TReK provides local ground support services that can simultaneously receive, process, record, playback, and display data from multiple sources. TReK also provides interfaces to use the remote services provided by the Payload Operations Integration Center which manages all ISS payloads. An application programming interface (API) allows for payload users to gain access to all data processed by TReK and allows payload-specific tools and programs to be built or integrated with TReK. Used in conjunction with other ISS-provided tools, TReK provides the ability to integrate payloads with the operational ground system early in the lifecycle. This reduces the potential for operational problems and provides "cradle-to-grave" end-to-end operations. TReK contains user guides and self-paced tutorials along with training applications to allow the user to become familiar with the system.

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

PubMed

Geissler, Kimberley H; Leatherman, Sheila

2015-05-01

The simultaneous burdens of communicable and chronic non-communicable diseases cause significant morbidity and mortality in middle-income countries. The poor are at particular risk, with lower access to health care and higher rates of avoidable mortality. Integrating health-related services with microfinance has been shown to improve health knowledge, behaviors, and access to appropriate health care. However, limited evidence is available on effects of fully integrating clinical health service delivery alongside microfinance services through large scale and sustained long-term programs. Using a conceptual model of health services access, we examine supply- and demand-side factors in a microfinance client population receiving integrated services. We conduct a case study using data from 2010 to 2012 of the design of a universal screening program and primary care services provided in conjunction with microfinance loans by Pro Mujer, a women's development organization in Latin America. The program operates in Argentina, Bolivia, Mexico, Nicaragua, and Peru. We analyze descriptive reports and administrative data for measures related to improving access to primary health services and management of chronic diseases. We find provision of preventive care is substantial, with an average of 13% of Pro Mujer clients being screened for cervical cancer each year, 21% receiving breast exams, 16% having a blood glucose measurement, 39% receiving a blood pressure measurement, and 46% having their body mass index calculated. This population, with more than half of those screened being overweight or obese and 9% of those screened having elevated glucose measures, has major risk factors for diabetes, high blood pressure, and cardiovascular disease without intervention. The components of the Pro Mujer health program address four dimensions of healthcare access: geographic accessibility, availability, affordability, and acceptability. Significant progress has been made to meet basic health needs, but challenges remain to ensure that health care provided is of reliable quality to predictably improve health outcomes over time. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

PubMed

Berdine, Hildegarde J; Skomo, Monica L

2012-01-01

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

HIV, tuberculosis, and noncommunicable diseases: what is known about the costs, effects, and cost-effectiveness of integrated care?

PubMed

Hyle, Emily P; Naidoo, Kogieleum; Su, Amanda E; El-Sadr, Wafaa M; Freedberg, Kenneth A

2014-09-01

Unprecedented investments in health systems in low- and middle-income countries (LMICs) have resulted in more than 8 million individuals on antiretroviral therapy. Such individuals experience dramatically increased survival but are increasingly at risk of developing common noncommunicable diseases (NCDs). Integrating clinical care for HIV, other infectious diseases, and NCDs could make health services more effective and provide greater value. Cost-effectiveness analysis is a method to evaluate the clinical benefits and costs associated with different health care interventions and offers guidance for prioritization of investments and scale-up, especially as resources are increasingly constrained. We first examine tuberculosis and HIV as 1 example of integrated care already successfully implemented in several LMICs; we then review the published literature regarding cervical cancer and depression as 2 examples of NCDs for which integrating care with HIV services could offer excellent value. Direct evidence of the benefits of integrated services generally remains scarce; however, data suggest that improved effectiveness and reduced costs may be attained by integrating additional services with existing HIV clinical care. Further investigation into clinical outcomes and costs of care for NCDs among people living with HIV in LMICs will help to prioritize specific health care services by contributing to an understanding of the affordability and implementation of an integrated approach.

Co-Leadership - A Management Solution for Integrated Health and Social Care.

PubMed

Klinga, Charlotte; Hansson, Johan; Hasson, Henna; Sachs, Magna Andreen

2016-05-23

Co-leadership has been identified as one approach to meet the managerial challenges of integrated services, but research on the topic is limited. In the present study, co-leadership, practised by pairs of managers - each manager representing one of the two principal organizations in integrated health and social care services - was explored. To investigate co-leadership in integrated health and social care, identify essential preconditions in fulfilling the management assignment, its operationalization and impact on provision of sustainable integration of health and social care. Interviews with eight managers exercising co-leadership were analysed using directed content analysis. Respondent validation was conducted through additional interviews with the same managers. Key contextual preconditions were an organization-wide model supporting co-leadership and co-location of services. Perception of the management role as a collective activity, continuous communication and lack of prestige were essential personal and interpersonal preconditions. In daily practice, office sharing, being able to give and take and support each other contributed to provision of sustainable integration of health and social care. Co-leadership promoted robust management by providing broader competence, continuous learning and joint responsibility for services. Integrated health and social care services should consider employing co-leadership as a managerial solution to achieve sustainability.

Co-Leadership – A Management Solution for Integrated Health and Social Care

PubMed Central

Hansson, Johan; Hasson, Henna; Sachs, Magna Andreen

2016-01-01

Introduction: Co-leadership has been identified as one approach to meet the managerial challenges of integrated services, but research on the topic is limited. In the present study, co-leadership, practised by pairs of managers – each manager representing one of the two principal organizations in integrated health and social care services – was explored. Aim: To investigate co-leadership in integrated health and social care, identify essential preconditions in fulfilling the management assignment, its operationalization and impact on provision of sustainable integration of health and social care. Method: Interviews with eight managers exercising co-leadership were analysed using directed content analysis. Respondent validation was conducted through additional interviews with the same managers. Results: Key contextual preconditions were an organization-wide model supporting co-leadership and co-location of services. Perception of the management role as a collective activity, continuous communication and lack of prestige were essential personal and interpersonal preconditions. In daily practice, office sharing, being able to give and take and support each other contributed to provision of sustainable integration of health and social care. Conclusion and discussion: Co-leadership promoted robust management by providing broader competence, continuous learning and joint responsibility for services. Integrated health and social care services should consider employing co-leadership as a managerial solution to achieve sustainability. PMID:27616963

Towards Integrating Distributed Energy Resources and Storage Devices in Smart Grid.

PubMed

Xu, Guobin; Yu, Wei; Griffith, David; Golmie, Nada; Moulema, Paul

2017-02-01

Internet of Things (IoT) provides a generic infrastructure for different applications to integrate information communication techniques with physical components to achieve automatic data collection, transmission, exchange, and computation. The smart grid, as one of typical applications supported by IoT, denoted as a re-engineering and a modernization of the traditional power grid, aims to provide reliable, secure, and efficient energy transmission and distribution to consumers. How to effectively integrate distributed (renewable) energy resources and storage devices to satisfy the energy service requirements of users, while minimizing the power generation and transmission cost, remains a highly pressing challenge in the smart grid. To address this challenge and assess the effectiveness of integrating distributed energy resources and storage devices, in this paper we develop a theoretical framework to model and analyze three types of power grid systems: the power grid with only bulk energy generators, the power grid with distributed energy resources, and the power grid with both distributed energy resources and storage devices. Based on the metrics of the power cumulative cost and the service reliability to users, we formally model and analyze the impact of integrating distributed energy resources and storage devices in the power grid. We also use the concept of network calculus, which has been traditionally used for carrying out traffic engineering in computer networks, to derive the bounds of both power supply and user demand to achieve a high service reliability to users. Through an extensive performance evaluation, our data shows that integrating distributed energy resources conjointly with energy storage devices can reduce generation costs, smooth the curve of bulk power generation over time, reduce bulk power generation and power distribution losses, and provide a sustainable service reliability to users in the power grid.

Towards Integrating Distributed Energy Resources and Storage Devices in Smart Grid

PubMed Central

Xu, Guobin; Yu, Wei; Griffith, David; Golmie, Nada; Moulema, Paul

2017-01-01

Internet of Things (IoT) provides a generic infrastructure for different applications to integrate information communication techniques with physical components to achieve automatic data collection, transmission, exchange, and computation. The smart grid, as one of typical applications supported by IoT, denoted as a re-engineering and a modernization of the traditional power grid, aims to provide reliable, secure, and efficient energy transmission and distribution to consumers. How to effectively integrate distributed (renewable) energy resources and storage devices to satisfy the energy service requirements of users, while minimizing the power generation and transmission cost, remains a highly pressing challenge in the smart grid. To address this challenge and assess the effectiveness of integrating distributed energy resources and storage devices, in this paper we develop a theoretical framework to model and analyze three types of power grid systems: the power grid with only bulk energy generators, the power grid with distributed energy resources, and the power grid with both distributed energy resources and storage devices. Based on the metrics of the power cumulative cost and the service reliability to users, we formally model and analyze the impact of integrating distributed energy resources and storage devices in the power grid. We also use the concept of network calculus, which has been traditionally used for carrying out traffic engineering in computer networks, to derive the bounds of both power supply and user demand to achieve a high service reliability to users. Through an extensive performance evaluation, our data shows that integrating distributed energy resources conjointly with energy storage devices can reduce generation costs, smooth the curve of bulk power generation over time, reduce bulk power generation and power distribution losses, and provide a sustainable service reliability to users in the power grid1. PMID:29354654

78 FR 62616 - Integrated System Power Rates

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-22

... sudden loss of generation or load. 1.1.5. Supplemental Operating Reserve Service provides an additional... experienced due to a sudden loss of generation or load. 1.1.5. Supplemental Operating Reserve Service provides... Deputy Secretary has approved and placed into effect on an interim basis Rate Order No. SWPA-66, which...

The Prevention Researcher, 1998.

ERIC Educational Resources Information Center

Ungerleider, Steven, Ed.

1998-01-01

As a service of Integrated Research Services, a non-profit organization, this newsletter reports on many facets of prevention research. Written in direct, accessible language, each issue provides a "snapshot" update on a specific topic. Some articles are reprinted (often in a briefer format) from other publications; others provide a synthesis of…

Promoting Professional Development for Physical Therapists in Early Intervention

ERIC Educational Resources Information Center

Catalino, Tricia; Chiarello, Lisa A.; Long, Toby; Weaver, Priscilla

2015-01-01

Early intervention service providers are expected to form cohesive teams to build the capacity of a family to promote their child's development. Given the differences in personnel preparation across disciplines of service providers, the Early Childhood Personnel Center is creating integrated and comprehensive professional development models for…

Cloud-Based Speech Technology for Assistive Technology Applications (CloudCAST).

PubMed

Cunningham, Stuart; Green, Phil; Christensen, Heidi; Atria, José Joaquín; Coy, André; Malavasi, Massimiliano; Desideri, Lorenzo; Rudzicz, Frank

2017-01-01

The CloudCAST platform provides a series of speech recognition services that can be integrated into assistive technology applications. The platform and the services provided by the public API are described. Several exemplar applications have been developed to demonstrate the platform to potential developers and users.

Patient care delivery and integration: stimulating advancement of ambulatory care pharmacy practice in an era of healthcare reform.

PubMed

Epplen, Kelly T

2014-08-15

This article discusses how to plan and implement an ambulatory care pharmacist service, how to integrate a hospital- or health-system-based service with the mission and operations of the institution, and how to help the institution meet its challenges related to quality improvement, continuity of care, and financial sustainability. The steps in implementing an ambulatory care pharmacist service include (1) conducting a needs assessment, (2) aligning plans for the service with the mission and goals of the parent institution, (3) collaborating with patients and physicians, (4) standardizing the patient care process, (5) proposing the service, (6) attaining the necessary resources, (7) identifying stakeholders, (8) identifying applicable quality standards, (9) defining competency standards, (10) planning for service payment, and (11) monitoring outcomes. Ambulatory care pharmacists have current opportunities to become engaged with patient-centered medical homes, accountable care organizations, preventive and wellness programs, and continuity of care initiatives. Common barriers to the advancement of ambulatory care pharmacist services include lack of complete access to patient information, inadequate information technology, and lack of payment. Ambulatory care pharmacy practitioners must assertively promote appropriate medication use, provide patient-centered care, pursue integration with the patient care team, and seek appropriate recognition and compensation for the services they provide. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

EPOS-Seismology: building the Thematic Core Service for Seismology during the EPOS Implementation Phase

NASA Astrophysics Data System (ADS)

Haslinger, Florian; EPOS Seismology Consortium, the

2015-04-01

After the successful completion of the EPOS Preparatory Phase, the community of European Research Infrastructures in Seismology is now moving ahead with the build-up of the Thematic Core Service (TCS) for Seismology in EPOS, EPOS-Seismology. Seismology is a domain where European-level infrastructures have been developed since decades, often supported by large-scale EU projects. Today these infrastructures provide services to access earthquake waveforms (ORFEUS), parameters (EMSC) and hazard data and products (EFEHR). The existing organizations constitute the backbone of infrastructures that also in future will continue to manage and host the services of the TCS EPOS-Seismology. While the governance and internal structure of these organizations will remain active, and continue to provide direct interaction with the community, EPOS-Seismology will provide the integration of these within EPOS. The main challenge in the build-up of the TCS EPOS-Seismology is to improve and extend these existing services, producing a single framework which is technically, organizationally and financially integrated with the EPOS architecture, and to further engage various kinds of end users (e.g. scientists, engineers, public managers, citizen scientists). On the technical side the focus lies on four major tasks: - the construction of the next generation software architecture for the European Integrated (waveform) Data Archive EIDA, developing advanced metadata and station information services, fully integrate strong motion waveforms and derived parametric engineering-domain data, and advancing the integration of mobile (temporary) networks and OBS deployments in EIDA; - the further development and expansion of services to access seismological products of scientific interest as provided by the community by implementing a common collection and development (IT) platform, improvements in the earthquake information services e.g. by introducing more robust quality indicators and diversifying collection and dissemination mechanisms, as well as improving historical earthquake data services; - the development of a comprehensive suite of earthquake hazard products, tools, and services harmonized on the European level and available through a common access platform, encompassing information on seismic sources, seismogenic faults, ground-motion prediction equations, geotechnical information, and strong-motion recordings in buildings, together with an interface to earthquake risk; - a portal implementation of computational seismology tools and services, specifically for seismic waveform propagation in complex 3D media following the results of the VERCE project, and initiating the inclusion of further suitable codes on that portal in discussion with the community, forming the basis of EPOS computational earth science infrastructure. Important features common to all tasks are the development of EPOS-wide integrated and interoperable metadata structures, the introduction and utilization of adequate and referencable persistent identifiers for data and products, and the implementation of appropriate user access and authorization mechanisms. Here we present further details on the technical work plan for Seismology during the EPOS Implementation Phase and its integration into the overall EPOS build-up, together with the current view and state of the discussion on the development of adequate governance structures, and discuss how we envision the interaction with and involvement of the wider community outside the consortium in these activities.

Globus Identity, Access, and Data Management: Platform Services for Collaborative Science

NASA Astrophysics Data System (ADS)

Ananthakrishnan, R.; Foster, I.; Wagner, R.

2016-12-01

Globus is software-as-a-service for research data management, developed at, and operated by, the University of Chicago. Globus, accessible at www.globus.org, provides high speed, secure file transfer; file sharing directly from existing storage systems; and data publication to institutional repositories. 40,000 registered users have used Globus to transfer tens of billions of files totaling hundreds of petabytes between more than 10,000 storage systems within campuses and national laboratories in the US and internationally. Web, command line, and REST interfaces support both interactive use and integration into applications and infrastructures. An important component of the Globus system is its foundational identity and access management (IAM) platform service, Globus Auth. Both Globus research data management and other applications use Globus Auth for brokering authentication and authorization interactions between end-users, identity providers, resource servers (services), and a range of clients, including web, mobile, and desktop applications, and other services. Compliant with important standards such as OAuth, OpenID, and SAML, Globus Auth provides mechanisms required for an extensible, integrated ecosystem of services and clients for the research and education community. It underpins projects such as the US National Science Foundation's XSEDE system, NCAR's Research Data Archive, and the DOE Systems Biology Knowledge Base. Current work is extending Globus services to be compliant with FEDRAMP standards for security assessment, authorization, and monitoring for cloud services. We will present Globus IAM solutions and give examples of Globus use in various projects for federated access to resources. We will also describe how Globus Auth and Globus research data management capabilities enable rapid development and low-cost operations of secure data sharing platforms that leverage Globus services and integrate them with local policy and security.

Integration and continuity of Care in health care network models for frail older adults

PubMed Central

Veras, Renato Peixoto; Caldas, Célia Pereira; da Motta, Luciana Branco; de Lima, Kenio Costa; Siqueira, Ricardo Carreño; Rodrigues, Renata Teixeira da Silva Vendas; Santos, Luciana Maria Alves Martins; Guerra, Ana Carolina Lima Cavaletti

2014-01-01

A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change. PMID:24897058

The Relationship of School-Based Services to Mental Health Networks.

ERIC Educational Resources Information Center

Polgar, Michael; Johnsen, Matthew; Calloway, Michael; Morrissey, Joseph P.

This paper uses data from a project in South Carolina that provides services to children with severe emotional disturbance (SED) to examine the role of schools in integrated service delivery. This study examined organizations participating in a demonstration project sponsored by the federal Center for Mental Health Services and administered by a…

The Role of Finance Reform in Comprehensive Service Initiatives.

ERIC Educational Resources Information Center

Cutler, Ira M.

The well-being of a large portion of American children is distressingly low. Integrated service delivery--which provides the broadest range of education, health, housing, and social services--is viewed as one way to remedy the failure of public and private institutions to deliver effective services that can ameliorate or reverse these problems and…

Using the framework of corporate culture in "mergers" to support the development of a cultural basis for integrative medicine - guidance for building an integrative medicine department or service.

PubMed

Witt, Claudia M; Pérard, Marion; Berman, Brian; Berman, Susan; Birdsall, Timothy C; Defren, Horst; Kümmel, Sherko; Deng, Gary; Dobos, Gustav; Drexler, Atje; Holmberg, Christine; Horneber, Markus; Jütte, Robert; Knutson, Lori; Kummer, Christopher; Volpers, Susanne; Schweiger, David

2015-01-01

An increasing number of clinics offer complementary or integrative medicine services; however, clear guidance about how complementary medicine could be successfully and efficiently integrated into conventional health care settings is still lacking. Combining conventional and complementary medicine into integrative medicine can be regarded as a kind of merger. In a merger, two or more organizations - usually companies - are combined into one in order to strengthen the companies financially and strategically. The corporate culture of both merger partners has an important influence on the integration. The aim of this project was to transfer the concept of corporate culture in mergers to the merging of two medical systems. A two-step approach (literature analyses and expert consensus procedure) was used to develop practical guidance for the development of a cultural basis for integrative medicine, based on the framework of corporate culture in "mergers," which could be used to build an integrative medicine department or integrative medicine service. Results include recommendations for general strategic dimensions (definition of the medical model, motivation for integration, clarification of the available resources, development of the integration team, and development of a communication strategy), and recommendations to overcome cultural differences (the clinic environment, the professional language, the professional image, and the implementation of evidence-based medicine). The framework of mergers in corporate culture provides an understanding of the difficulties involved in integrative medicine projects. The specific recommendations provide a good basis for more efficient implementation.

Using the framework of corporate culture in “mergers” to support the development of a cultural basis for integrative medicine – guidance for building an integrative medicine department or service

PubMed Central

Witt, Claudia M; Pérard, Marion; Berman, Brian; Berman, Susan; Birdsall, Timothy C; Defren, Horst; Kümmel, Sherko; Deng, Gary; Dobos, Gustav; Drexler, Atje; Holmberg, Christine; Horneber, Markus; Jütte, Robert; Knutson, Lori; Kummer, Christopher; Volpers, Susanne; Schweiger, David

2015-01-01

Background An increasing number of clinics offer complementary or integrative medicine services; however, clear guidance about how complementary medicine could be successfully and efficiently integrated into conventional health care settings is still lacking. Combining conventional and complementary medicine into integrative medicine can be regarded as a kind of merger. In a merger, two or more organizations − usually companies − are combined into one in order to strengthen the companies financially and strategically. The corporate culture of both merger partners has an important influence on the integration. Purpose The aim of this project was to transfer the concept of corporate culture in mergers to the merging of two medical systems. Methods A two-step approach (literature analyses and expert consensus procedure) was used to develop practical guidance for the development of a cultural basis for integrative medicine, based on the framework of corporate culture in “mergers,” which could be used to build an integrative medicine department or integrative medicine service. Results Results include recommendations for general strategic dimensions (definition of the medical model, motivation for integration, clarification of the available resources, development of the integration team, and development of a communication strategy), and recommendations to overcome cultural differences (the clinic environment, the professional language, the professional image, and the implementation of evidence-based medicine). Conclusion The framework of mergers in corporate culture provides an understanding of the difficulties involved in integrative medicine projects. The specific recommendations provide a good basis for more efficient implementation. PMID:25632226

Integrated Services for the Severely Physically Disabled

ERIC Educational Resources Information Center

Patrick, Donald

1975-01-01

Describes cooperative planning among a non-profit metropolitan tuberculosis sanitorium, a state vocational rehabilitation service and a medical center to provide a comprehensive rehabilitation program at Lakeshore Hospital, Birmingham, Alabama. (Author/EJT)

Semantic Service Matchmaking in the ATM Domain Considering Infrastructure Capability Constraints

NASA Astrophysics Data System (ADS)

Moser, Thomas; Mordinyi, Richard; Sunindyo, Wikan Danar; Biffl, Stefan

In a service-oriented environment business processes flexibly build on software services provided by systems in a network. A key design challenge is the semantic matchmaking of business processes and software services in two steps: 1. Find for one business process the software services that meet or exceed the BP requirements; 2. Find for all business processes the software services that can be implemented within the capability constraints of the underlying network, which poses a major problem since even for small scenarios the solution space is typically very large. In this chapter we analyze requirements from mission-critical business processes in the Air Traffic Management (ATM) domain and introduce an approach for semi-automatic semantic matchmaking for software services, the “System-Wide Information Sharing” (SWIS) business process integration framework. A tool-supported semantic matchmaking process like SWIS can provide system designers and integrators with a set of promising software service candidates and therefore strongly reduces the human matching effort by focusing on a much smaller space of matchmaking candidates. We evaluate the feasibility of the SWIS approach in an industry use case from the ATM domain.

Integration of Mobil Satellite and Cellular Systems

NASA Technical Reports Server (NTRS)

Drucker, E. H.; Estabrook, P.; Pinck, D.; Ekroot, L.

1993-01-01

By integrating the ground based infrastructure component of a mobile satellite system with the infrastructure systems of terrestrial 800 MHz cellular service providers, a seamless network of universal coverage can be established.

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

PubMed

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

2017-11-01

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

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

PubMed Central

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

2000-01-01

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

Implementing Service Learning: From Nutrition Education into Community Action

ERIC Educational Resources Information Center

Zinger, Lana; Sinclair, Alicia

2008-01-01

Service learning integrates academic learning and relevant community service with classroom instruction, focusing on critical, reflective thinking and personal civic responsibility. Through a grant, community college students were provided with grocery store vouchers to purchase unfamiliar, healthy foods. Students were taken on an educational…

Providing HIV-related services in China for men who have sex with men.

PubMed

Cheng, Weibin; Cai, Yanshan; Tang, Weiming; Zhong, Fei; Meng, Gang; Gu, Jing; Hao, Chun; Han, Zhigang; Li, Jingyan; Das, Aritra; Zhao, Jinkou; Xu, Huifang; Tucker, Joseph D; Wang, Ming

2016-03-01

In China, human immunodeficiency virus (HIV) care provided by community-based organizations and the public sector are not well integrated. A community-based organization and experts from the Guangzhou Center for Disease Control and Prevention developed internet-based services for men who have sex with men, in Guangzhou, China. The internet services were linked to clinical services offering HIV testing and care. The expanding HIV epidemic among men who have sex with men is a public health problem in China. HIV control and prevention measures are implemented primarily through the public system. Only a limited number of community organizations are involved in providing HIV services. The programme integrated community and public sector HIV services including health education, online HIV risk assessment, on-site HIV counselling and testing, partner notification, psychosocial care and support, counting of CD4+ T-lymphocytes and treatment guidance. The internet can facilitate HIV prevention among a subset of men who have sex with men by enhancing awareness, service uptake, retention in care and adherence to treatment. Collaboration between the public sector and the community group promoted acceptance by the target population. Task sharing by community groups can increase access of this high-risk group to available HIV-related services.

Overcoming roadblocks: current and emerging reimbursement strategies for integrated mental health services in primary care.

PubMed

O'Donnell, Allison N; Williams, Mark; Kilbourne, Amy M

2013-12-01

The Chronic Care Model (CCM) has been shown to improve medical and psychiatric outcomes for persons with mental disorders in primary care settings, and has been proposed as a model to integrate mental health care in the patient-centered medical home under healthcare reform. However, the CCM has not been widely implemented in primary care settings, primarily because of a lack of a comprehensive reimbursement strategy to compensate providers for day-to-day provision of its core components, including care management and provider decision support. Drawing upon the existing literature and regulatory guidelines, we provide a critical analysis of challenges and opportunities in reimbursing CCM components under the current fee-for-service system, and describe an emerging financial model involving bundled payments to support core CCM components to integrate mental health treatment into primary care settings. Ultimately, for the CCM to be used and sustained over time to integrate physical and mental health care, effective reimbursement models will need to be negotiated across payers and providers. Such payments should provide sufficient support for primary care providers to implement practice redesigns around core CCM components, including care management, measurement-based care, and mental health specialist consultation.

The Times They Are a Changin': Neuropsychology and Integrated Care Teams.

PubMed

Kubu, Cynthia S; Ready, Rebecca E; Festa, Joanne R; Roper, Brad L; Pliskin, Neil H

2016-01-01

To gather illustrative data from clinical neuropsychologists who are working in integrated care settings in order to provide an initial blueprint for moving forward in this new era of health care. A survey was designed to illustrate the ways in which neuropsychologists are participating in integrated care teams and distributed on major neuropsychology listservs. The survey evaluated the settings, roles, services provided, practice issues, remuneration, and impact of neuropsychologists' participation in integrated care teams with respect to patient care and health outcomes. Frequencies were used to summarize the findings as well as qualitative coding of narrative responses. There were 412 respondents to the survey and 261 of those indicated that they worked in at least one integrated care setting. Neuropsychologists work in a variety of integrated care settings and provide diverse services which contribute to improved patient care and outcomes. Three primary themes emerge from the findings with regard to the engagement and teams: advocacy, collaboration, and communication. We argue for the need for more easily accessible outcome studies illustrating the clinical benefits and cost-savings associated with inclusion of neuropsychologists in integrated care teams. In addition, educational and training initiatives are needed to better equip current and future clinical neuropsychologists to function effectively in integrated care settings.

EPA Facility Registry Service (FRS): ICIS

EPA Pesticide Factsheets

This web feature service contains location and facility identification information from EPA's Facility Registry Service (FRS) for the subset of facilities that link to the Integrated Compliance Information System (ICIS). When complete, ICIS will provide a database that will contain integrated enforcement and compliance information across most of EPA's programs. The vision for ICIS is to replace EPA's independent databases that contain enforcement data with a single repository for that information. Currently, ICIS contains all Federal Administrative and Judicial enforcement actions and a subset of the Permit Compliance System (PCS), which supports the National Pollutant Discharge Elimination System (NPDES). ICIS exchanges non-sensitive enforcement/compliance activities, non-sensitive formal enforcement actions and NPDES information with FRS. This web feature service contains the enforcement/compliance activities and formal enforcement action related facilities; the NPDES facilities are contained in the PCS_NPDES web feature service. FRS identifies and geospatially locates facilities, sites or places subject to environmental regulations or of environmental interest. Using vigorous verification and data management procedures, FRS integrates facility data from EPA's national program systems, other federal agencies, and State and tribal master facility records and provides EPA with a centrally managed, single source of comprehensive and authoritative information on f

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

PubMed Central

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

2001-01-01

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

Integrating Health Care for the Most Vulnerable: Bridging the Differences in Organizational Cultures Between US Hospitals and Community Health Centers.

PubMed

Ko, Michelle; Murphy, Julia; Bindman, Andrew B

2015-11-01

Policymakers have increasingly promoted health services integration to improve quality and efficiency. The US health care safety net, which comprises providers of health care to uninsured, Medicaid, and other vulnerable patients, remains a largely fragmented collection of providers. We interviewed leadership from safety net hospitals and community health centers in 5 US cities (Boston, MA; Denver, CO; Los Angeles, CA; Minneapolis, MN; and San Francisco, CA) throughout 2013 on their experiences with service integration. We identify conflicts in organizational mission, identity, and consumer orientation that have fostered reluctance to enter into collaborative arrangements. We describe how smaller scale initiatives, such as capitated model for targeted populations, health information exchange, and quality improvements led by health plans, can help bridge cultural differences to lay the groundwork for developing integrated care programs.

Integrating geo web services for a user driven exploratory analysis

NASA Astrophysics Data System (ADS)

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

2016-04-01

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

A Reference Software Architecture to Support Unmanned Aircraft Integration in the National Airspace System

DTIC Science & Technology

2012-07-01

and Avoid ( SAA ) testbed that provides some of the core services . This paper describes the general architecture and a SAA testbed implementation that...that provides data and software services to enable a set of Unmanned Aircraft (UA) platforms to operate in a wide range of air domains which may...implemented by MIT Lincoln Laboratory in the form of a Sense and Avoid ( SAA ) testbed that provides some of the core services . This paper describes the general

Who’s the BOS-I? Base Operating Support Integrator and Senior Airfield Authority at Deployed Bases

DTIC Science & Technology

2009-04-01

and trained than the Army to provide these functions at deployed airbases. The paper first examines CENTCOM guidance on BOS-I and SAA . How the Services ...provide these functions at deployed airbases. The paper first examines CENTCOM guidance on BOS-I and SAA . How the Services are organized to provide... SAA and BOS-I responsibilities do not neatly fall within their respective boundaries of control. This construct of having two separate Services with

Enabling OpenID Authentication for VO-integrated Portals

NASA Astrophysics Data System (ADS)

Plante, R.; Yekkirala, V.; Baker, W.

2012-09-01

To support interoperating services that share proprietary data and other user-specific information, the VAO Project provides login services for browser-based portals built on the open standard, OpenID. To help portal developers take advantage of this service, we have developed a downloadable toolkit for integrating OpenID single sign-on support into any portal. This toolkit provides APIs in a few languages commonly used on the server-side as well as a command-line version for use in any language. In addition to describing how to use this toolkit, we also discuss the general VAO framework for single sign-on. While a portal may, if it wishes, support any OpenID provider, the VAO service provides a few extra features to support VO interoperability. This includes a portal's ability to retrieve (with the user's permission) an X.509 certificate representing the authenticated user so that the portal can access other restricted services on the user's behalf. Other standard features of OpenID allow portals to request other information about the user; this feature will be used in the future for sharing information about a user's group membership to enable sharing within a group of collaborating scientists.

Human Services in Montgomery County, Ohio: Service Integration Writ Large.

ERIC Educational Resources Information Center

Ragan, Mark

The most striking characteristic of the human service system in Montgomery County, Ohio, is the size and scope of its job center. The center occupies 5.5 acres of office space, has ample parking, is well served by the public transportation system, and is the locus of many human service and employment programs and service providers. The county's…

[Development of second-line occupational health services: toward an integrated network of insurers and care providers].

PubMed

Plomp, H N

2000-06-10

To describe the development of the second-line Occupational Health Services and the role of private insurance companies in it over the period 1994-1999. Descriptive cross-sectional study. Data were collected in 1999 from written documents and supplementary interviews with the five largest private providers of disability insurance, the National Insurance Institute, nine Occupational Health Services of different natures and 24 institutions for second-line occupational health service. After the privatization of the Health Law in 1996 and parts of the Law on disability Insurance, most employers covered the risk of continued payment of wages in case of disability with private insurers. These attempted to keep claims down by active engagement in arbitration, treatment and diagnostics of disabled employees so as to counteract avoidable absenteeism. Under the influence of the insurance companies, a trend developed toward integrated nation-wide chains in which the services provided by insurers, by occupational health services and by implementing institutions are geared for one another. Commercial provision of Occupational Health Service is a new, demand-active form of care provision in which the financier plays a key part. This provision of services supplied important innovating impulses for health care in its entirety because of its large scale, strong protocolling of processes and management on the basis of continuous cost-benefit analyses. A lucid and socially acceptable regulation of commercial providers of occupational health services was lacking.

[Capacity of the legal framework of public health institutions in Mexico to support their functional integration].

PubMed

Ibarra, Ignacio; Martínez, Gabriel; Aguilera, Nelly; Orozco, Emanuel; Fajardo-Dolci, Germán E; González-Block, Miguel A

2013-01-01

Evaluate the capacity of the federal legal framework to govern financing of health institutions in the public sector through innovative schemes--otherwise known as functional integration--, enabling them to purchase and sell health services to and from other public providers as a strategy to improve their performance. Based on indicators of normative alignment with respect to functional integration across public health provider and governance institutions, content analysis was undertaken of national health programs and relevant laws and guidelines for financial coordination. Significant progress was identified in the implementation of agreements for the coordination of public institutions. While the legal framework provides for a National Health System and a health sector, gaps and contradictions limit their scope. The General Register of Health is also moving forward, yet it lacks the necessary legal foundation to become a comprehensive tool for integration. The medical service exchange agreements are also moving forward based on tariffs and shared guidelines. However, there is a lack of incentives to promote the expansion of these agreements. It is recommended to update the legal framework for the coordination of the National Health System, ensuring a more harmonious and general focus to provide functional integration with the needed impulse.

Providing a parallel and distributed capability for JMASS using SPEEDES

NASA Astrophysics Data System (ADS)

Valinski, Maria; Driscoll, Jonathan; McGraw, Robert M.; Meyer, Bob

2002-07-01

The Joint Modeling And Simulation System (JMASS) is a Tri-Service simulation environment that supports engineering and engagement-level simulations. As JMASS is expanded to support other Tri-Service domains, the current set of modeling services must be expanded for High Performance Computing (HPC) applications by adding support for advanced time-management algorithms, parallel and distributed topologies, and high speed communications. By providing support for these services, JMASS can better address modeling domains requiring parallel computationally intense calculations such clutter, vulnerability and lethality calculations, and underwater-based scenarios. A risk reduction effort implementing some HPC services for JMASS using the SPEEDES (Synchronous Parallel Environment for Emulation and Discrete Event Simulation) Simulation Framework has recently concluded. As an artifact of the JMASS-SPEEDES integration, not only can HPC functionality be brought to the JMASS program through SPEEDES, but an additional HLA-based capability can be demonstrated that further addresses interoperability issues. The JMASS-SPEEDES integration provided a means of adding HLA capability to preexisting JMASS scenarios through an implementation of the standard JMASS port communication mechanism that allows players to communicate.

EUTELTRACS: The European experience on mobile satellite services

NASA Technical Reports Server (NTRS)

Colcy, Jean-Noel; Steinhaeuser, Rafael

1993-01-01

EUTELTRACS is Europe's first commercially operated Mobile Satellite Service. Under the overall network operation of EUTELSAT, the European Telecommunications Satellite Organization, EUTELTRACS provides an integrated message exchange and position reporting service. This paper describes the EUTELTRACS system architecture, the message exchange and the position reporting services, including the result of recent analysis of message delivery time and positioning accuracy. It also provides an overview of the commercial deployment, the regulatory situation for its operation within Europe and new applications outside its target market, the international road transportation.

VOClient: Application Integration in the Virtual Observatory

NASA Astrophysics Data System (ADS)

Fitzpatrick, Michael J.; Tody, D.

2007-12-01

We present VOClient, a new software package that provides a high-level, easy-to-use, programmable interface between desktop applications and the distributed VO framework, providing access to remote VO data and services, reference implementations for VO data-providers and end-user applications. Applications have traditionally been written to deal directly with local images, catalogs or spectra; VOClient allows these applications to use remote VO data and services without requiring a developer to know the details of the underlying and evolving VO technologies. The programmable interface provides equivalent functionality for a wide variety of both legacy and modern development languages and environments and can be easily extended to add new functionality. The server component of the project provides a reference implementation and toolkit which can be used to build VO data services, and the commandline tools provide ready-to-use applications to access VO data and services from the desktop or scripting environment. The use of VOClient to integrate VO technologies with legacy systems such as IRAF is examined as a case-study, and the use of these techniques in other environments, especially their applicability to legacy code and systems, is also discussed. VOClient is meant both for the astronomer wishing to revive an old and trusted task with new VO capabiities, as well as the institutional project providing data or services to the Virtual Observatory.

The Heliophysics Integrated Observatory

NASA Astrophysics Data System (ADS)

Csillaghy, A.; Bentley, R. D.

2009-12-01

HELIO is a new Europe-wide, FP7-funded distributed network of services that will address the needs of a broad community of researchers in heliophysics. This new research field explores the “Sun-Solar System Connection” and requires the joint exploitation of solar, heliospheric, magnetospheric and ionospheric observations. HELIO will provide the most comprehensive integrated information system in this domain; it will coordinate access to the distributed resources needed by the community, and will provide access to services to mine and analyse the data. HELIO will be designed as a Service-oriented Architecture. The initial infrastructure will include services based on metadata and data servers deployed by the European Grid of Solar Observations (EGSO). We will extend these to address observations from all the disciplines of heliophysics; differences in the way the domains describe and handle the data will be resolved using semantic mapping techniques. Processing and storage services will allow the user to explore the data and create the products that meet stringent standards of interoperability. These capabilities will be orchestrated with the data and metadata services using the Taverna workflow tool. HELIO will address the challenges along the FP7 I3 activities model: (1) Networking: we will cooperate closely with the community to define new standards for heliophysics and the required capabilities of the HELIO system. (2) Services: we will integrate the services developed by the project and other groups to produce an infrastructure that can easily be extended to satisfy the growing and changing needs of the community. (3) Joint Research: we will develop search tools that span disciplinary boundaries and explore new types of user-friendly interfaces HELIO will be a key component of a worldwide effort to integrate heliophysics data and will coordinate closely with international organizations to exploit synergies with complementary domains.

An integrated information system for the acquisition, management and sharing of environmental data aimed to decision making

NASA Astrophysics Data System (ADS)

La Loggia, Goffredo; Arnone, Elisa; Ciraolo, Giuseppe; Maltese, Antonino; Noto, Leonardo; Pernice, Umberto

2012-09-01

This paper reports the first results of the Project SESAMO - SistEma informativo integrato per l'acquisizione, geStione e condivisione di dati AMbientali per il supportO alle decisioni (Integrated Information System for the acquisition, management and sharing of environmental data aimed to decision making). The main aim of the project is to design and develop an integrated environmental information platform able to provide monitoring services for decision support, integrating data from different environmental monitoring systems (including WSN). This ICT platform, based on a service-oriented architecture (SOA), will be developed to coordinate a wide variety of data acquisition systems, based on heterogeneous technologies and communication protocols, providing different sort of environmental monitoring services. The implementation and validation of the SESAMO platform and its services will involve three specific environmental domains: 1) Urban water losses; 2) Early warning system for rainfall-induced landslides; 3) Precision irrigation planning. Services in the first domain are enabled by a low cost sensors network collecting and transmitting data, in order to allow the pipeline network managers to analyze pressure, velocity and discharge data for reducing water losses in an urban contest. This paper outlines the SESAMO functional and technological structure and then gives a concise description of the service design and development process for the second and third domain. Services in the second domain are enabled by a prototypal early warning system able to identify in near-real time high-risk zones of rainfall-induced landslides. Services in the third domain are aimed to optimize irrigation planning of vineyards depending on plant water stress.

More than what the eye can see: the emotional journey and experience of powerlessness of integrated care service users and their carers

PubMed Central

Boudioni, Markella; Hallett, Nina; Lora, Cristina; Couchman, Wendy

2015-01-01

Purpose This article presents the emotional journey and experience of powerlessness of integrated care service users and carers. Materials and methods The experiences of seven integrated care service users and carers affected by complex conditions in a London borough were captured as video stories. The integrated care service coordinated a system of health and social care: primary care, community matrons, social workers, and the voluntary sector. The service was designed to respond to identified cases of high-risk individuals with long-term, multiple, and age-related conditions needing preventive interventions. The video stories were analyzed by researchers in collaboration with service users using a visual thematic qualitative approach. This report is part of an independent analysis of the integrated care service evaluation that used the experience-based codesign model. Results The findings are presented in the respective contexts of people with complex conditions and their carers. The overwhelming feelings and emotions of both were loss of control and power throughout their emotional journey, with family carers adopting a protective attitude toward the patients. Their experience of powerlessness was variable throughout their emotional journey. They were affected more strongly when in need of extra help and support and while they were undergoing the process of receiving extra services. When they were receiving help and support outside and within hospitals, some participants were empowered, gaining skills and knowledge by being provided with the mechanisms to cope with their condition at present and in the future. Conclusion Feelings of powerlessness were very common among integrated care service users and their carers. Powerless/empowerment has been poorly investigated to date. Visual methods and collaborative visual analysis with service users have proved to be powerful methods too, but have been rarely reported. PMID:25848232

Leadership for Recreation, Parks, and Leisure Services. Fourth Edition

ERIC Educational Resources Information Center

Edginton, Christopher R.; Hudson, Susan D.; Scholl, Kathleen G.; Lauzon, Lara

2011-01-01

"Leadership for Recreation, Parks and Leisure Services" presents new perspectives on the importance of leadership in the profession. Integrating theory with practice, the book provides foundational perspectives in the study of leadership at all levels--direct service, supervisory, managerial and community/civic--in recreation, parks and…

A Geospatial Information Grid Framework for Geological Survey.

PubMed

Wu, Liang; Xue, Lei; Li, Chaoling; Lv, Xia; Chen, Zhanlong; Guo, Mingqiang; Xie, Zhong

2015-01-01

The use of digital information in geological fields is becoming very important. Thus, informatization in geological surveys should not stagnate as a result of the level of data accumulation. The integration and sharing of distributed, multi-source, heterogeneous geological information is an open problem in geological domains. Applications and services use geological spatial data with many features, including being cross-region and cross-domain and requiring real-time updating. As a result of these features, desktop and web-based geographic information systems (GISs) experience difficulties in meeting the demand for geological spatial information. To facilitate the real-time sharing of data and services in distributed environments, a GIS platform that is open, integrative, reconfigurable, reusable and elastic would represent an indispensable tool. The purpose of this paper is to develop a geological cloud-computing platform for integrating and sharing geological information based on a cloud architecture. Thus, the geological cloud-computing platform defines geological ontology semantics; designs a standard geological information framework and a standard resource integration model; builds a peer-to-peer node management mechanism; achieves the description, organization, discovery, computing and integration of the distributed resources; and provides the distributed spatial meta service, the spatial information catalog service, the multi-mode geological data service and the spatial data interoperation service. The geological survey information cloud-computing platform has been implemented, and based on the platform, some geological data services and geological processing services were developed. Furthermore, an iron mine resource forecast and an evaluation service is introduced in this paper.

A Geospatial Information Grid Framework for Geological Survey

PubMed Central

Wu, Liang; Xue, Lei; Li, Chaoling; Lv, Xia; Chen, Zhanlong; Guo, Mingqiang; Xie, Zhong

2015-01-01

The use of digital information in geological fields is becoming very important. Thus, informatization in geological surveys should not stagnate as a result of the level of data accumulation. The integration and sharing of distributed, multi-source, heterogeneous geological information is an open problem in geological domains. Applications and services use geological spatial data with many features, including being cross-region and cross-domain and requiring real-time updating. As a result of these features, desktop and web-based geographic information systems (GISs) experience difficulties in meeting the demand for geological spatial information. To facilitate the real-time sharing of data and services in distributed environments, a GIS platform that is open, integrative, reconfigurable, reusable and elastic would represent an indispensable tool. The purpose of this paper is to develop a geological cloud-computing platform for integrating and sharing geological information based on a cloud architecture. Thus, the geological cloud-computing platform defines geological ontology semantics; designs a standard geological information framework and a standard resource integration model; builds a peer-to-peer node management mechanism; achieves the description, organization, discovery, computing and integration of the distributed resources; and provides the distributed spatial meta service, the spatial information catalog service, the multi-mode geological data service and the spatial data interoperation service. The geological survey information cloud-computing platform has been implemented, and based on the platform, some geological data services and geological processing services were developed. Furthermore, an iron mine resource forecast and an evaluation service is introduced in this paper. PMID:26710255

Strengthening Resiliency in Coastal Watersheds: An Ecosystem Services and Ecological Integrity Decision Support System

EPA Science Inventory

This product provides an integrated assessment framework linked to a decision support system (DSS) that incorporates the ecological integrity (EI) principles and goals described in detail in the US EPA’s Office of Water’s Healthy Watersheds Program (HWP), with Ecosyst...

Towards More Nuanced Classification of NGOs and Their Services to Improve Integrated Planning across Disaster Phases

PubMed Central

Towe, Vivian L.; Acosta, Joie D.; Chandra, Anita

2017-01-01

Nongovernmental organizations (NGOs) are being integrated into U.S. strategies to expand the services that are available during health security threats like disasters. Identifying better ways to classify NGOs and their services could optimize disaster planning. We surveyed NGOs about the types of services they provided during different disaster phases. Survey responses were used to categorize NGO services as core—critical to fulfilling their organizational mission—or adaptive—services implemented during a disaster based on community need. We also classified NGOs as being core or adaptive types of organizations by calculating the percentage of each NGO’s services classified as core. Service types classified as core were mainly social services, while adaptive service types were those typically relied upon during disasters (e.g., warehousing, food services, etc.). In total, 120 NGOs were classified as core organizations, meaning they mainly provided the same services across disaster phases, while 100 NGOs were adaptive organizations, meaning their services changed. Adaptive NGOs were eight times more likely to report routinely participating in disaster planning as compared to core NGOs. One reason for this association may be that adaptive NGOs are more aware of the changing needs in their communities across disaster phases because of their involvement in disaster planning. PMID:29160810

77 FR 2521 - Integrated System Power Rates

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-18

... experienced due to a sudden loss of generation or load. 1.1.5. Supplemental Operating Reserve Service provides... experienced due to a sudden loss of generation or load. 1.1.5. Supplemental Operating Reserve Service provides... Secretary has approved and placed into effect on an interim basis Rate Order No. SWPA-63, which increases...

The Public Television Library Policies and Procedures Manual 1971.

ERIC Educational Resources Information Center

Public Television Library, Washington, DC.

The Public Television Library (PTL), an integral part of the services provided by the Public Broadcasting Service (PBS), provides a national centralized storage and retrieval system for Public Television (PTV) programing distinct from the real time program offerings of the PBS interconnected network, and offers an opportunity for varied sources to…

Accounting Manual for Educational Service Districts in the State of Washington

ERIC Educational Resources Information Center

Lunghofer, Daniel S.

2010-01-01

This manual provides principles that are an integral part of the accounting requirements for educational service districts (ESDs) in the state of Washington. They are in conformance with generally accepted accounting principles, except where referenced in the ESD principles that follow. This manual provides guidance on the following topics:(1)…

Providing effective and preferred care closer to home: a realist review of intermediate care.

PubMed

Pearson, Mark; Hunt, Harriet; Cooper, Chris; Shepperd, Sasha; Pawson, Ray; Anderson, Rob

2015-11-01

Intermediate care is one of the number of service delivery models intended to integrate care and provide enhanced health and social care services closer to home, especially to reduce reliance on acute care hospital beds. In order for health and social care practitioners, service managers and commissioners to make informed decisions, it is vital to understand how to implement the admission avoidance and early supported discharge components of intermediate care within the context of local care systems. This paper reports the findings of a theory-driven (realist) review conducted in 2011-2012. A broad range of evidence contained in 193 sources was used to construct a conceptual framework for intermediate care. This framework forms the basis for exploring factors at service user, professional and organisational levels that should be considered when designing and delivering intermediate care services within a particular local context. Our synthesis found that involving service users and their carers in collaborative decision-making about the objectives of care and the place of care is central to achieving the aims of intermediate care. This pivotal involvement of the service user relies on practitioners, service managers and commissioners being aware of the impact that organisational structures at the local level can have on enabling or inhibiting collaborative decision-making and care co-ordination. Through all interactions with service users and their care networks, health and social care professionals should establish the meaning which alternative care environments have for different service users. Doing so means decisions about the best place of care will be better informed and gives service users choice. This in turn is likely to support psychological and social stability, and the attainment of functional goals. At an organisational level, integrated working can facilitate the delivery of intermediate care, but there is not a straightforward relationship between integrated organisational processes and integrated professional practice. © 2015 John Wiley & Sons Ltd.

42 CFR 455.18 - Provider's statements on claims forms.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud... in § 455.19, the agency must provide that all provider claims forms be imprinted in boldface type...

Integrating Grid Services into the Cray XT4 Environment

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

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

2009-05-01

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

Information integration for a sky survey by data warehousing

NASA Astrophysics Data System (ADS)

Luo, A.; Zhang, Y.; Zhao, Y.

The virtualization service of data system for a sky survey LAMOST is very important for astronomers The service needs to integrate information from data collections catalogs and references and support simple federation of a set of distributed files and associated metadata Data warehousing has been in existence for several years and demonstrated superiority over traditional relational database management systems by providing novel indexing schemes that supported efficient on-line analytical processing OLAP of large databases Now relational database systems such as Oracle etc support the warehouse capability which including extensions to the SQL language to support OLAP operations and a number of metadata management tools have been created The information integration of LAMOST by applying data warehousing is to effectively provide data and knowledge on-line

Providing Family Planning Services at Primary Care Organizations after the Exclusion of Planned Parenthood from Publicly Funded Programs in Texas: Early Qualitative Evidence.

PubMed

White, Kari; Hopkins, Kristine; Grossman, Daniel; Potter, Joseph E

2017-10-20

To explore organizations' experiences providing family planning during the first year of an expanded primary care program in Texas. Between November 2014 and February 2015, in-depth interviews were conducted with program administrators at 30 organizations: 7 women's health organizations, 13 established primary care contractors (e.g., community health centers, public health departments), and 10 new primary care contractors. Interviews addressed organizational capacities to expand family planning and integrate services with primary care. Interview transcripts were analyzed using a theme-based approach. Themes were compared across the three types of organizations. Established and new primary care contractors identified several challenges expanding family planning services, which were uncommon among women's health organizations. Clinicians often lacked training to provide intrauterine devices and contraceptive implants. Organizations often recruited existing clients into family planning services, rather than expanding their patient base, and new contractors found family planning difficult to integrate because of clients' other health needs. Primary care contractors frequently described contraceptive provision protocols that were not evidence-based. Many primary care organizations in Texas initially lacked the capacity to provide evidence-based family planning services that women's health organizations already provided. © Health Research and Educational Trust.

A hybrid mobile-based patient location tracking system for personal healthcare applications.

PubMed

Chew, S H; Chong, P A; Gunawan, E; Goh, K W; Kim, Y; Soh, C B

2006-01-01

In the next generation of Infocommunications, mobile Internet-enabled devices and third generation mobile communication networks have become reality, location based services (LBS) are expected to be a major area of growth. Providing information, content and services through positioning technologies forms the platform for new services for users and developers, as well as creating new revenue channels for service providers. These crucial advances in location based services have opened up new opportunities in real time patient tracking for personal healthcare applications. In this paper, a hybrid mobile-based location technique using the global positioning system (GPS) and cellular mobile network infrastructure is employed to provide the location tracking capability. This function will be integrated into the patient location tracking system (PLTS) to assist caregivers or family members in locating patients such as elderly or dependents when required, especially in emergencies. The capability of this PLTS is demonstrated through a series of location detection tests conducted over different operating conditions. Although the model is at its initial stage of development, it has shown relatively good accuracy for position tracking and potential of using integrated wireless technology to enhance the existing personal healthcare communication system through location based services.

Pedagogical Implications of Partnerships Between Psychiatry and Obstetrics-Gynecology in Caring for Patients with Major Mental Disorders.

PubMed

Coverdale, John; Roberts, Laura Weiss; Balon, Richard; Beresin, Eugene V

2015-08-01

Because there are no formal reviews, the authors set out to identify and describe programs that serve female patients with major mental disorders by integrating mental health care with services in obstetrics and gynecology and to describe the pedagogical implications of those programs. The authors searched PubMed for all articles describing a program in which psychiatry was formally integrated with obstetric or gynecological services, other than standard consultation-liaison programs, in the care of patients with major mental disorders. The search terms used included interdisciplinary, interprofessional, integrated, collaborative care, psychiatry, and obstetrics-gynecology or psychosomatic obstetrics-gynecology. The authors found six distinct integrated programs. These included family planning clinics that were integrated into inpatient psychiatry services; inpatient and outpatient psychiatry services for pregnant mentally ill women in close collaboration with obstetric services; a day hospital for pregnant women with psychiatric disorders in an obstetric setting; an interdisciplinary training site providing care for predominantly depressed, low-income, and minority women; a primary care HIV service for women integrated with departments of obstetrics-gynecology and psychiatry; and an obstetrics-gynecology clinic-based collaborative depression care intervention for socially disadvantaged women. Residents' involvement was described in four of the programs. These innovative and integrated programs potentially enhance the care of vulnerable and culturally diverse women with major mental disorders. The authors discuss how these programs may contribute to the education of residents in psychiatry and obstetrics-gynecology.

How to integrate social care services into primary health care? An experience from Iran

PubMed Central

Montazeri, Ali; Riazi-Isfahani, Sahand; Damari, Behzad

2016-01-01

Background: Social issues have prominent effects on the peoples' physical and mental health and on the health risk factors. In Iran, many organizations provide social care services to their target population. This study aimed to explore the roles and functions of Primary Health Care (PHC) system in providing social care services in Iran. Methods: This was a qualitative study, for which data were collected via three sources: A review of the literature, in-depth interviews and focus group discussions with experts and stakeholders. The main objective was to find a way to integrate social care into the Iranian PHC system. A conventional content analysis was performed to explore the data. Results: Overall, 20 experts were interviewed and the acquired data were classified into four major categories including priorities, implementation, requirements and stewardship. The main challenges were the existing controversies in the definition of social care, social service unit disintegration, multiple stewards for social care services, weaknesses of rules and regulations and low financing of the public budget. Social care services can be divided into two categories: Basic and advanced. Urban and rural health centers, as the first level of PHC, could potentially provide basic social care services for their defined population and catchment areas such as detecting social harms in high risk individuals and families and providing counseling for people in need. They can also refer the individuals to receive advanced services. Conclusion: Iran has a successful history of establishing the PHC System especially in rural areas. This network has an invaluable capacity to provide social health services. Establishing these services needs some prerequisites such as a reform PHC structure, macro support and technical intersectoral collaboration. They should also be piloted and evaluated before they could be implemented in the whole country. PMID:27683649

Implementation of Service Learning and Civic Engagement for Students of Computer Information Systems through a Course Project at the Hashemite University

ERIC Educational Resources Information Center

Al-Khasawneh, Ahmad; Hammad, Bashar K.

2015-01-01

Service learning methodologies provide students of information systems with the opportunity to create and implement systems in real-world, public service-oriented social contexts. This paper presents a case study which involves integrating a service learning project into an undergraduate Computer Information Systems course entitled…

Implementation of Service Learning and Civic Engagement for Computer Information Systems Students through a Course Project at the Hashemite University

ERIC Educational Resources Information Center

Al-Khasawneh, Ahmad; Hammad, Bashar K.

2013-01-01

Service learning methodologies provide information systems students with the opportunity to create and implement systems in real-world, public service-oriented social contexts. This paper presents a case study of integrating a service learning project into an undergraduate Computer Information Systems course titled "Information Systems"…

Advanced Communication System Engineering Proceedings Workshop held in Sedona, Arizona on 26-29 May 1987.

DTIC Science & Technology

1988-03-01

tried not to So you’ll see microphones around on the make the talks tightly integrated . You’re front tables -- I hope the speakers will pass going to...one of the most important thoroughly integrating the corn-system things that the com-systemn engineer does is engineer’s job into the rest of the design...future, we may provide " integrated on how much interruption and questions we services," where multiple types of services have ...-- data, voice, video

Achievements of the DOT-NASA Joint Program on Remote Sensing and Spatial Information Technologies: Application to Multimodal Transportation

NASA Technical Reports Server (NTRS)

2002-01-01

This report presents three-year accomplishments from the national program on Commercial Remote Sensing and Geospatial Technology (CRSGT) application to transportation, administered by the U.S. Department of Transportation (U.S. DOT) in collaboration with the National Aeronautics and Space Administration (NASA). The joint program was authorized under Section 5113 of the Transportation Equity Act for the 21st Century (TEA-21). This is the first national program of its type focusing on transportation applications of emerging commercial remote sensing technologies. U.S. DOT's Research and Special Programs Administration manages the program in coordination with NASA's Earth Science Enterprise's application programs. The program focuses on applications of CRSGT products and systems for providing smarter and more efficient transportation operations and services. The program is performed in partnership with four major National Consortia for Remote Sensing in Transportation (NCRST). Each consortium focuses on research and development of products in one of the four priority areas for transportation application, and includes technical application and demonstration projects carried out in partnership with industries and service providers in their respective areas. The report identifies products and accomplishments from each of the four consortia in meeting the goal of providing smarter and more efficient transportation services. The products and results emerging from the program are being implemented in transportation operations and services through state and local agencies. The Environmental Assessment and Application Consortium (NCRST-E) provides leadership for developing and deploying cost effective environmental and transportation planning services, and integrates CRSGT advances for achieving smarter and cost effective corridor planning. The Infrastructure Management Consortium (NCRST-I) provides leadership in technologies that achieve smarter and cheaper ways of managing transportation infrastructure assets, operation, and inspection, and integrates CRSGT advances for achieving infrastructure security. The Traffic Flow Consortium (NCRST-F) provides leadership to develop new tools for regional traffic flow management including heavy vehicles and intermodal flow of freight, and integrates CRSGT advances for complementing and extending the reach of ITS user services. The Safety, Hazards and Disasters (NCRST-H) provides leadership for deploying remote sensing technology to locate transportation hazards and improve disaster recovery, and integrates CRSGT advances for application to protect transportation systems from terrorism. The DOT-NASA team is proud to present this report of accomplishments on products and results emerging from the joint program for application to transportation practice.

Simulation Facilities and Test Beds for Galileo

NASA Astrophysics Data System (ADS)

Schlarmann, Bernhard Kl.; Leonard, Arian

2002-01-01

Galileo is the European satellite navigation system, financed by the European Space Agency (ESA) and the European Commission (EC). The Galileo System, currently under definition phase, will offer seamless global coverage, providing state-of-the-art positioning and timing services. Galileo services will include a standard service targeted at mass market users, an augmented integrity service, providing integrity warnings when fault occur and Public Regulated Services (ensuring a continuity of service for the public users). Other services are under consideration (SAR and integrated communications). Galileo will be interoperable with GPS, and will be complemented by local elements that will enhance the services for specific local users. In the frame of the Galileo definition phase, several system design and simulation facilities and test beds have been defined and developed for the coming phases of the project, respectively they are currently under development. These are mainly the following tools: Galileo Mission Analysis Simulator to design the Space Segment, especially to support constellation design, deployment and replacement. Galileo Service Volume Simulator to analyse the global performance requirements based on a coverage analysis for different service levels and degrades modes. Galileo System Simulation Facility is a sophisticated end-to-end simulation tool to assess the navigation performances for a complete variety of users under different operating conditions and different modes. Galileo Signal Validation Facility to evaluate signal and message structures for Galileo. Galileo System Test Bed (Version 1) to assess and refine the Orbit Determination &Time Synchronisation and Integrity algorithms, through experiments relying on GPS space infrastructure. This paper presents an overview on the so called "G-Facilities" and describes the use of the different system design tools during the project life cycle in order to design the system with respect to availability, continuity and integrity requirements. It gives more details on two of these system design tools: the Galileo Signal Validation Facility (GSVF) and the Galileo System Simulation Facility (GSSF). It will describe the operational use of these facilities within the complete set of design tools and especially the combined use of GSVF and GSSF will be described. Finally, this paper presents also examples and results obtained with these tools.

An Overview of the Concept of Operations for Assembly, Integration, Testing and Ground Servicing Develoed for the MPCV-ESM Propulsion System

NASA Technical Reports Server (NTRS)

Bielozer, M.; VanLear, Benjamin S.; Kindred, N.; Monien, G.; Schulte, U.

2014-01-01

A concept of operations for the Assembly, Integration and Testing (AIT) and the Ground Systems Development Operations (GSDO) of the European Service Module (ESM) propulsion system has been developed. The AIT concept of operations covers all fabrication, integration and testing activities in both Europe and in the United States. The GSDO Program develops the facilities, equipment, and procedures for the loading of hypergolic propellants, the filling of high-pressure gases, and contingency de-servicing operations for the ESM. NASA and ESA along with the Lockheed Martin and Airbus Space and Defense are currently working together for the EM-1 and EM-2 missions in which the ESM will be flown as part of the Orion Multi-Purpose Crew Vehicle (MPCV). The NASA/ESA SM propulsion team is collaborating with the AIT personnel from ESA/Airbus and NASA/Lockheed Martin to ensure successful integration of the European designed Service Module propulsion system, the Lockheed Martin designed Crew Module Adapter and the heritage Space Shuttle Orbital Maneuvering System Engines (OMS-E) being provided as Government Furnished Equipment (GFE). This paper will provide an overview of the current AIT and GSDO concept of operations for the ESM propulsion system.

An Overview of the Concept of Operations for Assembly, Integration, Testing and Ground Servicing Developed for the MPCV-ESM Propulsion System

NASA Technical Reports Server (NTRS)

Bielozer, Matthew C.

2014-01-01

A concept of operations for the Assembly, Integration and Testing (AIT) and the Ground Systems Development Operations (GSDO) of the European Service Module (ESM) propulsion system has been developed. The AIT concept of operations covers all fabrication, integration and testing activities in both Europe and in the United States. The GSDO Program develops the facilities, equipment, and procedures for the loading of hypergolic propellants, the filling of high-pressure gases, and contingency de-servicing operations for the ESM. NASA and ESA along with the Lockheed Martin and Airbus Space and Defense are currently working together for the EM-1 and EM-2 missions in which the ESM will be flown as part of the Orion Multi-Purpose Crew Vehicle (MPCV). The NASA/ESA SM propulsion team is collaborating with the AIT personnel from ESA/Airbus and NASA/Lockheed Martin to ensure successful integration of the European designed Service Module propulsion system, the Lockheed Martin designed Crew Module Adapter and the heritage Space Shuttle Orbital Maneuvering System Engines (OMS-E) being provided as Government Furnished Equipment (GFE). This paper will provide an overview of the current AIT and GSDO concept of operations for the ESM propulsion system.

Creating International Community Service Learning Experiences in a Capstone Marketing-Projects Course

ERIC Educational Resources Information Center

Metcalf, Lynn E.

2010-01-01

This article outlines the development of a project-based capstone marketing course, specifically designed to provide marketing students with an international community service learning experience. It differs significantly from previous studies, which focus on integrating service learning into existing marketing courses and on helping local…

Design of an Integrated Web Services Brokering System

DTIC Science & Technology

2009-01-01

new Web service is corralled by the IWB, its service description is broken into lexemes and matched to terms in the ontology. The ontology is manually...such data for the atmosphere and ocean. NOAA, in particular, provides a wide range of data including weather information, ocean data on reefs , tides

Stakeholders' Home and Community Based Services Settings Rule Knowledge

ERIC Educational Resources Information Center

Friedman, Carli

2018-01-01

Medicaid Home and Community Based Services (HCBS) waiver programs provide the majority of long-term services and supports for people with intellectual and developmental disabilities (IDD). Relatively new (2014) HCBS rules (CMS 2249-F/2296-F) governing these programs require "meaningful community" integration of people with disabilities…

Students Delivering Health Care to a Vulnerable Appalachian Population through Interprofessional Service-Learning

ERIC Educational Resources Information Center

Lee, Michelle L.; Hayes, Patricia A.; McConnell, Peggy; Henry, Robin M.

2013-01-01

Interprofessional student service-learning experiences are integrated into the preventive care of older adult residents of public housing in Appalachia. Receiving a Health Resources and Services Administration grant provided the College of Nursing at East Tennessee State University the opportunity to expand interprofessional clinical experiences…

Management, Entrepreneurship and Private Service Orientation: A Framework for Undergraduate Veterinary Education

ERIC Educational Resources Information Center

Sasidhar, P. V. K.; Van Den Ban, Anne W.

2006-01-01

The changing nature of livestock outreach service delivery, manpower requirements and opportunities in the private sector provide both push and pull dynamics for veterinary graduates to engage in managerial, entrepreneurial, public and private service activities. The veterinary schools should support this transition by integrating Managerial,…

75 FR 26759 - Health Care Integrity and Protection Data Bank (HIPDB) and National Practitioner Data Bank (NPDB...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-12

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Health Care... that license or certify health care practitioners, providers or suppliers, must report final adverse...-Compliant Government Agencies AGENCY: Health Resources and Services Administration, HHS. ACTION: Notice of...

Cargo Commercial Orbital Transportation Services Environmental Control and Life Support Integration

NASA Technical Reports Server (NTRS)

Duchesne, Stephanie; Thacker, Karen; Williams, Dave

2012-01-01

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

Commercial Orbital Transportation Cargo Services Environmental Control and Life Support Integration

NASA Technical Reports Server (NTRS)

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

2010-01-01

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

Ontology-Based Retrieval of Spatially Related Objects for Location Based Services

NASA Astrophysics Data System (ADS)

Haav, Hele-Mai; Kaljuvee, Aivi; Luts, Martin; Vajakas, Toivo

Advanced Location Based Service (LBS) applications have to integrate information stored in GIS, information about users' preferences (profile) as well as contextual information and information about application itself. Ontology engineering provides methods to semantically integrate several data sources. We propose an ontology-driven LBS development framework: the paper describes the architecture of ontologies and their usage for retrieval of spatially related objects relevant to the user. Our main contribution is to enable personalised ontology driven LBS by providing a novel approach for defining personalised semantic spatial relationships by means of ontologies. The approach is illustrated by an industrial case study.

HYDRA: A Middleware-Oriented Integrated Architecture for e-Procurement in Supply Chains

NASA Astrophysics Data System (ADS)

Alor-Hernandez, Giner; Aguilar-Lasserre, Alberto; Juarez-Martinez, Ulises; Posada-Gomez, Ruben; Cortes-Robles, Guillermo; Garcia-Martinez, Mario Alberto; Gomez-Berbis, Juan Miguel; Rodriguez-Gonzalez, Alejandro

The Service-Oriented Architecture (SOA) development paradigm has emerged to improve the critical issues of creating, modifying and extending solutions for business processes integration, incorporating process automation and automated exchange of information between organizations. Web services technology follows the SOA's principles for developing and deploying applications. Besides, Web services are considered as the platform for SOA, for both intra- and inter-enterprise communication. However, an SOA does not incorporate information about occurring events into business processes, which are the main features of supply chain management. These events and information delivery are addressed in an Event-Driven Architecture (EDA). Taking this into account, we propose a middleware-oriented integrated architecture that offers a brokering service for the procurement of products in a Supply Chain Management (SCM) scenario. As salient contributions, our system provides a hybrid architecture combining features of both SOA and EDA and a set of mechanisms for business processes pattern management, monitoring based on UML sequence diagrams, Web services-based management, event publish/subscription and reliable messaging service.

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

PubMed Central

Cornet, Ronald; Prins, Antoon K.

2003-01-01

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

Integrated Bibliographic Information System: Integrating Resources by Integrating Information Technologies.

ERIC Educational Resources Information Center

Cotter, Gladys A.; Hartt, Richard W.

The Defense Technical Information Center (DTIC), an organization charged with providing information services to the Department of Defense (DoD) scientific and technical community, actively seeks ways to promote resource sharing as a means for speeding access to information while reducing the costs of information processing throughout the technical…

NASA Integrated Space Communications Network

NASA Technical Reports Server (NTRS)

Tai, Wallace; Wright, Nate; Prior, Mike; Bhasin, Kul

2012-01-01

The NASA Integrated Network for Space Communications and Navigation (SCaN) has been in the definition phase since 2010. It is intended to integrate NASA s three existing network elements, i.e., the Space Network, Near Earth Network, and Deep Space Network, into a single network. In addition to the technical merits, the primary purpose of the Integrated Network is to achieve a level of operating cost efficiency significantly higher than it is today. Salient features of the Integrated Network include (a) a central system element that performs service management functions and user mission interfaces for service requests; (b) a set of common service execution equipment deployed at the all stations that provides return, forward, and radiometric data processing and delivery capabilities; (c) the network monitor and control operations for the entire integrated network are conducted remotely and centrally at a prime-shift site and rotating among three sites globally (a follow-the-sun approach); (d) the common network monitor and control software deployed at all three network elements that supports the follow-the-sun operations.

Projects That Matter: Concepts and Models for Service-Learning in Engineering. AAHE's Series on Service-Learning in the Disciplines.

ERIC Educational Resources Information Center

Tsang, Edmund, Ed.

This volume, the 14th in a series of monographs on service learning and academic disciplinary areas, is designed as a practical guide for faculty seeking to integrate service learning into an engineering course. The volume also deals with larger issues in engineering education and provides case studies of service-learning courses. The articles…

Availability of school health services for young children.

PubMed

Heneghan, A M; Malakoff, M E

1997-10-01

A survey to assess availability of school health services was distributed to 221 directors of Schools of the 21st Century, an educational model that provides integrated services to children and families. Of this distribution, 126 (57%) surveys were returned; 88% of respondents reported they provided some type of school health services for their students; 75% of schools had access to school nursing services, yet only 33% had a school nurse on-site; 50% had less than daily access to a school nurse. Despite a high reported prevalence of physical and mental health problems, other services such as acute care, nutrition counseling, dental screenings, or mental health services were provided less frequently. Barriers perceived as problematic for schools providing health services included inadequate funding, limited parental awareness, and opposition by school or community members. Respondents believed transportation, limited financial resources, and inadequate health insurance were barriers to care for children and families. Among this sample of schools, school health services varied in availability and comprehensiveness. Educators, health providers, and parents must work together to provide improved school health services for children.

Integrated opioid substitution therapy and HIV care: a qualitative systematic review and synthesis of client and provider experiences.

PubMed

Guise, Andy; Seguin, Maureen; Mburu, Gitau; McLean, Susie; Grenfell, Pippa; Islam, Zahed; Filippovych, Sergii; Assan, Happy; Low, Andrea; Vickerman, Peter; Rhodes, Tim

2017-09-01

People who use drugs in many contexts have limited access to opioid substitution therapy and HIV care. Service integration is one strategy identified to support increased access. We reviewed and synthesized literature exploring client and provider experiences of integrated opioid substitution therapy and HIV care to identify acceptable approaches to care delivery. We systematically reviewed qualitative literature. We searched nine bibliographic databases, supplemented by manual searches of reference lists of articles from the database search, relevant journals, conferences, key organizations and consultation with experts. Thematic synthesis was used to develop descriptive themes in client and provider experiences. The search yielded 11 articles for inclusion, along with 8 expert and policy reports. We identify five descriptive themes: the convenience and comprehensive nature of co-located care, contrasting care philosophies and their role in shaping integration, the limits to disclosure and communication between clients and providers, opioid substitution therapy enabling HIV care access and engagement, and health system challenges to delivering integrated services. The discussion explores how integrated opioid substitution therapy and HIV care needs to adapt to specific social conditions, rather than following universal approaches. We identify priorities for future research. Acceptable integrated opioid substitution therapy and HIV care for people who use drugs and providers is most likely through co-located care and relies upon attention to stigma, supportive relationships and client centred cultures of delivery. Further research is needed to understand experiences of integrated care, particularly delivery in low and middle income settings and models of care focused on community and non-clinic based delivery.

Migration strategies for service-enabling ground control stations for unmanned systems

NASA Astrophysics Data System (ADS)

Kroculick, Joseph B.

2011-06-01

Future unmanned systems will be integrated into the Global Information Grid (GIG) and support net-centric data sharing, where information in a domain is exposed to a wide variety of GIG stakeholders that can make use of the information provided. Adopting a Service-Oriented Architecture (SOA) approach to package reusable UAV control station functionality into common control services provides a number of benefits including enabling dynamic plug and play of components depending on changing mission requirements, supporting information sharing to the enterprise, and integrating information from authoritative sources such as mission planners with the UAV control stations data model. It also allows the wider enterprise community to use the services provided by unmanned systems and improve data quality to support more effective decision-making. We explore current challenges in migrating UAV control systems that manage multiple types of vehicles to a Service-Oriented Architecture (SOA). Service-oriented analysis involves reviewing legacy systems and determining which components can be made into a service. Existing UAV control stations provide audio/visual, navigation, and vehicle health and status information that are useful to C4I systems. However, many were designed to be closed systems with proprietary software and hardware implementations, message formats, and specific mission requirements. An architecture analysis can be performed that reviews legacy systems and determines which components can be made into a service. A phased SOA adoption approach can then be developed that improves system interoperability.

CMR Catalog Service for the Web

NASA Technical Reports Server (NTRS)

Newman, Doug; Mitchell, Andrew

2016-01-01

With the impending retirement of Global Change Master Directory (GCMD) Application Programming Interfaces (APIs) the Common Metadata Repository (CMR) was charged with providing a collection-level Catalog Service for the Web (CSW) that provided the same level of functionality as GCMD. This talk describes the capabilities of the CMR CSW API with particular reference to the support of the Committee on Earth Observation Satellites (CEOS) Working Group on Information Systems and Services (WGISS) Integrated Catalog (CWIC).

Factors Influencing Mental Health Screening and Treatment Among Women in a Rural South Central Appalachian Primary Care Clinic.

PubMed

Hill, Sarah K; Cantrell, Peggy; Edwards, Joellen; Dalton, Will

2016-01-01

Some of the most significant mental health concerns among US adults are depression, anxiety, substance abuse, and intimate partner violence. These concerns represent an ever-growing portion of the primary care population, especially in rural areas. However, few studies have examined factors influencing screening and treatment of these concerns by primary care providers, particularly in Appalachia. This study explores barriers and facilitators to mental health screening and treatment among women at a rural, primary care clinic in Appalachia. Eighteen patients and 4 providers were interviewed face-to-face. Thematic analysis was used to identify emergent themes. Patients identified 3 barriers (stigma, lack of support, and lack of education) and 2 facilitators (integrated care and positive experiences with providers). Providers identified 4 barriers (operational barriers, mental health competence, predicted patient reactions, and patient attitudes) and 3 facilitators (clinic characteristics, provider characteristics, and patient and provider education). Generally, patients focused more on individual and social factors influencing mental health service use, while providers were more aware of training gaps, logistical factors at the clinic, and systemic issues within the larger health care system. Both participant types emphasized specific interpersonal qualities and the importance of integrated services. Screening and treatment may be influenced by the availability and advertisement of integrated services, institutional support, strong patient-provider relationships, and provider training and experience. For rural south central Appalachia women, limited mental health resources may make these factors even more salient. © 2015 National Rural Health Association.

The structural and health policy environment for delivering integrated HIV and substance use disorder treatments in Puerto Rico.

PubMed

Leff, Jared A; Hernández, Diana; Teixeira, Paul A; Castellón, Pedro C; Feaster, Daniel J; Rodriguez, Allan E; Santana-Bagur, Jorge L; De León, Sandra Miranda; Vidot, José Vargas; Metsch, Lisa R; Schackman, Bruce R

2017-03-23

HIV prevalence in Puerto Rico is nearly twice that of the mainland United States, a level that was substantially fueled by injection drug use. Puerto Rico has a longstanding history of health provision by the public sector that directly affects how HIV and substance use disorder (SUD) treatment services are provided and funded. As part of pre-implementation research for a randomized trial of a community-level intervention to enhance HIV care access for substance users in San Juan, Puerto Rico, we sought to understand the structural and health policy environment for providing HIV and SUD treatments. We conducted semi-structured qualitative interviews (n = 8) with government and program administrators in English and Spanish. Data were analyzed to identify dominant and recurrent themes. Participants discussed how lack of integration among medical and mental health service providers, lack of public transportation, and turnover in appointed government officials were barriers to integrated HIV and SUD treatment. Federal funding for support services for HIV patients was a facilitator. The Affordable Care Act has limited impact in Puerto Rico because provisions related to health insurance reform do not apply to U.S. territories. Implications for intervention design include the need to provide care coordination for services from multiple providers, who are often physically separated and working in different reimbursement systems, and the potential for mobile and patient transportation services to bridge these gaps. Continuous interaction with political leaders is needed to maintain current facilitators. These findings are relevant as the current economic crisis in Puerto Rico affects funding, and may be relevant for other settings with substance use-driven epidemics.

The Cost Effectiveness of Embedding a Behavioral Health Clinician into an Existing Primary Care Practice to Facilitate the Integration of Care: A Prospective, Case-Control Program Evaluation.

PubMed

Ross, Kaile M; Klein, Betsy; Ferro, Katherine; McQueeney, Debra A; Gernon, Rebecca; Miller, Benjamin F

2018-04-30

This project evaluated the cost effectiveness of integrating behavioral health services into a primary care practice using a prospective, case-control design. New Directions Behavioral Health collaborated with a large Kansas City primary care practice to integrate a licensed psychologist (i.e., behavioral health clinician) into the practice. Patient claims data were examined 21 months prior to and 14 months after the psychologist began providing full-time behavioral health services within the practice. Claims data from patients with Blue Cross Blue Shield of Kansas City insurance (BCBSKC) who had at least one encounter with the psychologist (N = 239) were compared to control patients (BCBSKC fully insured patients at large) to calculate cost savings. The results demonstrated that integrating behavioral health services into the practice was associated with $860.16 per member per year savings or 10.8% savings in costs for BCBSKC patients. Integrating behavioral health services into primary care may lead to reductions in health care costs.

The INDIGO-Datacloud Authentication and Authorization Infrastructure

NASA Astrophysics Data System (ADS)

Ceccanti, A.; Hardt, M.; Wegh, B.; Millar, AP; Caberletti, M.; Vianello, E.; Licehammer, S.

2017-10-01

Contemporary distributed computing infrastructures (DCIs) are not easily and securely accessible by scientists. These computing environments are typically hard to integrate due to interoperability problems resulting from the use of different authentication mechanisms, identity negotiation protocols and access control policies. Such limitations have a big impact on the user experience making it hard for user communities to port and run their scientific applications on resources aggregated from multiple providers. The INDIGO-DataCloud project wants to provide the services and tools needed to enable a secure composition of resources from multiple providers in support of scientific applications. In order to do so, a common AAI architecture has to be defined that supports multiple authentication mechanisms, support delegated authorization across services and can be easily integrated in off-the-shelf software. In this contribution we introduce the INDIGO Authentication and Authorization Infrastructure, describing its main components and their status and how authentication, delegation and authorization flows are implemented across services.

Systems Architecture for a Nationwide Healthcare System.

PubMed

Abin, Jorge; Nemeth, Horacio; Friedmann, Ignacio

2015-01-01

From a national level to give Internet technology support, the Nationwide Integrated Healthcare System in Uruguay requires a model of Information Systems Architecture. This system has multiple healthcare providers (public and private), and a strong component of supplementary services. Thus, the data processing system should have an architecture that considers this fact, while integrating the central services provided by the Ministry of Public Health. The national electronic health record, as well as other related data processing systems, should be based on this architecture. The architecture model described here conceptualizes a federated framework of electronic health record systems, according to the IHE affinity model, HL7 standards, local standards on interoperability and security, as well as technical advice provided by AGESIC. It is the outcome of the research done by AGESIC and Systems Integration Laboratory (LINS) on the development and use of the e-Government Platform since 2008, as well as the research done by the team Salud.uy since 2013.

[Establishing the idea of holistic integrative medicine, optimizing the quality of health care service in prevention and treatment].

PubMed

Sun, Xing-guo

2015-07-01

Under background of reductionism in the modern science, physiology and medicine are stepwise refined into system, organ, disease, cell and gene etc. Although clinical medicine, only service in whole human object, obviously brought tremendous progress, it also appeared obvious defects and limits at the same time. Professionalized and specialized medicine not only needs to be integrated from basics to clinical fields, but also from prevention, health management, clinical treatment and functional rehabilitation medicine. People are indivisible organic whole. Professionalization, translation and integration must be combined. In order to provide the best quality and optimized medical service for the Chinese people and to lead in the world, we have to strengthen professional and technical knowledge, and have to establish the holistic integrative medical philosophy for physiology and medicine too.

The Integrated Day Comes to College.

ERIC Educational Resources Information Center

Walton, Sherry; And Others

1986-01-01

Describes how a university faculty used Carl Sagan's "Cosmos" series as a vehicle for demonstrating the integrated curriculum approach to instruction, modeling this approach with their pre-service teachers. A daily account of the week's activities is provided. (JDH)

Alaska Index of Watershed Integrity

EPA Science Inventory

The US Environmental Protection Agency’s (EPA) Index of Watershed Integrity (IWI) is used to calculate and visualize the status of natural watershed infrastructure that supports ecological processes (e.g., nutrient cycling) and services provided to society (e.g., subsistenc...

Rail Integrity Experience on the Washington Metro System

DOT National Transportation Integrated Search

2016-04-12

The Washington Metropolitan Area Transit Authority (WMATA) provides passenger rail service to the nations capital. Although the rail system carries only passenger trains, the rail integrity issues that WMATA must manage are similar to those that f...

Primary Care-Mental Health Integration in the Veterans Affairs Health System: Program Characteristics and Performance.

PubMed

Cornwell, Brittany L; Brockmann, Laurie M; Lasky, Elaine C; Mach, Jennifer; McCarthy, John F

2018-06-01

The Veterans Health Administration (VHA) has achieved substantial national implementation of primary care-mental health integration (PC-MHI) services. However, little is known regarding program characteristics, variation in characteristics across settings, or associations between program fidelity and performance. This study identified core elements of PC-MHI services and evaluated their associations with program characteristics and performance. A principal-components analysis (PCA) of reports from 349 sites identified factors associated with PC-MHI fidelity. Analyses assessed the correlation among factors and between each factor and facility type (medical center or community-based outpatient clinic), primary care population size, and performance indicators (receipt of PC-MHI services, same-day access to mental health and primary care services, and extended duration of services). PCA identified seven factors: core implementation, care management (CM) assessments and supervision, CM supervision receipt, colocated collaborative care (CCC) by prescribing providers, CCC by behavioral health providers, participation in patient aligned care teams (PACTs) for special populations, and treatment of complex mental health conditions. Sites serving larger populations had greater core implementation scores. Medical centers and sites serving larger populations had greater scores for CCC by prescribing providers, CM assessments and supervision, and participation in PACTs. Greater core implementation scores were associated with greater same-day access. Sites with greater scores for CM assessments and supervision had lower scores for treatment of complex conditions. Outpatient clinics and sites serving smaller populations experienced challenges in integrated care implementation. To enhance same-day access, VHA should continue to prioritize PC-MHI implementation. Providing brief, problem-focused care may enhance CM implementation.

Integrating Health Care for the Most Vulnerable: Bridging the Differences in Organizational Cultures Between US Hospitals and Community Health Centers

PubMed Central

Murphy, Julia; Bindman, Andrew B.

2015-01-01

Policymakers have increasingly promoted health services integration to improve quality and efficiency. The US health care safety net, which comprises providers of health care to uninsured, Medicaid, and other vulnerable patients, remains a largely fragmented collection of providers. We interviewed leadership from safety net hospitals and community health centers in 5 US cities (Boston, MA; Denver, CO; Los Angeles, CA; Minneapolis, MN; and San Francisco, CA) throughout 2013 on their experiences with service integration. We identify conflicts in organizational mission, identity, and consumer orientation that have fostered reluctance to enter into collaborative arrangements. We describe how smaller scale initiatives, such as capitated model for targeted populations, health information exchange, and quality improvements led by health plans, can help bridge cultural differences to lay the groundwork for developing integrated care programs. PMID:26509286

Significance of mental health legislation for successful primary care for mental health and community mental health services: A review.

PubMed

Ayano, Getinet

2018-03-29

 Mental health legislation (MHL) is required to ensure a regulatory framework for mental health services and other providers of treatment and care, and to ensure that the public and people with a mental illness are afforded protection from the often-devastating consequences of mental illness.  To provide an overview of evidence on the significance of MHL for successful primary care for mental health and community mental health servicesMethod: A qualitative review of the literature on the significance of MHL for successful primary care for mental health and community mental health services was conducted.  In many countries, especially in those who have no MHL, people do not have access to basic mental health care and treatment they require. One of the major aims of MHL is that all people with mental disorders should be provided with treatment based on the integration of mental health care services into the primary healthcare (PHC). In addition, MHL plays a crucial role in community integration of persons with mental disorders, the provision of care of high quality, the improvement of access to care at community level. Community-based mental health care further improves access to mental healthcare within the city, to have better health and mental health outcomes, and better quality of life, increase acceptability, reduce associated social stigma and human rights abuse, prevent chronicity and physical health comorbidity will likely to be detected early and managed.  Mental health legislation plays a crucial role in community integration of persons with mental disorders, integration of mental health at primary health care, the provision of care of high quality and the improvement of access to care at community level. It is vital and essential to have MHL for every country.

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

PubMed

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

2018-01-01

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

A framework for integration of scientific applications into the OpenTopography workflow

NASA Astrophysics Data System (ADS)

Nandigam, V.; Crosby, C.; Baru, C.

2012-12-01

The NSF-funded OpenTopography facility provides online access to Earth science-oriented high-resolution LIDAR topography data, online processing tools, and derivative products. The underlying cyberinfrastructure employs a multi-tier service oriented architecture that is comprised of an infrastructure tier, a processing services tier, and an application tier. The infrastructure tier consists of storage, compute resources as well as supporting databases. The services tier consists of the set of processing routines each deployed as a Web service. The applications tier provides client interfaces to the system. (e.g. Portal). We propose a "pluggable" infrastructure design that will allow new scientific algorithms and processing routines developed and maintained by the community to be integrated into the OpenTopography system so that the wider earth science community can benefit from its availability. All core components in OpenTopography are available as Web services using a customized open-source Opal toolkit. The Opal toolkit provides mechanisms to manage and track job submissions, with the help of a back-end database. It allows monitoring of job and system status by providing charting tools. All core components in OpenTopography have been developed, maintained and wrapped as Web services using Opal by OpenTopography developers. However, as the scientific community develops new processing and analysis approaches this integration approach is not scalable efficiently. Most of the new scientific applications will have their own active development teams performing regular updates, maintenance and other improvements. It would be optimal to have the application co-located where its developers can continue to actively work on it while still making it accessible within the OpenTopography workflow for processing capabilities. We will utilize a software framework for remote integration of these scientific applications into the OpenTopography system. This will be accomplished by virtually extending the OpenTopography service over the various infrastructures running these scientific applications and processing routines. This involves packaging and distributing a customized instance of the Opal toolkit that will wrap the software application as an OPAL-based web service and integrate it into the OpenTopography framework. We plan to make this as automated as possible. A structured specification of service inputs and outputs along with metadata annotations encoded in XML can be utilized to automate the generation of user interfaces, with appropriate tools tips and user help features, and generation of other internal software. The OpenTopography Opal toolkit will also include the customizations that will enable security authentication, authorization and the ability to write application usage and job statistics back to the OpenTopography databases. This usage information could then be reported to the original service providers and used for auditing and performance improvements. This pluggable framework will enable the application developers to continue to work on enhancing their application while making the latest iteration available in a timely manner to the earth sciences community. This will also help us establish an overall framework that other scientific application providers will also be able to use going forward.

A Data Services Upgrade for Advanced Composition Explorer (ACE) Data

NASA Astrophysics Data System (ADS)

Davis, A. J.; Hamell, G.

2008-12-01

Since early in 1998, NASA's Advanced Composition Explorer (ACE) spacecraft has provided continuous measurements of solar wind, interplanetary magnetic field, and energetic particle activity from L1, located approximately 0.01 AU sunward of Earth. The spacecraft has enough fuel to stay in orbit about L1 until ~2024. The ACE Science Center (ASC) provides access to ACE data, and performs level 1 and browse data processing for the science instruments. Thanks to a NASA Data Services Upgrade grant, we have recently retooled our legacy web interface to ACE data, enhancing data subsetting capabilities and improving online plotting options. We have also integrated a new application programming interface (API) and we are working to ensure that it will be compatible with emerging Virtual Observatory (VO) data services standards. The new API makes extensive use of metadata created using the Space Physics Archive Search and Extract (SPASE) data model. We describe these recent improvements to the ACE Science Center data services, and our plans for integrating these services into the VO system.

Geo-spatial Service and Application based on National E-government Network Platform and Cloud

NASA Astrophysics Data System (ADS)

Meng, X.; Deng, Y.; Li, H.; Yao, L.; Shi, J.

2014-04-01

With the acceleration of China's informatization process, our party and government take a substantive stride in advancing development and application of digital technology, which promotes the evolution of e-government and its informatization. Meanwhile, as a service mode based on innovative resources, cloud computing may connect huge pools together to provide a variety of IT services, and has become one relatively mature technical pattern with further studies and massive practical applications. Based on cloud computing technology and national e-government network platform, "National Natural Resources and Geospatial Database (NRGD)" project integrated and transformed natural resources and geospatial information dispersed in various sectors and regions, established logically unified and physically dispersed fundamental database and developed national integrated information database system supporting main e-government applications. Cross-sector e-government applications and services are realized to provide long-term, stable and standardized natural resources and geospatial fundamental information products and services for national egovernment and public users.

MAPI: towards the integrated exploitation of bioinformatics Web Services.

PubMed

Ramirez, Sergio; Karlsson, Johan; Trelles, Oswaldo

2011-10-27

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

77 FR 36611 - Core Principles and Other Requirements for Designated Contract Markets

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-19

.... 38.154--Regulatory Services Provided by a Third Party vi. Sec. 38.155--Compliance Staff and Resources... vi. Sec. 38.256--Trade Reconstruction vii. Sec. 38.257--Regulatory Service Provider viii. Sec. 38.258... Integrity iii. Sec. 38.603--Protection of Customer Funds iv. Sec. 38.604--Financial Surveillance v. Sec. 38...

Assessment of Utilization of Internet Facilities among Pre-Service Teachers in University of Ilorin, Nigeria

ERIC Educational Resources Information Center

Ogunlade, Oyeronke Olufunmilola; Fagbola, Oluwafunmilayo Faith; Ogunlade, Amos Akindele; Amosa, Abdulganiyu Alasela

2015-01-01

The use of the Internet can further equip teachers by providing them with the latest information on their discipline. The purpose of technology in teacher training is to provide pre-service teachers with the capability of integrating computer technologies into curriculum and instructional activities.This study therefore assessed the internet…

Web-Based Self-Service Systems for Managed IT Support: Service Provider Perspectives of Stakeholder-Based Issues

NASA Astrophysics Data System (ADS)

Cooper, Vanessa A.; Lichtenstein, Sharman; Smith, Ross

This chapter explores the provision of after-sales information technology (IT) support services using Web-based self-service systems (WSSs) in a business-to-business (B2B) context. A recent study conducted at six large multi-national IT support organisations revealed a number of critical success factors (CSFs) and stakeholder-based issues. To better identify and understand these important enablers and barriers, we explain how WSSs should be considered within a complex network of service providers, business partners and customer firms. The CSFs and stakeholder-based issues are discussed. The chapter highlights that for more successful service provision using WSSs, IT service providers should collaborate more effectively with enterprise customers and business partners and should better integrate their WSSs.

EPA Facility Registry Service (FRS): CERCLIS

EPA Pesticide Factsheets

This data provides location and attribute information on Facilities regulated under the Comprehensive Environmental Responsibility Compensation and Liability Information System (CERCLIS) for a intranet web feature service . The data provided in this service are obtained from EPA's Facility Registry Service (FRS). The FRS is an integrated source of comprehensive (air, water, and waste) environmental information about facilities, sites or places. This service connects directly to the FRS database to provide this data as a feature service. FRS creates high-quality, accurate, and authoritative facility identification records through rigorous verification and management procedures that incorporate information from program national systems, state master facility records, data collected from EPA's Central Data Exchange registrations and data management personnel. Additional Information on FRS is available at the EPA website https://www.epa.gov/enviro/facility-registry-service-frs.

Exploring New Ways to Deliver Value to Healthcare Organizations: Algorithmic Testing, Data Integration, and Diagnostic E-consult Service.

PubMed

Risin, Semyon A; Chang, Brian N; Welsh, Kerry J; Kidd, Laura R; Moreno, Vanessa; Chen, Lei; Tholpady, Ashok; Wahed, Amer; Nguyen, Nghia; Kott, Marylee; Hunter, Robert L

2015-01-01

As the USA Health Care System undergoes transformation and transitions to value-based models it is critical for laboratory medicine/clinical pathology physicians to explore opportunities and find new ways to deliver value, become an integral part of the healthcare team. This is also essential for ensuring financial health and stability of the profession when the payment paradigm changes from fee-for-service to fee-for-performance. About 5 years ago we started searching for ways to achieve this goal. Among other approaches, the search included addressing the laboratory work-ups for specialists' referrals in the HarrisHealth System, a major safety net health care organization serving mostly indigent and underserved population of Harris County, TX. We present here our experience in improving the efficiency of laboratory testing for the referral process and in building a prototype of a diagnostic e-consult service using rheumatologic diseases as a starting point. The service incorporates algorithmic testing, integration of clinical, laboratory and imaging data, issuing structured comprehensive consultation reports, incorporating all the relevant information, and maintaining personal contacts and an e-line of communications with the primary providers and referral center personnel. Ongoing survey of providers affords testimony of service value in terms of facilitating their work and increasing productivity. Analysis of the cost effectiveness and of other value indicators is currently underway. We also discuss our pioneering experience in building pathology residents and fellows training in integrated diagnostic consulting service. © 2015 by the Association of Clinical Scientists, Inc.

Sharing Health Big Data for Research - A Design by Use Cases: The INSHARE Platform Approach.

PubMed

Bouzillé, Guillaume; Westerlynck, Richard; Defossez, Gautier; Bouslimi, Dalel; Bayat, Sahar; Riou, Christine; Busnel, Yann; Le Guillou, Clara; Cauvin, Jean-Michel; Jacquelinet, Christian; Pladys, Patrick; Oger, Emmanuel; Stindel, Eric; Ingrand, Pierre; Coatrieux, Gouenou; Cuggia, Marc

2017-01-01

Sharing and exploiting Health Big Data (HBD) allow tackling challenges: data protection/governance taking into account legal, ethical, and deontological aspects enables trust, transparent and win-win relationship between researchers, citizens, and data providers. Lack of interoperability: compartmentalized and syntactically/semantica heterogeneous data. INSHARE project using experimental proof of concept explores how recent technologies overcome such issues. Using 6 data providers, platform is designed via 3 steps to: (1) analyze use cases, needs, and requirements; (2) define data sharing governance, secure access to platform; and (3) define platform specifications. Three use cases - from 5 studies and 11 data sources - were analyzed for platform design. Governance derived from SCANNER model was adapted to data sharing. Platform architecture integrates: data repository and hosting, semantic integration services, data processing, aggregate computing, data quality and integrity monitoring, Id linking, multisource query builder, visualization and data export services, data governance, study management service and security including data watermarking.

Enhanced service zone architecture for multiservices over IP

NASA Astrophysics Data System (ADS)

Michaely, Boaz; Mohan, Seshadri

2001-07-01

Recently, the field of IP Telephony has been experienced considerable evolution through the specification of new protocols and introduction of products implementing these protocols. We visualize IP Telephony evolving to soon offer multiservices encompassing not only voice, but also data, video and multimedia. While the progress has focused on refining protocols and architectures, very little attention has been given to business models for offering these services. This paper introduces the concept of a Service Zone, which from a service provider/network operator perspective fits within the operator's administrative domain, but is viewed as an independent zone with its own management and services, requiring minimal integration with the core network services. Besides its own management, the Enhanced Services Zone may also provide provisioning and maintenance features needed to provide the customer services and availability that subscribers expect from a telephony service providers. The platform must provide reliable service over time, be scalable to meet increased capacity demands, and be upgradeable to incorporate advanced services and features as they become available. Signaling flows are illustrated using SIP and H.323.

A Methodology for the Development of RESTful Semantic Web Services for Gene Expression Analysis

PubMed Central

Guardia, Gabriela D. A.; Pires, Luís Ferreira; Vêncio, Ricardo Z. N.; Malmegrim, Kelen C. R.; de Farias, Cléver R. G.

2015-01-01

Gene expression studies are generally performed through multi-step analysis processes, which require the integrated use of a number of analysis tools. In order to facilitate tool/data integration, an increasing number of analysis tools have been developed as or adapted to semantic web services. In recent years, some approaches have been defined for the development and semantic annotation of web services created from legacy software tools, but these approaches still present many limitations. In addition, to the best of our knowledge, no suitable approach has been defined for the functional genomics domain. Therefore, this paper aims at defining an integrated methodology for the implementation of RESTful semantic web services created from gene expression analysis tools and the semantic annotation of such services. We have applied our methodology to the development of a number of services to support the analysis of different types of gene expression data, including microarray and RNASeq. All developed services are publicly available in the Gene Expression Analysis Services (GEAS) Repository at http://dcm.ffclrp.usp.br/lssb/geas. Additionally, we have used a number of the developed services to create different integrated analysis scenarios to reproduce parts of two gene expression studies documented in the literature. The first study involves the analysis of one-color microarray data obtained from multiple sclerosis patients and healthy donors. The second study comprises the analysis of RNA-Seq data obtained from melanoma cells to investigate the role of the remodeller BRG1 in the proliferation and morphology of these cells. Our methodology provides concrete guidelines and technical details in order to facilitate the systematic development of semantic web services. Moreover, it encourages the development and reuse of these services for the creation of semantically integrated solutions for gene expression analysis. PMID:26207740

A Methodology for the Development of RESTful Semantic Web Services for Gene Expression Analysis.

PubMed

Guardia, Gabriela D A; Pires, Luís Ferreira; Vêncio, Ricardo Z N; Malmegrim, Kelen C R; de Farias, Cléver R G

2015-01-01

Gene expression studies are generally performed through multi-step analysis processes, which require the integrated use of a number of analysis tools. In order to facilitate tool/data integration, an increasing number of analysis tools have been developed as or adapted to semantic web services. In recent years, some approaches have been defined for the development and semantic annotation of web services created from legacy software tools, but these approaches still present many limitations. In addition, to the best of our knowledge, no suitable approach has been defined for the functional genomics domain. Therefore, this paper aims at defining an integrated methodology for the implementation of RESTful semantic web services created from gene expression analysis tools and the semantic annotation of such services. We have applied our methodology to the development of a number of services to support the analysis of different types of gene expression data, including microarray and RNASeq. All developed services are publicly available in the Gene Expression Analysis Services (GEAS) Repository at http://dcm.ffclrp.usp.br/lssb/geas. Additionally, we have used a number of the developed services to create different integrated analysis scenarios to reproduce parts of two gene expression studies documented in the literature. The first study involves the analysis of one-color microarray data obtained from multiple sclerosis patients and healthy donors. The second study comprises the analysis of RNA-Seq data obtained from melanoma cells to investigate the role of the remodeller BRG1 in the proliferation and morphology of these cells. Our methodology provides concrete guidelines and technical details in order to facilitate the systematic development of semantic web services. Moreover, it encourages the development and reuse of these services for the creation of semantically integrated solutions for gene expression analysis.

EntrezAJAX: direct web browser access to the Entrez Programming Utilities.

PubMed

Loman, Nicholas J; Pallen, Mark J

2010-06-21

Web applications for biology and medicine often need to integrate data from Entrez services provided by the National Center for Biotechnology Information. However, direct access to Entrez from a web browser is not possible due to 'same-origin' security restrictions. The use of "Asynchronous JavaScript and XML" (AJAX) to create rich, interactive web applications is now commonplace. The ability to access Entrez via AJAX would be advantageous in the creation of integrated biomedical web resources. We describe EntrezAJAX, which provides access to Entrez eUtils and is able to circumvent same-origin browser restrictions. EntrezAJAX is easily implemented by JavaScript developers and provides identical functionality as Entrez eUtils as well as enhanced functionality to ease development. We provide easy-to-understand developer examples written in JavaScript to illustrate potential uses of this service. For the purposes of speed, reliability and scalability, EntrezAJAX has been deployed on Google App Engine, a freely available cloud service. The EntrezAJAX webpage is located at http://entrezajax.appspot.com/

Automated UAV-based video exploitation using service oriented architecture framework

NASA Astrophysics Data System (ADS)

Se, Stephen; Nadeau, Christian; Wood, Scott

2011-05-01

Airborne surveillance and reconnaissance are essential for successful military missions. Such capabilities are critical for troop protection, situational awareness, mission planning, damage assessment, and others. Unmanned Aerial Vehicles (UAVs) gather huge amounts of video data but it is extremely labour-intensive for operators to analyze hours and hours of received data. At MDA, we have developed a suite of tools that can process the UAV video data automatically, including mosaicking, change detection and 3D reconstruction, which have been integrated within a standard GIS framework. In addition, the mosaicking and 3D reconstruction tools have also been integrated in a Service Oriented Architecture (SOA) framework. The Visualization and Exploitation Workstation (VIEW) integrates 2D and 3D visualization, processing, and analysis capabilities developed for UAV video exploitation. Visualization capabilities are supported through a thick-client Graphical User Interface (GUI), which allows visualization of 2D imagery, video, and 3D models. The GUI interacts with the VIEW server, which provides video mosaicking and 3D reconstruction exploitation services through the SOA framework. The SOA framework allows multiple users to perform video exploitation by running a GUI client on the operator's computer and invoking the video exploitation functionalities residing on the server. This allows the exploitation services to be upgraded easily and allows the intensive video processing to run on powerful workstations. MDA provides UAV services to the Canadian and Australian forces in Afghanistan with the Heron, a Medium Altitude Long Endurance (MALE) UAV system. On-going flight operations service provides important intelligence, surveillance, and reconnaissance information to commanders and front-line soldiers.

Integration of legal aspects and human rights approach in palliative care delivery-the Nyeri Hospice model.

PubMed

Musyoki, David; Gichohi, Sarafina; Ritho, Johnson; Ali, Zipporah; Kinyanjui, Asaph; Muinga, Esther

2016-01-01

Palliative care is patient and family-centred care that optimises quality of life by anticipating, preventing, and treating suffering. Open Society Foundation public health program (2011) notes that people facing life-threatening illnesses are deeply vulnerable: often in severe physical pain, worried about death, incapacitation, or the fate of their loved ones. Legal issues can increase stress for patients and families and make coping harder, impacting on the quality of care. In the absence of a clear legal provision expressly recognising palliative care in Kenya, providers may face numerous legal and ethical dilemmas that affect the availability, accessibility, and delivery of palliative care services and commodities. In order to ensure positive outcomes from patients, their families, and providers, palliative care services should be prioritised by all and includes advocating for the integration of legal support into those services. Palliative care service providers should be able to identify the various needs of patients and their families including specific issues requiring legal advice and interventions. Access to legal services remains a big challenge in Kenya, with limited availability of specialised legal services for health-related legal issues. An increased awareness of the benefits of legal services in palliative care will drive demand for easily accessible and more affordable direct legal services to address legal issues for a more holistic approach to quality palliative care.

Explorative search of distributed bio-data to answer complex biomedical questions

PubMed Central

2014-01-01

Background The huge amount of biomedical-molecular data increasingly produced is providing scientists with potentially valuable information. Yet, such data quantity makes difficult to find and extract those data that are most reliable and most related to the biomedical questions to be answered, which are increasingly complex and often involve many different biomedical-molecular aspects. Such questions can be addressed only by comprehensively searching and exploring different types of data, which frequently are ordered and provided by different data sources. Search Computing has been proposed for the management and integration of ranked results from heterogeneous search services. Here, we present its novel application to the explorative search of distributed biomedical-molecular data and the integration of the search results to answer complex biomedical questions. Results A set of available bioinformatics search services has been modelled and registered in the Search Computing framework, and a Bioinformatics Search Computing application (Bio-SeCo) using such services has been created and made publicly available at http://www.bioinformatics.deib.polimi.it/bio-seco/seco/. It offers an integrated environment which eases search, exploration and ranking-aware combination of heterogeneous data provided by the available registered services, and supplies global results that can support answering complex multi-topic biomedical questions. Conclusions By using Bio-SeCo, scientists can explore the very large and very heterogeneous biomedical-molecular data available. They can easily make different explorative search attempts, inspect obtained results, select the most appropriate, expand or refine them and move forward and backward in the construction of a global complex biomedical query on multiple distributed sources that could eventually find the most relevant results. Thus, it provides an extremely useful automated support for exploratory integrated bio search, which is fundamental for Life Science data driven knowledge discovery. PMID:24564278

HIPAA-compliant automatic monitoring system for RIS-integrated PACS operation

NASA Astrophysics Data System (ADS)

Jin, Jin; Zhang, Jianguo; Chen, Xiaomeng; Sun, Jianyong; Yang, Yuanyuan; Liang, Chenwen; Feng, Jie; Sheng, Liwei; Huang, H. K.

2006-03-01

As a governmental regulation, Health Insurance Portability and Accountability Act (HIPAA) was issued to protect the privacy of health information that identifies individuals who are living or deceased. HIPAA requires security services supporting implementation features: Access control; Audit controls; Authorization control; Data authentication; and Entity authentication. These controls, which proposed in HIPAA Security Standards, are Audit trails here. Audit trails can be used for surveillance purposes, to detect when interesting events might be happening that warrant further investigation. Or they can be used forensically, after the detection of a security breach, to determine what went wrong and who or what was at fault. In order to provide security control services and to achieve the high and continuous availability, we design the HIPAA-Compliant Automatic Monitoring System for RIS-Integrated PACS operation. The system consists of two parts: monitoring agents running in each PACS component computer and a Monitor Server running in a remote computer. Monitoring agents are deployed on all computer nodes in RIS-Integrated PACS system to collect the Audit trail messages defined by the Supplement 95 of the DICOM standard: Audit Trail Messages. Then the Monitor Server gathers all audit messages and processes them to provide security information in three levels: system resources, PACS/RIS applications, and users/patients data accessing. Now the RIS-Integrated PACS managers can monitor and control the entire RIS-Integrated PACS operation through web service provided by the Monitor Server. This paper presents the design of a HIPAA-compliant automatic monitoring system for RIS-Integrated PACS Operation, and gives the preliminary results performed by this monitoring system on a clinical RIS-integrated PACS.

Computational toxicology using the OpenTox application programming interface and Bioclipse

PubMed Central

2011-01-01

Background Toxicity is a complex phenomenon involving the potential adverse effect on a range of biological functions. Predicting toxicity involves using a combination of experimental data (endpoints) and computational methods to generate a set of predictive models. Such models rely strongly on being able to integrate information from many sources. The required integration of biological and chemical information sources requires, however, a common language to express our knowledge ontologically, and interoperating services to build reliable predictive toxicology applications. Findings This article describes progress in extending the integrative bio- and cheminformatics platform Bioclipse to interoperate with OpenTox, a semantic web framework which supports open data exchange and toxicology model building. The Bioclipse workbench environment enables functionality from OpenTox web services and easy access to OpenTox resources for evaluating toxicity properties of query molecules. Relevant cases and interfaces based on ten neurotoxins are described to demonstrate the capabilities provided to the user. The integration takes advantage of semantic web technologies, thereby providing an open and simplifying communication standard. Additionally, the use of ontologies ensures proper interoperation and reliable integration of toxicity information from both experimental and computational sources. Conclusions A novel computational toxicity assessment platform was generated from integration of two open science platforms related to toxicology: Bioclipse, that combines a rich scriptable and graphical workbench environment for integration of diverse sets of information sources, and OpenTox, a platform for interoperable toxicology data and computational services. The combination provides improved reliability and operability for handling large data sets by the use of the Open Standards from the OpenTox Application Programming Interface. This enables simultaneous access to a variety of distributed predictive toxicology databases, and algorithm and model resources, taking advantage of the Bioclipse workbench handling the technical layers. PMID:22075173

An integrated outsourcing solution at York Central Hospital.

PubMed

Marr, Jo-Anne; Tam, Richard; Simms, Stephen; Bacchus, Feria

2011-01-01

Canadian hospitals struggle to balance the need to increase and improve operational services and quality with diminishing resources. Many realize that sustaining their organization depends on how well they focus their resources and talents on their core business, clinical care delivery. Outsourcing of non-core, non-clinical support services is a solution for many organizations. Most often, this is put into action one service provider at a time. In 2007, however, York Central Hospital (YCH) implemented Sodexo's integrated Comprehensive Service Solutions (CSS) for all its support service functions. In doing so, YCH achieved significant improvements in patient and staff satisfaction rates, substantial cost savings through improved operational efficiency from process improvements and leveraging technology investments, and increased retail food revenue.

Final report for the Integrated and Robust Security Infrastructure (IRSI) laboratory directed research and development project

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

Hutchinson, R.L.; Hamilton, V.A.; Istrail, G.G.

1997-11-01

This report describes the results of a Sandia-funded laboratory-directed research and development project titled {open_quotes}Integrated and Robust Security Infrastructure{close_quotes} (IRSI). IRSI was to provide a broad range of commercial-grade security services to any software application. IRSI has two primary goals: application transparency and manageable public key infrastructure. IRSI must provide its security services to any application without the need to modify the application to invoke the security services. Public key mechanisms are well suited for a network with many end users and systems. There are many issues that make it difficult to deploy and manage a public key infrastructure. IRSImore » addressed some of these issues to create a more manageable public key infrastructure.« less

Toward a Unified Integration Approach: Uniting Diverse Primary Care Strategies Under the Primary Care Behavioral Health (PCBH) Model.

PubMed

Sandoval, Brian E; Bell, Jennifer; Khatri, Parinda; Robinson, Patricia J

2018-06-01

Primary care continues to be at the center of health care transformation. The Primary Care Behavioral Health (PCBH) model of service delivery includes patient-centered care delivery strategies that can improve clinical outcomes, cost, and patient and primary care provider satisfaction with services. This article reviews the link between the PCBH model of service delivery and health care services quality improvement, and provides guidance for initiating PCBH model clinical pathways for patients facing depression, chronic pain, alcohol misuse, obesity, insomnia, and social barriers to health.

Integration of Fixed and Flexible Route Public Transportation Systems, Phase I

DOT National Transportation Integrated Search

2012-01-01

To provide efficient public transportation services in areas with high demand variability over time, it may be desirable : to switch vehicles between conventional services (with fixed routes and schedules) during peak periods and flexible : route ser...

Demand Response and Energy Storage Integration Study

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

Ma, Ookie; Cheung, Kerry; Olsen, Daniel J.

2016-03-01

Demand response and energy storage resources present potentially important sources of bulk power system services that can aid in integrating variable renewable generation. While renewable integration studies have evaluated many of the challenges associated with deploying large amounts of variable wind and solar generation technologies, integration analyses have not yet fully incorporated demand response and energy storage resources. This report represents an initial effort in analyzing the potential integration value of demand response and energy storage, focusing on the western United States. It evaluates two major aspects of increased deployment of demand response and energy storage: (1) Their operational valuemore » in providing bulk power system services and (2) Market and regulatory issues, including potential barriers to deployment.« less

Demand Response and Energy Storage Integration Study

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

Ma, Ookie; Cheung, Kerry

Demand response and energy storage resources present potentially important sources of bulk power system services that can aid in integrating variable renewable generation. While renewable integration studies have evaluated many of the challenges associated with deploying large amounts of variable wind and solar generation technologies, integration analyses have not yet fully incorporated demand response and energy storage resources. This report represents an initial effort in analyzing the potential integration value of demand response and energy storage, focusing on the western United States. It evaluates two major aspects of increased deployment of demand response and energy storage: (1) Their operational valuemore » in providing bulk power system services and (2) Market and regulatory issues, including potential barriers to deployment.« less

Broadband wireless, integrated services, and their application to intelligent transportation systems

DOT National Transportation Integrated Search

2000-06-01

This paper introduces some of the newer broadband wireless communications alternatives and describes how they could be used to provide high-speed connections between fixed, transportable, and mobile facilities. We also describe the new integrated ser...

The implementation of integrated care: the empirical validation of the Development Model for Integrated Care

PubMed Central

2011-01-01

Background Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the integration of care. We have empirically validated this model in practice by assessing the relevance, implementation and plans of the elements in three integrated care service settings in The Netherlands: stroke, acute myocardial infarct (AMI), and dementia. Methods Based on the DMIC, a survey was developed for integrated care coordinators. We invited all Dutch stroke and AMI-services, as well as the dementia care networks to participate, of which 84 did (response rate 83%). Data were collected on relevance, presence, and year of implementation of the 89 elements. The data analysis was done by means of descriptive statistics, Chi Square, ANOVA and Kruskal-Wallis H tests. Results The results indicate that the integrated care practice organizations in all three care settings rated the nine clusters and 89 elements of the DMIC as highly relevant. The average number of elements implemented was 50 ± 18, 42 ± 13, and 45 ± 22 for stroke, acute myocardial infarction, and dementia care services, respectively. Although the dementia networks were significantly younger, their numbers of implemented elements were comparable to those of the other services. The analyses of the implementation timelines showed that the older integrated care services had fewer plans for further implementation than the younger ones. Integrated care coordinators stated that the DMIC helped them to assess their integrated care development in practice and supported them in obtaining ideas for expanding their integrated care activities. Conclusions Although the patient composites and the characteristics of the 84 participating integrated care services differed considerably, the results confirm that the clusters and the vast majority of DMIC elements are relevant to all three groups. Therefore, the DMIC can serve as a general quality management tool for integrated care. Applying the model in practice can help in steering further implementations as well as the development of new integrated care practices. PMID:21801428

The implementation of integrated care: the empirical validation of the Development Model for Integrated care.

PubMed

Minkman, Mirella M N; Vermeulen, Robbert P; Ahaus, Kees T B; Huijsman, Robbert

2011-07-30

Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the integration of care. We have empirically validated this model in practice by assessing the relevance, implementation and plans of the elements in three integrated care service settings in The Netherlands: stroke, acute myocardial infarct (AMI), and dementia. Based on the DMIC, a survey was developed for integrated care coordinators. We invited all Dutch stroke and AMI-services, as well as the dementia care networks to participate, of which 84 did (response rate 83%). Data were collected on relevance, presence, and year of implementation of the 89 elements. The data analysis was done by means of descriptive statistics, Chi Square, ANOVA and Kruskal-Wallis H tests. The results indicate that the integrated care practice organizations in all three care settings rated the nine clusters and 89 elements of the DMIC as highly relevant. The average number of elements implemented was 50 ± 18, 42 ± 13, and 45 ± 22 for stroke, acute myocardial infarction, and dementia care services, respectively. Although the dementia networks were significantly younger, their numbers of implemented elements were comparable to those of the other services. The analyses of the implementation timelines showed that the older integrated care services had fewer plans for further implementation than the younger ones. Integrated care coordinators stated that the DMIC helped them to assess their integrated care development in practice and supported them in obtaining ideas for expanding their integrated care activities. Although the patient composites and the characteristics of the 84 participating integrated care services differed considerably, the results confirm that the clusters and the vast majority of DMIC elements are relevant to all three groups. Therefore, the DMIC can serve as a general quality management tool for integrated care. Applying the model in practice can help in steering further implementations as well as the development of new integrated care practices.

The Requirements and Design of the Rapid Prototyping Capabilities System

NASA Astrophysics Data System (ADS)

Haupt, T. A.; Moorhead, R.; O'Hara, C.; Anantharaj, V.

2006-12-01

The Rapid Prototyping Capabilities (RPC) system will provide the capability to rapidly evaluate innovative methods of linking science observations. To this end, the RPC will provide the capability to integrate the software components and tools needed to evaluate the use of a wide variety of current and future NASA sensors, numerical models, and research results, model outputs, and knowledge, collectively referred to as "resources". It is assumed that the resources are geographically distributed, and thus RPC will provide the support for the location transparency of the resources. The RPC system requires providing support for: (1) discovery, semantic understanding, secure access and transport mechanisms for data products available from the known data provides; (2) data assimilation and geo- processing tools for all data transformations needed to match given data products to the model input requirements; (3) model management including catalogs of models and model metadata, and mechanisms for creation environments for model execution; and (4) tools for model output analysis and model benchmarking. The challenge involves developing a cyberinfrastructure for a coordinated aggregate of software, hardware and other technologies, necessary to facilitate RPC experiments, as well as human expertise to provide an integrated, "end-to-end" platform to support the RPC objectives. Such aggregation is to be achieved through a horizontal integration of loosely coupled services. The cyberinfrastructure comprises several software layers. At the bottom, the Grid fabric encompasses network protocols, optical networks, computational resources, storage devices, and sensors. At the top, applications use workload managers to coordinate their access to physical resources. Applications are not tightly bounded to a single physical resource. Instead, they bind dynamically to resources (i.e., they are provisioned) via a common grid infrastructure layer. For the RPC system, the cyberinfrastructure must support organizing computations (or "data transformations" in general) into complex workflows with resource discovery, automatic resource allocation, monitoring, preserving provenance as well as to aggregate heterogeneous, distributed data into knowledge databases. Such service orchestration is the responsibility of the "collective services" layer. For RPC, this layer will be based on Java Business Integration (JBI, [JSR-208]) specification which is a standards-based integration platform that combines messaging, web services, data transformation, and intelligent routing to reliably connect and coordinate the interaction of significant numbers of diverse applications (plug-in components) across organizational boundaries. JBI concept is a new approach to integration that can provide the underpinnings for loosely coupled, highly distributed integration network that can scale beyond the limits of currently used hub-and-spoke brokers. This presentation discusses the requirements, design and early prototype of the NASA-sponsored RPC system under development at Mississippi State University, demonstrating the integration of data provisioning mechanisms, data transformation tools and computational models into a single interoperable system enabling rapid execution of RPC experiments.

Are human service agencies ready for disasters? Findings from a mixed-methods needs assessment and planning project.

PubMed

Hipper, Thomas J; Orr, Ashley; Chernak, Esther

2015-01-01

A mixed-methods design was used to assess the current capacity of human service agencies to provide services in a major disaster, identify challenges and successful strategies for providing those services, and formulate specific recommendations for government planners and the nonprofit sector to promote the integration of human service agencies into emergency preparedness and response. A web-based survey was completed by 188 unique human service agencies, 31 semistructured interviews were conducted with human service agency and government leaders from southeastern Pennsylvania and the mid-Atlantic region, and a collaborative planning meeting was held to review the findings and develop systems-based recommendations. Survey results indicated that human service agencies serve the most vulnerable communities during disasters and would welcome integration into preparedness and response plans, but they currently face challenges that include a lack of real-time communication and opportunities for collaborative planning with government partners. Interview findings were grouped according to 5 themes that emerged: capacity, coordination, communication, training, and leadership. This study identified recommendations to assist human service agencies, local health departments, and emergency management agencies as they work to ensure that needed human services are available during disasters, despite the resource challenges that most agencies face.

The Volume and Mix of Inpatient Services Provided by Academic Medical Centers.

ERIC Educational Resources Information Center

Moy, Ernest; And Others

1996-01-01

A study examined trends in the volume and type of inpatient clinical diagnoses, common medical services, and specialized services in academic medical centers (AMCs)--integrated and independent, other teaching hospitals, and nonteaching hospitals. Results indicate that despite rapid change in the health care environment, little change has occurred…

Preparing Advocates: Service-Learning in TESOL for Future Mainstream Educators

ERIC Educational Resources Information Center

Moore, Jessie l.

2013-01-01

Service-learning pedagogy can provide future educators a meaningful introduction to the field of TESOL and the English language learners (ELLs) it serves. This article briefly describes one approach to integrating service-learning into an Introduction to TESOL course and presents research findings on TESOL students' learning outcomes, which…

Health Impact Assessment (HIA) and EnviroAtlas: Integrating Ecosystem Services into the Decision-Making Process-Guide

EPA Science Inventory

This document was created to highlight the many ways that the U.S. EPA EnviroAtlas suite of ecosystem services tools can be used to aid in the Health Impact Assessment (HIA) process. Ecosystems provide numerous services and benefits to individuals, communities, businesses, and ot...

The epidemiology of a specialist neurorehabilitation clinic: implications for clinical practice and regional service development.

PubMed

Seeley, Helen; Pickard, John; Allanson, Judith; Hutchinson, Peter

2014-01-01

To examine the epidemiology of referrals to a specialist neurotrauma clinic and explore and highlight implications for clinical practice and service development for persons with head injury/traumatic brain injury (HI/TBI). A retrospective population-based cohort study of all referrals to a specialist neurotrauma clinic over a 9-year period. Data from a specialist head injury database (which included all persons presenting to hospital with traumatic brain injury) were analysed. In total, 1235 new patients of all ages, severities of injury, both admitted and non-admitted were referred. Referrals have increased due to successful integration with new service developments and resulting optimization of resources. Data gathered from the cohort gives increased understanding of the characteristics and numbers of patients requiring rehabilitation and adds to the evidence-base. Integration with new and complementary service developments has optimized the function/aims of the clinic and enhanced its role in terms of patient service and outcome and as a research resource. The model provides principles which may be applied to planning, organizing and providing follow-up/rehabilitation services for HI/TBI.

Upstairs downstairs: vertical integration of a pediatric service.

PubMed

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

1998-07-01

The combined effects of recent changes in health care financing and training priorities have compelled academic medical centers to develop innovative structures to maintain service commitments yet conform to health care marketplace demands. In 1992, a municipal hospital in the Bronx, New York, affiliated with a major academic medical center reorganized its pediatric service into a vertically integrated system of four interdependent practice teams that provided comprehensive care in the ambulatory as well as inpatient settings. One of the goals of the new system was to conserve inpatient resources. To describe the development of a new vertically integrated pediatric service at an inner-city municipal hospital and to test whether its adoption was associated with the use of fewer inpatient resources. A descriptive analysis of the rationale, goals, implementation strategies, and structure of the vertically integrated pediatric service combined with a before-and-after comparison of in-hospital resource consumption. A before-and-after comparison was conducted for two periods: the period before vertical integration, from January 1989 to December 1991, and the period after the adoption of vertical integration, from July 1992 to December 1994. Four measures of inpatient resource use were compared after adjustment for case mix index: mean certified length of stay per case, mean number of radiologic tests per case, mean number of ancillary tests per case, and mean number of laboratory tests per case. Difference-in-differences-in-differences estimators were used to control for institution-wide trends throughout the time period and regional trends in inpatient pediatric practice occurring across institutions. Results. In 1992, the Department of Pediatrics at the Albert Einstein College of Medicine reorganized the pediatric service at Jacobi Medical Center, one of its principal municipal hospital affiliates, into a vertically integrated pediatric service that combines ambulatory and inpatient activities into four interdependent practice teams composed of attending pediatricians, allied health professionals, house officers, and social workers. The new vertically integrated service was designed to improve continuity of care for patients, provide a model of practice for professional trainees, conserve scarce resources, and create a clinical research infrastructure. The vertically integrated pediatric service augmented the role of attending pediatricians, extended the use of allied health professionals from the ambulatory to the inpatient sites, established interdisciplinary practice teams that unified the care of pediatric patients and their families, and used less inpatient resources. Controlling for trends within the study institution and trends in the practice of pediatrics across institutions throughout the time period, the vertical integration was associated with a decline in 0.6 days per case, the use of 0.62 fewer radiologic tests per case, 0.21 fewer ancillary tests per case, and 2.68 fewer laboratory tests per case. We conclude that vertical integration of a pediatric service at an inner-city municipal hospital is achievable; conveys advantages of improved continuity of care, enhanced opportunities for primary care training, and increased participation of senior clinicians; and has the potential to conserve significant amounts of inpatient resources.

Cost savings associated with an alternative payment model for integrating behavioral health in primary care.

PubMed

Ross, Kaile M; Gilchrist, Emma C; Melek, Stephen P; Gordon, Patrick D; Ruland, Sandra L; Miller, Benjamin F

2018-05-23

Financially supporting and sustaining behavioral health services integrated into primary care settings remains a major barrier to widespread implementation. Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) was a demonstration project designed to prospectively examine the cost savings associated with utilizing an alternative payment methodology to support behavioral health services in primary care practices with integrated behavioral health services. Six primary care practices in Colorado participated in this project. Each practice had at least one on-site behavioral health clinician providing integrated behavioral health services. Three practices received non-fee-for-service payments (i.e., SHAPE payment) to support provision of behavioral health services for 18 months. Three practices did not receive the SHAPE payment and served as control practices for comparison purposes. Assignment to condition was nonrandom. Patient claims data were collected for 9 months before the start of the SHAPE demonstration project (pre-period) and for 18 months during the SHAPE project (post-period) to evaluate cost savings. During the 18-month post-period, analysis of the practices' claims data demonstrated that practices receiving the SHAPE payment generated approximately $1.08 million in net cost savings for their public payer population (i.e., Medicare, Medicaid, and Dual Eligible; N = 9,042). The cost savings were primarily achieved through reduction in downstream utilization (e.g., hospitalizations). The SHAPE demonstration project found that non-fee-for-service payments for behavioral health integrated into primary care may be associated with significant cost savings for public payers, which could have implications on future delivery and payment work in public programs (e.g., Medicaid).

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

PubMed

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

2012-09-01

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

Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use.

PubMed

Bartels, Stephen J; Coakley, Eugenie H; Zubritsky, Cynthia; Ware, James H; Miles, Keith M; Areán, Patricia A; Chen, Hongtu; Oslin, David W; Llorente, Maria D; Costantino, Giuseppe; Quijano, Louise; McIntyre, Jack S; Linkins, Karen W; Oxman, Thomas E; Maxwell, James; Levkoff, Sue E

2004-08-01

The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients. This multisite randomized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics. Primary care patients 65 years old or older (N=24,930) were screened. The final study group consisted of 2,022 patients (mean age=73.5 years; 26% female; 48% ethnic minority) with depression (N=1,390), anxiety (N=70), at-risk alcohol use (N=414), or dual diagnosis (N=148) who were randomly assigned to integrated care (mental health and substance abuse providers co-located in primary care; N=999) or enhanced referral to specialty mental health/substance abuse clinics (i.e., facilitated scheduling, transportation, payment; N=1,023). Seventy-one percent of patients engaged in treatment in the integrated model compared with 49% in the enhanced referral model. Integrated care was associated with more mental health and substance abuse visits per patient (mean=3.04) relative to enhanced referral (mean=1.91). Overall, greater engagement was predicted by integrated care and higher mental distress. For depression, greater engagement was predicted by integrated care and more severe depression. For at-risk alcohol users, greater engagement was predicted by integrated care and more severe problem drinking. For all conditions, greater engagement was associated with closer proximity of mental health/substance abuse services to primary care. Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics. These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services.

The role of nurse specialists in the delivery of integrated diabetes care: a cross-sectional survey of diabetes nurse specialist services

PubMed Central

Riordan, Fiona; McHugh, Sheena M; Murphy, Katie; Barrett, Julie; Kearney, Patricia M

2017-01-01

Objectives International evidence suggests the diabetes nurse specialist (DNS) has a key role in supporting integrated management of diabetes. We examine whether hospital and community DNS currently support the integration of care, examine regional variation in aspects of the service relevant to the delivery of integrated care and identify barriers to service delivery and areas for improvement. Design A cross-sectional survey of hospital and community-based DNS in Ireland. Methods Between September 2015 and April 2016, a 67-item online survey, comprising closed and open questions on their clinical role, diabetes clinics, multidisciplinary working, and barriers and facilitators to service delivery, was administered to all eligible DNS (n=152) in Ireland. DNS were excluded if they were retired or on maternity leave or extended leave. Results The response rate was 66.4% (n=101): 60.6% (n=74) and 89.3% (n=25) among hospital and community DNS, respectively. Most DNS had patients with stable (81.8%) and complicated type 2 diabetes mellitus (89.9%) attending their service. The majority were delivering nurse-led clinics (81.1%). Almost all DNS had a role liaising with (91%), and providing support and education to (95%), other professionals. However, only a third reported that there was local agreement on how their service should operate between the hospital and primary care. Barriers to service delivery that were experienced by DNS included deficits in the availability of specialist staff (allied health professionals, endocrinologists and DNS), insufficient space for clinics, structured education and issues with integration. Conclusions Delivering integrated diabetes care through a nurse specialist-led approach requires that wider service issues, including regional disparities in access to specialist resources and formalising agreements and protocols on multidisciplinary working between settings, be explicitly addressed. PMID:28801394

Applications of satellite technology to broadband ISDN networks

NASA Technical Reports Server (NTRS)

Price, Kent M.; Kwan, Robert K.; Chitre, D. M.; Henderson, T. R.; White, L. W.; Morgan, W. L.

1992-01-01

Two satellite architectures for delivering broadband integrated services digital network (B-ISDN) service are evaluated. The first is assumed integral to an existing terrestrial network, and provides complementary services such as interconnects to remote nodes as well as high-rate multicast and broadcast service. The interconnects are at a 155 Mbs rate and are shown as being met with a nonregenerative multibeam satellite having 10-1.5 degree spots. The second satellite architecture focuses on providing private B-ISDN networks as well as acting as a gateway to the public network. This is conceived as being provided by a regenerative multibeam satellite with on-board ATM (asynchronous transfer mode) processing payload. With up to 800 Mbs offered, higher satellite EIRP is required. This is accomplished with 12-0.4 degree hopping beams, covering a total of 110 dwell positions. It is estimated the space segment capital cost for architecture one would be about $190M whereas the second architecture would be about $250M. The net user cost is given for a variety of scenarios, but the cost for 155 Mbs services is shown to be about $15-22/minute for 25 percent system utilization.

Measuring patrons' technology habits: an evidence-based approach to tailoring library services

PubMed Central

Wu, Jin; Chatfield, Amy J.; Hughes, Annie M.; Kysh, Lynn; Rosenbloom, Megan Curran

2014-01-01

Librarians continually integrate new technologies into library services for health sciences students. Recently published data are lacking about student ownership of technological devices, awareness of new technologies, and interest in using devices and technologies to interact with the library. A survey was implemented at seven health sciences libraries to help answer these questions. Results show that librarian assumptions about awareness of technologies are not supported, and student interest in using new technologies to interact with the library varies widely. Collecting this evidence provides useful information for successfully integrating technologies into library services. PMID:24860272

Measuring patrons' technology habits: an evidence-based approach to tailoring library services.

PubMed

Wu, Jin; Chatfield, Amy J; Hughes, Annie M; Kysh, Lynn; Rosenbloom, Megan Curran

2014-04-01

Librarians continually integrate new technologies into library services for health sciences students. Recently published data are lacking about student ownership of technological devices, awareness of new technologies, and interest in using devices and technologies to interact with the library. A survey was implemented at seven health sciences libraries to help answer these questions. Results show that librarian assumptions about awareness of technologies are not supported, and student interest in using new technologies to interact with the library varies widely. Collecting this evidence provides useful information for successfully integrating technologies into library services.

Securing Ground Data System Applications for Space Operations

NASA Technical Reports Server (NTRS)

Pajevski, Michael J.; Tso, Kam S.; Johnson, Bryan

2014-01-01

The increasing prevalence and sophistication of cyber attacks has prompted the Multimission Ground Systems and Services (MGSS) Program Office at Jet Propulsion Laboratory (JPL) to initiate the Common Access Manager (CAM) effort to protect software applications used in Ground Data Systems (GDSs) at JPL and other NASA Centers. The CAM software provides centralized services and software components used by GDS subsystems to meet access control requirements and ensure data integrity, confidentiality, and availability. In this paper we describe the CAM software; examples of its integration with spacecraft commanding software applications and an information management service; and measurements of its performance and reliability.

EUDAT and EPOS moving towards the efficient management of scientific data sets

NASA Astrophysics Data System (ADS)

Fiameni, Giuseppe; Bailo, Daniele; Cacciari, Claudio

2016-04-01

This abstract presents the collaboration between the European Collaborative Data Infrastructure (EUDAT) and the pan-European infrastructure for solid Earth science (EPOS) which draws on the management of scientific data sets through a reciprocal support agreement. EUDAT is a Consortium of European Data Centers and Scientific Communities whose focus is the development and realisation of the Collaborative Data Infrastructure (CDI), a common model for managing data spanning all European research data centres and data repositories and providing an interoperable layer of common data services. The EUDAT Service Suite is a set of a) implementations of the CDI model and b) standards, developed and offered by members of the EUDAT Consortium. These EUDAT Services include a baseline of CDI-compliant interface and API services - a "CDI Gateway" - plus a number of web-based GUIs and command-line client tools. On the other hand,the EPOS initiative aims at creating a pan-European infrastructure for the solid Earth science to support a safe and sustainable society. In accordance with this scientific vision, the mission of EPOS is to integrate the diverse and advanced European Research Infrastructures for solid Earth Science relying on new e-science opportunities to monitor and unravel the dynamic and complex Earth System. EPOS will enable innovative multidisciplinary research for a better understanding of the Earth's physical and chemical processes that control earthquakes, volcanic eruptions, ground instability and tsunami as well as the processes driving tectonics and Earth's surface dynamics. Through the integration of data, models and facilities EPOS will allow the Earth Science community to make a step change in developing new concepts and tools for key answers to scientific and socio-economic questions concerning geo-hazards and geo-resources as well as Earth sciences applications to the environment and to human welfare. To achieve this integration challenge and the interoperability among all involved communities, EPOS has designed an architecture capable to organize and manage distributed discipline-oriented centers (called Thematic Core Services - TCS). Such design envisage the creation of an integrating e-Infrastructure called Integrated Core Service (ICS), whose aim is to collect and integrate Data, Data Products, Software and Services, and provide homogeneous access to them to the end user, hiding all the complexity of the underlying network of TCS and National data centers. Therefore, EPOS can take advantage of EUDAT CDI at different levels: at the TCS level, providing technologies, knowledge and B2* services to discipline-oriented communities, and at the ICS level, by facilitating the integration and interoperability of different communities with different level of maturity in terms of technology expertise. EUDAT services are particularly suitable to facilitate this process as they can be deployed across the community centers to complement or augment existing services of more mature communities as well as be used by less mature communities as a gateway towards the EPOS integration. To this purpose, a pilot is being carried on in the context of the EPOS Seismological community to foster the uptake of EUDAT services among centers and thus ensure the efficient and sustainable management of scientific data sets. Data sets, e.g. seismic waveforms, collected through the Italian Seismic Network and the ORFEUS organization, are currently replicated onto EUDAT resources to ensure their long-term preservation and accessibility. The pilot will be extend to cover other use cases such as the management of meta-data and the fine-grained control of access.

A service-based framework for pharmacogenomics data integration

NASA Astrophysics Data System (ADS)

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

2010-08-01

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

Clinical Decision Support Systems (CDSS) for preventive management of COPD patients.

PubMed

Velickovski, Filip; Ceccaroni, Luigi; Roca, Josep; Burgos, Felip; Galdiz, Juan B; Marina, Nuria; Lluch-Ariet, Magí

2014-11-28

The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway. The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow. The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team. A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms. Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems.

Clinical Decision Support Systems (CDSS) for preventive management of COPD patients

PubMed Central

2014-01-01

Background The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway. Objectives The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow. Methods The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team. Results A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms. Conclusions Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems. PMID:25471545

The EPOS e-Infrastructure

NASA Astrophysics Data System (ADS)

Jeffery, Keith; Bailo, Daniele

2014-05-01

The European Plate Observing System (EPOS) is integrating geoscientific information concerning earth movements in Europe. We are approaching the end of the PP (Preparatory Project) phase and in October 2014 expect to continue with the full project within ESFRI (European Strategic Framework for Research Infrastructures). The key aspects of EPOS concern providing services to allow homogeneous access by end-users over heterogeneous data, software, facilities, equipment and services. The e-infrastructure of EPOS is the heart of the project since it integrates the work on organisational, legal, economic and scientific aspects. Following the creation of an inventory of relevant organisations, persons, facilities, equipment, services, datasets and software (RIDE) the scale of integration required became apparent. The EPOS e-infrastructure architecture has been developed systematically based on recorded primary (user) requirements and secondary (interoperation with other systems) requirements through Strawman, Woodman and Ironman phases with the specification - and developed confirmatory prototypes - becoming more precise and progressively moving from paper to implemented system. The EPOS architecture is based on global core services (Integrated Core Services - ICS) which access thematic nodes (domain-specific European-wide collections, called thematic Core Services - TCS), national nodes and specific institutional nodes. The key aspect is the metadata catalog. In one dimension this is described in 3 levels: (1) discovery metadata using well-known and commonly used standards such as DC (Dublin Core) to enable users (via an intelligent user interface) to search for objects within the EPOS environment relevant to their needs; (2) contextual metadata providing the context of the object described in the catalog to enable a user or the system to determine the relevance of the discovered object(s) to their requirement - the context includes projects, funding, organisations involved, persons involved, related publications, facilities, equipment and others, and utilises CERIF (Common European Research Information Format) standard (see www.eurocris.org); (3) detailed metadata which is specific to a domain or to a particular object and includes the schema describing the object to processing software. The other dimension of the metadata concerns the objects described. These are classified into users, services (including software), data and resources (computing, data storage, instruments and scientific equipment). An alternative architecture has been considered: using brokering. This technique has been used especially in North America geoscience projects to interoperate datasets. The technique involves writing software to interconvert between any two node datasets. Given n nodes this implies writing n*(n-1) convertors. EPOS Working Group 7 (e-infrastructures and virtual community) which deals with the design and implementation of a prototype of the EPOS services, chose to use an approach which endows the system with an extreme flexibility and sustainability. It is called the Metadata Catalogue approach. With the use of the catalogue the EPOS system can: 1. interoperate with software, services, users, organisations, facilities, equipment etc. as well as datasets; 2. avoid to write n*(n-1) software convertors and generate as much as possible, through the information contained in the catalogue only n convertors. This is a huge saving - especially in maintenance as the datasets (or other node resources) evolve. We are working on (semi-) automation of convertor generation by metadata mapping - this is leading-edge computer science research; 3. make large use of contextual metadata which enable a user or a machine to: (i) improve discovery of resources at nodes; (ii) improve precision and recall in search; (iii) drive the systems for identification, authentication, authorisation, security and privacy recording the relevant attributes of the node resources and of the user; (iv) manage provenance and long-term digital preservation; The linkage between the Integrated Services, which provide the integration of data and services, with the diverse Thematic Services Nodes is provided by means of a compatibility layer, which includes the aforementioned metadata catalogue. This layer provides 'connectors' to make local data, software and services available through the EPOS Integrated Services layer. In conclusion, we believe the EPOS e-infrastructure architecture is fit for purpose including long-term sustainability and pan-European access to data and services.

Integrative Medicine Experience in the U.S. Department of Defense

PubMed Central

Delgado, Roxana E.

2015-01-01

Abstract Background: Over the past 15 years, the use of complementary and alternative medicine (CAM) services, currently described as integrative medicine (IM) when used together with conventional medicine , has continued to rise in the United States. The trends seen in the civilian population are mirrored within the U.S. Military. Objective: A survey was conducted to show the change in the prevalence of integrative medicine services, budgeting of those services, and ongoing research in IM within Department of Defense (DoD) medical treatment facilities (MTFs) from 2005 through 2009. Materials and Methods: Design: The Deputy Chief of Clinical Services or Service equivalent was contacted at fourteen selected DoD MTFs. Comprehensive structured telephone interviews were conducted using a formatted 20-item questionnaire. The questionnaire design was of a mixed model with open and closed formats as well as dichotomous yes/no questions. The questions covered the subject areas of available services, budgeting, and research. The initial survey was conducted in 2005 with a follow-up survey conducted in 2009. Setting: This survey involved DoD MTFs. Main Outcome Measures: The surveys were conducted to determine the prevalence of IM services within selected DoD facilities. Results: There was a steady increase in the number of IM services available in the DoD MTFs from 2005 through 2009. Acupuncture, biofeedback, nutritional counseling, and spiritual healing were the most prevalent IM services in 2009. Funding sources changed from central funding (Offices of the Surgeon General) to Congressional and local funding. Conclusions: It is essential that the DoD medical community provides safe and effective treatments by providing oversight of IM services, collaboration for research, credentialing of practitioners, and establishing educational programs. PMID:26543518

Determining Appropriate Coupling between User Experiences and Earth Science Data Services

NASA Astrophysics Data System (ADS)

Moghaddam-Taaheri, E.; Pilone, D.; Newman, D. J.; Mitchell, A. E.; Goff, T. D.; Baynes, K.

2012-12-01

NASA's Earth Observing System ClearingHOuse (ECHO) is a format agnostic metadata repository supporting over 3000 collections and 100M granules. ECHO exposes FTP and RESTful Data Ingest APIs in addition to both SOAP and RESTful search and order capabilities. Built on top of ECHO is a human facing search and order web application named Reverb. Reverb exposes ECHO's capabilities through an interactive, Web 2.0 application designed around searching for Earth Science data and downloading or ordering data of interest. ECHO and Reverb have supported the concept of Earth Science data services for several years but only for discovery. Invocation of these services was not a primary capability of the user experience. As more and more Earth Science data moves online and away from the concept of data ordering, progress has been made in making on demand services available for directly accessed data. These concepts have existed through access mechanisms such as OPeNDAP but are proliferating to accommodate a wider variety of services and service providers. Recently, the EOSDIS Service Interface (ESI) was defined and integrated into the ECS system. The ESI allows data providers to expose a wide variety of service capabilities including reprojection, reformatting, spatial and band subsetting, and resampling. ECHO and Reverb were tasked with making these services available to end-users in a meaningful and usable way that integrated into its existing search and ordering workflow. This presentation discusses the challenges associated with exposing disparate service capabilities while presenting a meaningful and cohesive user experience. Specifically, we'll discuss: - Benefits and challenges of tightly coupling the user interface with underlying services - Approaches to generic service descriptions - Approaches to dynamic user interfaces that better describe service capabilities while minimizing application coupling - Challenges associated with traditional WSDL / UDDI style service descriptions - Walkthrough of the solution used by ECHO and Reverb to integrate and expose ESI compliant services to our users

Off the Shelf Cloud Robotics for the Smart Home: Empowering a Wireless Robot through Cloud Computing.

PubMed

Ramírez De La Pinta, Javier; Maestre Torreblanca, José María; Jurado, Isabel; Reyes De Cozar, Sergio

2017-03-06

In this paper, we explore the possibilities offered by the integration of home automation systems and service robots. In particular, we examine how advanced computationally expensive services can be provided by using a cloud computing approach to overcome the limitations of the hardware available at the user's home. To this end, we integrate two wireless low-cost, off-the-shelf systems in this work, namely, the service robot Rovio and the home automation system Z-wave. Cloud computing is used to enhance the capabilities of these systems so that advanced sensing and interaction services based on image processing and voice recognition can be offered.

Off the Shelf Cloud Robotics for the Smart Home: Empowering a Wireless Robot through Cloud Computing

PubMed Central

Ramírez De La Pinta, Javier; Maestre Torreblanca, José María; Jurado, Isabel; Reyes De Cozar, Sergio

2017-01-01

In this paper, we explore the possibilities offered by the integration of home automation systems and service robots. In particular, we examine how advanced computationally expensive services can be provided by using a cloud computing approach to overcome the limitations of the hardware available at the user’s home. To this end, we integrate two wireless low-cost, off-the-shelf systems in this work, namely, the service robot Rovio and the home automation system Z-wave. Cloud computing is used to enhance the capabilities of these systems so that advanced sensing and interaction services based on image processing and voice recognition can be offered. PMID:28272305

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

PubMed

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

2004-10-01

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

Integrating existing software toolkits into VO system

NASA Astrophysics Data System (ADS)

Cui, Chenzhou; Zhao, Yong-Heng; Wang, Xiaoqian; Sang, Jian; Luo, Ze

2004-09-01

Virtual Observatory (VO) is a collection of interoperating data archives and software tools. Taking advantages of the latest information technologies, it aims to provide a data-intensively online research environment for astronomers all around the world. A large number of high-qualified astronomical software packages and libraries are powerful and easy of use, and have been widely used by astronomers for many years. Integrating those toolkits into the VO system is a necessary and important task for the VO developers. VO architecture greatly depends on Grid and Web services, consequently the general VO integration route is "Java Ready - Grid Ready - VO Ready". In the paper, we discuss the importance of VO integration for existing toolkits and discuss the possible solutions. We introduce two efforts in the field from China-VO project, "gImageMagick" and "Galactic abundance gradients statistical research under grid environment". We also discuss what additional work should be done to convert Grid service to VO service.

Towards Semantic e-Science for Traditional Chinese Medicine

PubMed Central

Chen, Huajun; Mao, Yuxin; Zheng, Xiaoqing; Cui, Meng; Feng, Yi; Deng, Shuiguang; Yin, Aining; Zhou, Chunying; Tang, Jinming; Jiang, Xiaohong; Wu, Zhaohui

2007-01-01

Background Recent advances in Web and information technologies with the increasing decentralization of organizational structures have resulted in massive amounts of information resources and domain-specific services in Traditional Chinese Medicine. The massive volume and diversity of information and services available have made it difficult to achieve seamless and interoperable e-Science for knowledge-intensive disciplines like TCM. Therefore, information integration and service coordination are two major challenges in e-Science for TCM. We still lack sophisticated approaches to integrate scientific data and services for TCM e-Science. Results We present a comprehensive approach to build dynamic and extendable e-Science applications for knowledge-intensive disciplines like TCM based on semantic and knowledge-based techniques. The semantic e-Science infrastructure for TCM supports large-scale database integration and service coordination in a virtual organization. We use domain ontologies to integrate TCM database resources and services in a semantic cyberspace and deliver a semantically superior experience including browsing, searching, querying and knowledge discovering to users. We have developed a collection of semantic-based toolkits to facilitate TCM scientists and researchers in information sharing and collaborative research. Conclusion Semantic and knowledge-based techniques are suitable to knowledge-intensive disciplines like TCM. It's possible to build on-demand e-Science system for TCM based on existing semantic and knowledge-based techniques. The presented approach in the paper integrates heterogeneous distributed TCM databases and services, and provides scientists with semantically superior experience to support collaborative research in TCM discipline. PMID:17493289

Accessing Electronic Journals.

ERIC Educational Resources Information Center

McKay, Sharon Cline

1999-01-01

Discusses issues librarians need to consider when providing access to electronic journals. Topics include gateways; index and abstract services; validation and pay-per-view; title selection; integration with OPACs (online public access catalogs)or Web sites; paper availability; ownership versus access; usage restrictions; and services offered…

The Effect of Integrating Family Planning with a Maternal and Newborn Health Program on Postpartum Contraceptive Use and Optimal Birth Spacing in Rural Bangladesh.

PubMed

Ahmed, Saifuddin; Ahmed, Salahuddin; McKaig, Catharine; Begum, Nazma; Mungia, Jaime; Norton, Maureen; Baqui, Abdullah H

2015-09-01

Meeting postpartum contraceptive need remains a major challenge in developing countries, where the majority of women deliver at home. Using a quasi-experimental trial design, we examine the effect of integrating family planning (FP) with a community-based maternal and newborn health (MNH) program on improving postpartum contraceptive use and reducing short birth intervals <24 months. In this two-arm trial, community health workers (CHWs) provided integrated FP counseling and services during home visits along with their outreach MNH activities in the intervention arm, but provided only MNH services in the control arm. The contraceptive prevalence rate (CPR) in the intervention arm was 15 percent higher than in the control arm at 12 months, and the difference in CPRs remained statistically significant throughout the 24 months of observation. The short birth interval of less than 24 months was significantly lower in the intervention arm. The study demonstrates that it is feasible and effective to integrate FP services into a community-based MNH care program for improving postpartum contraceptive use and lengthening birth intervals. © 2015 The Population Council, Inc.

Integrating geographically isolated wetlands into land ...

EPA Pesticide Factsheets

Wetlands across the globe provide extensive ecosystem services. However, many wetlands – especially those surrounded by uplands, often referred to as geographically isolated wetlands (GIWs) – remain poorly protected. Protection and restoration of wetlands frequently requires information on their hydrologic connectivity to other surface waters, and their cumulative watershed-scale effects. The integration of measurements and models can supply this information. However, the types of measurements and models that should be integrated are dependent on management questions and information compatibility. We summarize the importance of GIWs in watersheds and discuss what wetland connectivity means in both science and management contexts. We then describe the latest tools available to quantify GIW connectivity and explore crucial next steps to enhancing and integrating such tools. These advancements will ensure that appropriate tools are used in GIW decision making and maintaining the important ecosystem services that these wetlands support. In a nutshell: Wetlands in general receive insufficient protection and this is particularly true for geographically isolated wetlands (GIWs), which are completely surrounded by upland areas GIWs have recently gained policy attention because they provide important ecosystem services, but like most wetlands, their loss and degradation continues Knowledge of the hydrologic connections of GIWs to downstream waters is necessary for th

Knowledge, Skills, and Abilities of Youth Service Practitioners: The Centerpiece of a Successful Workforce Development System. A Background Paper

ERIC Educational Resources Information Center

McCain, Mary; Gill, Patricia; Wills, Joan; Larson, Mindy

2004-01-01

This paper provides baseline information for the National Collaborative on Workforce and Disability for Youth (NCWD/Youth) to fulfill its overall mission: To ensure that youth with disabilities are provided full access to high quality services in integrated settings in order to maximize their opportunity for employment and independent living. It…

Providing Primary Health Care to Children: Integrating Primary Care Services with Health Insurance Principles.

ERIC Educational Resources Information Center

Rosenbaum, Sara

1993-01-01

Examines how health care reform might be structured to provide support for a package of primary care services for children of all socioeconomic strata. An insurance-like financing system, such as the special Medicaid payment system adopted by New York State for public and nonprofit primary health care programs, may be useful as a model for a…

A Practice Approach of Multi-source Geospatial Data Integration for Web-based Geoinformation Services

NASA Astrophysics Data System (ADS)

Huang, W.; Jiang, J.; Zha, Z.; Zhang, H.; Wang, C.; Zhang, J.

2014-04-01

Geospatial data resources are the foundation of the construction of geo portal which is designed to provide online geoinformation services for the government, enterprise and public. It is vital to keep geospatial data fresh, accurate and comprehensive in order to satisfy the requirements of application and development of geographic location, route navigation, geo search and so on. One of the major problems we are facing is data acquisition. For us, integrating multi-sources geospatial data is the mainly means of data acquisition. This paper introduced a practice integration approach of multi-source geospatial data with different data model, structure and format, which provided the construction of National Geospatial Information Service Platform of China (NGISP) with effective technical supports. NGISP is the China's official geo portal which provides online geoinformation services based on internet, e-government network and classified network. Within the NGISP architecture, there are three kinds of nodes: national, provincial and municipal. Therefore, the geospatial data is from these nodes and the different datasets are heterogeneous. According to the results of analysis of the heterogeneous datasets, the first thing we do is to define the basic principles of data fusion, including following aspects: 1. location precision; 2.geometric representation; 3. up-to-date state; 4. attribute values; and 5. spatial relationship. Then the technical procedure is researched and the method that used to process different categories of features such as road, railway, boundary, river, settlement and building is proposed based on the principles. A case study in Jiangsu province demonstrated the applicability of the principle, procedure and method of multi-source geospatial data integration.

Assessing Watershed Integrity in the Matanuska-Susitna River Basin

EPA Science Inventory

The US Environmental Protection Agency’s (EPA) Index of Watershed Integrity (IWI) is used to calculate and visualize the status of natural watershed infrastructure that supports ecological processes (e.g., nutrient cycling) and services provided to society (e.g., subsistenc...

Matanuska-Susitna Index of Watershed Integrity (AK IWI)

EPA Science Inventory

The US Environmental Protection Agency’s (EPA) Index of Watershed Integrity (IWI) is used to calculate and visualize the status of natural watershed infrastructure that supports ecological processes (e.g., nutrient cycling) and services provided to society (e.g., subsistenc...

Community dental clinics: providers' perspectives.

PubMed

Wallace, Bruce B; MacEntee, Michael I; Harrison, Rosamund; Hole, Rachelle; Mitton, Craig

2013-06-01

Not-for-profit community dental clinics attempt to address the inequities of oral health care for disadvantaged communities, but there is little information about how they operate. The objective of this article is to explain from the perspective of senior staff how five community dental clinics in British Columbia, Canada, provide services. The mixed-methods case study included the five not-for-profit dental clinics with full-time staff who provided a wide range of dental services. We conducted open-ended interviews to saturation with eight senior administrative staff selected purposefully because of their comprehensive knowledge of the development and operation of the clinics and supplemented their information with a year's aggregated data on patients, treatments, and operating costs. The interview participants described the benefits of integrating dentistry with other health and social services usually within community health centres, although they doubted the sustainability of the clinics without reliable financial support from public funds. Aggregated data showed that 75% of the patients had either publically funded or no coverage for dental services, while the others had employer-sponsored dental insurance. Financial subsidies from regional health authorities allowed two of the clinics to treat only patients who are economically vulnerable and provide all services at reduced costs. Clinics without government subsidies used the fees paid by some patients to subsidize treatment for others who could not afford treatment. Not-for-profit dental clinics provide dental services beyond pain relief for underserved communities. Dental services are integrated with other health and community services and located in accessible locations. However, all of the participants expressed concerns about the sustainability of the clinics without reliable public revenues. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A Successful Model for a Comprehensive Patient Flow Management Center at an Academic Health System.

PubMed

Lovett, Paris B; Illg, Megan L; Sweeney, Brian E

2016-05-01

This article reports on an innovative approach to managing patient flow at a multicampus academic health system, integrating multiple services into a single, centralized Patient Flow Management Center that manages supply and demand for inpatient services across the system. Control of bed management was centralized across 3 campuses and key services were integrated, including bed management, case management, environmental services, patient transport, ambulance and helicopter dispatch, and transfer center. A single technology platform was introduced, as was providing round-the-clock patient placement by critical care nurses, and adding medical directors. Daily bed meetings with nurse managers and charge nurses drive action plans. This article reports immediate improvements in the first year of operations in emergency department walkouts, emergency department boarding, ambulance diversion, growth in transfer volume, reduction in lost transfers, reduction in time to bed assignment, and bed turnover time. The authors believe theirs is the first institution to integrate services and centralize bed management so comprehensively. © The Author(s) 2014.

Telehealth Education in Nursing Curricula.

PubMed

Ali, Nagia S; Carlton, Kay Hodson; Ali, Omar S

2015-01-01

Telehealth care is a fast-growing avenue of providing health care services at a distance. A descriptive study was conducted to identify trends of telehealth education in 43 schools of nursing. Findings reflected inadequate integration of telehealth in classroom content, simulation, and clinical experiences. Interviews with 4 nursing leaders of telehealth provided some recommendations on how to integrate telehealth education in nursing curricula.

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

PubMed Central

2014-01-01

Background Based on practices in commercial organizations and public services, healthcare organizations are using service charters to inform patients about the quality of service they can expect and to increase patient-centeredness. In the Netherlands, an integrated regional stroke service involving five organizations has developed and implemented a single service charter. The purpose of this study is to determine the organizational enablers for the effective development and implementation of this service charter. Methods We have conducted an exploratory qualitative study using Grounded Theory to determine the organizational enablers of charter development and implementation. Individual semi-structured interviews were held with all members of the steering committee and the taskforce responsible for the service charter. In these twelve interviews, participants were retrospectively asked for their opinions of the enablers. Interview transcripts have been analysed using Glaser’s approach of substantive coding consisting of open and selective coding in order to develop a framework of these enablers. A tabula rasa approach was used without any preconceived frameworks used in the coding process. Results We have determined seven categories of enablers formed of a total of 27 properties. The categories address a broad spectrum of enablers dealing with the basic foundations for cooperation, the way to manage the project’s organization and the way to implement the service charter. In addition to the enablers within each individual organization, enablers that reflect the whole chain seem to be important for the effective development and implementation of this service charter. Strategic alignment of goals within the chain, trust between organizations, willingness to cooperate and the extent of process integration are all important properties. Conclusions This first exploratory study into the enablers of the effective development and implementation was based on a single case study in the Netherlands. This is the only integrated care chain using a single service charter that we could find. Nevertheless, the results of our explorative study provide an initial framework for the development and implementation of service charters in integrated care settings. This research contributes to the literature on service charters, on patient-centeredness in integrated care and on the implementation of innovations. PMID:24678839

FHIR Healthcare Directories: Adopting Shared Interfaces to Achieve Interoperable Medical Device Data Integration.

PubMed

Tyndall, Timothy; Tyndall, Ayami

2018-01-01

Healthcare directories are vital for interoperability among healthcare providers, researchers and patients. Past efforts at directory services have not provided the tools to allow integration of the diverse data sources. Many are overly strict, incompatible with legacy databases, and do not provide Data Provenance. A more architecture-independent system is needed to enable secure, GDPR-compatible (8) service discovery across organizational boundaries. We review our development of a portable Data Provenance Toolkit supporting provenance within Health Information Exchange (HIE) systems. The Toolkit has been integrated with client software and successfully leveraged in clinical data integration. The Toolkit validates provenance stored in a Blockchain or Directory record and creates provenance signatures, providing standardized provenance that moves with the data. This healthcare directory suite implements discovery of healthcare data by HIE and EHR systems via FHIR. Shortcomings of past directory efforts include the ability to map complex datasets and enabling interoperability via exchange endpoint discovery. By delivering data without dictating how it is stored we improve exchange and facilitate discovery on a multi-national level through open source, fully interoperable tools. With the development of Data Provenance resources we enhance exchange and improve security and usability throughout the health data continuum.

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

PubMed

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

2017-03-01

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

The future of community nursing: Hospital in the Home.

PubMed

Lee, Gerry; Pickstone, Nicola; Facultad, Jose; Titchener, Karen

2017-04-02

With an increasing ageing population who often have multiple long-term conditions, there is a growing need to provide an alternative type of care to the traditional hospital-based model. 'Hospital in the Home' is a model that provides integrated care for patients in their home. The @home service was established in 2013 by Guy's and St Thomas' NHS Foundation Trust. The service provides health care in patients' home, supporting early discharge from hospital as well as preventing avoidable admissions and readmissions saving valuable hospital bed days and reducing length of stay. This article describes the service available with the use of a case study of a 78-year-old lady who was referred by the London Ambulance Service with exacerbation of chronic obstructive pulmonary disease (COPD). This case study highlights the ability to assess, treat and manage an acutely unwell patient with newly diagnosed heart failure in the community without the need for hospitalisation. This type of integrated care model with a multidisciplinary team is a feasible alternative to the traditional models of care in both the acute and community settings.

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

PubMed Central

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

2017-01-01

Abstract Background The frequency in which HIV and AIDS and mental health problems co-exist, and the complex bi-directional relationship between them, highlights the need for effective care models combining services for HIV and mental health. Here, we present a systematic review that synthesizes the literature on interventions and approaches integrating these services. Methods This review was part of a larger systematic review on integration of services for HIV and non-communicable diseases. Eligible studies included those that described or evaluated an intervention or approach aimed at integrating HIV and mental health care. We searched multiple databases from inception until October 2015, independently screened articles identified for inclusion, conducted data extraction, and assessed evaluative papers for risk of bias. Results Forty-five articles were eligible for this review. We identified three models of integration at the meso and micro levels: single-facility integration, multi-facility integration, and integrated care coordinated by a non-physician case manager. Single-site integration enhances multidisciplinary coordination and reduces access barriers for patients. However, the practicality and cost-effectiveness of providing a full continuum of specialized care on-site for patients with complex needs is arguable. Integration based on a collaborative network of specialized agencies may serve those with multiple co-morbidities but fragmented and poorly coordinated care can pose barriers. Integrated care coordinated by a single case manager can enable continuity of care for patients but requires appropriate training and support for case managers. Involving patients as key actors in facilitating integration within their own treatment plan is a promising approach. Conclusion This review identified much diversity in integration models combining HIV and mental health services, which are shown to have potential in yielding positive patient and service delivery outcomes when implemented within appropriate contexts. Our review revealed a lack of research in low- and middle- income countries, and was limited to most studies being descriptive. Overall, studies that seek to evaluate and compare integration models in terms of long-term outcomes and cost-effectiveness are needed, particularly at the health system level and in regions with high HIV and AIDS burden. PMID:29106512

The organization and delivery of family planning services in community health centers.

PubMed

Goldberg, Debora Goetz; Wood, Susan F; Johnson, Kay; Mead, Katherine Holly; Beeson, Tishra; Lewis, Julie; Rosenbaum, Sara

2015-01-01

Family planning and related reproductive health services are essential primary care services for women. Access is limited for women with low incomes and those living in medically underserved areas. Little information is available on how federally funded health centers organize and provide family planning services. This was a mixed methods study of the organization and delivery of family planning services in federally funded health centers across the United States. A national survey was developed and administered (n = 423) and in-depth case studies were conducted of nine health centers to obtain detailed information on their approach to family planning. Study findings indicate that health centers utilize a variety of organizational models and staffing arrangements to deliver family planning services. Health centers' family planning offerings are organized in one of two ways, either a separate service with specific providers and clinic times or fully integrated with primary care. Health centers experience difficulties in providing a full range of family planning services. Major challenges include funding limitations; hiring obstetricians/gynecologists, counselors, and advanced practice clinicians; and connecting patients to specialized services not offered by the health center. Health centers play an integral role in delivering primary care and family planning services to women in medically underserved communities. Improving the accessibility and comprehensiveness of family planning services will require a combination of additional direct funding, technical assistance, and policies that emphasize how health centers can incorporate quality family planning as a fundamental element of primary care. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

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

PubMed Central

Sobczak, Alicja

2002-01-01

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

Successful Proof of Concept of Family Planning and Immunization Integration in Liberia

PubMed Central

Cooper, Chelsea M; Fields, Rebecca; Mazzeo, Corinne I; Taylor, Nyapu; Pfitzer, Anne; Momolu, Mary; Jabbeh-Howe, Cuallau

2015-01-01

ABSTRACT Globally, unmet need for postpartum family planning remains high, while immunization services are among the most wide-reaching and equitable interventions. Given overlapping time frames, integrating these services provides an opportunity to leverage existing health visits to offer women more comprehensive services. From March through November 2012, Liberia's government, with support from the Maternal and Child Health Integrated Program (MCHIP), piloted an integrated family planning and immunization model at 10 health facilities in Bong and Lofa counties. Vaccinators provided mothers bringing infants for routine immunization with targeted family planning and immunization messages and same-day referrals to co-located family planning services. In February 2013, we compared service statistics for family planning and immunization during the pilot against the previous year's statistics. We also conducted in-depth interviews with service providers and other personnel and focus group discussions with clients. Results showed that referral acceptance across the facilities varied from 10% to 45% per month, on average. Over 80% of referral acceptors completed the family planning visit that day, of whom over 90% accepted a contraceptive method that day. The total number of new contraceptive users at participating facilities increased by 73% in Bong and by 90% in Lofa. Women referred from immunization who accepted family planning that day accounted for 44% and 34% of total new contraceptive users in Bong and Lofa, respectively. In Lofa, pilot sites administered 35% more Penta 1 and 21% more Penta 3 doses during the pilot period compared with the same period of the previous year, while Penta 1 and Penta 3 administration decreased in non-pilot facilities. In Bong, there was little difference in the number of Penta 1 and Penta 3 doses administered between pilot and non-pilot facilities. In both counties, Penta 1 to Penta 3 dropout rates increased at pilot sites but not in non-pilot facilities, possibly due to higher than average background dropout rates at pilot sites prior to the intervention in Lofa and the disproportionate effect of data from 1 large facility in Bong. The project provided considerable basic support to assess this proof of concept. However, results suggest that introducing a simple model that is minimally disruptive to existing immunization service delivery can facilitate integration. The model is currently being scaled-up to other counties in Liberia, which could potentially contribute to increased postpartum contraceptive uptake, leading to longer birth intervals and improved health outcomes for children and mothers. PMID:25745121

SPACEHAB missions as pathfinders for ISS services development

NASA Astrophysics Data System (ADS)

Hamill, Doris; Jackson, Kenneth; Mirra, Carlo

2003-01-01

SPACEHAB, Inc. has established a commercial business model for providing access to space. The model, based on private initiative and investment, has offered "turn key" access to space including both launch and integration and operations services. Some features of this business model should be applied directly to providing service in the ISS era: offering packaged service at a fixed price; customer focus; private investment as the basis for offering services; and efficient and continually improving customer service. But International Space Station (ISS) will pose challenges that have not been pioneered in the STS era: a new base of customers must be developed; on-orbit hardware will be more difficult to modify; access to ISS is controlled by government space agencies. These problems will tax the ingenuity of those who wish to provide services in space on a commercial business model.

An integrated Ka/Ku-band payload for personal, mobile and private business communications

NASA Technical Reports Server (NTRS)

Hayes, Edward J.; Keelty, J. Malcolm

1991-01-01

The Canadian Department of Communications has been studying options for a government-sponsored demonstration payload to be launched before the end of the century. A summary of the proposed system concepts and network architectures for providing an advanced private business network service at Ku-band and personal and mobile communications at Ka-band is presented. The system aspects addressed include coverage patterns, traffic capacity, and grade of service, multiple access options as well as special problems, such as Doppler in mobile applications. Earth terminal types and the advanced payload concept proposed in a feasibility study for the demonstration mission are described. This concept is a combined Ka-band/Ku-band payload which incorporates a number of advanced satellite technologies including a group demodulator to convert single-channel-per-carrier frequency division multiple access uplink signals to a time division multiplex downlink, on-board signal regeneration, and baseband switching to support packet switched data operation. The on-board processing capability of the payload provides a hubless VSAT architecture which permits single-hop full mesh interconnectivity. The Ka-band and Ku-band portions of the payload are fully integrated through an on-board switch, thereby providing the capability for fully integrated services, such as using the Ku-band VSAT terminals as gateway stations for the Ka-band personal and mobile communications services.

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

PubMed

Pritchard, A M; Page, D

2008-05-01

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

Ethical challenges in integrating patient-care with clinical research in a resource-limited setting: perspectives from Papua New Guinea

PubMed Central

2013-01-01

Background In resource-limited settings where healthcare services are limited and poverty is common, it is difficult to ethically conduct clinical research without providing patient-care. Therefore, integration of patient-care with clinical research appears as an attractive way of conducting research while providing patient-care. In this article, we discuss the ethical implications of such approach with perspectives from Papua New Guinea. Discussion Considering the difficulties of providing basic healthcare services in developing countries, it may be argued that integration of clinical research with patient-care is an effective, rational and ethical way of conducting research. However, blending patient-care with clinical research may increase the risk of subordinating patient-care in favour of scientific gains; therapeutic misconception and inappropriate inducement; and the risk of causing health system failures due to limited capacity in developing countries to sustain the level of healthcare services sponsored by the research. Nevertheless, these ethical and administrative implications can be minimised if patient-care takes precedence over research; the input of local ethics committees and institutions are considered; and funding agencies acknowledge their ethical obligation when sponsoring research in resource-limited settings. Summary Although integration of patient-care with clinical research in developing countries appears as an attractive way of conducting research when resources are limited, careful planning and consideration on the ethical implications of such approach must be considered. PMID:23885908

Ethical challenges in integrating patient-care with clinical research in a resource-limited setting: perspectives from Papua New Guinea.

PubMed

Laman, Moses; Pomat, William; Siba, Peter; Betuela, Inoni

2013-07-26

In resource-limited settings where healthcare services are limited and poverty is common, it is difficult to ethically conduct clinical research without providing patient-care. Therefore, integration of patient-care with clinical research appears as an attractive way of conducting research while providing patient-care. In this article, we discuss the ethical implications of such approach with perspectives from Papua New Guinea. Considering the difficulties of providing basic healthcare services in developing countries, it may be argued that integration of clinical research with patient-care is an effective, rational and ethical way of conducting research. However, blending patient-care with clinical research may increase the risk of subordinating patient-care in favour of scientific gains; therapeutic misconception and inappropriate inducement; and the risk of causing health system failures due to limited capacity in developing countries to sustain the level of healthcare services sponsored by the research. Nevertheless, these ethical and administrative implications can be minimised if patient-care takes precedence over research; the input of local ethics committees and institutions are considered; and funding agencies acknowledge their ethical obligation when sponsoring research in resource-limited settings. Although integration of patient-care with clinical research in developing countries appears as an attractive way of conducting research when resources are limited, careful planning and consideration on the ethical implications of such approach must be considered.

Optimal service using Matlab - simulink controlled Queuing system at call centers

NASA Astrophysics Data System (ADS)

Balaji, N.; Siva, E. P.; Chandrasekaran, A. D.; Tamilazhagan, V.

2018-04-01

This paper presents graphical integrated model based academic research on telephone call centres. This paper introduces an important feature of impatient customers and abandonments in the queue system. However the modern call centre is a complex socio-technical system. Queuing theory has now become a suitable application in the telecom industry to provide better online services. Through this Matlab-simulink multi queuing structured models provide better solutions in complex situations at call centres. Service performance measures analyzed at optimal level through Simulink queuing model.

Towards a taxonomy for integrated care: a mixed-methods study

PubMed Central

Valentijn, Pim P.; Boesveld, Inge C.; van der Klauw, Denise M.; Ruwaard, Dirk; Struijs, Jeroen N.; Molema, Johanna J.W.; Bruijnzeels, Marc A.; Vrijhoef, Hubertus JM.

2015-01-01

Introduction Building integrated services in a primary care setting is considered an essential important strategy for establishing a high-quality and affordable health care system. The theoretical foundations of such integrated service models are described by the Rainbow Model of Integrated Care, which distinguishes six integration dimensions (clinical, professional, organisational, system, functional and normative integration). The aim of the present study is to refine the Rainbow Model of Integrated Care by developing a taxonomy that specifies the underlying key features of the six dimensions. Methods First, a literature review was conducted to identify features for achieving integrated service delivery. Second, a thematic analysis method was used to develop a taxonomy of key features organised into the dimensions of the Rainbow Model of Integrated Care. Finally, the appropriateness of the key features was tested in a Delphi study among Dutch experts. Results The taxonomy consists of 59 key features distributed across the six integration dimensions of the Rainbow Model of Integrated Care. Key features associated with the clinical, professional, organisational and normative dimensions were considered appropriate by the experts. Key features linked to the functional and system dimensions were considered less appropriate. Discussion This study contributes to the ongoing debate of defining the concept and typology of integrated care. This taxonomy provides a development agenda for establishing an accepted scientific framework of integrated care from an end-user, professional, managerial and policy perspective. PMID:25759607

Towards a taxonomy for integrated care: a mixed-methods study.

PubMed

Valentijn, Pim P; Boesveld, Inge C; van der Klauw, Denise M; Ruwaard, Dirk; Struijs, Jeroen N; Molema, Johanna J W; Bruijnzeels, Marc A; Vrijhoef, Hubertus Jm

2015-01-01

Building integrated services in a primary care setting is considered an essential important strategy for establishing a high-quality and affordable health care system. The theoretical foundations of such integrated service models are described by the Rainbow Model of Integrated Care, which distinguishes six integration dimensions (clinical, professional, organisational, system, functional and normative integration). The aim of the present study is to refine the Rainbow Model of Integrated Care by developing a taxonomy that specifies the underlying key features of the six dimensions. First, a literature review was conducted to identify features for achieving integrated service delivery. Second, a thematic analysis method was used to develop a taxonomy of key features organised into the dimensions of the Rainbow Model of Integrated Care. Finally, the appropriateness of the key features was tested in a Delphi study among Dutch experts. The taxonomy consists of 59 key features distributed across the six integration dimensions of the Rainbow Model of Integrated Care. Key features associated with the clinical, professional, organisational and normative dimensions were considered appropriate by the experts. Key features linked to the functional and system dimensions were considered less appropriate. This study contributes to the ongoing debate of defining the concept and typology of integrated care. This taxonomy provides a development agenda for establishing an accepted scientific framework of integrated care from an end-user, professional, managerial and policy perspective.

Linking private, for-profit providers to public sector services for HIV and tuberculosis co-infected patients: A systematic review.

PubMed

Hudson, Mollie; Rutherford, George W; Weiser, Sheri; Fair, Elizabeth

2018-01-01

Tuberculosis (TB) is the leading cause of infectious disease deaths worldwide and is the leading cause of death among people with HIV. The World Health Organization (WHO) has called for collaboration between public and private healthcare providers to maximize integration of TB/HIV services and minimize costs. We systematically reviewed published models of public-private sector diagnostic and referral services for TB/HIV co-infected patients. We searched PubMed, the Cochrane Central Register of Controlled Trials, Google Scholar, Science Direct, CINAHL and Web of Science. We included studies that discussed programs that linked private and public providers for TB/HIV concurrent diagnostic and referral services and used Review Manager (Version 5.3, 2015) for meta-analysis. We found 1,218 unduplicated potentially relevant articles and abstracts; three met our eligibility criteria. All three described public-private TB/HIV diagnostic/referral services with varying degrees of integration. In Kenya private practitioners were able to test for both TB and HIV and offer state-subsidized TB medication, but they could not provide state-subsidized antiretroviral therapy (ART) to co-infected patients. In India private practitioners not contractually engaged with the public sector offered TB/HIV services inconsistently and on a subjective basis. Those partnered with the state, however, could test for both TB and HIV and offer state-subsidized medications. In Nigeria some private providers had access to both state-subsidized medications and diagnostic tests; others required patients to pay out-of-pocket for testing and/or treatment. In a meta-analysis of the two quantitative reports, TB patients who sought care in the public sector were almost twice as likely to have been tested for HIV than TB patients who sought care in the private sector (risk ratio [RR] 1.98, 95% confidence interval [CI] 1.88-2.08). However, HIV-infected TB patients who sought care in the public sector were marginally less likely to initiate ART than TB patients who sought care from private providers (RR 0.89, 95% CI 0.78-1.03). These three studies are examples of public-private TB/HIV service delivery and can potentially serve as models for integrated TB/HIV care systems. Successful public-private diagnostic and treatment services can both improve outcomes and decrease costs for patients co-infected with HIV and TB.

Barriers and facilitators to the integration of mental health services into primary health care: a systematic review protocol.

PubMed

Wakida, Edith K; Akena, Dickens; Okello, Elialilia S; Kinengyere, Alison; Kamoga, Ronald; Mindra, Arnold; Obua, Celestino; Talib, Zohray M

2017-08-25

Mental health is an integral part of health and well-being and yet health systems have not adequately responded to the burden of mental disorders. Integrating mental health services into primary health care (PHC) is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. PHC was formally adapted by the World Health Organization (WHO), and they have since invested enormous amounts of resources across the globe to ensure that integration of mental health services into PHC works. This review will use the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework approach to identify experiences of mental health integration into PHC; the findings will be reported using the "Best fit" framework synthesis. PubMed, EMBASE, PsycINFO, and Cochrane Central Register of Controlled trials (CENTRAL) will be searched including other sources like the WHO website and OpenGrey database. Assessment of bias and quality will be done at study level using two separate tools to check for the quality of evidence presented. Data synthesis will take on two synergistic approaches (qualitative and quantitative studies). Synthesizing evidence from countries across the globe will provide useful insights into the experiences of integrating mental health services into PHC and how the barriers and challenges have been handled. The findings will be useful to a wide array of stakeholders involved in the implementation of the mental health integration into PHC. The SPIDER framework has been chosen for this review because of its suitable application to qualitative and mixed methods research and will be used as a guide when selecting articles for inclusion. Data extracted will be synthesized using the "Best fit" framework because it has been used before and proved its suitability in producing new conceptual models for explaining decision-making and possible behaviors. Synthesizing evidence from countries across the globe will provide useful insights into the experiences of integrating mental health services into PHC and how the barriers and challenges have been handled. PROSPERO CRD42016052000.

A New Method for Conceptual Modelling of Information Systems

NASA Astrophysics Data System (ADS)

Gustas, Remigijus; Gustiene, Prima

Service architecture is not necessarily bound to the technical aspects of information system development. It can be defined by using conceptual models that are independent of any implementation technology. Unfortunately, the conventional information system analysis and design methods cover just a part of required modelling notations for engineering of service architectures. They do not provide effective support to maintain semantic integrity between business processes and data. Service orientation is a paradigm that can be applied for conceptual modelling of information systems. The concept of service is rather well understood in different domains. It can be applied equally well for conceptualization of organizational and technical information system components. This chapter concentrates on analysis of the differences between service-oriented modelling and object-oriented modelling. Service-oriented method is used for semantic integration of information system static and dynamic aspects.

Logical optical line terminal technologies towards flexible and highly reliable metro- and access-integrated networks

NASA Astrophysics Data System (ADS)

Okamoto, Satoru; Sato, Takehiro; Yamanaka, Naoaki

2017-01-01

In this paper, flexible and highly reliable metro and access integrated networks with network virtualization and software defined networking technologies will be presented. Logical optical line terminal (L-OLT) technologies and active optical distribution networks (ODNs) are the key to introduce flexibility and high reliability into the metro and access integrated networks. In the Elastic Lambda Aggregation Network (EλAN) project which was started in 2012, a concept of the programmable optical line terminal (P-OLT) has been proposed. A role of the P-OLT is providing multiple network services that have different protocols and quality of service requirements by single OLT box. Accommodated services will be Internet access, mobile front-haul/back-haul, data-center access, and leased line. L-OLTs are configured within the P-OLT box to support the functions required for each network service. Multiple P-OLTs and programmable optical network units (P-ONUs) are connected by the active ODN. Optical access paths which have flexible capacity are set on the ODN to provide network services from L-OLT to logical ONUs (L-ONUs). The L-OLT to L-ONU path on the active ODN provides a logical connection. Therefore, introducing virtualization technologies becomes possible. One example is moving an L-OLT from one P-OLT to another P-OLT like a virtual machine. This movement is called L-OLT migration. The L-OLT migration provides flexible and reliable network functions such as energy saving by aggregating L-OLTs to a limited number of P-OLTs, and network wide optical access path restoration. Other L-OLT virtualization technologies and experimental results will be also discussed in the paper.

The right location? Experiences of refugee adolescents seen by school-based mental health services.

PubMed

Fazel, Mina; Garcia, Jo; Stein, Alan

2016-07-01

Access to needed mental health services can be particularly difficult for newly arrived refugee and asylum-seeking adolescents, although many attend school. This study examined young refugees' impressions and experience of mental health services integrated within the school system. Semi-structured interviews were conducted with 40 adolescent refugees discharged by three school-based mental health services across the United Kingdom. Two-thirds preferred to be seen at school. Rumination and worry about insecurity in the asylum process had a negative impact particularly on the adolescents' social functioning and ability to focus at school. The important role played by teachers in supporting and mediating contact with mental health services was valued by those interviewed. The study confirms that schools offer an important location for mental health services for adolescent refugees and provide an important portal for integration of services. © The Author(s) 2016.

Service Integration in Oregon: Successful Local Efforts Influence Major State Reorganization.

ERIC Educational Resources Information Center

Ragan, Mark

In a number of human service offices in Oregon's Jackson and Coos Counties, workers from multiple programs work together in shared offices to provide families with ready access to a wide range of benefits and services. Other factors besides co-location that have proved critical to these programs' success are as follows: shared intake and…

Asset-building, financial self-management service model: piecing together consumer financial independence.

PubMed

Swarbrick, Margaret

2006-10-01

This program represents an innovative approach to traditional money-management services. This asset-building, financial self-management service model has the potential to positively affect recovery, self-sufficiency, and community integration for people with mental illnesses. It is hoped this program will be replicated by other providers in a way that may effect systems change.

Helping Families Shine: Evaluation of the Family and Community Partnership, Palm Beach County, Florida. Final Report

ERIC Educational Resources Information Center

Lyons, Sandra; Winje, Carolyn

2007-01-01

Collaboration and coordination among providers of social and health services have long been prescribed for remedying fragmented service systems and achieving integrated services. Yet ambitious efforts to achieve these goals have often been disappointing. This three-year study examined the Family and Community Partnership (FCP) in Palm Beach…

Learning By Serving: 2,000 Ideas for Service-Learning Projects. Hot Topics: Usable Research.

ERIC Educational Resources Information Center

Follman, Joseph; And Others

Defining service learning as the formal integration of public service into student instruction and learning, this guide provides teachers with ideas for narrowing the gap between what students do in school and what they will do after they leave school. The example activities, derived from actual projects, demonstrate the nearly limitless range of…

Flexibility in community pharmacy: a qualitative study of business models and cognitive services.

PubMed

Feletto, Eleonora; Wilson, Laura K; Roberts, Alison S; Benrimoj, Shalom I

2010-04-01

To identify the capacity of current pharmacy business models, and the dimensions of organisational flexibility within them, to integrate products and services as well as the perceptions of viability of these models. Fifty-seven semi-structured interviews were conducted with community pharmacy owners or managers and support staff in 30 pharmacies across Australia. A framework of organisational flexibility was used to analyse their capacity to integrate services and perceptions of viability. Data were analysed using the method of constant comparison by two independent researchers. The study found that Australian community pharmacies have used the four types of flexibility to build capacity in distinct ways and react to changes in the local environment. This capacity building was manifested in four emerging business models which integrate services to varying degrees: classic community pharmacy, retail destination pharmacy, health care solution pharmacy and networked pharmacy. The perception of viability is less focused on dispensing medications and more focused on differentiating pharmacies through either a retail or services focus. Strategic flexibility appeared to offer pharmacies the ability to integrate and sustainably deliver services more successfully than other types, as exhibited by health care solution and networked pharmacies. Active support and encouragement to transition from being dependent on dispensing to implementing services is needed. The study showed that pharmacies where services were implemented and showed success are those strategically differentiating their businesses to become focused health care providers. This holistic approach should inevitably influence the sustainability of services.

[Integrated delivery systems and other examples of collaboration among providers. SESPAS report, 2012].

PubMed

Vázquez, M Luisa; Vargas, Ingrid; Nuño, Roberto; Toro, Nuria

2012-03-01

Because of the steady increase in healthcare complexity, due to high specialization and the involvement of a number of services, as well as the increase in patients with chronic diseases and pluripathology, coordination has become a high-priority need in healthcare systems. The distinct regional services that comprise the decentralized Spanish National Health System have developed a number of experiences to improve collaboration among the providers involved in the healthcare process. The present article aims to analyze the experiences with integrated healthcare providers in Catalonia and the Basque Country and the chronic diseases programs of the latter. In Catalonia, which promoted the purchaser-provider split and maintained diversity in providers' ownership, organizations were slowly created that manage the provision of the healthcare continuum, known as integrated healthcare organizations (IHO). These organizations have evolved and, despite some common characteristics, they also show some differences, such as the emphasis on formal instruments or on coordination mechanisms and organic structures. This is also reflected in their results regarding culture and perceived coordination across the organization. In the Basque Country, in addition to the establishment of an IHO, a variety of integration experiences have been developed to improve the care of chronic diseases. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

Better and more efficient care through ICT-enabled integration of social care and healthcare services: experiences from two European projects

PubMed Central

Müller, Sonja; Meyer, Ingo; Kubitschke, Lutz; Delaney, Sarah

2012-01-01

Unsynchronised social and health care service delivery leads to inefficiencies, duplication of resources and reduced levels of quality of care. Older people are particularly affected by this situation. They often need both types of services, such as support with daily living activities and chronic disease management. ICT has the potential to support integrated service delivery to achieve high quality independent living and wellbeing for older people across Europe and elsewhere. Against this background, the presentation will demonstrate experiences and results derived from the development and piloting of ICT-supported integrated care services in eight sites across Europe, namely Dublin, Hull, Milton Keynes, Malaga, Veldhoven, Geldrop, Eindhoven and Bielefeld. Through innovative usage of ICT, current ‘silos’ in service delivery are broken up to allow for cooperation across relevant care sectors and participation of family members. The integrated services are to support the effective management of chronic diseases, and to address issues which affect independence, such as reduced agility, vision or hearing, in order to significantly improve the quality of life for older people and their carers. A dedicated programme of service process innovation complemented by adaptation of technology is being pursued in order to develop an integrated digital support infrastructure and related services: using appropriate existing technology to provide as many older people as possible with digital access to support services they needaugmenting and opening sectoral care platforms to enable coordinated cross-sector support deliveryadopting a clearly demand-driven inclusive approach and avoiding a technology ‘push’. Wider deployment of the services is supported by a dedicated programme of socio-economic service evaluation. The evaluation framework utilises a multi-method and multi-perspective approach, involving end users, family carers, service provider staff and key informants at corporate level. Triangulation is used to cross-reference data from different sources in order to maximize the reliability and robustness of conclusions drawn from the evaluation. Based on an overall framework taking into account themes such as integration, user outcomes, staff impact, organisational impact, technology, implementation and overall satisfaction, the specifics of each site are taken into account in operationally applying the overall framework in each case. The designs to be employed at each site have been developed to be as robust as possible, taking into account the constraints of the realities of the interventions. The evaluation is accompanied by a business case modelling approach that builds largely on a cost-benefit analysis covering the service development and implementation activities as well as the pilots and modelling the further deployment of services in each of the pilot sites. The presentation builds upon experiences gained within the framework of two European projects, CommonWell and INDEPENDENT. They are both co-funded under the EU’s Competitiveness and Innovation Framework Programme (CIP) focus on better joining-up of formal social/healthcare services and strengthening participation of the so-called ‘third sector’.

42 CFR 455.16 - Resolution of full investigation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 455.16 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Agency Fraud Detection and... further action; (2) Suspending or terminating the provider from participation in the Medicaid program; (3...

Integrating Sustainability as a Learning Tool

ERIC Educational Resources Information Center

Shiver, Steven M.; Dale, John R.

2011-01-01

Implementation of user interfaces designed to explain sustainable practices and provide opportunities for integration into curriculum include the new Renton Secondary Learning Center near Seattle, Washington. The Renton Secondary Learning Center (RSLC) builds upon a "Continuum of Services" to expand offerings and opportunities for…

Performance of National Maps of Watershed Integrity at Watershed Scales

EPA Science Inventory

Watershed integrity, the capacity of a watershed to support and maintain ecological processes essential to the sustainability of services provided to society, can be influenced by a range of landscape and in-stream factors. Ecological response data from four intensively monitored...

Phoenix: SOA based information management services

NASA Astrophysics Data System (ADS)

Grant, Rob; Combs, Vaughn; Hanna, Jim; Lipa, Brian; Reilly, Jim

2009-05-01

The Air Force Research Laboratory (AFRL) has developed a reference set of Information Management (IM) Services that will provide an essential piece of the envisioned final Net-Centric IM solution for the Department of Defense (DoD). These IM Services will provide mission critical functionality to enable seamless interoperability between existing and future DoD systems and services while maintaining a highly available IM capability across the wide spectrum of differing scalability and performance requirements. AFRL designed this set of IM Services for integration with other DoD and commercial SOA environments. The services developed will provide capabilities for information submission, information brokering and discovery, repository, query, type management, dissemination, session management, authorization, service brokering and event notification. In addition, the IM services support common information models that facilitate the management and dissemination of information consistent with client needs and established policy. The services support flexible and extensible definitions of session, service, and channel contexts that enable the application of Quality of Service (QoS) and security policies at many levels within the SOA.

Does Integrated Behavioral Health Care Reduce Mental Health Disparities for Latinos? Initial Findings

PubMed Central

Bridges, Ana J.; Andrews, Arthur R.; Villalobos, Bianca T.; Pastrana, Freddie A.; Cavell, Timothy A.; Gomez, Debbie

2014-01-01

Integrated behavioral health care (IBHC) is a model of mental health care service delivery that seeks to reduce stigma and service utilization barriers by embedding mental health professionals into the primary care team. This study explored whether IBHC service referrals, utilization, and outcomes were comparable for Latinos and non-Latino White primary care patients. Data for the current study were collected from 793 consecutive patients (63.8% Latino; M age = 29.02 years [SD = 17.96]; 35.1% under 18 years; 65.3% women; 54.3% uninsured) seen for behavioral health services in 2 primary care clinics during a 10.5 month period. The most common presenting concerns were depression (21.6%), anxiety (18.5%), adjustment disorder (13.0%), and externalizing behavior problems (9.8%). Results revealed that while Latino patients had significantly lower self-reported psychiatric distress, significantly higher clinician-assigned global assessment of functioning scores, and fewer received a psychiatric diagnosis at their initial visit compared to non-Latino White patients, both groups had comparable utilization rates, comparable and clinically significant improvements in symptoms (Cohen’s d values > .50), and expressed high satisfaction with integrated behavioral services. These data provide preliminary evidence suggesting integration of behavioral health services into primary care clinics may help reduce mental health disparities for Latinos. PMID:25309845

Performance evaluation of multi-stratum resources integrated resilience for software defined inter-data center interconnect.

PubMed

Yang, Hui; Zhang, Jie; Zhao, Yongli; Ji, Yuefeng; Wu, Jialin; Lin, Yi; Han, Jianrui; Lee, Young

2015-05-18

Inter-data center interconnect with IP over elastic optical network (EON) is a promising scenario to meet the high burstiness and high-bandwidth requirements of data center services. In our previous work, we implemented multi-stratum resources integration among IP networks, optical networks and application stratums resources that allows to accommodate data center services. In view of this, this study extends to consider the service resilience in case of edge optical node failure. We propose a novel multi-stratum resources integrated resilience (MSRIR) architecture for the services in software defined inter-data center interconnect based on IP over EON. A global resources integrated resilience (GRIR) algorithm is introduced based on the proposed architecture. The MSRIR can enable cross stratum optimization and provide resilience using the multiple stratums resources, and enhance the data center service resilience responsiveness to the dynamic end-to-end service demands. The overall feasibility and efficiency of the proposed architecture is experimentally verified on the control plane of our OpenFlow-based enhanced SDN (eSDN) testbed. The performance of GRIR algorithm under heavy traffic load scenario is also quantitatively evaluated based on MSRIR architecture in terms of path blocking probability, resilience latency and resource utilization, compared with other resilience algorithms.

A clinical database management system for improved integration of the Veterans Affairs Hospital Information System.

PubMed

Andrews, R D; Beauchamp, C

1989-12-01

The Department of Veterans Affairs (VA) Decentralized Hospital Computer Program (DHCP) contains data modules derived from separate ancillary services (e.g., Lab, Pharmacy and Radiology). It is currently difficult to integrate information between the modules. A prototype is being developed aimed at integrating ancillary data by storing clinical data oriented to the patient so that there is easy interaction of data from multiple services. A set of program utilities provides for user-defined functions of decision support, queries, and reports. Information can be used to monitor quality of care by providing feedback in the form of reports, and reminders. Initial testing has indicated the prototype's design and implementation are feasible (in terms of space requirements, speed, and ease of use) in outpatient and inpatient settings. The design, development, and clinical use of this prototype are described.

EpiAssist: Service-learning in public health education.

PubMed

Horney, Jennifer A; Bamrara, Sanjana; Macik, Maria Lazo; Shehane, Melissa

2016-01-01

Although public health degree programs typically require practica and other field experiences, service-learning courses, with a focus on civic engagement and the application of classroom learning in real world settings, can go beyond these requirements and provide benefits to students and community-based practice partners. The goal of this paper is to assess potential benefits of service-learning programs for both graduate-level public health students and state and local public health agency partners. EpiAssist is a new service-learning program developed at the School of Public Health of the Texas A and M University Health Science Center, USA, in January 2015. EpiAssist was integrated into a new course, Methods in Field Epidemiology. The integration of service-learning was guided by a partnership with the Texas A and M Center for Teaching Excellence. State, regional, and local public health partners requested EpiAssist via email or telephone. A listserv was used to recruit student volunteers to meet requests. 54 of 86 registered EpiAssist students (63%) participated in at least one of ten service-learning and three training activities between January and June, 2015. Service-learning activities included questionnaire development, in-person and telephone data collection, and data analysis. Training topics for students included the Epi Info™ software, community assessment and communicable disease reporting. Students and partner organizations provided generally positive assessments of this service learning program through an online evaluation. Service-learning provides students with enhanced classroom learning through applied public health experience in state, regional and local health departments. These experiences provide both needed surge capacity to public health departments and valuable hands-on field experience to students.

The rare and undiagnosed diseases diagnostic service - application of massively parallel sequencing in a state-wide clinical service.

PubMed

Baynam, Gareth; Pachter, Nicholas; McKenzie, Fiona; Townshend, Sharon; Slee, Jennie; Kiraly-Borri, Cathy; Vasudevan, Anand; Hawkins, Anne; Broley, Stephanie; Schofield, Lyn; Verhoef, Hedwig; Walker, Caroline E; Molster, Caron; Blackwell, Jenefer M; Jamieson, Sarra; Tang, Dave; Lassmann, Timo; Mina, Kym; Beilby, John; Davis, Mark; Laing, Nigel; Murphy, Lesley; Weeramanthri, Tarun; Dawkins, Hugh; Goldblatt, Jack

2016-06-11

The Rare and Undiagnosed Diseases Diagnostic Service (RUDDS) refers to a genomic diagnostic platform operating within the Western Australian Government clinical services delivered through Genetic Services of Western Australia (GSWA). GSWA has provided a state-wide service for clinical genetic care for 28 years and it serves a population of 2.5 million people across a geographical area of 2.5milion Km(2). Within this context, GSWA has established a clinically integrated genomic diagnostic platform in partnership with other public health system managers and service providers, including but not limited to the Office of Population Health Genomics, Diagnostic Genomics (PathWest Laboratories) and with executive level support from the Department of Health. Herein we describe report presents the components of this service that are most relevant to the heterogeneity of paediatric clinical genetic care. Briefly the platform : i) offers multiple options including non-genetic testing; monogenic and genomic (targeted in silico filtered and whole exome) analysis; and matchmaking; ii) is delivered in a patient-centric manner that is resonant with the patient journey, it has multiple points for entry, exit and re-entry to allow people access to information they can use, when they want to receive it; iii) is synchronous with precision phenotyping methods; iv) captures new knowledge, including multiple expert review; v) is integrated with current translational genomic research activities and best practice; and vi) is designed for flexibility for interactive generation of, and integration with, clinical research for diagnostics, community engagement, policy and models of care. The RUDDS has been established as part of routine clinical genetic services and is thus sustainable, equitably managed and seeks to translate new knowledge into efficient diagnostics and improved health for the whole community.

Is health systems integration being advanced through Local Health District planning?

PubMed

Saunders, Carla; Carter, David J

2017-05-01

Objective Delivering genuine integrated health care is one of three strategic directions in the New South Wales (NSW) Government State Health Plan: Towards 2021. This study investigated the current key health service plan of each NSW Local Health District (LHD) to evaluate the extent and nature of health systems integration strategies that are currently planned. Methods A scoping review was conducted to identify common key principles and practices for successful health systems integration to enable the development of an appraisal tool to content assess LHD strategic health service plans. Results The strategies that are planned for health systems integration across LHDs focus most often on improvements in coordination, health care access and care delivery for complex at-risk patients across the care continuum by both state- and commonwealth-funded systems, providers and agencies. The most common reasons given for integrated activities were to reduce avoidable hospitalisation, avoid inappropriate emergency department attendance and improve patient care. Conclusions Despite the importance of health systems integration and finding that all NSW LHDs have made some commitment towards integration in their current strategic health plans, this analysis suggests that health systems integration is in relatively early development across NSW. What is known about the topic? Effective approaches to managing complex chronic diseases have been found to involve health systems integration, which necessitates sound communication and connection between healthcare providers across community and hospital settings. Planning based on current health systems integration knowledge to ensure the efficient use of scarce resources is a responsibility of all health systems. What does this paper add? Appropriate planning and implementation of health systems integration is becoming an increasingly important expectation and requirement of effective health systems. The present study is the first of its kind to assess the planned activity in health systems integration in the NSW public health system. NSW health districts play a central role in health systems integration; each health service plan outlines the strategic directions for the development and delivery of all state-funded services across each district for the coming years, equating to hundreds of millions of dollars in health sector funding. The inclusion of effective health systems integration strategies allows Local Health Districts to lay the foundation for quality patient outcomes and long-term financial sustainability despite projected increases in demand for health services. What are the implications for practice? Establishing robust ongoing mechanisms for effective health systems integration is now a necessary part of health planning. The present study identifies several key areas and strategies that are wide in scope and indicative of efforts towards health systems integration, which may support Local Health Districts and other organisations in systematic planning and implementation.

The Satellite Data Thematic Core Service within the EPOS Research Infrastructure

NASA Astrophysics Data System (ADS)

Manunta, Michele; Casu, Francesco; Zinno, Ivana; De Luca, Claudio; Buonanno, Sabatino; Zeni, Giovanni; Wright, Tim; Hooper, Andy; Diament, Michel; Ostanciaux, Emilie; Mandea, Mioara; Walter, Thomas; Maccaferri, Francesco; Fernandez, Josè; Stramondo, Salvatore; Bignami, Christian; Bally, Philippe; Pinto, Salvatore; Marin, Alessandro; Cuomo, Antonio

2017-04-01

EPOS, the European Plate Observing System, is a long-term plan to facilitate the integrated use of data, data products, software and services, available from distributed Research Infrastructures (RI), for solid Earth science in Europe. Indeed, EPOS integrates a large number of existing European RIs belonging to several fields of the Earth science, from seismology to geodesy, near fault and volcanic observatories as well as anthropogenic hazards. The EPOS vision is that the integration of the existing national and trans-national research infrastructures will increase access and use of the multidisciplinary data recorded by the solid Earth monitoring networks, acquired in laboratory experiments and/or produced by computational simulations. The establishment of EPOS will foster the interoperability of products and services in the Earth science field to a worldwide community of users. Accordingly, the EPOS aim is to integrate the diverse and advanced European Research Infrastructures for solid Earth science, and build on new e-science opportunities to monitor and understand the dynamic and complex solid-Earth System. One of the EPOS Thematic Core Services (TCS), referred to as Satellite Data, aims at developing, implementing and deploying advanced satellite data products and services, mainly based on Copernicus data (namely Sentinel acquisitions), for the Earth science community. This work intends to present the technological enhancements, fostered by EPOS, to deploy effective satellite services in a harmonized and integrated way. In particular, the Satellite Data TCS will deploy five services, EPOSAR, GDM, COMET, 3D-Def and MOD, which are mainly based on the exploitation of SAR data acquired by the Sentinel-1 constellation and designed to provide information on Earth surface displacements. In particular, the planned services will provide both advanced DInSAR products (deformation maps, velocity maps, deformation time series) and value-added measurements (source model, 3D displacement maps, seismic hazard maps). Moreover, the services will release both on-demand and systematic products. The latter will be generated and made available to the users on a continuous basis, by processing each Sentinel-1 data once acquired, over a defined number of areas of interest; while the former will allow users to select data, areas, and time period to carry out their own analyses via an on-line platform. The satellite components will be integrated within the EPOS infrastructure through a common and harmonized interface that will allow users to search, process and share remote sensing images and results. This gateway to the satellite services will be represented by the ESA- Geohazards Exploitation Platform (GEP), a new cloud-based platform for the satellite Earth Observations designed to support the scientific community in the understanding of high impact natural disasters. Satellite Data TCS will use GEP as the common interface toward the main EPOS portal to provide EPOS users not only with data products but also with relevant processing and visualisation software, thus allowing users to gather and process on a cloud-computing infrastructure large datasets without any need to download them locally.

Peer Workers in the Behavioral and Integrated Health Workforce: Opportunities and Future Directions.

PubMed

Gagne, Cheryl A; Finch, Wanda L; Myrick, Keris J; Davis, Livia M

2018-06-01

The growth of the peer workforce in behavioral health services is bringing opportunities to organizations and institutions that serve people living with mental and substance use disorders and their families. Peer workers are defined as people in recovery from mental illness or substance use disorders or both that possess specific peer support competencies. Similar roles are identified for families of people in recovery. Peer support has been implemented in a vast range of behavioral health services, including in the relatively new use of peer support in criminal justice and emergency service environments. Behavioral health services are striving to integrate peer workers into their workforce to augment existing service delivery, in part because peer support has demonstrated effectiveness in helping people with behavioral health conditions to connect to, engage in, and be active participants in treatment and recovery support services across all levels of care. This article describes the experiences that organizations and their workforce, including peer workers, encounter as they integrate peer support services into the array of behavioral health services. Specific attention is given to the similarities and differences of services provided by peers in mental health settings and substance use settings, and implications for future directions. The article also addresses the role of peer workers in integrated behavioral and physical healthcare services. This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services. Copyright © 2018 American Journal of Preventive Medicine. All rights reserved.

Network architecture in a converged optical + IP network

NASA Astrophysics Data System (ADS)

Wakim, Walid; Zottmann, Harald

2012-01-01

As demands on Provider Networks continue to grow at exponential rates, providers are forced to evaluate how to continue to grow the network while increasing service velocity, enhancing resiliency while decreasing the total cost of ownership (TCO). The bandwidth growth that networks are experiencing is in the form packet based multimedia services such as video, video conferencing, gaming, etc... mixed with Over the Top (OTT) content providers such as Netflix, and the customer's expectations that best effort is not enough you end up with a situation that forces the provider to analyze how to gain more out of the network with less cost. In this paper we will discuss changes in the network that are driving us to a tighter integration between packet and optical layers and how to improve on today's multi - layer inefficiencies to drive down network TCO and provide for a fully integrated and dynamic network that will decrease time to revenue.

Evaluating the Economic Impact of Smart Care Platforms: Qualitative and Quantitative Results of a Case Study

PubMed Central

Van der Auwermeulen, Thomas; Van Ooteghem, Jan; Jacobs, An; Verbrugge, Sofie; Colle, Didier

2016-01-01

Background In response to the increasing pressure of the societal challenge because of a graying society, a gulf of new Information and Communication Technology (ICT) supported care services (eCare) can now be noticed. Their common goal is to increase the quality of care while decreasing its costs. Smart Care Platforms (SCPs), installed in the homes of care-dependent people, foster the interoperability of these services and offer a set of eCare services that are complementary on one platform. These eCare services could not only result in more quality care for care receivers, but they also offer opportunities to care providers to optimize their processes. Objective The objective of the study was to identify and describe the expected added values and impacts of integrating SCPs in current home care delivery processes for all actors. In addition, the potential economic impact of SCP deployment is quantified from the perspective of home care organizations. Methods Semistructured and informal interviews and focus groups and cocreation workshops with service providers, managers of home care organizations, and formal and informal care providers led to the identification of added values of SCP integration. In a second step, process breakdown analyses of home care provisioning allowed defining the operational impact for home care organization. Impacts on 2 different process steps of providing home care were quantified. After modeling the investment, an economic evaluation compared the business as usual (BAU) scenario versus the integrated SCP scenario. Results The added value of SCP integration for all actors involved in home care was identified. Most impacts were qualitative such as increase in peace of mind, better quality of care, strengthened involvement in care provisioning, and more transparent care communication. For home care organizations, integrating SCPs could lead to a decrease of 38% of the current annual expenses for two administrative process steps namely, care rescheduling and the billing for care provisioning. Conclusions Although integrating SCP in home care processes could affect both the quality of life of the care receiver and informal care giver, only scarce and weak evidence was found that supports this assumption. In contrast, there exists evidence that indicates the lack of the impact on quality of life of the care receiver while it increases the cost of care provisioning. However, our cost-benefit quantification model shows that integrating SCPs in home care provisioning could lead to a considerable decrease of costs for care administrative tasks. Because of this cost decreasing impact, we believe that the integration of SCPs will be driven by home care organizations instead of the care receivers themselves. PMID:27799137

Evaluating the Economic Impact of Smart Care Platforms: Qualitative and Quantitative Results of a Case Study.

PubMed

Vannieuwenborg, Frederic; Van der Auwermeulen, Thomas; Van Ooteghem, Jan; Jacobs, An; Verbrugge, Sofie; Colle, Didier

2016-10-31

In response to the increasing pressure of the societal challenge because of a graying society, a gulf of new Information and Communication Technology (ICT) supported care services (eCare) can now be noticed. Their common goal is to increase the quality of care while decreasing its costs. Smart Care Platforms (SCPs), installed in the homes of care-dependent people, foster the interoperability of these services and offer a set of eCare services that are complementary on one platform. These eCare services could not only result in more quality care for care receivers, but they also offer opportunities to care providers to optimize their processes. The objective of the study was to identify and describe the expected added values and impacts of integrating SCPs in current home care delivery processes for all actors. In addition, the potential economic impact of SCP deployment is quantified from the perspective of home care organizations. Semistructured and informal interviews and focus groups and cocreation workshops with service providers, managers of home care organizations, and formal and informal care providers led to the identification of added values of SCP integration. In a second step, process breakdown analyses of home care provisioning allowed defining the operational impact for home care organization. Impacts on 2 different process steps of providing home care were quantified. After modeling the investment, an economic evaluation compared the business as usual (BAU) scenario versus the integrated SCP scenario. The added value of SCP integration for all actors involved in home care was identified. Most impacts were qualitative such as increase in peace of mind, better quality of care, strengthened involvement in care provisioning, and more transparent care communication. For home care organizations, integrating SCPs could lead to a decrease of 38% of the current annual expenses for two administrative process steps namely, care rescheduling and the billing for care provisioning. Although integrating SCP in home care processes could affect both the quality of life of the care receiver and informal care giver, only scarce and weak evidence was found that supports this assumption. In contrast, there exists evidence that indicates the lack of the impact on quality of life of the care receiver while it increases the cost of care provisioning. However, our cost-benefit quantification model shows that integrating SCPs in home care provisioning could lead to a considerable decrease of costs for care administrative tasks. Because of this cost decreasing impact, we believe that the integration of SCPs will be driven by home care organizations instead of the care receivers themselves. ©Frederic Vannieuwenborg, Thomas Van der Auwermeulen, Jan Van Ooteghem, An Jacobs, Sofie Verbrugge, Didier Colle. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 31.10.2016.

The impact of pharmacy services on opioid prescribing in dental practice.

PubMed

Stewart, Autumn; Zborovancik, Kelsey J; Stiely, Kara L

To compare rates of dental opioid prescribing between periods of full and partial integration of pharmacy services and periods of no integration. This observational study used a retrospective chart review of opioid prescriptions written by dental providers practicing in a free dental clinic for the medically underserved over a period of 74 months. Pharmacy services were fully integrated into the practice model for 48 of the 74 months under study. During this time frame, all dental opioid orders required review by the pharmacy department before prescribing. Outcomes related to prescribing rates and errors were compared between groups, which were defined by the level of integrated pharmacy services. Demographic and prescription-specific data (drug name, dose, quantity, directions, professional designation of individual entering order) and clinic appointment data were collected and analyzed with the use of descriptive and inferential statistics. A total of 102 opioids were prescribed to 89 patients; hydrocodone-acetaminophen combination products were the most frequently used. Opioid prescribing rates were 5 times greater when pharmacy services were not integrated (P <0.001); and dentists were 81% less likely to prescribe opioids when pharmacy was fully integrated (odds ratio 0.19, 95% confidence interval 0.124-0.293; P <0.001). Frequency of hydrocodone use compared with other opioids did not decrease after the rescheduling of hydrocodone to a Schedule II controlled substance. The frequency of prescribing errors was not statistically different between groups, although there were numerically fewer errors with integrated pharmacy services. The literature reports that dentists are the third most frequent prescribers of opioids. The findings from this study suggest that collaboration between pharmacists and dentists has the potential to decrease opioid utilization in primary dental practice. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Sex education and family planning services for young adults: alternative urban strategies in Mexico.

PubMed

Townsend, J W; Diaz de May, E; Sepúlveda, Y; Santos de Garza, Y; Rosenhouse, S

1987-01-01

In Mexico, youth face difficulties in obtaining reliable information on sex education and family planning through existing community programs. Two alternative strategies to provide these services are being tested in poor urban areas of Monterrey. In one experimental area, Integrated Youth Centers were established, which provide sex education and family planning services as well as counseling, academic tutoring, and recreational activities. In another area, trained young adults and community counselors work through informal networks to provide sex education and family planning information. Both utilization and the cost of these services are examined in the context of plans for expanding coverage in Mexico-U.S. border areas.

Analysis of Human Resources and Services Administration-funded services for HIV-positive substance users: a study of Ryan White CARE Act Title III, Title IV, and Special Projects of National Significance providers.

PubMed

Tobias, Carol; Drainoni, Mari-Lynn; Wood, Starr

2004-10-01

In this study, 175 organizations providing health care and/or social services to HIV-positive substance users responded to a questionnaire to: (1) investigate how programs were configured to serve consumer needs and (2) identify potential innovative strategies to be explored in greater depth in a subsequent study. The results demonstrated wide variability in types of services provided, racial and ethnic diversity, methods of addressing cultural and linguistic needs, accessibility provisions, strategies for engagement and retention, strategies for coordination and integrations of care, most difficult barriers to care, and funding sources.

Design Research of TIANDITU (Map Worl)-Based Geographic Information System for Travelling Service

NASA Astrophysics Data System (ADS)

Zhang, J.; Zhang, H.; Wang, C.

2014-04-01

TIANDITU (Map World) is the public version of the National Platform for Common Geospatial Information Service, and the travelling channel is TIANDITU-based geographic information platform for travelling service. With the development of tourism, traditional ways for providing travelling information cannot meet the needs of travelers. As such, the travelling channel of TIANDITU focuses on providing travel information abundantly and precisely, which integrated the geographic information data of TIANDITU Version 2.0 and the authoritative information resources from China National Tourism Administration. Furthermore, spatial positioning, category and information query of various travelling information were offered for the public in the travelling channel. This research mainly involves three important parts: the system design, key technologies of the system design and application examples. Firstly, this paper introduced the design of TIANDITU-based geographic information system for travelling service, and the general and database design were described in detail. The designs for general, database and travelling service above should consider lots of factors which illustrated in the paper in order to guarantee the efficient service. The process of system construction, the content of geographic information for travelling and system functions of geographic information for travelling are also proposed via diagram in this part. Then several key technologies were discussed, including the travelling information integration for main node and among nodes, general architecture design and management system for travelling channel, web portals and system interface. From the perspective of main technologies, this part describes how TIANDITU travelling channel can realize various functions and reach the requirements from different users. Finally, three application examples about travelling information query were listed shortly. The functions and search results are shown clearly in this part. In all, TIANDITU-based geographic information system for travelling service aimed to integrate the travelling information resources from national, provincial and municipal levels, and finally realized to provide "one stop" travelling service for users in the end.

Making the case for a fracture liaison service: a qualitative study of the experiences of clinicians and service managers.

PubMed

Drew, Sarah; Gooberman-Hill, Rachael; Farmer, Andrew; Graham, Laura; Javaid, M Kassim; Cooper, Cyrus; Judge, Andrew

2015-10-01

To develop services, healthcare professionals must make business cases to managerial bodies within Hospital Trusts and if approved, to commissioning bodies. Patients with hip fracture are at high risk of subsequent fracture. To prevent this, guidance recommends structuring fracture prevention services around coordinator based models. These are known as Fracture Liaison Services (FLS). 33 semi-structured qualitative interviews were conducted with healthcare professionals with experience of making business cases for FLS. Data was analysed thematically. Challenges in the development of business cases included collecting all the relevant data and negotiating compartmentalised budgets that impeded service development. Participants described communication and cooperation between providers and commissioners as variable. They felt financial considerations were the most important factor in funding decisions, while improved quality of care was less influential. Other factors included national guidelines and political priorities. The personalities of clinicians championing services, and the clinical interests of commissioners were seen to influence the decision-making process, suggesting that participants felt that decisions were not always made on the basis of evidence-based care. Effective strategies included ways of providing support, demonstrating potential cost effectiveness and improved quality of care. Using a range of sources including audit data collected on the successful Glasgow FLS, and improving cooperation between stakeholders was advocated. Participants felt that the work of commissioners and providers should be better integrated and suggested strategies for doing this. This study provides information to healthcare professionals about how best to develop business cases for FLS. We conclude with recommendations on how to develop effective cases. These include using guidance such as toolkits, aligning the aims of FLS with national priorities and benchmarking services against comparators. Introducing a 'Local Champion' to work alongside the service manager and establishing a multi-disciplinary working team would facilitate communication between stakeholders. Involving commissioners in service design would help integrate the roles of purchasers and providers.

The National Blood Service. Supporting better blood transfusion.

PubMed

Gerrard, Rebecca

2004-05-01

The National Blood Service (NBS) is an integral part of the National Health Service that provides blood, blood components, blood products and tissues from fifteen blood centres to England and North Wales. Each year, the NBS collects tests, processes, stores and issues approximately 2.3 million blood donations. The service also undertakes research into blood safety, provides clinical advice to hospital staff and supports hospital transfusion practitioners. Rebecca Gerrard describes some of the initiatives to improve blood transfusion practices, including monitoring of the serious hazards of transfusion, bench marking schemes and the roles of blood transfusion liaison (BTL) nurses.

Stormwater management and ecosystem services: a review

NASA Astrophysics Data System (ADS)

Prudencio, Liana; Null, Sarah E.

2018-03-01

Researchers and water managers have turned to green stormwater infrastructure, such as bioswales, retention basins, wetlands, rain gardens, and urban green spaces to reduce flooding, augment surface water supplies, recharge groundwater, and improve water quality. It is increasingly clear that green stormwater infrastructure not only controls stormwater volume and timing, but also promotes ecosystem services, which are the benefits that ecosystems provide to humans. Yet there has been little synthesis focused on understanding how green stormwater management affects ecosystem services. The objectives of this paper are to review and synthesize published literature on ecosystem services and green stormwater infrastructure and identify gaps in research and understanding, establishing a foundation for research at the intersection of ecosystems services and green stormwater management. We reviewed 170 publications on stormwater management and ecosystem services, and summarized the state-of-the-science categorized by the four types of ecosystem services. Major findings show that: (1) most research was conducted at the parcel-scale and should expand to larger scales to more closely understand green stormwater infrastructure impacts, (2) nearly a third of papers developed frameworks for implementing green stormwater infrastructure and highlighted barriers, (3) papers discussed ecosystem services, but less than 40% quantified ecosystem services, (4) no geographic trends emerged, indicating interest in applying green stormwater infrastructure across different contexts, (5) studies increasingly integrate engineering, physical science, and social science approaches for holistic understanding, and (6) standardizing green stormwater infrastructure terminology would provide a more cohesive field of study than the diverse and often redundant terminology currently in use. We recommend that future research provide metrics and quantify ecosystem services, integrate disciplines to measure ecosystem services from green stormwater infrastructure, and better incorporate stormwater management into environmental policy. Our conclusions outline promising future research directions at the intersection of stormwater management and ecosystem services.

Early abortion services in the United States: a provider survey.

PubMed

Benson, Janie; Clark, Kathryn Andersen; Gerhardt, Ann; Randall, Lynne; Dudley, Susan

2003-04-01

The objective of this study was to describe the availability of early surgical and medical abortion among members of the National Abortion Federation (NAF) and to identify factors affecting the integration of early abortion services into current services. Telephone interviews were conducted with staff at 113 Planned Parenthood affiliates and independent abortion providers between February and April 2000, prior to FDA approval of mifepristone. Early abortion services were available at 59% of sites, and establishing services was less difficult than or about what was anticipated. Sites generally found it easier to begin offering early surgical abortion than early medical abortion. Physician participation was found to be critical to implementing early services. At sites where some but not all providers offered early abortion, variations in service availability resulted. Given the option of reconsidering early services, virtually all sites would make the same decision again. These data suggest that developing mentoring relationships between experienced early abortion providers/sites and those not offering early services, and training physicians and other staff, are likely to be effective approaches to expanding service availability.

Strategic Mobility 21 Transition Plan: From Research Federation to Business Enterprise

DTIC Science & Technology

2010-12-31

Transportation Management System (GTMS), Service Oriented Architecture (SOA), Service -as-a- Software ( SaaS ), Joint Capability Technolgoy Demonstration...the Software -as-a- Service ( SaaS ) format, whereby users access the application with the appropriate Internet authorizations. Security is provided by...integrating best-of-breed dual-use systems deployed in the software as a service ( SaaS ) environment. It includes single sign-on capabilities and was

ASC Distribution Management Center (DMC) Provides Materiel Management Capability

DTIC Science & Technology

2008-09-01

Distribution Management Center (DMC) is the single interface for the synchronization and integration of logistical functions among active Army units in CONUS...with an integrated team of Soldiers, government service employees, and contractors assigned to Rock Island, as well as forward-positioned Distribution ... Management Teams (DMTs) at 15 major Army installations throughout CONUS, Alaska, and Hawaii. The current DMC structure provides the benefit of

ATM over hybrid fiber-coaxial cable networks: practical issues in deploying residential ATM services

NASA Astrophysics Data System (ADS)

Laubach, Mark

1996-11-01

Residential broadband access network technology based on asynchronous transfer modem (ATM) will soon reach commercial availability. The capabilities provided by ATM access network promise integrated services bandwidth available in excess of those provided by traditional twisted pair copper wire public telephone networks. ATM to the side of the home placed need quality of service capability closest to the subscriber allowing immediate support for Internet services and traditional voice telephony. Other services such as desktop video teleconferencing and enhanced server-based application support can be added as part of future evolution of the network. Additionally, advanced subscriber home networks can be supported easily. This paper presents an updated summary of the standardization efforts for the ATM over HFC definition work currently taking place in the ATM forum's residential broadband working group and the standards progress in the IEEE 802.14 cable TV media access control and physical protocol working group. This update is fundamental for establishing the foundation for delivering ATM-based integrated services via a cable TV network. An economic model for deploying multi-tiered services is presenting showing that a single-tier service is insufficient for a viable cable operator business. Finally, the use of an ATM based system lends itself well to various deployment scenarios of synchronous optical networks (SONET).

Using benchmarking to assist the improvement of service quality in home support services for older people-IN TOUCH (Integrated Networks Towards Optimising Understanding of Community Health).

PubMed

Jacobs, Stephen P; Parsons, Matthew; Rouse, Paul; Parsons, John; Gunderson-Reid, Michelle

2018-04-01

Service providers and funders need ways to work together to improve services. Identifying critical performance variables provides a mechanism by which funders can understand what they are purchasing without getting caught up in restrictive service specifications that restrict the ability of service providers to meet the needs of the clients. An implementation pathway and benchmarking programme called IN TOUCH provided contracted providers of home support and funders with a consistent methodology to follow when developing and implementing new restorative approaches for service delivery. Data from performance measurement was used to triangulate the personal and social worlds of the stakeholders enabling them to develop a shared understanding of what is working and what is not. The initial implementation of IN TOUCH involved five District Health Boards. The recursive dialogue encouraged by the IN TOUCH programme supports better and more sustainable service development because performance management is anchored to agreed data that has meaning to all stakeholders. Copyright © 2017 Elsevier Ltd. All rights reserved.

Secure and Resilient Cloud Computing for the Department of Defense

DTIC Science & Technology

2015-07-21

that addresses that threat model, and (3) integrate the technology into a usable, secure, resilient cloud test bed. Underpinning this work is the...risks for the DoD’s acquisition of secure, resilient cloud technology by providing proofs of concept, technology maturity, integration demonstrations...we need a strategy for integrating LLSRC technology with the cloud services and applications that need to be secured. The LLSRC integration

Life in a Fishbowl: Accountability and Integrity in Pharmacy Leadership

PubMed Central

Haumschild, Ryan J.; Weber, Robert J.

2014-01-01

The Director’s Forum is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems by providing practical information on various leadership topics. Pharmacists are bound to practice in the best interest of the patient and are obligated to act with integrity and in an ethical manner. Pharmacy directors and their leadership staff are additionally bound to manage their department with integrity. Staff often scrutinize the pharmacy director’s actions, giving the director a feeling of “life in a fishbowl.” Every action of the leader is judged in the context of personal integrity or their individual commitment to moral, spiritual, and ethical values. The objective of this article is to describe how a pharmacy leader manages this responsibility. This article addresses the pharmacy leader’s obligations to act with integrity, reviews key integrity concerns in pharmacy leadership, and provides guidance for leading and managing in the context of ethics and integrity. Pharmacy directors must always be aware that they are open to both department and public scrutiny if they do not conduct themselves in a professional manner. Being accountable for their actions and maintaining a high standard of integrity, leaders can keep the focus of their departments on the goal of patient-centered pharmacy services. PMID:25477587

Improving health related quality of life among rural hypertensive patients through the integrative strategy of health services delivery: a quasi-experimental trial from Chongqing, China.

PubMed

Miao, Yudong; Zhang, Liang; Sparring, Vibeke; Sandeep, Sandeep; Tang, Wenxi; Sun, Xiaowei; Feng, Da; Ye, Ting

2016-08-23

Integrative strategy of health services delivery has been proven to be effective in economically developed countries, where the healthcare systems have enough qualified primary care providers. However rural China lacks such providers to act as gatekeeper, besides, Chinese rural hypertensive patients are usually of old age, more likely to be exposed to health risk factors and they experience a greater socio-economic burden. All these Chinese rural setting specific features make the effectiveness of integrative strategy of health services in improving health related quality of life among Chinese rural hypertensive patients uncertain. In order to assess the impact of integrative strategy of health services delivery on health related quality of life among Chinese rural hypertensive patients, a two-year quasi-experimental trial was conducted in Chongqing, China. At baseline the sample enrolled 1006 hypertensive patients into intervention group and 420 hypertensive patients into control group. Physicians from village clinics, town hospitals and county hospitals worked collaboratively to deliver multidisciplinary health services for the intervention group, while physicians in the control group provided services without cooperation. The quality of life was studied by SF-36 Scale. Blood pressures were reported by town hospitals. The Difference-in-Differences model was used to estimate the differences in SF-36 score and blood pressure of both groups to assess the impact. The study showed that at baseline there was no statistical difference in SF-36 scores between both groups. While at follow-up the intervention group scored higher in overall SF-36, Role Physical, Body Pain, Social Functioning and Role Emotional than the control group. The Difference-in-Differences result demonstrated that there were statistical differences in SF-36 total score (p = 0.011), Role Physical (p = 0.027), Social Functioning (p = 0.000), Role Emotional (p = 0.002) between both groups. Integrative services delivery improved the score of SF-36 by 4.591 ± 1.794, and also improved the score in domains of Role Physical, Social Functioning and Role Emotional by 8.289 ± 3.753, 9.762 ± 2.019 and 12.534 ± 4.083, respectively. Patients in the intervention group obtained lower systolic blood pressure and diastolic blood pressure. Integrative strategy of health services delivery improved health related quality of life and blood pressure control among rural Chinese hypertensive patients. The Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology, ChiCTR-OOR-14005563, Registered on 7 June 2011.

Semantic Registration and Discovery System of Subsystems and Services within an Interoperable Coordination Platform in Smart Cities

PubMed Central

Rubio, Gregorio; Martínez, José Fernán; Gómez, David; Li, Xin

2016-01-01

Smart subsystems like traffic, Smart Homes, the Smart Grid, outdoor lighting, etc. are built in many urban areas, each with a set of services that are offered to citizens. These subsystems are managed by self-contained embedded systems. However, coordination and cooperation between them are scarce. An integration of these systems which truly represents a “system of systems” could introduce more benefits, such as allowing the development of new applications and collective optimization. The integration should allow maximum reusability of available services provided by entities (e.g., sensors or Wireless Sensor Networks). Thus, it is of major importance to facilitate the discovery and registration of available services and subsystems in an integrated way. Therefore, an ontology-based and automatic system for subsystem and service registration and discovery is presented. Using this proposed system, heterogeneous subsystems and services could be registered and discovered in a dynamic manner with additional semantic annotations. In this way, users are able to build customized applications across different subsystems by using available services. The proposed system has been fully implemented and a case study is presented to show the usefulness of the proposed method. PMID:27347965

Semantic Registration and Discovery System of Subsystems and Services within an Interoperable Coordination Platform in Smart Cities.

PubMed

Rubio, Gregorio; Martínez, José Fernán; Gómez, David; Li, Xin

2016-06-24

Smart subsystems like traffic, Smart Homes, the Smart Grid, outdoor lighting, etc. are built in many urban areas, each with a set of services that are offered to citizens. These subsystems are managed by self-contained embedded systems. However, coordination and cooperation between them are scarce. An integration of these systems which truly represents a "system of systems" could introduce more benefits, such as allowing the development of new applications and collective optimization. The integration should allow maximum reusability of available services provided by entities (e.g., sensors or Wireless Sensor Networks). Thus, it is of major importance to facilitate the discovery and registration of available services and subsystems in an integrated way. Therefore, an ontology-based and automatic system for subsystem and service registration and discovery is presented. Using this proposed system, heterogeneous subsystems and services could be registered and discovered in a dynamic manner with additional semantic annotations. In this way, users are able to build customized applications across different subsystems by using available services. The proposed system has been fully implemented and a case study is presented to show the usefulness of the proposed method.

Integrated HIV care and service engagement among people living with HIV who use drugs in a setting with a community-wide treatment as prevention initiative: a qualitative study in Vancouver, Canada

PubMed Central

Collins, Alexandra B; Parashar, Surita; Hogg, Robert S; Fernando, Saranee; Worthington, Catherine; McDougall, Patrick; Turje, Rosalind Baltzer; McNeil, Ryan

2017-01-01

Abstract Introduction: Social-structural inequities impede access to, and retention in, HIV care among structurally vulnerable people living with HIV (PLHIV) who use drugs. The resulting disparities in HIV-related outcomes among PLHIV who use drugs pose barriers to the optimization of HIV treatment as prevention (TasP) initiatives. We undertook this study to examine engagement with, and impacts of, an integrated HIV care services model tailored to the needs of PLHIV who use drugs in Vancouver, Canada – a setting with a community-wide TasP initiative. Methods: We conducted qualitative interviews with 30 PLHIV who use drugs recruited from the Dr. Peter Centre, an HIV care facility operating under an integrated services model and harm reduction approach. We employed novel analytical techniques to analyse participants’ service trajectories within this facility to understand how this HIV service environment influences access to, and retention in, HIV care among structurally vulnerable PLHIV who use drugs. Results: Our findings demonstrate that participants’ structural vulnerability shaped their engagement with the HIV care facility that provided access to resources that facilitated retention in HIV care and antiretroviral treatment adherence. Additionally, the integrated service environment helped reduce burdens associated with living in extreme poverty by meeting participants’ subsistence (e.g. food, shelter) needs. Moreover, access to multiple supports created a structured environment in which participants could develop routine service use patterns and have prolonged engagement with supportive care services. Our findings demonstrate that low-barrier service models can mitigate social and structural barriers to HIV care and complement TasP initiatives for PLHIV who use drugs. Conclusions: These findings highlight the critical role of integrated service models in promoting access to health and support services for structurally vulnerable PLHIV. Complementing structural interventions with integrated service models that are tailored to the needs of structurally vulnerable PLHIV who use drugs will be pursuant to the goals of TasP. PMID:28426185

Job submission and management through web services: the experience with the CREAM service

NASA Astrophysics Data System (ADS)

Aiftimiei, C.; Andreetto, P.; Bertocco, S.; Fina, S. D.; Ronco, S. D.; Dorigo, A.; Gianelle, A.; Marzolla, M.; Mazzucato, M.; Sgaravatto, M.; Verlato, M.; Zangrando, L.; Corvo, M.; Miccio, V.; Sciaba, A.; Cesini, D.; Dongiovanni, D.; Grandi, C.

2008-07-01

Modern Grid middleware is built around components providing basic functionality, such as data storage, authentication, security, job management, resource monitoring and reservation. In this paper we describe the Computing Resource Execution and Management (CREAM) service. CREAM provides a Web service-based job execution and management capability for Grid systems; in particular, it is being used within the gLite middleware. CREAM exposes a Web service interface allowing conforming clients to submit and manage computational jobs to a Local Resource Management System. We developed a special component, called ICE (Interface to CREAM Environment) to integrate CREAM in gLite. ICE transfers job submissions and cancellations from the Workload Management System, allowing users to manage CREAM jobs from the gLite User Interface. This paper describes some recent studies aimed at assessing the performance and reliability of CREAM and ICE; those tests have been performed as part of the acceptance tests for integration of CREAM and ICE in gLite. We also discuss recent work towards enhancing CREAM with a BES and JSDL compliant interface.

A cross-domain communication resource scheduling method for grid-enabled communication networks

NASA Astrophysics Data System (ADS)

Zheng, Xiangquan; Wen, Xiang; Zhang, Yongding

2011-10-01

To support a wide range of different grid applications in environments where various heterogeneous communication networks coexist, it is important to enable advanced capabilities in on-demand and dynamical integration and efficient co-share with cross-domain heterogeneous communication resource, thus providing communication services which are impossible for single communication resource to afford. Based on plug-and-play co-share and soft integration with communication resource, Grid-enabled communication network is flexibly built up to provide on-demand communication services for gird applications with various requirements on quality of service. Based on the analysis of joint job and communication resource scheduling in grid-enabled communication networks (GECN), this paper presents a cross multi-domain communication resource cooperatively scheduling method and describes the main processes such as traffic requirement resolution for communication services, cross multi-domain negotiation on communication resource, on-demand communication resource scheduling, and so on. The presented method is to afford communication service capability to cross-domain traffic delivery in GECNs. Further research work towards validation and implement of the presented method is pointed out at last.

41 CFR 102-74.35 - What building services must Executive agencies provide?

Code of Federal Regulations, 2011 CFR

2011-01-01

... Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 74... grounds maintenance, tenant alterations, minor repairs, building maintenance, integrated pest management... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false What building services...

41 CFR 102-74.35 - What building services must Executive agencies provide?

Code of Federal Regulations, 2014 CFR

2014-01-01

... Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 74... grounds maintenance, tenant alterations, minor repairs, building maintenance, integrated pest management... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false What building services...

41 CFR 102-74.35 - What building services must Executive agencies provide?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 74... grounds maintenance, tenant alterations, minor repairs, building maintenance, integrated pest management... 41 Public Contracts and Property Management 3 2013-07-01 2013-07-01 false What building services...

41 CFR 102-74.35 - What building services must Executive agencies provide?

Code of Federal Regulations, 2012 CFR

2012-01-01

... Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 74... grounds maintenance, tenant alterations, minor repairs, building maintenance, integrated pest management... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false What building services...

Using Ecosystem Services to Inform Decisions on U.S. Air Quality Standards

EPA Science Inventory

The ecosystem services (ES) framework provides a link between changes in a natural system’s structure and function and public welfare. This systematic integration of ecology and economics allows for more consistency and transparency in environmental decision making by enab...