49 CFR 1.13 - OST Key Responsibilities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 1 2014-10-01 2014-10-01 false OST Key Responsibilities. 1.13 Section 1.13... of the Secretary § 1.13 OST Key Responsibilities. (a) The OST is responsible for: (1) Providing... Government; (5) Encouraging maximum private development of transportation services; (6) Providing responsive...

Biogeochemical cycles and biodiversity as key drivers of ecosystem services provided by soils

NASA Astrophysics Data System (ADS)

Smith, P.; Cotrufo, M. F.; Rumpel, C.; Paustian, K.; Kuikman, P. J.; Elliott, J. A.; McDowell, R.; Griffiths, R. I.; Asakawa, S.; Bustamante, M.; House, J. I.; Sobocká, J.; Harper, R.; Pan, G.; West, P. C.; Gerber, J. S.; Clark, J. M.; Adhya, T.; Scholes, R. J.; Scholes, M. C.

2015-06-01

Soils play a pivotal role in major global biogeochemical cycles (carbon, nutrient and water), while hosting the largest diversity of organisms on land. Because of this, soils deliver fundamental ecosystem services, and management to change a soil process in support of one ecosystem service can either provide co-benefits to other services or can result in trade-offs. In this critical review, we report the state-of-the-art understanding concerning the biogeochemical cycles and biodiversity in soil, and relate these to the provisioning, regulating, supporting and cultural ecosystem services which they underpin. We then outline key knowledge gaps and research challenges, before providing recommendations for management activities to support the continued delivery of ecosystem services from soils. We conclude that although there are knowledge gaps that require further research, enough is known to start improving soils globally. The main challenge is in finding ways to share knowledge with soil managers and policy-makers, so that best-practice management can be implemented. A key element of this knowledge sharing must be in raising awareness of the multiple ecosystem services underpinned by soils, and the natural capital they provide. The International Year of Soils in 2015 presents the perfect opportunity to begin a step-change in how we harness scientific knowledge to bring about more sustainable use of soils for a secure global society.

Enhanced primary mental healthcare for Indigenous Australians: service implementation strategies and perspectives of providers.

PubMed

Reifels, Lennart; Nicholas, Angela; Fletcher, Justine; Bassilios, Bridget; King, Kylie; Ewen, Shaun; Pirkis, Jane

2018-01-01

Improving access to culturally appropriate mental healthcare has been recognised as a key strategy to address the often greater burden of mental health issues experienced by Indigenous populations. We present data from the evaluation of a national attempt at improving access to culturally appropriate mental healthcare for Indigenous Australians through a mainstream primary mental healthcare program, the Access to Allied Psychological Services program, whilst specifically focusing on the implementation strategies and perspectives of service providers. We conducted semi-structured interviews with 31 service providers (primary care agency staff, referrers, and mental health professionals) that were analysed thematically and descriptively. Agency-level implementation strategies to enhance service access and cultural appropriateness included: the conduct of local service needs assessments; Indigenous stakeholder consultation and partnership development; establishment of clinical governance frameworks; workforce recruitment, clinical/cultural training and supervision; stakeholder and referrer education; and service co-location at Indigenous health organisations. Dedicated provider-level strategies to ensure the cultural appropriateness of services were primarily aimed at the context and process of delivery (involving, flexible referral pathways, suitable locations, adaptation of client engagement and service feedback processes) and, to a lesser extent, the nature and content of interventions (provision of culturally adapted therapy). This study offers insights into key factors underpinning the successful national service implementation approach. Study findings highlight that concerted national attempts to enhance mainstream primary mental healthcare for Indigenous people are critically dependent on effective local agency- and provider-level strategies to optimise the integration, adaptation and broader utility of these services within local Indigenous community and healthcare service contexts. Despite the explicit provider focus, this study was limited by a lack of Indigenous stakeholder perspectives. Key study findings are of direct relevance to inform the future implementation and delivery of culturally appropriate primary mental healthcare programs for Indigenous populations in Australia and internationally.

Mental Health Service Delivery Systems and Perceived Qualifications of Mental Health Service Providers in School Settings

ERIC Educational Resources Information Center

Dixon, Decia Nicole

2009-01-01

Latest research on the mental health status of children indicates that schools are key providers of mental health services (U.S. Department of Health and Human Services, 2003). The push for school mental health services has only increased as stakeholders have begun to recognize the significance of sound mental health as an essential part of…

Nutrition in primary health care: using a Delphi process to design new interdisciplinary services.

PubMed

Brauer, Paula; Dietrich, Linda; Davidson, Bridget

2006-01-01

A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers' nutrition services. The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

31 CFR 31.201 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Stabilization Act of 2008. Key individual means an individual providing services to a private sector entity who... agency agreement between a private sector entity and the Treasury for services under the TARP, other than... arrangement with the Treasury. For purposes of the definition of key individual, the words “personally and...

Designing insurance to promote use of childhood obesity prevention services.

PubMed

Rask, Kimberly J; Gazmararian, Julie A; Kohler, Susan S; Hawley, Jonathan N; Bogard, Jenny; Brown, Victoria A

2013-01-01

Childhood obesity is a recognized public health crisis. This paper reviews the lessons learned from a voluntary initiative to expand insurance coverage for childhood obesity prevention and treatment services in the United States. In-depth telephone interviews were conducted with key informants from 16 participating health plans and employers in 2010-11. Key informants reported difficulty ensuring that both providers and families were aware of the available services. Participating health plans and employers are beginning new tactics including removing enrollment requirements, piloting enhanced outreach to selected physician practices, and educating providers on effective care coordination and use of obesity-specific billing codes through professional organizations. The voluntary initiative successfully increased private health insurance coverage for obesity services, but the interviews described variability in implementation with both best practices and barriers identified. Increasing utilization of obesity-related health services in the long term will require both family- and provider-focused interventions in partnership with improved health insurance coverage.

Enhancing End-to-End Performance of Information Services Over Ka-Band Global Satellite Networks

NASA Technical Reports Server (NTRS)

Bhasin, Kul B.; Glover, Daniel R.; Ivancic, William D.; vonDeak, Thomas C.

1997-01-01

The Internet has been growing at a rapid rate as the key medium to provide information services such as e-mail, WWW and multimedia etc., however its global reach is limited. Ka-band communication satellite networks are being developed to increase the accessibility of information services via the Internet at global scale. There is need to assess satellite networks in their ability to provide these services and interconnect seamlessly with existing and proposed terrestrial telecommunication networks. In this paper the significant issues and requirements in providing end-to-end high performance for the delivery of information services over satellite networks based on various layers in the OSI reference model are identified. Key experiments have been performed to evaluate the performance of digital video and Internet over satellite-like testbeds. The results of the early developments in ATM and TCP protocols over satellite networks are summarized.

Biodiversity Metrics

EPA Science Inventory

Ecosystem services, i.e., "services provided to humans from natural systems," have become a key focus of this century in resource management, conservation planning, human well-being, and environmental decision analysis. Mapping and quantifying ecosystem services have become strat...

UReturn: University of Minnesota Services for Faculty and Staff with Disabilities

ERIC Educational Resources Information Center

Fuecker, Dave; Harbour, Wendy S.

2011-01-01

This chapter provides an overview of UReturn, the Disability Services (DS) unit providing services to University of Minnesota-Twin Cities (UMN) faculty and staff with disabilities and health conditions. The physical layout of DS, case management policies, and collaborative work with other UMN departments all emphasize three key ideas: (1)…

Ecosystem Services Valuation as an Opportunity for Inquiry Learning

ERIC Educational Resources Information Center

Taylor, Zachary P.; Bennett, Drew E.

2016-01-01

Teaching ecosystem services provides an ideal opportunity to use inquiry-based learning to help students make connections between ecological, geological, and social systems. The idea of ecosystem services, or the benefits nature provides to society, has emerged as a key concept in a host of environmental fields and is just beginning to gain…

A Web-Based Tool to Support Data-Based Early Intervention Decision Making

ERIC Educational Resources Information Center

Buzhardt, Jay; Greenwood, Charles; Walker, Dale; Carta, Judith; Terry, Barbara; Garrett, Matthew

2010-01-01

Progress monitoring and data-based intervention decision making have become key components of providing evidence-based early childhood special education services. Unfortunately, there is a lack of tools to support early childhood service providers' decision-making efforts. The authors describe a Web-based system that guides service providers…

Strategic information systems planning for health service providers.

PubMed

Moriarty, D D

1992-01-01

There is significant opportunity for health service providers to gain competitive advantage through the innovative use of strategic information systems. This analysis presents some key strategic information systems issues that will enable managers to identify opportunities within their organizations.

Key successes and challenges in providing mental health care in an urban male remand prison: a qualitative study.

PubMed

Samele, Chiara; Forrester, Andrew; Urquía, Norman; Hopkin, Gareth

2016-04-01

This study aimed to describe the workings of an urban male remand prison mental health service exploring the key challenges and successes, levels of integration and collaboration with other services. A purposive sampling was used to recruit key prison and healthcare professionals for in-depth interviews. A thematic analysis was used to analyse transcripts based on an initial coding frame of several predefined themes. Other key themes were also identified. Twenty-eight interviews were conducted. Prisoners referred to the service had complex, sometimes acute mental illness requiring specialist assessment and treatment. Key successes of the in-reach service included the introduction of an open referral system, locating a mental health nurse at reception to screen all new prisoners and a zoning system to prioritise urgent or non-urgent cases. Achieving an integrated system of healthcare was challenging because of the numerous internal and external services operating across the prison, a highly transient population, limited time and space to deliver services and difficulties with providing inpatient care (e.g., establishing the criteria for admission and managing patient flow). Collaborative working between prison and healthcare staff was required to enable best care for prisoners. The prison mental health in-reach service worked well in assessing and prioritising those who required specialist mental health care. Although the challenges of working within the prison context limited what the in-reach team could achieve. Further work was needed to improve the unit environment and how best to target and deliver inpatient care within the prison.

Supporting interoperability of collaborative networks through engineering of a service-based Mediation Information System (MISE 2.0)

NASA Astrophysics Data System (ADS)

Benaben, Frederick; Mu, Wenxin; Boissel-Dallier, Nicolas; Barthe-Delanoe, Anne-Marie; Zribi, Sarah; Pingaud, Herve

2015-08-01

The Mediation Information System Engineering project is currently finishing its second iteration (MISE 2.0). The main objective of this scientific project is to provide any emerging collaborative situation with methods and tools to deploy a Mediation Information System (MIS). MISE 2.0 aims at defining and designing a service-based platform, dedicated to initiating and supporting the interoperability of collaborative situations among potential partners. This MISE 2.0 platform implements a model-driven engineering approach to the design of a service-oriented MIS dedicated to supporting the collaborative situation. This approach is structured in three layers, each providing their own key innovative points: (i) the gathering of individual and collaborative knowledge to provide appropriate collaborative business behaviour (key point: knowledge management, including semantics, exploitation and capitalisation), (ii) deployment of a mediation information system able to computerise the previously deduced collaborative processes (key point: the automatic generation of collaborative workflows, including connection with existing devices or services) (iii) the management of the agility of the obtained collaborative network of organisations (key point: supervision of collaborative situations and relevant exploitation of the gathered data). MISE covers business issues (through BPM), technical issues (through an SOA) and agility issues of collaborative situations (through EDA).

Are HIV and reproductive health services adapted to the needs of female sex workers? Results of a policy and situational analysis in Tete, Mozambique.

PubMed

Lafort, Yves; Jocitala, Osvaldo; Candrinho, Balthazar; Greener, Letitia; Beksinska, Mags; Smit, Jenni A; Chersich, Matthew; Delva, Wim

2016-07-26

In the context of an implementation research project aiming at improving use of HIV and sexual and reproductive health (SRH) services for female sex workers (FSWs), a broad situational analysis was conducted in Tete, Mozambique, assessing if services are adapted to the needs of FSWs. Methods comprised (1) a policy analysis including a review of national guidelines and interviews with policy makers, and (2) health facility assessments at 6 public and 1 private health facilities, and 1 clinic specifically targeting FSWs, consisting of an audit checklist, interviews with 18 HIV/SRH care providers and interviews of 99 HIV/SRH care users. There exist national guidelines for most HIV/SRH care services, but none provides guidance for care adapted to the needs of high-risk women such as FSWs. The Ministry of Health recently initiated the process of establishing guidelines for attendance of key populations, including FSWs, at public health facilities. Policy makers have different views on the best approach for providing services to FSWs-integrated in the general health services or through parallel services for key populations-and there exists no national strategy. The most important provider of HIV/SRH services in the study area is the government. Most basic services are widely available, with the exception of certain family planning methods, cervical cancer screening, services for victims of sexual and gender-based violence, and termination of pregnancy (TOP). The public facilities face serious limitations in term of space, staff, equipment, regular supplies and adequate provider practices. A stand-alone clinic targeting key populations offers a limited range of services to the FSW population in part of the area. Private clinics offer only a few services, at commercial prices. There is a need to improve the availability of quality HIV/SRH services in general and to FSWs specifically, and to develop guidelines for care adapted to the needs of FSWs. Access for FSWs can be improved by either expanding the range of services and the coverage of the targeted clinic and/or by improving access to adapted care at the public health services and ensure a minimum standard of quality.

A Socio-technical Approach for Transient SME Alliances

NASA Astrophysics Data System (ADS)

Rezgui, Yacine

The paper discusses technical requirements to promote the adoption of alliance modes of operation by SMEs in the construction sector. These requirements have provided a basis for specifying a set of functionality to support the collaboration and cooperation needs of SMEs. While service-oriented architectures and semantic web services provide the middleware technology to implement the identified functionality, a number of key technical limitations have been identified, including lack of support for the dynamic and non-functional characteristics of SME alliances distributed business processes, lack of execution monitoring functionality to manage running business processes, and lack of support for semantic reasoning to enable SME business process service composition. The paper examines these issues and provides key directions for supporting SME alliances effectively.

DOD Inventory of Contracted Services: Timely Decisions and Further Actions Needed to Address Long Standing Issues

DTIC Science & Technology

2016-10-01

which contractors were providing services that are closely associated with inherently governmental functions, a key review objective to help ensure...or dinapolit@gao.gov. Why GAO Did This Study DOD is the government’s largest purchaser of contractor -provided services. In 2008, Congress...required DOD to compile and review an annual inventory of its contracted services to identify the number of contractors performing services and the

U of M Civil Service Wellness Survey: Finding Out Employees' Health and Wellness Needs. A Report of Key Findings.

ERIC Educational Resources Information Center

Matross, Ron; Roesler, Jon

Key findings from a wellness survey conducted with University of Minnesota civil service employees are discussed. The survey was designed to provide information to guide future campus health and wellness programming. Four topics were covered: physical fitness/exercise, nutrition, self-improvement/psychological health, and general health/preventive…

A National Approach to Quantify and Map Biodiversity Conservation Metrics within an Ecosystem Services Framework

EPA Science Inventory

Ecosystem services, i.e., "services provided to humans from natural systems," have become a key issue of this century in resource management, conservation planning, human well-being, and environmental decision analysis. Mapping and quantifying ecosystem services have be...

Study on Customer Satisfaction with Facilities Management Services in Lithuania

NASA Astrophysics Data System (ADS)

Lepkova, Natalija; Žūkaitė-Jefimovienė, Giedrė

2012-12-01

The article introduces the concept and content of facilities management (FM) services. The paper presents the concept of customer satisfaction and discusses the key factors which influence the opinions of customers and their satisfaction or dissatisfaction with the services provided. The article presents two studies: a brief survey of several FM service providers and a survey of customer satisfaction with FM services in Lithuania. The conclusions are given at the end of the article.

Transportation Service Center Analysis Using GIS Technology

DOT National Transportation Integrated Search

1997-01-01

The Transportation Service Center (TSC) concept originated as a result of the department's evaluation of its key business processes and its commitment to improve the quality of the goods and services it provides. TSCs are local Michigan Department of...

Recommendations for Planning and Managing International Short-term Pharmacy Service Trips

PubMed Central

Alsharif, Naser Z.; Rovers, John; Connor, Sharon; White, Nicole D.; Hogue, Michael D.

2017-01-01

International pharmacy service trips by schools and colleges of pharmacy allow students to provide health care to medically underserved areas. A literature review (2000-2016) in databases and Internet searches with specific keywords or terms was performed to assess current practices to establish and maintain successful pharmacy service trips. Educational documents such as syllabi were obtained from pharmacy programs and examined. A preliminary draft was developed and authors worked on sections of interest and expertise. Considerations and current recommendations are provided for the key aspects of the home institution and the host country requirements for pharmacy service trips based on findings from a literature search and the authors’ collective, extensive experience. Evaluation of the trip and ethical considerations are also discussed. This article serves as a resource for schools and colleges of pharmacy that are interested in the development of new pharmacy service trips and provides key considerations for continuous quality improvement of current or future activities. PMID:28381883

Recommendations for Planning and Managing International Short-term Pharmacy Service Trips.

PubMed

Johnson, Kalin L; Alsharif, Naser Z; Rovers, John; Connor, Sharon; White, Nicole D; Hogue, Michael D

2017-03-25

International pharmacy service trips by schools and colleges of pharmacy allow students to provide health care to medically underserved areas. A literature review (2000-2016) in databases and Internet searches with specific keywords or terms was performed to assess current practices to establish and maintain successful pharmacy service trips. Educational documents such as syllabi were obtained from pharmacy programs and examined. A preliminary draft was developed and authors worked on sections of interest and expertise. Considerations and current recommendations are provided for the key aspects of the home institution and the host country requirements for pharmacy service trips based on findings from a literature search and the authors' collective, extensive experience. Evaluation of the trip and ethical considerations are also discussed. This article serves as a resource for schools and colleges of pharmacy that are interested in the development of new pharmacy service trips and provides key considerations for continuous quality improvement of current or future activities.

A Secure Authenticated Key Exchange Protocol for Credential Services

NASA Astrophysics Data System (ADS)

Shin, Seonghan; Kobara, Kazukuni; Imai, Hideki

In this paper, we propose a leakage-resilient and proactive authenticated key exchange (called LRP-AKE) protocol for credential services which provides not only a higher level of security against leakage of stored secrets but also secrecy of private key with respect to the involving server. And we show that the LRP-AKE protocol is provably secure in the random oracle model with the reduction to the computational Difie-Hellman problem. In addition, we discuss about some possible applications of the LRP-AKE protocol.

Key Working for Families with Young Disabled Children

PubMed Central

Carter, Bernie; Thomas, Megan

2011-01-01

For families with a disabled child, the usual challenges of family life can be further complicated by the need to access a wide range of services provided by a plethora of professionals and agencies. Key working aims to support children and their families in navigating these complexities ensuring easy access to relevant, high quality, and coordinated care. The aim of this paper is to explore the key worker role in relation to “being a key worker” and “having a key worker”. The data within this paper draw on a larger evaluation study of the Blackpool Early Support Pilot Programme. The qualitative study used an appreciative and narrative approach and utilised mixed methods (interviews, surveys and a nominal group workshop). Data were collected from 43 participants (parents, key workers, and other stakeholders). All stakeholders who had been involved with the service were invited to participate. In the paper we present and discuss the ways in which key working made a difference to the lives of children and their families. We also consider how key working transformed the perspectives of the key workers creating a deeper and richer understanding of family lives and the ways in which other disciplines and agencies worked. Key working contributed to the shift to a much more family-centred approach, and enhanced communication and information sharing between professionals and agencies improved. This resulted in families feeling more informed. Key workers acted in an entrepreneurial fashion, forging new relationships with families and between families and other stakeholders. Parents of young disabled children and their service providers benefited from key working. Much of the benefit accrued came from strong, relational, and social-professional networking which facilitated the embedding of new ways of working into everyday practice. Using an appreciative inquiry approach provided an effective and relevant way of engaging with parents, professionals, and other stakeholders to explore what was working well with key working within an Early Support Pilot Programme. PMID:21994827

Models of HIV Preconception Care and Key Elements Influencing These Services: Findings from Healthcare Providers in Seven US Cities.

PubMed

Simone, Joanne; Hoyt, Mary Jo; Storm, Deborah S; Finocchario-Kessler, Sarah

2018-06-05

Preconception care can improve maternal and infant outcomes by identifying and modifying health risks before pregnancy and reducing unplanned pregnancies. However, information about how preconception care is provided to persons living with HIV (PLWH) is lacking. This study uses qualitative interviews with HIV care providers to describe current models of preconception care and explore factors influencing services. Single, anonymous, telephone interviews were conducted with 92 purposively selected HIV healthcare providers in Atlanta, Baltimore, Houston, Kansas City, Newark, Philadelphia, and San Francisco in 2013-2014. Content analysis and a grounded theory approach were used to analyze data. Participants included 57% physicians with a median of 10 [interquartile range (IQR) = 5-17] years HIV care experience; the mean proportion of female patients was 45%. Participants described Individual Provider (48.9%), Team-based (43.2%), and Referral-only (7.6%) models of preconception care, with 63% incorporating referrals outside their clinics. Thematic analysis identified five key elements influencing the provision of preconception care within and across models: consistency of delivery, knowledge and attitudes, clinic characteristics, coordination of care, and referral accessibility. Described models of preconception care reflect the complexity of our healthcare system. Qualitative analysis offers insights about how HIV clinicians provide preconception care and how key elements influence services. However, additional research about the models and outcomes of preconception care services are needed. To improve preconception care for PLWH, research and quality improvement initiatives must utilize available strengths and tackle existing barriers, identified by our study and others, to define and implement effective models of preconception care services.

Closing the health equity gap: evidence-based strategies for primary health care organizations

PubMed Central

2012-01-01

Introduction International evidence shows that enhancement of primary health care (PHC) services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a) the key dimensions of equity-oriented services to guide PHC organizations, and (b) strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations. Methods The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a) in-depth interviews with a total of 114 participants (73 patients; 41 staff), (b) over 900 hours of participant observation, and (c) an analysis of key organizational documents, which shed light on the policy and funding environments. Results Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved 'fit' between people's needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions. Conclusions These evidence- and theoretically-informed key dimensions and strategies provide direction for PHC organizations aiming to redress the increasing levels of health and health care inequities across population groups. The findings provide a framework for conceptualizing and operationalizing the essential elements of equity-oriented PHC services when working with marginalized populations, and will have broad application to a wide range of settings, contexts and jurisdictions. Future research is needed to link these strategies to quantifiable process and outcome measures, and to test their impact in diverse PHC settings. PMID:23061433

A framework for m-health service development and success evaluation.

PubMed

Sadegh, S Saeedeh; Khakshour Saadat, Parisa; Sepehri, Mohammad Mehdi; Assadi, Vahid

2018-04-01

The emergence of mobile technology has influenced many service industries including health care. Mobile health (m-Health) applications have been used widely, and many services have been developed that have changed delivery systems and have improved effectiveness of health care services. Stakeholders of m-Health services have various resources and rights that lends to a complexity in service delivery. In addition, abundance of different m-Health services makes it difficult to choose an appropriate service for these stakeholders that include customers, patients, users or even providers. Moreover, a comprehensive framework is not yet provided in the literature that would help manage and evaluate m-health services, considering various stakeholder's benefits. In this paper, a comprehensive literature review has been done on famous frameworks and models in the field of Information Technology and electronic health with the aim of finding different aspects of developing and managing m-health services. Using the results of literature review and conducting a stakeholder analysis, we have proposed an m-health evaluation framework which evaluates the success of a given m-health service through a three-stage life cycle: (1) Service Requirement Analysis, (2) Service Development, and (3) Service Delivery. Key factors of m-health evaluation in each step are introduced in the proposed framework considering m-health key stakeholder's benefits. The proposed framework is validated via expert interviews, and key factors in each evaluation step is validated using PLS model. Results show that path coefficients are higher than their threshold which supports the validity of proposed framework. Copyright © 2018 Elsevier B.V. All rights reserved.

Using and joining a franchised private sector provider network in Myanmar.

PubMed

O'Connell, Kathryn; Hom, Mo; Aung, Tin; Theuss, Marc; Huntington, Dale

2011-01-01

Quality is central to understanding provider motivations to join and remain within a social franchising network. Quality also appears as a key issue from the client's perspective, and may influence why a client chooses to use a franchised provider over another type of provider. The dynamic relationships between providers of social franchising clinics and clients who use these services have not been thoroughly investigated in the context of Myanmar, which has an established social franchising network. This study examines client motivations to use a Sun Quality Health network provider and provider motivations to join and remain in the Sun Quality Health network. Taken together, these two aims provide an opportunity to explore the symbiotic relationship between client satisfaction and provider incentives to increase the utilization of reproductive health care services. Results from a series of focus group discussions with clients of reproductive health services and franchised providers shows that women chose health services provided by franchised private sector general practitioners because of its perceived higher quality, associated with the availability of effective, affordable, drugs. A key finding of the study is associated with providers. Provider focus group discussions indicate that a principle determinate for joining and remaining in the Sun Quality Health Network was serving the poor.

Using and Joining a Franchised Private Sector Provider Network in Myanmar

PubMed Central

O'Connell, Kathryn; Hom, Mo; Aung, Tin; Theuss, Marc; Huntington, Dale

2011-01-01

Background Quality is central to understanding provider motivations to join and remain within a social franchising network. Quality also appears as a key issue from the client's perspective, and may influence why a client chooses to use a franchised provider over another type of provider. The dynamic relationships between providers of social franchising clinics and clients who use these services have not been thoroughly investigated in the context of Myanmar, which has an established social franchising network. This study examines client motivations to use a Sun Quality Health network provider and provider motivations to join and remain in the Sun Quality Health network. Taken together, these two aims provide an opportunity to explore the symbiotic relationship between client satisfaction and provider incentives to increase the utilization of reproductive health care services. Methods and Findings Results from a series of focus group discussions with clients of reproductive health services and franchised providers shows that women chose health services provided by franchised private sector general practitioners because of its perceived higher quality, associated with the availability of effective, affordable, drugs. A key finding of the study is associated with providers. Provider focus group discussions indicate that a principle determinate for joining and remaining in the Sun Quality Health Network was serving the poor. PMID:22180781

Rationing is a reality in rural physiotherapy: a qualitative exploration of service level decision-making.

PubMed

Adams, Robyn; Jones, Anne; Lefmann, Sophie; Sheppard, Lorraine

2015-03-27

Deciding what health services are provided is a key consideration in delivering appropriate and accessible health care for rural and remote populations. Despite residents of rural communities experiencing poorer health outcomes and exhibiting higher health need, workforce shortages and maldistribution mean that rural communities do not have access to the range of services available in metropolitan centres. Where demand exceeds available resources, decisions about resource allocation are required. A qualitative approach enabled the researchers to explore participant perspectives about decisions informing rural physiotherapy service provision. Stakeholder perspectives were obtained through surveys and in-depth interviews. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of rural, regional and remote communities. Thirty-nine surveys were received from participants in eleven communities. Nineteen in-depth interviews were conducted with physiotherapist and key decision-makers. Increasing demand, organisational priorities, fiscal austerity measures and workforce challenges were identified as factors influencing both decision-making and service provision. Rationing of physiotherapy services was common to all sites of this study. Rationing of services, more commonly expressed as service prioritisation, was more evident in responses of public sector physiotherapy participants compared to private physiotherapists. However, private physiotherapists in rural areas reported capacity limits, including expertise, space and affordability that constrained service provision. The imbalance between increasing service demands and limited physiotherapy capacity meant making choices was inevitable. Decreased community access to local physiotherapy services and increased workforce stress, a key determinant of retention, are two results of such choices or decisions. Decreased access was particularly evident for adults and children requiring neurological rehabilitation and for people requiring post-acute physiotherapy. It should not be presumed that rural private physiotherapy providers will cover service gaps that may emerge from changes to public sector service provision. Clinician preference combines with capacity limits and the imperative of financial viability to negate such assumptions. This study provides insight into rural physiotherapy service provision not usually evident and can be used to inform health service planning and decision-making and education of current and future rural physiotherapists.

The Power of Service-Learning.

ERIC Educational Resources Information Center

McCarthy, Mary H.; Corbin, Linda

2003-01-01

Describes key elements of service learning: response to the community, student-led decision-making, analytical reflection. Includes a case study of service learning in the Hudson, Massachusetts, Public School District, the main goal of which is to provide students with opportunities to learn the core values of empathy, ethics, and service. (PKP)

Provider Perspectives on School-Based Mental Health for Urban Minority Youth: Access and Services

ERIC Educational Resources Information Center

Gamble, Brandon E.; Lambros, Katina M.

2014-01-01

This article provides results from a qualitative study on the efforts of school-based mental health providers (SBMHPs) who serve students in urban, suburban, and ethnically diverse settings to help families access quality mental health services. School-based mental health plays a key role in the provision of direct and indirect intervention…

Early Infant Male Circumcision in Cameroon and Senegal: Demand, Service Provision, and Cultural Context.

PubMed

Kenu, Ernest; Sint, Tin Tin; Kamenga, Claude; Ekpini, Rene

2016-07-01

Male circumcision is almost universal in North and West Africa, and practiced for various reasons. Yet there is little documentation on service delivery, clinical procedures, policies, and programmatic strategies. The United Nations Children's Fund (UNICEF) commissioned country program reviews in 2014 to shed light on the delivery of male circumcision services for infants in Cameroon and Senegal. We conducted a policy desk review, key informant interviews, and focus group discussions at health centers and in communities. Between December 2014 and January 2015, we conducted 21 key informant interviews (13 with regional and district officers, 5 with national officers, and 3 with UNICEF officials) and 36 focus group discussions (6 with men, 6 with women, 12 with adolescent boys, and 12 with service providers). Some of the men and women were parents of the adolescents who participated in the focus group discussions. In the French-speaking areas, the focus group discussions were conducted in French through an accredited translator, audio recorded, and transcribed into English. All of the facilities we visited in Cameroon and Senegal offer medical male circumcision, with 10 out of 12 performing early infant male circumcision (EIMC) routinely. Neither country has policies, guidelines, or strategies for EIMC. The procedure is done mainly by untrained service providers, with some providers using modern circumcision devices. There are no key messages on EIMC for families; the increasing demand for EIMC is led by the community. Despite the absence of national policies and strategies, EIMC is routinely offered at all levels of the health care system in Cameroon and Senegal, mainly by untrained service providers. Improving circumcision services will require guidelines for EIMC and improvements in training, equipment, supply chains, recordkeeping, and demand creation. © Kenu et al.

Successful collaboration between occupational health service providers and client companies: Key factors.

PubMed

Schmidt, Lisa; Sjöström, John; Antonsson, Ann-Beth

2015-06-05

Occupational health services (OHS) are often described as an important resource to reduce work-related diseases and improve the workplace. This paper identifies key factors for successful collaboration between Swedish OHS providers and their client companies. Interviews were carried out with representatives of 15 companies and their OHS providers. The interviews were transcribed and their content analyzed. The results revealed that successful collaboration was highly correlated with six factors. First, the collaboration depends on both parties; ``it takes two to tango''. Second, the company and the OHS provider have a joint commitment to a long-term collaboration. Third, the collaboration is built on frequent contact at different organizational levels. Fourth, the company has a well-structured work environment for occupational health and safety management. Fifth, the OHS provider uses a consultative approach in its prevention and promotion activities. Finally, OHS providers seek to treat the company, not the individual. Our research indicates that a successful collaboration requires both occupational health and safety management (OHSM) within the company and the assistance of a competent OHS provider. A change toward more promotion and prevention services benefits the company, since the occupational health services are better tailored to the company's needs.

Key components of a service model providing early childhood support for women attending opioid treatment clinics: an Australian state health service review.

PubMed

Harvey, Susan R; Schmied, Virginia; Nicholls, Daniel; Dahlen, Hannah

2012-09-01

To report the findings of a service review--specifically the strategy to provide early childhood services 'on site' at opioid treatment clinics to address access difficulties. Child and family health nurses are skilled in the assessment and support of families during early childhood. However, women with a history of substance abuse are often cautious when engaging with universal and other health services, with the result that the infant may miss recommended developmental screening and early referral to improve health outcomes. In 2006, an internal review was undertaken of the integration of early childhood and parenting services at opioid treatment clinics in a large Area Health Service of New South Wales, Australia. A qualitative study design, using semi-structured interview questions was used. Data were collected via six focus groups (4-15 participants in each group) and individual interview of child and family health nurses, nurse unit managers and clinical staff (n=58). Three key components of a model for providing early childhood support in collaboration with opioid treatment services were identified. First, the importance of building a trusting relationship between the woman and the child and family health nurses, second, maintaining continuity of care and a multidisciplinary/multiagency approach, and finally the importance of staff education, support and professional development. The provision of early childhood and parenting services on site, as part of a multidisciplinary 'one stop shop' approach to service delivery was a clear recommendation of the review. Reduction of access difficulties to specialised early childhood support is of benefit to clients, community health services attempting to provide a service to this difficult to reach population and to drug and alcohol services seeking to provide a high level of holistic care for clients. © 2012 Blackwell Publishing Ltd.

Family-Centered Early Intervention with Infants & Toddlers: Innovative Cross-Disciplinary Approaches.

ERIC Educational Resources Information Center

Brown, Wesley, Ed.; And Others

This multi-contributor volume addresses the challenges of providing early intervention services to infants and toddlers with disabilities, within a family-centered framework. The book provides a legislative review of the key elements of eligibility, assessment, and evaluation and then examines service coordination, curricula, special intervention…

Developer Network

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

2012-08-21

NREL's Developer Network, developer.nrel.gov, provides data that users can access to provide data to their own analyses, mobile and web applications. Developers can retrieve the data through a Web services API (application programming interface). The Developer Network handles overhead of serving up web services such as key management, authentication, analytics, reporting, documentation standards, and throttling in a common architecture, while allowing web services and APIs to be maintained and managed independently.

Children admitted to hospital following unintentional injury: perspectives of health service providers in Aotearoa/New Zealand

PubMed Central

2010-01-01

Background Unintentional injuries are the leading cause of death and hospitalisation among New Zealand children, with indigenous Māori and ethnic minority Pacific children significantly over represented in these statistics. International research has shown that many children hospitalised for injury, as well as their families experience high levels of stress, and ethnic disparities in the quality of trauma care are not uncommon. The research on which this paper is based sought to identify key issues and concerns for New Zealand's multi-ethnic community following hospitalisation for childhood injury in order to inform efforts to improve the quality of trauma services. This paper reports on service providers' perspectives complementing previously published research on the experiences of families of injured children. Methods A qualitative research design involving eleven in-depth individual interviews and three focus groups was used to elicit the views of 21 purposefully selected service provider key informants from a range of professional backgrounds involved in the care and support of injured children and their families in Auckland, New Zealand. Interviews were transcribed and data were analysed using thematic analysis. Results Key issues identified by service providers included limited ability to meet the needs of children with mild injuries, particularly their emotional needs; lack of psychological support for families; some issues related to Māori and Pacific family support services; lack of accessible and comprehensive information for children and families; poor staff continuity and coordination; and poor coordination of hospital and community services, including inadequacies in follow-up plans. There was considerable agreement between these issues and those identified by the participant families. Conclusions The identified issues and barriers indicate the need for interventions for service improvement at systemic, provider and patient levels. Of particular relevance are strategies that enable families to have better access to information, including culturally appropriate oral and written sources; improve communication amongst staff and between staff and families; and carefully developed discharge plans that provide care continuity across boundaries between hospital and community settings. Māori and Pacific family support services are important and need better resourcing and support from an organisational culture responsive to the needs of these populations. PMID:21138584

Children admitted to hospital following unintentional injury: perspectives of health service providers in Aotearoa/New Zealand.

PubMed

Ameratunga, Shanthi; Abel, Sally; Tin Tin, Sandar; Asiasiga, Lanuola; Milne, Sharon; Crengle, Sue

2010-12-07

Unintentional injuries are the leading cause of death and hospitalisation among New Zealand children, with indigenous Māori and ethnic minority Pacific children significantly over represented in these statistics. International research has shown that many children hospitalised for injury, as well as their families experience high levels of stress, and ethnic disparities in the quality of trauma care are not uncommon. The research on which this paper is based sought to identify key issues and concerns for New Zealand's multi-ethnic community following hospitalisation for childhood injury in order to inform efforts to improve the quality of trauma services. This paper reports on service providers' perspectives complementing previously published research on the experiences of families of injured children. A qualitative research design involving eleven in-depth individual interviews and three focus groups was used to elicit the views of 21 purposefully selected service provider key informants from a range of professional backgrounds involved in the care and support of injured children and their families in Auckland, New Zealand. Interviews were transcribed and data were analysed using thematic analysis. Key issues identified by service providers included limited ability to meet the needs of children with mild injuries, particularly their emotional needs; lack of psychological support for families; some issues related to Māori and Pacific family support services; lack of accessible and comprehensive information for children and families; poor staff continuity and coordination; and poor coordination of hospital and community services, including inadequacies in follow-up plans. There was considerable agreement between these issues and those identified by the participant families. The identified issues and barriers indicate the need for interventions for service improvement at systemic, provider and patient levels. Of particular relevance are strategies that enable families to have better access to information, including culturally appropriate oral and written sources; improve communication amongst staff and between staff and families; and carefully developed discharge plans that provide care continuity across boundaries between hospital and community settings. Māori and Pacific family support services are important and need better resourcing and support from an organisational culture responsive to the needs of these populations.

Managed Behavioral Health Care: An Instrument to Characterize Critical Elements of Public Sector Programs

PubMed Central

Ridgely, M Susan; Giard, Julienne; Shern, David; Mulkern, Virginia; Burnam, M Audrey

2002-01-01

Objective To develop an instrument to characterize public sector managed behavioral health care arrangements to capture key differences between managed and “unmanaged” care and among managed care arrangements. Study Design The instrument was developed by a multi-institutional group of collaborators with participation of an expert panel. Included are six domains predicted to have an impact on access, service utilization, costs, and quality. The domains are: characteristics of the managed care plan, enrolled population, benefit design, payment and risk arrangements, composition of provider networks, and accountability. Data are collected at three levels: managed care organization, subcontractor, and network of service providers. Data Collection Methods Data are collected through contract abstraction and key informant interviews. A multilevel coding scheme is used to organize the data into a matrix along key domains, which is then reviewed and verified by the key informants. Principal Findings This instrument can usefully differentiate between and among Medicaid fee-for-service programs and Medicaid managed care plans along key domains of interest. Beyond documenting basic features of the plans and providing contextual information, these data will support the refinement and testing of hypotheses about the impact of public sector managed care on access, quality, costs, and outcomes of care. Conclusions If managed behavioral health care research is to advance beyond simple case study comparisons, a well-conceptualized set of instruments is necessary. PMID:12236386

The EnviroAtlas ‐ Developing a National Approach to Quantify and Map Metrics within an Ecosystem Services Framework. Subfocus: Multi‐scale Biodiversity Conservation Metrics

EPA Science Inventory

Ecosystem services, i.e., "services provided to humans from natural systems," have become a key issue of this century in resource management, conservation planning, human well-being, and environmental decision analysis. Mapping and quantifying ecosystem services have become stra...

NETWORK. A History of the Scottish Telephone Referral Service.

ERIC Educational Resources Information Center

Smith, Vernon

Since its beginnings in 1974 as an outgrowth of the BBC Adult Literacy project, NETWORK SCOTLAND LTD (formerly the Scottish Telephone Referral Service) has grown to play a key role in the provision of broadcast support and educational information services in the United Kingdom. The referral service was originally established to provide a mechanism…

Reflecting on Reflection as a Critical Component in Service Learning

ERIC Educational Resources Information Center

Bloomquist, Catherine

2015-01-01

Despite the popularity of service learning, it is sometimes criticized for its lack of academic rigor. This piece provides a counterpoint to that argument by describing a LIS service-learning course from the student's perspective. I focus particularly on the role of reflection, a key component in service-learning courses that helps to…

Assessing Service Delivery Systems for Assitive Technology in Brazil using HEART Study quality indicators.

PubMed

Maximo, Tulio; Clift, Laurence

2015-01-01

recently in Brazil, there have been investments and improvements in the service delivery system for assistive technology provision. However, there is little documentation of this process, or evidence that users are being involved appropriately. to understand how a ssistive technology service provision currently functions in Belo Horizonte city, Brazil, in order to provide context-specific interventions and recommendations to improve services. Qualitative research design, including visits to key institutions and semi-structured interviews with key stakeholders. Interview questions were divided with two purposes: 1) Exploratory, aiming to understand present service functioning; 2) Evaluative, aiming to assess staff difficulties in applying best existing best practices. Assistive Technology services in Belo Horizonte fall under the 'medical model' definition of service delivery developed by AAATE. It was also found that staff lack training and knowledge support to assess user requirements and involve them during the decision process. Additionally, there is no follow up stage after the device is delivered. The study clearly defines the service provision function and the staff difficulties at Belo Horizonte city, providing information for further studies.

A National Approach for Mapping and Quantifying Habitat-based Biodiversity Metrics Across Multiple Spatial Scales

EPA Science Inventory

Ecosystem services, i.e., "services provided to humans from natural systems," have become a key issue of this century in resource management, conservation planning, and environmental decision analysis. Mapping and quantifying ecosystem services have become strategic national inte...

Efficiency and factors influencing efficiency of Community Health Strategy in providing Maternal and Child Health services in Mwingi District, Kenya: an expert opinion perspective

PubMed Central

Nzioki, Japheth Mativo; Onyango, Rosebella Ogutu; Ombaka, James Herbert

2015-01-01

Introduction Community Health Strategy (CHS) is a new Primary Health Care (PHC) model in Kenya, designed to provide PHC services in Kenya. In 2011, CHS was initiated in Mwingi district as one of the components of APHIA plus kamili program. The objectives of this study was to evaluate the efficiency of the CHS in providing MCH services in Mwingi district and to establish the factors influencing efficiency of the CHS in providing MCH services in the district. Methods This was a qualitative study. Fifteen Key informants were sampled from key stakeholders. Sampling was done using purposive and maximum variation sampling methods. Semi-structured in-depth interviews were used for data collection. Data was managed and analyzed using NVIVO. Framework analysis and quasi statistics were used in data analysis. Results Expert opinion data indicated that the CHS was efficient in providing MCH services. Factors influencing efficiency of the CHS in provision of MCH services were: challenges facing Community Health Workers (CHWs), Social cultural and economic factors influencing MCH in the district, and motivation among CHWs. Conclusion Though CHS was found to be efficient in providing MCH services, this was an expert opinion perspective, a quantitative Cost Effectiveness Analysis (CEA) to confirm these findings is recommended. To improve efficiency of the CHS in the district, challenges facing CHWs and Social cultural and economic factors that influence efficiency of the CHS in the district need to be addressed. PMID:26090046

Best practice in smoking cessation services for pregnant women: results of a survey of three services reporting the highest national returns, and three beacon services.

PubMed

Lee, Michelle; Hajek, Peter; McRobbie, Hayden; Owen, Lesley

2006-09-01

The NHS allocated dedicated funds to establish specialist smoking cessation services for pregnant smokers in England in 2000. An early survey revealed some uncertainty as to how the new services should work and monitor their outcome. The current survey focused on identifying examples of good practice in this difficult new field. Three services with the highest number of successful four-week quitters reported for the 2003/4 monitoring year were identified from Department of Health (DH) monitoring records, and three services were nominated from those known in the field as examples of best practice. There was no overlap between the two groups. All six services provided in-depth interviews. All three highest ranking services that reported close to 100 per cent success rates included unaided quitters identified from hospital wards, rather then smokers actually treated. They had only minimal or average genuine treatment provision for pregnant smokers in place. The three beacon services far exceeded the national throughput and outcome average identified in the previous survey, and provided a wealth of useful information. Although they differed in staffing levels and other aspects of their activities, they all shared several key elements, including a systematic training of midwives in how to refer pregnant smokers, offering nicotine replacement treatment to almost all clients and having an efficient system of providing the prescriptions, offering flexible home visits, and providing intensive multi-session treatment delivered by a small number of dedicated staff. Smoking cessation services for pregnant women may need clearer guidance on what they are expected to provide, and how they should monitor their outcome. The key features of the beacon services can serve as a practical model of current best practice applicable across most PCTs.

Biogeochemical cycles and biodiversity as key drivers of ecosystem services provided by soils

NASA Astrophysics Data System (ADS)

Smith, P.; Cotrufo, M. F.; Rumpel, C.; Paustian, K.; Kuikman, P. J.; Elliott, J. A.; McDowell, R.; Griffiths, R. I.; Asakawa, S.; Bustamante, M.; House, J. I.; Sobocká, J.; Harper, R.; Pan, G.; West, P. C.; Gerber, J. S.; Clark, J. M.; Adhya, T.; Scholes, R. J.; Scholes, M. C.

2015-11-01

Soils play a pivotal role in major global biogeochemical cycles (carbon, nutrient, and water), while hosting the largest diversity of organisms on land. Because of this, soils deliver fundamental ecosystem services, and management to change a soil process in support of one ecosystem service can either provide co-benefits to other services or result in trade-offs. In this critical review, we report the state-of-the-art understanding concerning the biogeochemical cycles and biodiversity in soil, and relate these to the provisioning, regulating, supporting, and cultural ecosystem services which they underpin. We then outline key knowledge gaps and research challenges, before providing recommendations for management activities to support the continued delivery of ecosystem services from soils. We conclude that, although soils are complex, there are still knowledge gaps, and fundamental research is still needed to better understand the relationships between different facets of soils and the array of ecosystem services they underpin, enough is known to implement best practices now. There is a tendency among soil scientists to dwell on the complexity and knowledge gaps rather than to focus on what we do know and how this knowledge can be put to use to improve the delivery of ecosystem services. A significant challenge is to find effective ways to share knowledge with soil managers and policy makers so that best management can be implemented. A key element of this knowledge exchange must be to raise awareness of the ecosystems services underpinned by soils and thus the natural capital they provide. We know enough to start moving in the right direction while we conduct research to fill in our knowledge gaps. The lasting legacy of the International Year of Soils in 2015 should be for soil scientists to work together with policy makers and land managers to put soils at the centre of environmental policy making and land management decisions.

How To Work with Small Businesses: Advice and Guidance for Providers of Training and Business Support.

ERIC Educational Resources Information Center

Allen, Anne Marie, Ed.

This publication provides guidance on good practice to help training providers in the United Kingdom improve the quality and relevance of services to small and medium-sized enterprises (SMEs). Section 1 focuses on key research findings regarding SMEs' needs and SME-college collaboration, including trading conditions for SMEs; services on offer by…

Key stakeholders' experiences of respite services for people with dementia and their perspectives on respite service development: a qualitative systematic review.

PubMed

Shea, Emma O'; Timmons, Suzanne; Shea, Eamon O'; Fox, Siobhan; Irving, Kate

2017-12-07

Respite services provide a break in the caregiving relationship for people with dementia and their carers, however they are often under-used and service acceptability can be low. This study aims to understand key stakeholders' experiences of respite services for people with dementia, with a view to informing respite service development. A systematic search was conducted of the Pubmed/MedLine, Embase, Cinahl, PsychInfo, Scopus, Web of Science, and Cochrane databases (1980-2016, English) with fixed search terms relating to 'respite' and 'dementia', following PRISMA guidelines. Noblit and Hare's approach to meta-ethnography was employed. Key concepts were identified across the papers and reciprocal and refutational translation techniques were applied to primary studies; findings were synthesized into third order interpretations and finally, a 'line-of-argument' was developed. In total 23 papers were reviewed, which described 20 independent samples across 12 countries. The views of 889 participants were synthesized (13 people with dementia, 690 carers, 44 'service providers', 52 frontline staff, 70 managers, 12 volunteers, six academic/policy-makers, and two independent consultants). Five key concepts were identified and outlined i.e. 1) the transition to service use 2) expanding organizational capacity 3) dementia care quality 4) building a collaborative care partnership and 5) dyad restoration. There was broad agreement around the key areas for service development across the range of stakeholders (flexible and responsive person-centred care, meaningful activity for people with dementia, enhanced client-service communication and informational support). However, there was clear divergence in stakeholder perspectives around the barriers to implementation of such developments. Organizational tension was evident between frontline staff and management in respite services, hindering the cultural change necessary to facilitate service development in line with dyad's needs and preferences. Respite services must surmount internal organizational barriers to change, and cultivate a collaborative solution-focused care culture, which acknowledges the centrality of the dyad and their care preferences. Future research should explore the development of alternative/modified community respite service models, which have greater capacity to be responsive to the needs of each individual dyad. The perspectives of people with dementia must be included in research in this area going forward. PROSPERO Registration Number: CRD42016050191 .

Vacant urban lot soils and their potential to support ecosystem services

EPA Science Inventory

AimsUrban soils are the basis of many ecosystem services in cities. Here, we examine formerly residential vacant lot soils in Cleveland, Ohio and Detroit, Michigan, USA for their potential to provide multiple ecosystem services. We examine two key contrasts: 1) differences betwee...

Is ownership the decisive factor in collaborations between occupational health services and client companies?

PubMed

Schmidt, Lisa; Sjöström, John; Antonsson, Ann-Beth

2017-01-01

Swedish employers are required to use external resources such as Occupational Health Services (OHS providers) if their own knowledge of occupational health and safety is insufficient. Some large employers have their own in-house OHS units but it is more common to engage the services of an external provider. However, no studies have been carried out from a critical perspective regarding how ownership of the OHS provider is related to a successful collaboration with client companies. This study explores the extent to which the six key factors for a successful collaboration are related to ownership and seeks to identify the challenges that the different models of ownership pose. Interviews with 15 client companies and their OHS providers were conducted in order to identify key factors in achieving a successful collaboration with an OHS provider. This study utilizes existing data to identify challenges related to ownership. Two key factors were identified with challenges related to ownership of the OHS provider: The importance of having a long-term perspective when building a relationship; and ensuring that collaboration extends beyond the client's HR Department to the various organisational levels of the company. Whatever form the ownership of an OHS provider may take, each comes with its own specific set of challenges that must be managed in order to achieve a successful collaboration with the client company.

Perceptions of Service Providers and Community Members on Intimate Partner Violence within a Latino Community

ERIC Educational Resources Information Center

Lewis, M. Jane; West, Bernadette; Bautista, Leyna; Greenberg, Alexandra M.; Done-Perez, Iris

2005-01-01

This study examined perceptions regarding intimate partner abuse (IPV) in a largely Latino community in New Jersey through focus groups with Latino community members and key informant interviews with providers of services to this population. Questions examined definitions of partner abuse; perceptions of factors contributing to, or protecting…

Developing Inclusive Schools: A Systemic Approach

ERIC Educational Resources Information Center

Kinsella, William; Senior, Joyce

2008-01-01

This paper emerges from an ongoing study which involved, firstly, key informant interviews with strategic personnel within the Irish education system, such personnel representing both service providers and service users. The first part of this paper provides a brief summary of the findings of that aspect of the study in relation to the key…

School-Based Training and Information for Paraprofessionals: A Handbook for Practicing Paraprofessionals

ERIC Educational Resources Information Center

Santana, Jesse

2016-01-01

School enrollment is expected to increase over the next decade, and with this increase, schools in the United States have seen an increase in the number of paraprofessionals employed to provide services for special education students. Paraprofessionals are key to providing services and assistance to students with special needs toward their…

PEM public key certificate cache server

NASA Astrophysics Data System (ADS)

Cheung, T.

1993-12-01

Privacy Enhanced Mail (PEM) provides privacy enhancement services to users of Internet electronic mail. Confidentiality, authentication, message integrity, and non-repudiation of origin are provided by applying cryptographic measures to messages transferred between end systems by the Message Transfer System. PEM supports both symmetric and asymmetric key distribution. However, the prevalent implementation uses a public key certificate-based strategy, modeled after the X.509 directory authentication framework. This scheme provides an infrastructure compatible with X.509. According to RFC 1422, public key certificates can be stored in directory servers, transmitted via non-secure message exchanges, or distributed via other means. Directory services provide a specialized distributed database for OSI applications. The directory contains information about objects and then provides structured mechanisms for accessing that information. Since directory services are not widely available now, a good approach is to manage certificates in a centralized certificate server. This document describes the detailed design of a centralized certificate cache serve. This server manages a cache of certificates and a cache of Certificate Revocation Lists (CRL's) for PEM applications. PEMapplications contact the server to obtain/store certificates and CRL's. The server software is programmed in C and ELROS. To use this server, ISODE has to be configured and installed properly. The ISODE library 'libisode.a' has to be linked together with this library because ELROS uses the transport layer functions provided by 'libisode.a.' The X.500 DAP library that is included with the ELROS distribution has to be linked in also, since the server uses the DAP library functions to communicate with directory servers.

Bibliotherapy for mental health service users Part 2: a survey of psychiatric libraries in the UK.

PubMed

Fanner, Deborah; Urqhuart, Christine

2009-06-01

UK health policy advocates a patient-centred approach to patient care. Library services could serve the rehabilitation needs of mental health service users through bibliotherapy (the use of written, audio or e-learning materials to provide therapeutic support). Part 2 of this two-part paper assesses the views of psychiatric libraries in the UK on providing access to service users and possible services provided. An e-mail questionnaire survey of psychiatric library members of the psychiatric lending co-operative scheme (n = 100) obtained a response rate of 55%, mostly from libraries based in hospitals. At present, libraries funded by the health service provide minimal facilities for service users. Librarians are uncertain about the benefits and practicalities of providing access to service users. In order to implement change, information providers across the National Health Service (NHS) will need to work collaboratively to overcome attitudinal and institutional barriers, including the key issue of funding.

What factors influence physiotherapy service provision in rural communities? A pilot study.

PubMed

Adams, Robyn; Sheppard, Lorraine; Jones, Anne; Lefmann, Sophie

2014-06-01

To obtain stakeholder perspectives on factors influencing rural physiotherapy service provision and insights into decision making about service provision. Purposive sampling, open-ended survey questions and semi-structured interviews were used in this exploratory, qualitative study. A rural centre and its regional referral centre formed the pilot sites. Nine participant perspectives were obtained on rural physiotherapy services. Stakeholder perspectives on factors influencing rural physiotherapy service provision and service level decision making. Workforce capacity and capability, decision maker's knowledge of the role and scope of physiotherapy, consideration of physiotherapy within resource allocation decisions and proof of practice emerged as key issues. The latter three were particularly reflected in public sector participant comments. Business models and market size were identified factors in influencing private practice. Influencing factors described by participants both align and extend our understanding of issues described in the rural physiotherapy literature. Participant insights add depth and meaning to quantitative data by revealing impacts on local service provision. Available funding and facility priorities were key determinants of public sector physiotherapy service provision, with market size and business model appearing more influential in private practice. The level of self direction or choice about which services to provide, emerged as a point of difference between public and private providers. Decisions by public sector physiotherapists about service provision appear constrained by existing capacity and workload. Further research into service level decision making might provide valuable insights into rural health service delivery. © 2014 National Rural Health Alliance Inc.

Education Technology Services at Indiana University: A Case Study.

ERIC Educational Resources Information Center

Bichelmeyer, B. A.; Hara, Noriko; Yi, Jessi; Dennen, Vanessa; Avers, Dale; Tzeng, Jeng-Yi

1998-01-01

This paper, based on a qualitative research study, describes the technology resources available in the Indiana University School of Education, explains the range of services provided by Education Technology Services (ETS), documents the organizational structure of ETS, and describes the key processes and culture of ETS. (Author/AEF)

Refocusing and Evolving Subseasonal-to-Seasonal Services in NOAA's National Weather Service

NASA Astrophysics Data System (ADS)

Timofeyeva-Livezey, M. M.; Horsfall, F. M. C.; Silva, V.; Mangan, M. R.; Meyers, J. C.; Zdrojewski, J.

2017-12-01

NOAA's National Weather Service (NWS) recently completed a reorganization to better support its goal to build a Weather-Ready Nation. As part of the reorganization, NWS streamlined its 11 national service programs, including climate services, to provide a more structured approach to supporting service delivery needs. As the American public increasingly requests information at sub-seasonal and seasonal time scales for decision making, the NWS Climate Services Program is striving to meet those needs by accelerating transition of research to operations, improving delivery of products and services, and enhancing partnerships to facilitate provision of seamless weather, water, and climate products and services at regional and local scales. Additionally, NWS forecasters are requesting more tools to be able to put severe weather and water events into a climate context to provide more effective impact-based decision support services (IDSS). This paper will describe the activities to more effectively integrate climate services into the NWS suite of environmental information, the roles of the NWS offices supporting or delivering sub-seasonal and seasonal information to the US public, and engaging NWS core and deep-core partners in provision of information on climatological risks and preparedness as a part of IDSS. We will discuss the process by which we collect user requests and/or needs and the NWS process that allows us to move these requests and needs through a formal requirements validation process and thus place the requirement on a path to identify a potential solution for implementation. The validation of a NWS climate-related requirement is also key to identify research, development, and transition mission delivery needs that are supported through the Office of Oceanic and Atmospheric Research (OAR) Climate Program Office (CPO). In addition, we will present the outcomes of key actions of the first ever NWS National Climate Services Meeting (NCSM) that was held in May 2016 with the participation of more than 250 NWS climate services staff and key partners from across the country. The key actions include understanding core and deep-core partners, advancing training for NWS staff focused on IDSS, and better organization of service delivery at regional and local levels.

The Senior Executive Service

NASA Technical Reports Server (NTRS)

1992-01-01

A major innovation of the Civil Service Reform Act of 1978 was the creation of a Senior Executive Service (SES). The purpose of the SES is both simple and bold: to attract executives of the highest quality into Federal service and to retain them by providing outstanding opportunities for career growth and reward. The SES is intended to: provide greater authority in managing executive resources; attract and retain highly competent executives, and assign them where they will effectively accomplish their missions and best use their talents; provide for systematic development of executives; hold executives accountable for individual and organizational performance; reward outstanding performers and remove poor performers; and provide for an executive merit system free of inappropriate personnel practices and arbitrary actions. This Handbook summarizes the key features of the SES at NASA. It is intended as a special welcome to new appointees and also as a general reference document. It contains an overview of SES management at NASA, including the Executive Resources Board and the Performance Review Board, which are mandated by law to carry out key SES functions. In addition, assistance is provided by a Senior Executive Committee in certain reviews and decisions and by Executive Position Managers in day-to-day administration and oversight.

A comprehensive health service evaluation and monitoring framework.

PubMed

Reeve, Carole; Humphreys, John; Wakerman, John

2015-12-01

To develop a framework for evaluating and monitoring a primary health care service, integrating hospital and community services. A targeted literature review of primary health service evaluation frameworks was performed to inform the development of the framework specifically for remote communities. Key principles underlying primary health care evaluation were determined and sentinel indicators developed to operationalise the evaluation framework. This framework was then validated with key stakeholders. The framework includes Donabedian's three seminal domains of structure, process and outcomes to determine health service performance. These in turn are dependent on sustainability, quality of patient care and the determinants of health to provide a comprehensive health service evaluation framework. The principles underpinning primary health service evaluation were pertinent to health services in remote contexts. Sentinel indicators were developed to fit the demographic characteristics and health needs of the population. Consultation with key stakeholders confirmed that the evaluation framework was applicable. Data collected routinely by health services can be used to operationalise the proposed health service evaluation framework. Use of an evaluation framework which links policy and health service performance to health outcomes will assist health services to improve performance as part of a continuous quality improvement cycle. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Assessing early implementation of state autism insurance mandates.

PubMed

Baller, Julia Berlin; Barry, Colleen L; Shea, Kathleen; Walker, Megan M; Ouellette, Rachel; Mandell, David S

2016-10-01

In the United States, health insurance coverage for autism spectrum disorder treatments has been historically limited. In response, as of 2015, 40 states and Washington, DC, have passed state autism insurance mandates requiring many health plans in the private insurance market to cover autism diagnostic and treatment services. This study examined five states' experiences implementing autism insurance mandates. Semi-structured, key-informant interviews were conducted with 17 participants representing consumer advocacy organizations, provider organizations, and health insurance companies. Overall, participants thought that the mandates substantially affected the delivery of autism services. While access to autism treatment services has increased as a result of implementation of state mandates, states have struggled to keep up with the demand for services. Participants provided specific information about barriers and facilitators to meeting this demand. Understanding of key informants' perceptions about states' experiences implementing autism insurance mandates is useful for other states considering adopting or expanding mandates or other policies to expand access to autism treatment services. © The Author(s) 2015.

Leveraging the real value of laboratory medicine with the value proposition.

PubMed

Price, Christopher P; John, Andrew St; Christenson, Robert; Scharnhorst, Volker; Oellerich, Michael; Jones, Patricia; Morris, Howard A

2016-11-01

Improving quality and patient safety, containing costs and delivering value-for-money are the key drivers of change in the delivery of healthcare and have stimulated a shift from an activity-based service to a service based on patient-outcomes. The delivery of an outcomes-based healthcare agenda requires that the real value of laboratory medicine to all stakeholders be understood, effectively defined and communicated. The value proposition of any product or service is the link between the provider and the needs of the customer describing the utility of the product or service in terms of benefit to the customer. The framework of a value proposition for laboratory medicine provides the core business case that drives key activities in the evolution and maintenance of high quality healthcare from research through to adoption and quality improvement in an established service. The framework of a value proposition for laboratory medicine is described. The content is endorsed by IFCC and WASPaLM. Copyright © 2016 Elsevier B.V. All rights reserved.

Upholding the human right of children in New Zealand experiencing communication difficulties to voice their needs and dreams.

PubMed

Doell, Elizabeth; Clendon, Sally

2018-02-01

New Zealand Ministry of Education's proposal for an updated service to support children experiencing communication difficulties provides an opportunity to consider the essential criteria required for children to express their opinion, information and ideas as outlined under Article 19 of the Universal Declaration of Human Rights. This commentary begins with a summary of key policies that provide strategic direction for enhancing children's rights to be actively involved in the development of services designed to support them and to communicate and participate in inclusive environments. The authors use a human rights lens to inform the development of speech-language pathology services that facilitate individuals' contribution and engagement and are responsive to their needs. A review of international literature describing the lived experience of children and young people identifies key factors related to accessible information, service coordination, holistic practice, and partnerships that facilitate co-constructed understanding and decision-making. The commentary concludes with suggested recommendations for structuring services, establishing partnership models, and capability building.

Assessment of health facility capacity to provide newborn care in Bangladesh, Haiti, Malawi, Senegal, and Tanzania

PubMed Central

Winter, Rebecca; Yourkavitch, Jennifer; Wang, Wenjuan; Mallick, Lindsay

2017-01-01

Background Despite the importance of health facility capacity to provide comprehensive care, the most widely used indicators for global monitoring of maternal and child health remain contact measures which assess women’s use of services only and not the capacity of health facilities to provide those services; there is a gap in monitoring health facilities’ capacity to provide newborn care services in low and middle income countries. Methods In this study we demonstrate a measurable framework for assessing health facility capacity to provide newborn care using open access, nationally–representative Service Provision Assessment (SPA) data from the Demographic Health Surveys Program. In particular, we examine whether key newborn–related services are available at the facility (ie, service availability, measured by the availability of basic emergency obstetric care (BEmOC) signal functions, newborn signal functions, and routine perinatal services), and whether the facility has the equipment, medications, training and knowledge necessary to provide those services (ie, service readiness, measured by general facility requirements, equipment, medicines and commodities, and guidelines and staffing) in five countries with high levels of neonatal mortality and recent SPA data: Bangladesh, Haiti, Malawi, Senegal, and Tanzania. Findings In each country, we find that key services and commodities needed for comprehensive delivery and newborn care are missing from a large percentage of facilities with delivery services. Of three domains of service availability examined, scores for routine care availability are highest, while scores for newborn signal function availability are lowest. Of four domains of service readiness examined, scores for general requirements and equipment are highest, while scores for guidelines and staffing are lowest. Conclusions Both service availability and readiness tend to be highest in hospitals and facilities in urban areas, pointing to substantial equity gaps in the availability of essential newborn care services for rural areas and for people accessing lower–level facilities. Together, the low levels of both service availability and readiness across the five countries reinforce the vital importance of monitoring health facility capacity to provide care. In order to save newborn lives and improve equity in child survival, not only does women’s use of services need to increase, but facility capacity to provide those services must also be enhanced. PMID:29423186

23 CFR 450.316 - Interested parties, participation, and consultation.

Code of Federal Regulations, 2013 CFR

2013-04-01

... public transportation employees, freight shippers, providers of freight transportation services, private... at key decision points, including but not limited to a reasonable opportunity to comment on the... extent practicable, develop a documented process(es) that outlines roles, responsibilities, and key...

23 CFR 450.316 - Interested parties, participation, and consultation.

Code of Federal Regulations, 2012 CFR

2012-04-01

... public transportation employees, freight shippers, providers of freight transportation services, private... at key decision points, including but not limited to a reasonable opportunity to comment on the... extent practicable, develop a documented process(es) that outlines roles, responsibilities, and key...

23 CFR 450.316 - Interested parties, participation, and consultation.

Code of Federal Regulations, 2014 CFR

2014-04-01

... public transportation employees, freight shippers, providers of freight transportation services, private... at key decision points, including but not limited to a reasonable opportunity to comment on the... extent practicable, develop a documented process(es) that outlines roles, responsibilities, and key...

Supporting reputation based trust management enhancing security layer for cloud service models

NASA Astrophysics Data System (ADS)

Karthiga, R.; Vanitha, M.; Sumaiya Thaseen, I.; Mangaiyarkarasi, R.

2017-11-01

In the existing system trust between cloud providers and consumers is inadequate to establish the service level agreement though the consumer’s response is good cause to assess the overall reliability of cloud services. Investigators recognized the significance of trust can be managed and security can be provided based on feedback collected from participant. In this work a face recognition system that helps to identify the user effectively. So we use an image comparison algorithm where the user face is captured during registration time and get stored in database. With that original image we compare it with the sample image that is already stored in database. If both the image get matched then the users are identified effectively. When the confidential data are subcontracted to the cloud, data holders will become worried about the confidentiality of their data in the cloud. Encrypting the data before subcontracting has been regarded as the important resources of keeping user data privacy beside the cloud server. So in order to keep the data secure we use an AES algorithm. Symmetric-key algorithms practice a shared key concept, keeping data secret requires keeping this key secret. So only the user with private key can decrypt data.

Scalable service architecture for providing strong service guarantees

NASA Astrophysics Data System (ADS)

Christin, Nicolas; Liebeherr, Joerg

2002-07-01

For the past decade, a lot of Internet research has been devoted to providing different levels of service to applications. Initial proposals for service differentiation provided strong service guarantees, with strict bounds on delays, loss rates, and throughput, but required high overhead in terms of computational complexity and memory, both of which raise scalability concerns. Recently, the interest has shifted to service architectures with low overhead. However, these newer service architectures only provide weak service guarantees, which do not always address the needs of applications. In this paper, we describe a service architecture that supports strong service guarantees, can be implemented with low computational complexity, and only requires to maintain little state information. A key mechanism of the proposed service architecture is that it addresses scheduling and buffer management in a single algorithm. The presented architecture offers no solution for controlling the amount of traffic that enters the network. Instead, we plan on exploiting feedback mechanisms of TCP congestion control algorithms for the purpose of regulating the traffic entering the network.

Effect of E-Service Quality on Customer Online Repurchase Intentions

ERIC Educational Resources Information Center

Liu, Tung-Hsuan

2012-01-01

In the early years of online retailing, having an online presence and low prices were believed to be key drivers of success. More recently, electronic service quality has become essential as an online marketing strategy. Online stores provide higher service quality to create online customer loyalty, improve customer satisfaction, and keep a…

Relationships and Reciprocality in Student and Academic Services

ERIC Educational Resources Information Center

Small, Kate

2008-01-01

As part of the "face" a university projects to the world, student service staff play a key role in constructing an institution's external identity. Yet, there have been few studies of who are the general staff providing these services, and how they define their role within their institutions. Although there have been several excellent studies…

Default Parallels Plesk Panel Page

Science.gov Websites

services that small businesses want and need. Our software includes key building blocks of cloud service virtualized servers Service Provider Products Parallels® Automation Hosting, SaaS, and cloud computing , the leading hosting automation software. You see this page because there is no Web site at this

Community and consumer participation in Australian health services--an overview of organisational commitment and participation processes.

PubMed

Johnson, A; Silburn, K

2000-01-01

This article briefly describes recent initiatives to improve consumer participation in health services that have led to the establishment of the National Resource Centre for Consumer Participation in Health. The results of a component of the needs assessment undertaken by the newly established Centre are presented. They provide a 'snapshot' of the types of feedback and participation processes mainly being utilised by Australian health services at the different levels of seeking information, information sharing and consultation, partnership, delegated power and consumer control. They also allow identification of the organisational commitment made by Australian health services to support a more coordinated approach to community and consumer feedback and participation at different levels of health services such as particular emphasis on determining the presence of community and consumer participation in key organisational statements, specific consumer policies and plans, identifiable leadership, inclusion into job descriptions, allocation of resources, and staff development and consumer training. Discussion centres around four key observations and some of the key perceived external barriers.

The Educational Rights of Children and Youth Experiencing Homelessness: What Service Providers Need to Know. McKinney-Vento Law into Practice Brief Series

ERIC Educational Resources Information Center

National Center for Homeless Education at SERVE, 2016

2016-01-01

Children and youth who experience homelessness face many barriers to education, yet school can be a source of stability, affirmation, and hope during a time of chaos and trauma when a young person loses his or her housing. Community service providers play a key role in linking homeless children and youth to schools and providing wraparound…

Mobile satellite service for Canada

NASA Technical Reports Server (NTRS)

Sward, David

1988-01-01

The Mobile Satellite (MSAT) system and a special program designed to provide interim mobile satellite services (IMSS) during the construction phase of MSAT are described. A mobile satellite system is a key element in extending voice and and data telecommunications to all Canadians.

Exploring the context in which different close-to-community sexual and reproductive health service providers operate in Bangladesh: a qualitative study.

PubMed

Mahmud, Ilias; Chowdhury, Sadia; Siddiqi, Bulbul Ashraf; Theobald, Sally; Ormel, Hermen; Biswas, Salauddin; Jahangir, Yamin Tauseef; Sarker, Malabika; Rashid, Sabina Faiz

2015-09-01

A range of formal and informal close-to-community (CTC) health service providers operate in an increasingly urbanized Bangladesh. Informal CTC health service providers play a key role in Bangladesh's pluralistic health system, yet the reasons for their popularity and their interactions with formal providers and the community are poorly understood. This paper aims to understand the factors shaping poor urban and rural women's choice of service provider for their sexual and reproductive health (SRH)-related problems and the interrelationships between these providers and communities. Building this evidence base is important, as the number and range of CTC providers continue to expand in both urban slums and rural communities in Bangladesh. This has implications for policy and future programme interventions addressing the poor women's SRH needs. Data was generated through 24 in-depth interviews with menstrual regulation clients, 12 focus group discussions with married men and women in communities and 24 semi-structured interviews with formal and informal CTC SRH service providers. Data was collected between July and September 2013 from three urban slums and one rural site in Dhaka and Sylhet, Bangladesh. Atlas.ti software was used to manage data analysis and coding, and a thematic analysis was undertaken. Poor women living in urban slums and rural areas visit a diverse range of CTC providers for SRH-related problems. Key factors influencing their choice of provider include the following: availability, accessibility, expenses and perceived quality of care, the latter being shaped by notions of trust, respect and familiarity. Informal providers are usually the first point of contact even for those clients who subsequently access SRH services from formal providers. Despite existing informal interactions between both types of providers and a shared understanding that this can be beneficial for clients, there is no effective link or partnership between these providers for referral, coordination and communication regarding SRH services. Training informal CTC providers and developing strategies to enable better links and coordination between this community-embedded cadre and the formal health sector has the potential to reduce service cost and improve availability of quality SRH (and other) care at the community level.

Food security in older adults: community service provider perceptions of their roles.

PubMed

Keller, Heather H; Dwyer, John J M; Edwards, Vicki; Senson, Christine; Gayle Edward, H

2007-01-01

Food insecurity in older adults is influenced by financial constraints, functional disability, and isolation. Twenty-eight social- and community-service providers participated in four focus groups to report (a) perceptions and experiences with food insecurity in their older clients, (b) beliefs about their potential role(s) in promoting food security, and (c) opinions about constraints that influenced these roles. A constant comparison analysis identified key themes. The formal caregivers reported six roles for improving food security: (a) monitoring, (b) coordination, and (c) promoting services, (d) education, (e) advocacy, and (f) providing a social environment. The final theme summarizes these roles as "the need for personalization of service". Social and community service providers are involved in roles that can promote the health of older adults by addressing their food insecurity. Social service providers need to be acknowledged and supported in this health promotion role.

Comparative study of key exchange and authentication methods in application, transport and network level security mechanisms

NASA Astrophysics Data System (ADS)

Fathirad, Iraj; Devlin, John; Jiang, Frank

2012-09-01

The key-exchange and authentication are two crucial elements of any network security mechanism. IPsec, SSL/TLS, PGP and S/MIME are well-known security approaches in providing security service to network, transport and application layers; these protocols use different methods (based on their requirements) to establish keying materials and authenticates key-negotiation and participated parties. This paper studies and compares the authenticated key negotiation methods in mentioned protocols.

Assessing public-private reproductive health efforts to reach young married couples in rural Bangladesh.

PubMed

Khatun, Mahmuda; Mahboob-E-Alam; Nazneen, Quamrun Nahar

Young married couples (YMC) in Bangladesh receive insufficient attention from service providers for reproductive health and family planning needs. The ACQUIRE Project, undertaken by EngenderHealth, Bangladesh, provides intervention for service providers, social and local leaders, and mothers-in-law as effective agents of channeling information to YMCs. EngenderHealth, in collaboration with the public sector, examined the extent to which an intervention program enhances overall quality of services, respondents' knowledge and attitude, and service-seeking behavior related to reproductive health issues. A quasi-experimental design with two matching groups, one watching the intervention, was used. The endline survey was carried out 10 months after the Baseline survey. Key informants interviews and FGDs were conducted. The findings were mixed. Importantly, young married men and women need friendly services and service providers with positive attitudes.

Young Children in Wales: An Evaluation of the Implementation of the Children Act 1989 for Day Care Services.

ERIC Educational Resources Information Center

Statham, June

This 3-year study examined the implementation of the Children Act in Wales, which deals with providing, coordinating, and regulating day care and related services for children under 8 years. Data were collected through interviews with key officers and representatives of child care organizations, a national survey of day care providers, and an…

Providing comprehensive health services for young key populations: needs, barriers and gaps

PubMed Central

Delany-Moretlwe, Sinead; Cowan, Frances M; Busza, Joanna; Bolton-Moore, Carolyn; Kelley, Karen; Fairlie, Lee

2015-01-01

Introduction Adolescence is a time of physical, emotional and social transitions that have implications for health. In addition to being at high risk for HIV, young key populations (YKP) may experience other health problems attributable to high-risk behaviour or their developmental stage, or a combination of both. Discussion We reviewed the needs, barriers and gaps for other non-HIV health services for YKP. We searched PubMed and Google Scholar for articles that provided specific age-related data on sexual and reproductive health; mental health; violence; and substance use problems for adolescent, youth or young sex workers, men who have sex with men, transgender people, and people who inject drugs. Results YKP experience more unprotected sex, sexually transmitted infections including HIV, unintended pregnancy, violence, mental health disorders and substance use compared to older members of key populations and youth among the general population. YKP experience significant barriers to accessing care; coverage of services is low, largely because of stigma and discrimination experienced at both the health system and policy levels. Discussion YKP require comprehensive, integrated services that respond to their specific developmental needs, including health, educational and social services within the context of a human rights-based approach. The recent WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations are an important first step for a more comprehensive approach to HIV programming for YKP, but there are limited data on the effective delivery of combined interventions for YKP. Significant investments in research and implementation will be required to ensure adequate provision and coverage of services for YKP. In addition, greater commitments to harm reduction and rights-based approaches are needed to address structural barriers to access to care. PMID:25724511

A Quality Improvement Customer Service Process and CSS [Customer Service System]. Burlington County College Employee Development Series, Volumes I & II.

ERIC Educational Resources Information Center

Burlington County Coll., Pemberton, NJ.

Prepared for use by staff in development workshops at Burlington County College (BCC), in New Jersey, this handbook offers college-wide guidelines for improving the quality of service provided to internal and external customers, and reviews key elements of BCC's Customer Service System (CSS), a computerized method of recording and following-up on…

Redesigning community mental health services for urban children: Supporting schooling to promote mental health.

PubMed

Atkins, Marc S; Shernoff, Elisa S; Frazier, Stacy L; Schoenwald, Sonja K; Cappella, Elise; Marinez-Lora, Ane; Mehta, Tara G; Lakind, Davielle; Cua, Grace; Bhaumik, Runa; Bhaumik, Dulal

2015-10-01

This study examined a school- and home-based mental health service model, Links to Learning, focused on empirical predictors of learning as primary goals for services in high-poverty urban communities. Teacher key opinion leaders were identified through sociometric surveys and trained, with mental health providers and parent advocates, on evidence-based practices to enhance children's learning. Teacher key opinion leaders and mental health providers cofacilitated professional development sessions for classroom teachers to disseminate 2 universal (Good Behavior Game, peer-assisted learning) and 2 targeted (Good News Notes, Daily Report Card) interventions. Group-based and home-based family education and support were delivered by mental health providers and parent advocates for children in kindergarten through 4th grade diagnosed with 1 or more disruptive behavior disorders. Services were Medicaid-funded through 4 social service agencies (N = 17 providers) in 7 schools (N = 136 teachers, 171 children) in a 2 (Links to Learning vs. services as usual) × 6 (pre- and posttests for 3 years) longitudinal design with random assignment of schools to conditions. Services as usual consisted of supported referral to a nearby social service agency. Mixed effects regression models indicated significant positive effects of Links to Learning on mental health service use, classroom observations of academic engagement, teacher report of academic competence and social skills, and parent report of social skills. Nonsignificant between-groups effects were found on teacher and parent report of problem behaviors, daily hassles, and curriculum-based measures. Effects were strongest for young children, girls, and children with fewer symptoms. Community mental health services targeting empirical predictors of learning can improve school and home behavior for children living in high-poverty urban communities. (c) 2015 APA, all rights reserved).

Security Concepts for Satellite Links

NASA Astrophysics Data System (ADS)

Tobehn, C.; Penné, B.; Rathje, R.; Weigl, A.; Gorecki, Ch.; Michalik, H.

2008-08-01

The high costs to develop, launch and maintain a satellite network makes protecting the assets imperative. Attacks may be passive such as eavesdropping on the payload data. More serious threat are active attacks that try to gain control of the satellite, which may lead to the total lost of the satellite asset. To counter these threats, new satellite and ground systems are using cryptographic technologies to provide a range of services: confidentiality, entity & message authentication, and data integrity. Additionally, key management cryptographic services are required to support these services. This paper describes the key points of current satellite control and operations, that are authentication of the access to the satellite TMTC link and encryption of security relevant TM/TC data. For payload data management the key points are multi-user ground station access and high data rates both requiring frequent updates and uploads of keys with the corresponding key management methods. For secure satellite management authentication & key negotiation algorithms as HMAC-RIPEMD160, EC- DSA and EC-DH are used. Encryption of data uses algorithms as IDEA, AES, Triple-DES, or other. A channel coding and encryption unit for payload data provides download data rates up to Nx250 Mbps. The presented concepts are based on our experience and heritage of the security systems for all German MOD satellite projects (SATCOMBw2, SAR-Lupe multi- satellite system and German-French SAR-Lupe-Helios- II systems inter-operability) as well as for further international (KOMPSAT-II Payload data link system) and ESA activities (TMTC security and GMES).

An impetus to move the field forward: a look at child and adolescent mental health services participants' views of the prospects for change.

PubMed

Haynes, Katherine Taylor

2010-03-01

In September 2009 key stakeholders convened for the invitation-only Child and Adolescent Mental Health Services (CAMHS): Issues and Solutions conference. This paper provides a brief synopsis of the key high points and issues in children's mental health (CMH) and describes the process by which participants collectively brainstormed the priorities and distilled the four key foci for the new action agenda, and summarizes the key outcomes. In addition, this paper offers participants' perspectives on the conference. Based on observation notes and post-conference qualitative interviews, this paper reports conference participants' feedback on the event, their views on the prospects for change generated by the conference and suggestions for follow-up.

Who does the public think should perform health care tasks?

PubMed

Koteski, D R; McKinney, S

1988-10-01

The dietitian was identified as the most appropriate provider of such key nutrition services as nutrition assessment, determination of caloric requirements, provision of diet counseling, and prescription of diets. Several tasks fundamental to nutrition services were not viewed as highly suitable tasks for the dietitian, e.g., plan for care at home, monitor client progress, and check laboratory values. Activities that constitute key nutrition services need to be accentuated to clarify the numerous skills and extensive knowledge that dietitians possess. In the health care system of today, the dietetic profession must be associated with a wider range of health-related tasks than the traditional triad of diet, food, and hospital. Public relations and marketing strategies should focus on activities that provide the public with a clearer understanding of how the dietetic profession contributes to patient/client care.

31 CFR 31.201 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... agency agreement between a private sector entity and the Treasury for services under the TARP, other than... Economic Stabilization Act of 2008, as amended. Key individual means an individual providing services to a private sector entity who participates personally and substantially, through, for example, decision...

31 CFR 31.201 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... agency agreement between a private sector entity and the Treasury for services under the TARP, other than... Economic Stabilization Act of 2008, as amended. Key individual means an individual providing services to a private sector entity who participates personally and substantially, through, for example, decision...

31 CFR 31.201 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... agency agreement between a private sector entity and the Treasury for services under the TARP, other than... Economic Stabilization Act of 2008, as amended. Key individual means an individual providing services to a private sector entity who participates personally and substantially, through, for example, decision...

The Process of Psychological Consultation

ERIC Educational Resources Information Center

Nolan, Anna; Moreland, Neil

2014-01-01

Consultation is a key means of service delivery in many psychological services. However, the "process" of consultation is little explored in Educational Psychology literature, particularly in the United Kingdom (UK). This paper focuses on a small-scale qualitative research study of psychological consultation provided by educational…

Evaluating a Bilingual Text-Mining System with a Taxonomy of Key Words and Hierarchical Visualization for Understanding Learner-Generated Text

ERIC Educational Resources Information Center

Kong, Siu Cheung; Li, Ping; Song, Yanjie

2018-01-01

This study evaluated a bilingual text-mining system, which incorporated a bilingual taxonomy of key words and provided hierarchical visualization, for understanding learner-generated text in the learning management systems through automatic identification and counting of matching key words. A class of 27 in-service teachers studied a course…

Reciprocity and Critical Reflection as the Key to Social Justice in Service Learning: A Case Study

ERIC Educational Resources Information Center

Asghar, Mandy; Rowe, Nick

2017-01-01

Service learning is experiential education that encourages students as socially responsible and active citizens working in and with members of the community. We consider how these ideas illuminate the ambitions of a unique service-learning opportunity known as "Converge", a university partnership with a health care provider that brings…

Learning Racial Hierarchies: Communication Skills Training in Transnational Customer Service Work

ERIC Educational Resources Information Center

Mirchandani, Kiran

2012-01-01

Purpose: This paper aims to focus on the communications skills training given to transnational call center workers in India whose jobs involve providing customer service to Western customers. Emotion work is a key component of customer service jobs, and this work is constructed as an important soft skill. Design/methodology/approach: Between 2002…

Service Provider Perceptions of Key Factors Related to Postsecondary Success of Students with Learning Disabilities in Institutions of Higher Education

ERIC Educational Resources Information Center

Herring, Nathan L.

2012-01-01

Students with learning disabilities have been attending postsecondary education in increasing numbers since the early 1990's. Improvements in secondary education services, legal rights to reasonable accommodations, and college services for these students have been credited with this increase (Browning, 1997; Flexer, Simmons, Luft, & Baer,…

Management of Security Services in Higher Education. National Report.

ERIC Educational Resources Information Center

Higher Education Funding Council for Wales, Cardiff.

This report, the seventh in a series from the Value for Money Steering Group, identifies the key management issues for governors, senior managers, and heads of security services at institutions of higher education in the United Kingdom in developing and reviewing security services to ensure that they are effective and provide value for money.…

The applicability of the tetraclass model to the management of the patient satisfaction in the pharmacies

PubMed Central

Petrova, Guenka; Clerfeuille, Fabrice; Vakrilova, Milena; Mitkov, Cvetomir; Poubanne, Yannick

2008-01-01

The objective of this work is to study the possibilities of the tetraclass model for the evaluation of the changes in the consumer satisfaction from the provided pharmacy services during the time. Methods Within the same 4 months period in 2004 and 2006 were questioned at approximately 10 pharmacy consumers per working day. Every consumer evaluated the 34 service elements on a 5 points semantic-differential scale. The technique of the correspondence data analysis was used for the categorisation of the services. Results Most of the services have been categorized as basic ones. For the age group up to 40 years the access to pharmacy became a key element and external aspects became a secondary element in 2006 year. For the group of patients that are using the services of the pharmacy for more than 2 years, availability of phone connection, quality of answers and product prices move from plus to secondary element. The ratio quality/price moves from the group of basic to key services, visibility of the prices and hygiene became basic elements from secondary ones. During the two years period, all the service elements connected with the staff as availability, identification, good looking, confidence, dressing, advices, technical competence, explanation, and time spent with clients remain basic services. The confidentiality of the staff remains always a key element. Conclusion Our study shows that the tetraclass model allows taking more informed managerial decisions in the pharmacies, as well as, is providing information for the concrete area of services and possible measures. In case of a development of a simple statistical program for quick processing of the inquiry data, the method will became applicable and affordable even for small pharmacies. PMID:25147588

KeySlinger and StarSlinger: Secure Key Exchange and Encrypted File Transfer on Smartphones

DTIC Science & Technology

2011-05-01

format data to exchange because contact information can be exported to V- Cards using existing APIs. For these reasons it was chosen as the medium to... Card format allows customization of this field. The service provider field serves to identify the app the key is for and the username field stores the...public key data. A sample V- Card field looks like Listing 1 below. IMPP;TextSecure

SSeCloud: Using secret sharing scheme to secure keys

NASA Astrophysics Data System (ADS)

Hu, Liang; Huang, Yang; Yang, Disheng; Zhang, Yuzhen; Liu, Hengchang

2017-08-01

With the use of cloud storage services, one of the concerns is how to protect sensitive data securely and privately. While users enjoy the convenience of data storage provided by semi-trusted cloud storage providers, they are confronted with all kinds of risks at the same time. In this paper, we present SSeCloud, a secure cloud storage system that improves security and usability by applying secret sharing scheme to secure keys. The system encrypts uploading files on the client side and splits encrypted keys into three shares. Each of them is respectively stored by users, cloud storage providers and the alternative third trusted party. Any two of the parties can reconstruct keys. Evaluation results of prototype system show that SSeCloud provides high security without too much performance penalty.

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.

The impact of chemical pollution on biodiversity and ecosystem services: the need for an improved understanding

EPA Science Inventory

The Millennium Ecosystem Assessment (2005) provided a framework that acknowledges biodiversity as one key factor for ensuring the continuous supply of ecosystem services, facilitating ecosystem stability and consequently as a critical basis for sustainable development. The close...

Summary of Key Issues Raised in the Technology for Early Awareness of Addiction and Mental Illness (TEAAM-I) Meeting.

PubMed

Baumel, Amit; Baker, Justin; Birnbaum, Michael L; Christensen, Helen; De Choudhury, Munmun; Mohr, David C; Muench, Fred; Schlosser, Danielle; Titov, Nick; Kane, John M

2018-05-01

Technology provides an unparalleled opportunity to remove barriers to earlier identification and engagement in services for mental and addictive disorders by reaching people earlier in the course of illness and providing links to just-in-time, cost-effective interventions. Achieving this opportunity, however, requires stakeholders to challenge underlying assumptions about traditional pathways to mental health care. In this Open Forum, the authors highlight key issues discussed in the Technology for Early Awareness of Addiction and Mental Illness (TEAAM-I) meeting-held October 13-14, 2016, in New York City-that are related to three identified areas in which technology provides important and unique opportunities to advance early identification, increase service engagement, and decrease the duration of untreated mental and addictive disorders.

Secure Service Invocation in a Peer-to-Peer Environment Using JXTA-SOAP

NASA Astrophysics Data System (ADS)

Laghi, Maria Chiara; Amoretti, Michele; Conte, Gianni

The effective convergence of service-oriented architectures (SOA) and peer-to-peer (P2P) is an urgent task, with many important applications ranging from e-business to ambient intelligence. A considerable standardization effort is being carried out from both SOA and P2P communities, but a complete platform for the development of secure, distributed applications is still missing. In this context, the result of our research and development activity is JXTA-SOAP, an official extension for JXTA enabling Web Service sharing in peer-to-peer networks. Recently we focused on security aspects, providing JXTA-SOAP with a general security management system, and specialized policies that target both J2SE and J2ME versions of the component. Among others, we implemented a policy based on Multimedia Internet KEYing (MIKEY), which can be used to create a key pair and all the required parameters for encryption and decryption of service messages in consumer and provider peers running on resource-constrained devices.

Engine Tune-Up Service. Unit 1: Battery and Cranking System. Posttests. Automotive Mechanics Curriculum.

ERIC Educational Resources Information Center

Goodson-Roberts, Ludy; And Others

This book of posttests is designed to accompany the Engine Tune-Up Service Student Guide for Unit 1, Battery and Cranking System. Focus of the posttests is the testing of the battery and cranking system. Four multiple choice posttests are provided, one for each of the performance objectives contained in the unit. (No answer keys are provided.)…

Stakeholder perceptions of a nurse led walk-in centre.

PubMed

Parker, Rhian M; Desborough, Jane L; Forrest, Laura E

2012-11-05

As many countries face primary care medical workforce shortages and find it difficult to provide timely and affordable care they seek to find new ways of delivering first point of contact health care through developing new service models. In common with other areas of rural and regional Australia, the Australian Capital Territory (ACT) is currently experiencing a general practitioner (GP) workforce shortage which impacts significantly on the ability of patients to access GP led primary care services. The introduction of a nurse led primary care Walk-in Centre in the ACT aimed to fulfill an unmet health care need in the community and meet projected demand for health care services as well as relieve pressure on the hospital system. Stakeholders have the potential to influence health service planning and policy, to advise on the potential of services to meet population health needs and to assess how acceptable health service innovation is to key stakeholder groups. This study aimed to ascertain the views of key stakeholders about the Walk-in Centre. Stakeholders were purposively selected through the identification of individuals and organisations which had organisational or professional contact with the Walk-in Centre. Semi structured interviews around key themes were conducted with seventeen stakeholders. Stakeholders were generally supportive of the Walk-in Centre but identified key areas which they considered needed to be addressed. These included the service's systems, full utilisation of the nurse practitioner role and adequate education and training. It was also suggested that a doctor could be available to the Centre as a source of referral for patients who fall outside the nurses' scope of practice. The location of the Centre was seen to impact on patient flows to the Emergency Department. Nurse led Walk-in Centres are one response to addressing primary health care medical workforce shortages. Whilst some stakeholders have reservations about the model others are supportive and see the potential the model has to provide accessible primary health care. Any further developments of nurse-led Walk-in Centres need to take into account the views of key stakeholders so as to ensure that the model is acceptable and sustainable.

REGIONAL COORDINATION OF NOAA/NATIONAL WEATHER SERVICE CLIMATE SERVICES IN THE WEST (Invited)

NASA Astrophysics Data System (ADS)

Bair, A.

2009-12-01

The climate services program is an important component in the National Weather Service’s (NWS) mission, and is one of the National Oceanic and Atmospheric Administration’s (NOAA) top five priorities. The Western Region NWS started building a regional and local climate services program in late 2001, with input from local NWS offices and key partners. The original goals of the Western Region climate services program were to strive to provide climate services that were useful, easily accessible, well understood, coordinated and supported by partners, and reflect customer needs. While the program has evolved, and lessons have been learned, these goals are still guiding the program. Regional and local level Climate Services are a fundamental part of NOAA/NWS’s current and future role in providing climate services. There is an ever growing demand for climate information and services to aid the public in decision-making and no single entity alone can provide the range of information and services needed. Coordination and building strong partnerships at the local and regional levels is the key to providing optimal climate services. Over the past 8 years, Western Region NWS has embarked on numerous coordination efforts to build the regional and local climate services programs, such as: collaboration (both internally and externally to NOAA) meetings and projects, internal staff training, surveys, and outreach efforts. In order to gain regional and local buy-in from the NWS staff, multiple committees were utilized to plan and develop goals and structure for the program. While the regional and local climate services program in the NWS Western Region has had many successes, there have been several important lessons learned from efforts that have not been as successful. These lessons, along with past experience, close coordination with partners, and the need to constantly improve/change the program as the climate changes, form the basis for future program development and goals.

Opportunities, challenges and systems requirements for developing post-abortion family planning services: Perceptions of service stakeholders in China.

PubMed

Jiang, Hong; Xu, Jieshuang; Richards, Esther; Qian, Xu; Zhang, Weihong; Hu, Lina; Wu, Shangchun; Tolhurst, Rachel

2017-01-01

Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers' perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces-Zhejiang, Hubei and Yunnan-were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources.

Advancing LGBT Elder Policy and Support Services: The Massachusetts Model.

PubMed

Krinsky, Lisa; Cahill, Sean R

2017-12-01

The Massachusetts-based LGBT Aging Project has trained elder service providers in affirming and culturally competent care for LGBT older adults, supported development of LGBT-friendly meal programs, and advanced LGBT equality under aging policy. Working across sectors, this innovative model launched the country's first statewide Legislative Commission on Lesbian, Gay, Bisexual, and Transgender Aging. Advocates are working with policymakers to implement key recommendations, including cultural competency training and data collection in statewide networks of elder services. The LGBT Aging Project's success provides a template for improving services and policy for LGBT older adults throughout the country.

Customer assessment of long-term care pharmacy provider services.

PubMed

Clark, Thomas R

2008-09-01

Assess performance of long-term care pharmacy providers on key services offered to nursing facilities. Cross-sectional; nursing facility team. Random phone survey of nursing facility team members. 485 nursing facility team members (practicing in nursing facilities, interacting with > or = 1 consultant pharmacist); 46 members excluded, unable to identify facility's pharmacy provider. Directors of nursing, medical directors, and administrators were asked to rate long-term care pharmacy provider performance of eight commonly offered pharmacy services. All groups evaluated pharmacy provider performance of these services using a five-point scale. Results are broken down by employer type. Average rating for eight pharmacy services was 3.64. Top two services: "Labeling medications accurately" ranked in top 1-2 services for all groups (combined rating of 3.97) and "Provides medication administration system" ranked in top 1-3 services for all groups (combined rating of 3.95). One service, "Provides educational inservices," ranked lowest for all groups (combined rating of 3.54). In general, when looking at the eight services in combination for all providers, all services were ranked between Good and Very Good (average score of 3.64). Therefore, while the pharmacy provider is performing above average for these services, there is room for improvement in all of these services. These results can be used as a benchmark. Detailed data results and sample surveys are available online at www.ascp.com/supplements. These surveys can be used by the pharmacy provider to solicit assessments from their own facilities on these services.

Emergency medical services key performance measurement in Asian cities.

PubMed

Rahman, Nik Hisamuddin; Tanaka, Hideharu; Shin, Sang Do; Ng, Yih Yng; Piyasuwankul, Thammapad; Lin, Chih-Hao; Ong, Marcus Eng Hock

2015-01-01

One of the key principles in the recommended standards is that emergency medical service (EMS) providers should continuously monitor the quality and safety of their services. This requires service providers to implement performance monitoring using appropriate and relevant measures including key performance indicators. In Asia, EMS systems are at different developmental phases and maturity. This will create difficultly in benchmarking or assessing the quality of EMS performance across the region. An attempt was made to compare the EMS performance index based on the structure, process, and outcome analysis. The data was collected from the Pan-Asian Resuscitation Outcome Study (PAROS) data among few Asian cities, namely, Tokyo, Osaka, Singapore, Bangkok, Kuala Lumpur, Taipei, and Seoul. The parameters of inclusions were broadly divided into structure, process, and outcome measurements. The data was collected by the site investigators from each city and keyed into the electronic web-based data form which is secured strictly by username and passwords. Generally, there seems to be a more uniformity for EMS performance parameters among the more developed EMS systems. The major problem with the EMS agencies in the cities of developing countries like Bangkok and Kuala Lumpur is inadequate or unavailable data pertaining to EMS performance. There is non-uniformity in the EMS performance measurement across the Asian cities. This creates difficulty for EMS performance index comparison and benchmarking. Hopefully, in the future, collaborative efforts such as the PAROS networking group will further enhance the standardization in EMS performance reporting across the region.

Understanding Career Context as a Key to Best Serving Adult Students

ERIC Educational Resources Information Center

Bohonos, Jeremy

2014-01-01

Professional development plays a key role in motivating many adult learners. Understanding these students' career contexts allows for more effective program development and better student services. This article presents five broad categories of career context and provides a brief framework which educators can use to more effectively…

Education Facilities Sector-Specific Plan: An Annex to the Government Facilities Sector-Specific Plan

ERIC Educational Resources Information Center

US Department of Homeland Security, 2010

2010-01-01

Critical infrastructure and key resources (CIKR) provide the essential services that support basic elements of American society. Compromise of these CIKR could disrupt key government and industry activities, facilities, and systems, producing cascading effects throughout the Nation's economy and society and profoundly affecting the national…

Turning Old Problems into New Problems: The Role of Young Citizens in Improving Accountability in Education in Malawi and Kenya

ERIC Educational Resources Information Center

Porter, Caitlin

2014-01-01

Accountability is increasingly recognised as the key mediating variable that encourages service providers to deliver efficient and effective local services. In the context of education, accountability strategies do not always explicitly consider young citizens as the primary users of education services. In this paper, a client approach to…

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

Utilization of Services Provided by Village-Based Ethnic Minority Midwives in Vietnam: Lessons From Implementation Research.

PubMed

Doan, Duong Thi Thuy; Mirzoev, Tolib; Nguyen, Canh Chuong; Bui, Ha Thi Thu

Global progress in reducing maternal mortality requires improving access to maternal and child health services for the most vulnerable groups. This article reports results of implementation research that aimed to increase the acceptability of village-based ethnic minority midwives (EMMs) by local communities in Vietnam through implementing an integrated interventions package. The study was carried out in 2 provinces in Vietnam, Dien Bien and Kon Tum. A quasi-experimental survey with pretest/posttest design was adopted, which included 6 months of intervention implementation. The interventions package included introductory "launch" meetings, monthly review meetings at community health centers, and 5-day refresher training for EMMs. A mixed-methods approach was used involving both quantitative and qualitative data. A structured questionnaire was used in the pre- and posttest surveys, complemented by in-depth interviews and focus group discussions with EMMs, relatives of pregnant women, community representatives, and health managers. Introductions of EMMs to their local communities by local authorities and supervision of performance of EMMs contributed to significant increases in utilization of services provided by EMMs, from 58.6% to 87.7%. Key facilitators included information on how to contact EMMs, awareness of services provided by EMMs, and trust in services provided by EMMs. The main barriers to utilization of EMM services, which may affect sustainability of the EMM scheme, were low self-esteem of EMMs and small allowances to EMMs, which also affected the recognition of EMMs in the community. Providing continuous support and integration of EMMs within frontline service provision and ensuring adequate local budget for monthly allowances are the key factors that should allow sustainability of the EMM scheme and continued improvement of access to maternal and child health care among poor ethnic minority people living in mountainous areas in Vietnam.

Working Together: California Indians and the Forest Service. Accomplishment Report.

ERIC Educational Resources Information Center

Forest Service (USDA), Berkeley, CA. Pacific Southwest Forest and Range Experiment Station.

This report describes accomplishments of the Forest Services's Tribal Relations Program in California, highlighting coordinated efforts with tribal governments and Native American communities throughout California's national forests. The regional office provided intensive training on federal-tribal relations to key staff throughout the region, and…

[Barriers to the normalization of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts].

PubMed

Roig, Francesc; Saigí, Francesc

2011-01-01

Despite the clear political will to promote telemedicine and the large number of initiatives, the incorporation of this modality in clinical practice remains limited. The objective of this study was to identify the barriers perceived by key professionals who actively participate in the design and implementation of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts. We performed a qualitative study based on data from semi-structured interviews with 17 key informants belonging to distinct Catalan health organizations. The barriers identified were grouped in four areas: technological, organizational, human and economic. The main barriers identified were changes in the healthcare model caused by telemedicine, problems with strategic alignment, resistance to change in the (re)definition of roles, responsibilities and new skills, and lack of a business model that incorporates telemedicine in the services portfolio to ensure its sustainability. In addition to suitable management of change and of the necessary strategic alignment, the definitive normalization of telemedicine in a mixed healthcare model based on purchasing of healthcare services using providers' contracts requires a clear and stable business model that incorporates this modality in the services portfolio and allows healthcare organizations to obtain reimbursement from the payer. 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

Earth Observation-Supported Service Platform for the Development and Provision of Thematic Information on the Built Environment - the Tep-Urban Project

NASA Astrophysics Data System (ADS)

Esch, T.; Asamer, H.; Boettcher, M.; Brito, F.; Hirner, A.; Marconcini, M.; Mathot, E.; Metz, A.; Permana, H.; Soukop, T.; Stanek, F.; Kuchar, S.; Zeidler, J.; Balhar, J.

2016-06-01

The Sentinel fleet will provide a so-far unique coverage with Earth observation data and therewith new opportunities for the implementation of methodologies to generate innovative geo-information products and services. It is here where the TEP Urban project is supposed to initiate a step change by providing an open and participatory platform based on modern ICT technologies and services that enables any interested user to easily exploit Earth observation data pools, in particular those of the Sentinel missions, and derive thematic information on the status and development of the built environment from these data. Key component of TEP Urban project is the implementation of a web-based platform employing distributed high-level computing infrastructures and providing key functionalities for i) high-performance access to satellite imagery and derived thematic data, ii) modular and generic state-of-the art pre-processing, analysis, and visualization techniques, iii) customized development and dissemination of algorithms, products and services, and iv) networking and communication. This contribution introduces the main facts about the TEP Urban project, including a description of the general objectives, the platform systems design and functionalities, and the preliminary portfolio products and services available at the TEP Urban platform.

Meeting the needs of parents around the time of diagnosis of disability among their children: evaluation of a novel program for information, support, and liaison by key workers.

PubMed

Rahi, Jugnoo S; Manaras, Irene; Tuomainen, Helena; Hundt, Gillian Lewando

2004-10-01

Key worker programs for families of children with disabilities, to promote information provision, emotional support, and liaisons among different agencies, have long been advocated but not extensively implemented. We report the impact on the experiences of parents and the practices of health care professionals of a novel, hospital-based, key worker service (Community Link Team [CLT]), implemented in the pediatric ophthalmology department of Great Ormond Street Hospital (London, United Kingdom). The CLT included 2 members, 1 of whom was present during the first outpatient assessment by the consultant ophthalmologist of any child newly diagnosed as visually impaired (corrected acuity of 6/18 or worse in the better eye) and accompanied the family during other assessments performed during that visit. A dedicated room was used by the CLT members to spend time with each family after completion of the clinical assessments. The CLT members reiterated and/or clarified clinical information already provided, specifically advised the families about visual stimulation programs and the benefits and purpose of visual impairment certification, and provided information about educational and social services. The same CLT member met the family at subsequent visits to the department and acted as the first point of contact for parents. Parents of children newly diagnosed with visual impairment and/or ophthalmic disorders at Great Ormond Street Hospital participated in a 2-stage study to assess their needs, their views about the processes of care, and their overall satisfaction. The study included a questionnaire survey with 2 standard instruments, ie, the Measure of Processes of Care, specifically developed and used to assess parents' views of the degree to which health services for a range of childhood disorders are family-centered, and the short form of the Client Satisfaction Questionnaire, used to assess overall parental satisfaction or dissatisfaction with services in the preceding year, as in other studies of parental satisfaction with pediatric services. This was followed by in-depth individual interviews with a subsample of parents who returned completed questionnaires. The views of families with experience with the new service (CLT) were compared with those without. The experiences of health care professionals before and after implementation of the service were elicited through group interviews and were compared. We recognized that any differences would be attributable to both the direct effects of the CLT, ie, actual services provided by the team, and indirect effects, ie, broader changes in approaches or practices within the department resulting from shifting roles and responsibilities regarding specific elements of management. Therefore, both the specific tasks/activities undertaken by the CLT and broader changes in practices within the department were identified. Seventy-nine families from the pre-CLT group and 68 from the post-CLT group (68% and 65% of those invited, respectively) participated in the questionnaire survey, of which 29 and 19 (71% and 79% of those invited), respectively, took part in interviews. The 2 groups were comparable with respect to sociodemographic and clinical characteristics. Parents and health care professionals agreed that the CLT provided important information and facilitated access to specific services, while providing both emotional and social support and facilitating meetings with other families with children with similar conditions. A number of key generic components of the service were identified. First, provision, within the outpatient setting, of a dedicated "quiet room" and office space for key workers was an essential physical requirement. Second, early identification of the key workers as the parents' point of contact was essential; this was achieved in this case by the CLT members attending the first consultation, combined with their detailed debriefing of families at the end of the outpatient visit. Third, the adoption of certain tasks by the key workers, including some previously undertaken by ophthalmologists, helped to define the liaison role of the program. These tasks included discussing the process and benefits of visual impairment certification, contacting the advisory teacher for the visually impaired, and providing written reports to educational and social services; analogous tasks would exist for other disabilities. Research on the needs of families of visually impaired children has been limited but indicates that, as with other childhood disabilities, the greatest needs during the critical period around diagnosis are for information, especially about educational and social services, and emotional support from professionals, informal and formal social networks, and support groups. Although not widely implemented or studied, key worker programs for families of visually impaired children, particularly in the context of multidisciplinary visual impairment teams, have been advocated, on the basis of their potential to facilitate coordination of health, educational, and social services. The model of such provision evaluated in this study reflects the fact that it was established as an outpatient service in a tertiary referral center for pediatric ophthalmology in the United Kingdom, with the specific structure and specialized roles for health care professionals that this requires. Different models might be more suitable in other settings in the United Kingdom or elsewhere. However, the important general lessons learned should guide implementation of such services for families of children with other disabilities. The recently launched National Service Framework for Children provides a new context and standards for meeting the needs of disabled children and their families in the United Kingdom and may also guide initiatives elsewhere. The findings of this study support implementation of programs for information provision, support, and liaison by key workers in all specialized centers for the assessment and diagnosis of children with serious visual problems. Implementation of similar services for families with children with other disabilities is likely to be equally valuable.

Nurses' perceptions and experiences at daycare for elderly with stroke.

PubMed

Park, Yeon-Hwan; Han, Hae-Ra

2010-09-01

While adult daycare (ADC) is considered a culturally acceptable model of long-term care in countries with a tradition of family-oriented caregiving, Korea is struggling as soaring needs for ADC outpace qualified staff and regulatory systems. This study aimed to describe Korean daycare nurses' perceptions of key daycare services and their working experiences with stroke patients and their families. A mixed-method design was used. First, we conducted a cross-sectional descriptive survey to assess Korean nurses' perceptions about the importance of daycare services. Then focus group interviews were performed to explore the nurses' experiences at ADC. Seventy of a total of 96 nurses at ADC that specialized in the care of stroke patients responded to the survey (response rate 72.9%) and rated the importance of 11 key daycare service items on a visual analogue scale (0-10). Using a purposive sampling design, 16 eligible nurses were interviewed as a group. The qualitative data from focus group interviews were analyzed using thematic analysis to classify common themes into larger categories. Survey data revealed that the nurses perceived "skilled nursing services,"functional recovery," and "general health counseling" as the most important daycare service areas. Focus group data resulted in five themes: "Providing the same, standard care,"Lack of partnership with family caregivers,"Conflict with other staff: ambiguity of the roles and tasks,"Lack of proper education and training," and "Need for quality control and monitoring." Daycare nurses fully recognized the importance of direct nursing care services that are keys to adequate recovery and rehabilitation of older patients with stroke. However, they experienced substantial barriers to carrying out these services due to role confusion, insufficient number of qualified nursing staff, and lack of partnership with family caregivers. The results provide insight into changing healthcare policy to support daycare nurses in a country with limited resources and regulations. Strategies such as better quality control and monitoring of daycare services, provision of continuing education, and prioritizing key services should be considered as a way to address challenges experienced by daycare nurses.

Barriers to providing quality emergency obstetric care in Addis Ababa, Ethiopia: Healthcare providers' perspectives on training, referrals and supervision, a mixed methods study.

PubMed

Austin, Anne; Gulema, Hanna; Belizan, Maria; Colaci, Daniela S; Kendall, Tamil; Tebeka, Mahlet; Hailemariam, Mengistu; Bekele, Delayehu; Tadesse, Lia; Berhane, Yemane; Langer, Ana

2015-03-29

Increasing women's access to and use of facilities for childbirth is a critical national strategy to improve maternal health outcomes in Ethiopia; however coverage alone is not enough as the quality of emergency obstetric services affects maternal mortality and morbidity. Addis Ababa has a much higher proportion of facility-based births (82%) than the national average (11%), but timely provision of quality emergency obstetric care remains a significant challenge for reducing maternal mortality and improving maternal health. The purpose of this study was to assess barriers to the provision of emergency obstetric care in Addis Ababa from the perspective of healthcare providers by analyzing three factors: implementation of national referral guidelines, staff training, and staff supervision. A mixed methods approach was used to assess barriers to quality emergency obstetric care. Qualitative analyses included twenty-nine, semi-structured, key informant interviews with providers from an urban referral network consisting of a hospital and seven health centers. Quantitative survey data were collected from 111 providers, 80% (111/138) of those providing maternal health services in the same referral network. Respondents identified a lack of transportation and communication infrastructure, overcrowding at the referral hospital, insufficient pre-service and in-service training, and absence of supportive supervision as key barriers to provision of quality emergency obstetric care. Dedicated transportation and communication infrastructure, improvements in pre-service and in-service training, and supportive supervision are needed to maximize the effective use of existing human resources and infrastructure, thus increasing access to and the provision of timely, high quality emergency obstetric care in Addis Ababa, Ethiopia.

Valuing Blue Carbon: Carbon Sequestration Benefits Provided by the Marine Protected Areas in Colombia

PubMed Central

2015-01-01

Marine protected areas are aimed to protect and conserve key ecosystems for the provision of a number of ecosystem services that are the basis for numerous economic activities. Among the several services that these areas provide, the capacity of sequestering (capturing and storing) organic carbon is a regulating service, provided mainly by mangroves and seagrasses, that gains importance as alternatives for mitigating global warming become a priority in the international agenda. The objective of this study is to value the services associated with the capture and storage of oceanic carbon, known as Blue Carbon, provided by a new network of marine protected areas in Colombia. We approach the monetary value associated to these services through the simulation of a hypothetical market for oceanic carbon. To do that, we construct a benefit function that considers the capacity of mangroves and seagrasses for capturing and storing blue carbon, and simulate scenarios for the variation of key variables such as the market carbon price, the discount rate, the natural rate of loss of the ecosystems, and the expectations about the post-Kyoto negotiations. The results indicate that the expected benefits associated to carbon capture and storage provided by these ecosystems are substantial but highly dependent on the expectations in terms of the negotiations surrounding the extension of the Kyoto Protocol and the dynamics of the carbon credit’s demand and supply. We also find that the natural loss rate of these ecosystems does not seem to have a significant effect on the annual value of the benefits. This approach constitutes one of the first attempts to value blue carbon as one of the services provided by conservation. PMID:26018814

Collaboration between non-governmental organizations and public services in health - a qualitative case study from rural Ecuador.

PubMed

Biermann, Olivia; Eckhardt, Martin; Carlfjord, Siw; Falk, Magnus; Forsberg, Birger C

2016-01-01

Non-governmental organizations (NGOs) have a key role in improving health in low- and middle-income countries. Their work needs to be synergistic, complementary to public services, and rooted in community mobilization and collective action. The study explores how an NGO and its health services are perceived by the population that it serves, and how it can contribute to reducing barriers to care. A qualitative exploratory study was conducted in remote Ecuador, characterized by its widespread poverty and lack of official governance. An international NGO collaborated closely with the public services to deliver preventative and curative health services. Data were collected using focus group discussions and semistructured interviews with purposively sampled community members, healthcare personnel, and community health workers based on their links to the health services. Conventional qualitative content analysis was used, focusing on manifest content. Emerging themes relate to the public private partnership (PPP), the NGO and its services, and community participation. The population perceives the NGO positively, linking it to healthcare improvements. Their priority is to get services, irrespective of the provider's structure. The presence of an NGO in the operation may contribute to unrealistic expectations of health services, affecting perceptions of the latter negatively. To avoid unrealistic expectations and dissatisfaction, and to increase and sustain the population's trust in the organization, an NGO should operate in a manner that is as integrated as possible within the existing structure. The NGO should work close to the population it serves, with services anchored in the community. PPP parties should develop a common platform with joint messages to the target population on the provider's structure, and regarding partners' roles and responsibilities. Interaction between the population and the providers on service content and their expectations is key to positive outcomes of PPP operations.

A case study detailing key considerations for implementing a telehealth approach to office ergonomics.

PubMed

Ritchie, Catherine L W; Miller, Linda L; Antle, David M

2017-01-01

Telehealth approaches to delivering ergonomics assessment hold great potential to improve service delivery in rural and remote settings. This case study describes a telehealth-based ergonomics service delivery process, and compares in-person and telehealth-based ergonomics approaches at an Alberta-based non-profit advocacy group. This project demonstrates that telehealth approaches to ergonomics do not lead to significantly different scoring outcomes for assessment of ergonomics issues, when compared to in-person assessments. This project also outlines the importance of live real-time video conferencing to improving communication, attaining key assessment information, and demonstrating ergonomic adjustments. However, some key considerations of bandwidth and hardware capabilities need to be taken into account. Key communication strategies are outlined to improve rapport, maintain employee confidentiality, and reduce client anxiety around telehealth ergonomics assessments. This project provides further support for telehealth approaches to office ergonomics, and outlines some key implementation strategies and barriers that should be considered.

Three-factor anonymous authentication and key agreement scheme for Telecare Medicine Information Systems.

PubMed

Arshad, Hamed; Nikooghadam, Morteza

2014-12-01

Nowadays, with comprehensive employment of the internet, healthcare delivery services is provided remotely by telecare medicine information systems (TMISs). A secure mechanism for authentication and key agreement is one of the most important security requirements for TMISs. Recently, Tan proposed a user anonymity preserving three-factor authentication scheme for TMIS. The present paper shows that Tan's scheme is vulnerable to replay attacks and Denial-of-Service attacks. In order to overcome these security flaws, a new and efficient three-factor anonymous authentication and key agreement scheme for TMIS is proposed. Security and performance analysis shows superiority of the proposed scheme in comparison with previously proposed schemes that are related to security of TMISs.

Stakeholder analysis for the development of a community pharmacy service aimed at preventing cardiovascular disease.

PubMed

Franco-Trigo, L; Hossain, L N; Durks, D; Fam, D; Inglis, S C; Benrimoj, S I; Sabater-Hernández, D

Participatory approaches involving stakeholders across the health care system can help enhance the development, implementation and evaluation of health services. These approaches may be particularly useful in planning community pharmacy services and so overcome challenges in their implementation into practice. Conducting a stakeholder analysis is a key first step since it allows relevant stakeholders to be identified, as well as providing planners a better understanding of the complexity of the health care system. The main aim of this study was to conduct a stakeholder analysis to identify those individuals and organizations that could be part of a leading planning group for the development of a community pharmacy service (CPS) to prevent cardiovascular disease (CVD) in Australia. An experienced facilitator conducted a workshop with 8 key informants of the Australian health care system. Two structured activities were undertaken. The first explored current needs and gaps in cardiovascular care and the role of community pharmacists. The second was a stakeholder analysis, using both ex-ante and ad-hoc approaches. Identified stakeholders were then classified into three groups according to their relative influence on the development of the pharmacy service. The information gathered was analyzed using qualitative content analysis. The key informants identified 46 stakeholders, including (1) patient/consumers and their representative organizations, (2) health care providers and their professional organizations and (3) institutions and organizations that do not directly interact with patients but organize and manage the health care system, develop and implement health policies, pay for health care, influence funding for health service research or promote new health initiatives. From the 46 stakeholders, a core group of 12 stakeholders was defined. These were considered crucial to the service's development because they held positions that could drive or inhibit progress. Secondary results of the workshop included: a list of needs and gaps in cardiovascular care (n = 6), a list of roles for community pharmacists in cardiovascular prevention (n = 12) and a list of potential factors (n = 7) that can hinder the integration of community pharmacy services into practice. This stakeholder analysis provided a detailed picture of the wide range of stakeholders across the entire health care system that have a stake in the development of a community pharmacy service aimed at preventing CVD. Of these, a core group of key stakeholders, with complementary roles, can then be approached for further planning of the service. The results of this analysis highlight the relevance of establishing multilevel stakeholder groups for CPS planning. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

Bootstrapping and Maintaining Trust in the Cloud

DTIC Science & Technology

2016-03-16

of infrastructure-as-a- service (IaaS) cloud computing services such as Ama- zon Web Services, Google Compute Engine, Rackspace, et. al. means that...Implementation We implemented keylime in ∼3.2k lines of Python in four components: registrar, node, CV, and tenant. The registrar offers a REST-based web ...bootstrap key K. It provides an unencrypted REST-based web service for these two functions. As described earlier, the pro- tocols for exchanging data

Issues in Developing the IFSP: A Framework for Establishing Family Outcomes.

ERIC Educational Resources Information Center

Beckman, Paula J.; Bristol, Marie M.

1991-01-01

This paper identifies four key issues in the implementation of Individualized Family Service Plans (IFSPs) to provide services to young handicapped children as required by Public Law 99-457. These include sensitivity to cultural diversity, family assessment, intrusiveness, and establishing family outcomes. A typology of family outcomes which…

USDA forest service southern region – It’s all about GRITS

Treesearch

Barbara S. Crane; Kevin M. Potter

2017-01-01

Genetic resource management programs across the U.S. Department of Agriculture Forest Service (USDA FS) play a key role in supporting successful land management activities. The programs are responsible for developing and providing plant material for revegetation, seed management guidelines, emergency fire recovery assistance, genetic conservation strategies, climate...

Private vs. Public Care for Juvenile Offenders: A Qualitative Examination.

ERIC Educational Resources Information Center

Kronick, Robert F.

1993-01-01

Examined effectiveness of methods used by public and private institutions' handling of incarcerated delinquents. Concluded that organizational culture is key concept in delivery of services to incarcerated children and youth; that private sector provides alternative to public in delivery of services; that alcohol and drug treatment programs are…

Applying LD Documentation Guidelines at the Postsecondary Level: Decision Making with Sparse or Missing Data

ERIC Educational Resources Information Center

Banerjee, Manju; Madaus, Joseph W.; Gelbar, Nicholas

2015-01-01

A key issue in fostering transition to postsecondary education for students with disabilities is documentation verifying the nature of the disability and supporting the need for services and reasonable accommodations. Documentation guidelines assist postsecondary disability service providers in making decisions about eligibility and reasonable…

A behavioral choice model of the use of car-sharing and ride-sourcing services

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

Dias, Felipe F.; Lavieri, Patrícia S.; Garikapati, Venu M.

There are a number of disruptive mobility services that are increasingly finding their way into the marketplace. Two key examples of such services are car-sharing services and ride-sourcing services. In an effort to better understand the influence of various exogenous socio-economic and demographic variables on the frequency of use of ride-sourcing and car-sharing services, this paper presents a bivariate ordered probit model estimated on a survey data set derived from the 2014-2015 Puget Sound Regional Travel Study. Model estimation results show that users of these services tend to be young, well-educated, higher-income, working individuals residing in higher-density areas. There aremore » significant interaction effects reflecting the influence of children and the built environment on disruptive mobility service usage. The model developed in this paper provides key insights into factors affecting market penetration of these services, and can be integrated in larger travel forecasting model systems to better predict the adoption and use of mobility-on-demand services.« less

Using EMBL-EBI services via Web interface and programmatically via Web Services

PubMed Central

Lopez, Rodrigo; Cowley, Andrew; Li, Weizhong; McWilliam, Hamish

2015-01-01

The European Bioinformatics Institute (EMBL-EBI) provides access to a wide range of databases and analysis tools that are of key importance in bioinformatics. As well as providing Web interfaces to these resources, Web Services are available using SOAP and REST protocols that enable programmatic access to our resources and allow their integration into other applications and analytical workflows. This unit describes the various options available to a typical researcher or bioinformatician who wishes to use our resources via Web interface or programmatically via a range of programming languages. PMID:25501941

Getting Paid for Clinical Services.

PubMed

Martin, Caren McHenry

2018-05-01

Increasingly, pharmacists are providing advanced, patient-centered clinical services. However, pharmacists are not currently included in key sections of the Social Security Act, which determines eligibility to bill and be reimbursed by Medicare. Many state and private health plans also cite the omission from Medicare as the rationale for excluding reimbursement of pharmacists for clinical services. This has prompted forward-thinking pharmacists to seek opportunities for reimbursement in other ways, allowing them to provide value to the health care system, while carving out unique niches for pharmacists to care for patients.

Using object-oriented analysis to design a multi-mission ground data system

NASA Technical Reports Server (NTRS)

Shames, Peter

1995-01-01

This paper describes an analytical approach and descriptive methodology that is adapted from Object-Oriented Analysis (OOA) techniques. The technique is described and then used to communicate key issues of system logical architecture. The essence of the approach is to limit the analysis to only service objects, with the idea of providing a direct mapping from the design to a client-server implementation. Key perspectives on the system, such as user interaction, data flow and management, service interfaces, hardware configuration, and system and data integrity are covered. A significant advantage of this service-oriented approach is that it permits mapping all of these different perspectives on the system onto a single common substrate. This services substrate is readily represented diagramatically, thus making details of the overall design much more accessible.

Distributed hydrological models to quantify ecosystem services and inform land use decisions in Europe

NASA Astrophysics Data System (ADS)

Wilebore, Beccy; Willis, Kathy

2016-04-01

Landcover conversion is one of the largest anthropogenic threats to ecological services globally; in the EU around 1500 ha of biodiverse land are lost every day to changes in infrastructure and urbanisation. This land conversion directly affects key ecosystem services that support natural infrastructure, including water flow regulation and the mitigation of flood risks. We assess the sensitivity of runoff production to landcover in the UK at a high spatial resolution, using a distributed hydrologic model in the regional land-surface model JULES (Joint UK Land Environment Simulator). This work, as part of the wider initiative 'NaturEtrade', will create a novel suite of easy-to-use tools and mechanisms to allow EU landowners to quickly map and assess the value of their land in providing key ecosystem services.

Using fuzzy gap analysis to measure service quality of medical tourism in Taiwan.

PubMed

Ho, Li-Hsing; Feng, Shu-Yun; Yen, Tieh-Min

2015-01-01

The purpose of this paper is intended to create a model to measure quality of service, using fuzzy linguistics to analyze the quality of service of medical tourism in Taiwan so as to find the direction for improvement of service quality in medical tourism. The study developed fuzzy questionnaires based on the characteristics of medical tourism quality of service in Taiwan. Questionnaires were delivered and recovered from February to April 2014, using random sampling according to the proportion of medical tourism companies in each region, and 150 effective samples were obtained. The critical quality of service level is found through the fuzzy gap analysis using questionnaires examining expectations and perceptions of customers, as the direction for continuous improvement. From the study, the primary five critical service items that improve the quality of service for medical tourism in Taiwan include, in order: the capability of the service provider to provide committed medical tourism services reliably and accurately, facility service providers in conjunction with the services provided, the cordial and polite attitude of the service provider eliciting a sense of trust from the customer, professional ability of medical (nursing) personnel in hospital and reliability of service provider. The contribution of this study is to create a fuzzy gap analysis to assess the performance of medical tourism service quality, identify key quality characteristics and provide a direction for improvement and development for medical tourism service quality in Taiwan.

Patients’ Data Management System Protected by Identity-Based Authentication and Key Exchange

PubMed Central

Rivero-García, Alexandra; Santos-González, Iván; Hernández-Goya, Candelaria; Caballero-Gil, Pino; Yung, Moti

2017-01-01

A secure and distributed framework for the management of patients’ information in emergency and hospitalization services is proposed here in order to seek improvements in efficiency and security in this important area. In particular, confidentiality protection, mutual authentication, and automatic identification of patients are provided. The proposed system is based on two types of devices: Near Field Communication (NFC) wristbands assigned to patients, and mobile devices assigned to medical staff. Two other main elements of the system are an intermediate server to manage the involved data, and a second server with a private key generator to define the information required to protect communications. An identity-based authentication and key exchange scheme is essential to provide confidential communication and mutual authentication between the medical staff and the private key generator through an intermediate server. The identification of patients is carried out through a keyed-hash message authentication code. Thanks to the combination of the aforementioned tools, a secure alternative mobile health (mHealth) scheme for managing patients’ data is defined for emergency and hospitalization services. Different parts of the proposed system have been implemented, including mobile application, intermediate server, private key generator and communication channels. Apart from that, several simulations have been performed, and, compared with the current system, significant improvements in efficiency have been observed. PMID:28362328

Patients' Data Management System Protected by Identity-Based Authentication and Key Exchange.

PubMed

Rivero-García, Alexandra; Santos-González, Iván; Hernández-Goya, Candelaria; Caballero-Gil, Pino; Yung, Moti

2017-03-31

A secure and distributed framework for the management of patients' information in emergency and hospitalization services is proposed here in order to seek improvements in efficiency and security in this important area. In particular, confidentiality protection, mutual authentication, and automatic identification of patients are provided. The proposed system is based on two types of devices: Near Field Communication (NFC) wristbands assigned to patients, and mobile devices assigned to medical staff. Two other main elements of the system are an intermediate server to manage the involved data, and a second server with a private key generator to define the information required to protect communications. An identity-based authentication and key exchange scheme is essential to provide confidential communication and mutual authentication between the medical staff and the private key generator through an intermediate server. The identification of patients is carried out through a keyed-hash message authentication code. Thanks to the combination of the aforementioned tools, a secure alternative mobile health (mHealth) scheme for managing patients' data is defined for emergency and hospitalization services. Different parts of the proposed system have been implemented, including mobile application, intermediate server, private key generator and communication channels. Apart from that, several simulations have been performed, and, compared with the current system, significant improvements in efficiency have been observed.

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.

Geographic information systems (GIS): an emerging method to assess demand and provision for rehabilitation services.

PubMed

Passalent, Laura; Borsy, Emily; Landry, Michel D; Cott, Cheryl

2013-09-01

To illustrate the application of geographic information systems (GIS) as a tool to assess rehabilitation service delivery by presenting results from research recently conducted to assess demand and provision for community rehabilitation service delivery in Ontario, Canada. Secondary analysis of data obtained from existing sources was used to establish demand and provision profiles for community rehabilitation services. These data were integrated using GIS software. A number of descriptive maps were produced that show the geographical distribution of service provision variables (location of individual rehabilitation health care providers and location of private and publicly funded community rehabilitation clinics) in relation to the distribution of demand variables (location of the general population; location of specific populations (i.e., residents age 65 and older) and distribution of household income). GIS provides a set of tools for describing and understanding the spatial organization of the health of populations and the distribution of health services that can aid the development of health policy and answer key research questions with respect to rehabilitation health services delivery. Implications for Rehabilitation It is important to seek out alternative and innovative methods to examine rehabilitation service delivery. GIS is a computer-based program that takes any data linked to a geographically referenced location and processes it through a software system that manages, analyses and displays the data in the form of a map, allowing for an alternative level of analysis. GIS provides a set of tools for describing and understanding the spatial organization of population health and health services that can aid the development of health policy and answer key research questions with respect to rehabilitation health services delivery.

School Climate Improvement Action Guide for District Leaders. School Climate Improvement Resource Package

ERIC Educational Resources Information Center

National Center on Safe Supportive Learning Environments, 2017

2017-01-01

Improving school climate takes time and commitment from a variety of people in a variety of roles. This document outlines key action steps that district leaders--including superintendents, assistant superintendents, directors of student support services, or others--can take to support school climate improvements. Key action steps are provided for…

Relationships, Expertise, Incentives, and Governance: Supporting Care Home Residents' Access to Health Care. An Interview Study From England

PubMed Central

Goodman, Claire; Davies, Sue L.; Gordon, Adam L.; Meyer, Julienne; Dening, Tom; Gladman, John R.F.; Iliffe, Steve; Zubair, Maria; Bowman, Clive; Victor, Christina; Martin, Finbarr C.

2015-01-01

Objectives To explore what commissioners of care, regulators, providers, and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of National Health Service (NHS) provision to independent care homes. Methods Qualitative, semistructured interviews with a purposive sample of people with direct experience of commissioning, providing, and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health. Results Participants identified 3 overlapping approaches to the provision of NHS that they believed supported access to health care for older people in care homes: (1) Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff, (2) the provision of age-appropriate clinical services, and (3) governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive. Conclusion The 3 approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organizations. PMID:25687930

A Key Establishment Protocol for RFID User in IPTV Environment

NASA Astrophysics Data System (ADS)

Jeong, Yoon-Su; Kim, Yong-Tae; Sohn, Jae-Min; Park, Gil-Cheol; Lee, Sang-Ho

In recent years, the usage of IPTV (Internet Protocol Television) has been increased. The reason is a technological convergence of broadcasting and telecommunication delivering interactive applications and multimedia content through high speed Internet connections. The main critical point of IPTV security requirements is subscriber authentication. That is, IPTV service should have the capability to identify the subscribers to prohibit illegal access. Currently, IPTV service does not provide a sound authentication mechanism to verify the identity of its wireless users (or devices). This paper focuses on a lightweight authentication and key establishment protocol based on the use of hash functions. The proposed approach provides effective authentication for a mobile user with a RFID tag whose authentication information is communicated back and forth with the IPTV authentication server via IPTV set-top box (STB). That is, the proposed protocol generates user's authentication information that is a bundle of two public keys derived from hashing user's private keys and RFID tag's session identifier, and adds 1bit to this bundled information for subscriber's information confidentiality before passing it to the authentication server.

Models for Access to Maternal Smoking cessation Support (MAMSS): a study protocol of a quasi-experiment to increase the engagement of pregnant women who smoke in NHS Stop Smoking Services.

PubMed

Bennett, Lorna; Grant, Aimee; Jones, Siobhan; Bowley, Mererid; Heathcote-Elliott, Christian; Ford, Catrin; Jones, Angela; Lewis, Rachel; Munkley, Margaret; Owen, Carol; Petherick, Annie; Paranjothy, Shantini

2014-10-06

Maternal smoking is a key cause of poor outcomes for mothers, babies and children and Wales has higher rates of smoking in pregnancy than any other UK country. Despite various improvements within the NHS Stop Smoking Service to strengthen the intervention for pregnant women, referrals and successful quit attempts for this group have continued to remain extremely low. A key element of UK national guidance for smoking cessation during pregnancy is to provide a flexible and tailored service to help increase levels of engagement. This study aims to test the effectiveness of three different models of service delivery to address the gap in the evidence base about how to deliver a flexible, tailored smoking cessation service to pregnant women. This study will adopt a quasi-experimental design over a 12 month period. The setting is four of Wales' seven Health Boards using an integrated approach between maternity services, local public health teams and the NHS Stop Smoking Service. Core recommendations from UK public health guidance are being implemented across intervention and usual care sites. Stop smoking support for pregnant women in intervention sites is being delivered more flexibly than in usual care sites. Both qualitative and quantitative approaches will be adopted to capture important contextual information and consider multiple perspectives. A health economic analysis will be undertaken using a cost-consequences analysis approach. The primary outcome measure is engagement with stop smoking services (defined as having at least one face-to-face therapeutic contact with a clinician). Supporting pregnant women to stop smoking is a challenging area of public health. The proposed study will address several areas where there are key evidence gaps relating to smoking cessation interventions for pregnant women. Specifically, how best to encourage pregnant women to attend a specialist stop smoking support service, how to deliver the service and who should provide it.

Regional scale prioritisation for key ecosystem services, renewable energy production and urban development.

PubMed

Casalegno, Stefano; Bennie, Jonathan J; Inger, Richard; Gaston, Kevin J

2014-01-01

Although the importance of addressing ecosystem service benefits in regional land use planning and decision-making is evident, substantial practical challenges remain. In particular, methods to identify priority areas for the provision of key ecosystem services and other environmental services (benefits from the environment not directly linked to the function of ecosystems) need to be developed. Priority areas are locations which provide disproportionally high benefits from one or more service. Here we map a set of ecosystem and environmental services and delineate priority areas according to different scenarios. Each scenario is produced by a set of weightings allocated to different services and corresponds to different landscape management strategies which decision makers could undertake. Using the county of Cornwall, U.K., as a case study, we processed gridded maps of key ecosystem services and environmental services, including renewable energy production and urban development. We explored their spatial distribution patterns and their spatial covariance and spatial stationarity within the region. Finally we applied a complementarity-based priority ranking algorithm (zonation) using different weighting schemes. Our conclusions are that (i) there are two main patterns of service distribution in this region, clustered services (including agriculture, carbon stocks, urban development and plant production) and dispersed services (including cultural services, energy production and floods mitigation); (ii) more than half of the services are spatially correlated and there is high non-stationarity in the spatial covariance between services; and (iii) it is important to consider both ecosystem services and other environmental services in identifying priority areas. Different weighting schemes provoke drastic changes in the delineation of priority areas and therefore decision making processes need to carefully consider the relative values attributed to different services.

Regional Scale Prioritisation for Key Ecosystem Services, Renewable Energy Production and Urban Development

PubMed Central

Casalegno, Stefano; Bennie, Jonathan J.; Inger, Richard; Gaston, Kevin J.

2014-01-01

Although the importance of addressing ecosystem service benefits in regional land use planning and decision-making is evident, substantial practical challenges remain. In particular, methods to identify priority areas for the provision of key ecosystem services and other environmental services (benefits from the environment not directly linked to the function of ecosystems) need to be developed. Priority areas are locations which provide disproportionally high benefits from one or more service. Here we map a set of ecosystem and environmental services and delineate priority areas according to different scenarios. Each scenario is produced by a set of weightings allocated to different services and corresponds to different landscape management strategies which decision makers could undertake. Using the county of Cornwall, U.K., as a case study, we processed gridded maps of key ecosystem services and environmental services, including renewable energy production and urban development. We explored their spatial distribution patterns and their spatial covariance and spatial stationarity within the region. Finally we applied a complementarity-based priority ranking algorithm (zonation) using different weighting schemes. Our conclusions are that (i) there are two main patterns of service distribution in this region, clustered services (including agriculture, carbon stocks, urban development and plant production) and dispersed services (including cultural services, energy production and floods mitigation); (ii) more than half of the services are spatially correlated and there is high non-stationarity in the spatial covariance between services; and (iii) it is important to consider both ecosystem services and other environmental services in identifying priority areas. Different weighting schemes provoke drastic changes in the delineation of priority areas and therefore decision making processes need to carefully consider the relative values attributed to different services. PMID:25250775

Building evaluative culture in community services: Caring for evidence.

PubMed

Mayne, John

2017-05-25

An organization with a strong evaluative culture engages in self-reflection, evidence-based learning and experimentation. It sees evidence as essential for managing well, but building such a culture is challenging. Community service organizations seek to provide effective services for their clients. To build an evaluative culture, they need to acquire basic monitoring and evaluation capabilities, be provided with opportunities for using these capabilities and be adequately motivated to care about evidence as a means to improve services to their clients. Leadership along with a phased in approach are key in bringing about these behaviour changes. Copyright © 2017. Published by Elsevier Ltd.

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

New directions in health sciences libraries in China.

PubMed

Xie, Zhiyun; Zhang, Jianjing

2018-06-01

This article briefly describes the services provided by Chinese health science libraries and the factors which influence service provision. Driven by new technologies and national initiatives, the key services delivered by Chinese health libraries in the last 10 years have been research support services (such as research impact assessment, support for data management), evidence-based medicine, systematic reviews, the promotion of health information literacy, and the development of institutional repositories. J.M. © 2018 Health Libraries Group.

System Control for the Transitional DCS. Appendices.

DTIC Science & Technology

1978-12-01

the deployment of the AN/TTC-39 circuit switch. This is a hybrid analog/digital switch providing the following services: o Non- secure analog telephone...service. o Non- secure 16 Kb/s digital telephone service. o Secure 16 Kb/s digital telephone service with automatic key distribution and end to end... security . o Analog circuits to support current inventory 50 Kb/sec and 9.6 Kb/sec secure digital communications. In the deployment model for this study

Enhancing success in transition service coordinators: use of transformational leadership.

PubMed

Rearick, Ellen

2007-01-01

The lifespan of children with special healthcare needs has been extended because of improved technology and medical advances. Successful transition to the adult arena of healthcare, social services, and education by adolescents with special healthcare needs (ASHCN) is lacking. The transition service coordinator (TSC) is a multifaceted role of advanced practice nursing that provides highly specialized transition services to adolescents with special healthcare needs. The use of key concepts from the transformational leadership theory may improve healthcare outcomes. This article applies to pediatric and adult primary care and case management services that serve adolescents with special healthcare needs. Employing key concepts of transformational leadership theory will enhance the success of the TSC to improve both collaboration among stakeholders in the transitional team and young adults' transition to the world of adult services. Enhanced communication resulting in improved sharing of information, understanding of the stakeholder roles, and provision of formal linkages between pediatric and adult medical providers is a significant outcome affecting the ASHCN. Improved collaboration will produce a smooth transition for the ASHCN to the world of adult social services education, and employment. Incorporating the transformational leadership dimensions of idealized influence, inspirational motivation intellectual stimulation, and individualized consideration will enhance the ability of the TSC to improve collaboration among stakeholders in the transitional team and the quality of services for the ASHCN.

What Factors Do Allied Health Take Into Account When Making Resource Allocation Decisions?

PubMed Central

Lane, Haylee; Sturgess, Tamica; Philip, Kathleen; Markham, Donna; Martin, Jennifer; Walsh, Jill; Hubbard, Wendy; Haines, Terry

2018-01-01

Background: Allied health comprises multiple professional groups including dietetics, medical radiation practitioners, occupational therapists, optometrists and psychologists. Different to medical and nursing, Allied health are often organized in discipline specific departments and allocate budgets within these to provide services to a range of clinical areas. Little is known of how managers of allied health go about allocating these resources, the factors they consider when making these decisions, and the sources of information they rely upon. The purpose of this study was to identify the key factors that allied health consider when making resource allocation decisions and the sources of information they are based upon. Methods: Four forums were conducted each consisting of case studies, a large group discussion and two hypothetical scenarios to elicit data. A thematic content analysis commenced during post-forum discussions of key factors by forum facilitators. These factors were then presented to an expert working party for further discussion and refinement. Transcripts were generated of all data recordings and a detailed thematic analysis was undertaken by one author to ensure coded data matched the initial thematic analysis. Results: Twelve factors affecting the decision-making of allied health managers and clinicians were identified. One of these factors was disendorsed by the expert working party. The 11 remaining factors can be considered to be key decision-making principles that should be consistently applied to resource allocation. These principles were clustered into three overarching themes of readiness, impact and appropriateness. Conclusion: Understanding these principles now means further research can be completed to more effectively integrate research evidence into health policy and service delivery, create partnerships among policy-makers, managers, service providers and researchers, and to provide support to answer difficult questions that policy-makers, managers and service providers face. PMID:29764105

Contingency management: perspectives of Australian service providers.

PubMed

Cameron, Jacqui; Ritter, Alison

2007-03-01

Given the very positive and extensive research evidence demonstrating efficacy and effectiveness of contingency management, it is important that Australia explore whether contingency management has a role to play in our own treatment context. Qualitative interviews were conducted with 30 experienced alcohol and drug practitioners, service managers and policy-makers in Victoria. Interviewees were selected to represent the range of drug treatment services types and included rural representation. A semi-structured interview schedule, covering their perceptions and practices of contingency management was used. All interviews were transcribed verbatim and analysed using N2 qualitative data analysis program. The majority of key informants were positively inclined toward contingency management, notwithstanding some concerns about the philosophical underpinnings. Concerns were raised in relation to the use of monetary rewards. Examples of the use of contingency management provided by key informants demonstrated an over-inclusive definition: all the examples did not adhere to the key principles of contingency management. This may create problems if a structured contingency management were to be introduced in Australia. Contingency management is an important adjunctive treatment intervention and its use in Australia has the potential to enhance treatment outcomes. No unmanageable barriers were identified in this study.

Blending Key Ingredients to Assure Quality in Home Health Care.

ERIC Educational Resources Information Center

Griffith, Deloris G.

1986-01-01

Careful staff selection, training, and review are among the methods the author recommends to home care agencies striving to provide top-notch services. Discusses measuring the quality of care employees are providing, accreditation, and the benefits of accreditation. (CT)

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

PubMed

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

2017-01-01

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

Obesity services planning framework for interprofessional primary care organizations.

PubMed

Brauer, Paula; Royall, Dawna; Dwyer, John; Edwards, A Michelle; Hussey, Tracy; Kates, Nick; Smith, Heidi; Kirkconnell, Ross

2017-03-01

Aim We report on a formative project to develop an organization-level planning framework for obesity prevention and management services. It is common when developing new services to first develop a logic model outlining expected outcomes and key processes. This can be onerous for single primary care organizations, especially for complex conditions like obesity. The initial draft was developed by the research team, based on results from provider and patient focus groups in one large Family Health Team (FHT) in Ontario. This draft was reviewed and activities prioritized by 20 FHTs using a moderated electronic consensus process. A national panel then reviewed the draft. Findings Providers identified five main target groups: pregnancy to 2, 3-12, 13-18, 18+ years at health risk, and 18+ with complex care needs. Desired outcomes were identified and activities were prioritized under categories: raising awareness (eg, providing information and resources on weight-health), identification and initial management (eg, wellness care), follow-up management (eg, group programs), expanded services (eg, availability of team services), and practice initiatives (eg, interprofessional education). Overall, there was strong support for raising awareness by providing information on the weight-health connection and on community services. There was also strong support for growth assessment in pediatric care. In adults, there was strong support for wellness care/health check visits and episodic care to identify people for interventions, for group programs, and for additional provider education. Joint development by different teams proved useful for consensus on outcomes and for ensuring relevancy across practices. While priorities will vary depending on local context, the basic descriptions of care processes were endorsed by reviewers. Key next steps are to trial the use of the framework and for further implementation studies to find optimally effective approaches for obesity prevention and management across the lifespan.

Efficient biometric authenticated key agreements based on extended chaotic maps for telecare medicine information systems.

PubMed

Lou, Der-Chyuan; Lee, Tian-Fu; Lin, Tsung-Hung

2015-05-01

Authenticated key agreements for telecare medicine information systems provide patients, doctors, nurses and health visitors with accessing medical information systems and getting remote services efficiently and conveniently through an open network. In order to have higher security, many authenticated key agreement schemes appended biometric keys to realize identification except for using passwords and smartcards. Due to too many transmissions and computational costs, these authenticated key agreement schemes are inefficient in communication and computation. This investigation develops two secure and efficient authenticated key agreement schemes for telecare medicine information systems by using biometric key and extended chaotic maps. One scheme is synchronization-based, while the other nonce-based. Compared to related approaches, the proposed schemes not only retain the same security properties with previous schemes, but also provide users with privacy protection and have fewer transmissions and lower computational cost.

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.

A service model for delivering care closer to home.

PubMed

Dodd, Joanna; Taylor, Charlotte Elizabeth; Bunyan, Paul; White, Philippa Mary; Thomas, Siân Myra; Upton, Dominic

2011-04-01

Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient.This is a practical example of early implementation of the principles underlying the Department of Health's (DH) recent Best Practice Guidance, 'Delivering Care Closer to Home' (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the 'Customer Care' award by 'Management in Practice'. The Surgery was also awarded the 'Practice of the Year' award for this and a number of other customer-focussed projects.

Introduction strategies raise key questions.

PubMed

Finger, W R; Keller, S

1995-09-01

Key issues that must be considered before a new contraceptive is introduced center on the need for a trained provider to begin or terminate the method, its side effects, duration of use, method's ability to meet users' needs and preferences, and extra training or staff requirements. Logistics and economic issues to consider are identifying a dependable way of effectively supplying commodities, planning extra services needed for the method, and cost of providing the method. Each contraceptive method presents a different side effect pattern and burdens the service delivery setting differently. The strategy developed to introduce or expand the 3-month injectable Depo-Provera (DMPA) can be used for any method. It includes a needs assessment and addresses regulatory issues, service delivery policies and procedures, information and training, evaluation, and other concerns. Viet Nam's needs assessment showed that Norplant should not be introduced until the service delivery system becomes stronger. Any needs assessment for expansion of contraceptive services should cover sexually transmitted disease/HIV issues. A World Health Organization strategy helps officials identify the best method mix for local situations. Introductory strategies must aim to improve the quality of family planning programs and expand choices. Many begin by examining existing data and conducting interviews with policymakers, users, providers, and women's health advocates. Introductory programs for Norplant focus on provider training, adequate counseling and informed consent for users, and ready access to removal. They need a well-prepared service delivery infrastructure. The first phase of the DMPA introductory strategy for the Philippines comprised a social marketing campaign and DMPA introduction at public clinics in 10 pilot areas with strong service delivery. Successful AIDS prevention programs show that people tend to use barrier methods when they are available. USAID is currently studying whether or not women in developing countries will use the female condom.

Service delivery under translation: multi-stakeholder accountability in the non-profit community sector in New Zealand.

PubMed

Boon, Bronwyn; Greatbanks, Richard; Munro, Jenny; Gaffney, Michael

2017-03-01

This paper addresses the challenge reported in the research literature of providing adequate accounts of service quality and value to multiple stakeholders. Rather than starting with a particular accountability practice, we examine the accounts of complex service delivery and results from the perspective of five key stakeholder groups. The case study at the empirical centre of this research is a small New Zealand non-profit organisation that provides community-based wraparound casework to young people, and their families, with multiple and complex needs. This paper reports on data collected during 2009-2012 through interviews with five key stakeholders of this service: the young people, the caseworkers, the co-providers, the managers and the funders. Drawing on translation theory, the different points of reference and the consequential shifts in focus, content and meaning within the multiple stakeholder accounts are traced. The findings show that while each stakeholder group brings a unique point of reference to the service delivery, there are degrees of overlap in the focus and content of the accounts. This is particularly evident in the 'relationship' dimension. While overlaps may exist, points of invisibility are also revealed. Accountability tensions can be traced directly to these points of invisibility. As a result of this analysis, it is argued that more explicit attention to the impact of multiple stakeholders at the level of epistemology provides a mechanism for addressing some of the tensions routinely raised. © 2015 John Wiley & Sons Ltd.

The Power of the Cloud: Google Forms for Transition Assessment

ERIC Educational Resources Information Center

Scheef, Andrew R.; Johnson, Cinda

2017-01-01

The inclusion of age-appropriate transition assessments is a key component of transition services for students with disabilities. Although these assessments may focus on a variety of areas, their general purpose is to provide guidance in developing individualized postschool goals and design transition services to help students achieve these goals.…

Service Learning in an Indigenous Not-for-Profit Organization

ERIC Educational Resources Information Center

Young, Suzanne; Karme, Tina

2015-01-01

Purpose: The purpose of this paper is to provide an understanding of how service learning pedagogy assists in student and organizational learning. Design/methodology/approach: The authors use case study reflection and ethnography approaches. Findings: The key to the success of the internship was time spent on relationship building between the…

State Library Agency Service Trends: 1999-2008. Research Brief Number 2

ERIC Educational Resources Information Center

Henderson, Everett; Manjarrez, Carlos

2010-01-01

State library agencies (StLAs) provide key leadership for library services planning and development in each state. Their structure and governance varies widely across states; StLAs are located in various departments in state government and they report to different authorities. This research brief gives an overview of the revenues, expenditures,…

CCBD's Position Executive Summary on School-Based Mental Health Services

ERIC Educational Resources Information Center

Mathur, Sarup R.; Kern, Lee; Albrecht, Susan F.; Poland, Scott; Rozalski, Michael; Skiba, Russell J.

2017-01-01

This document provides administrative recommendations of the Council for Children with Behavioral Disorders (CCBD) regarding the need for school-based mental health services (SBMHS) in schools (Kern et al., 2017). It includes (1) an introduction, (2) key considerations for successful SBMHS, and (3) recommendations regarding local, state, and…

Ohio Financial Services and Risk Management. Technical Competency Profile (TCP).

ERIC Educational Resources Information Center

Ray, Gayl M.; Wilson, Nick; Mangini, Rick

This document describes the essential competencies from secondary through post-secondary associate degree programs for a career in financial services and risk management. Ohio College Tech Prep Program standards are described, and a key to profile codes is provided. Sample occupations in this career area, such as financial accountant, loan…

Providing Services for Handicapped Persons in Rural/Sparsely Populated Areas.

ERIC Educational Resources Information Center

Weatherman, Richard

The experiences of the 3-year Minnesota Severely Handicapped Delivery System Project have led to a model which utilizes resources of regional systems as key elements of a differentiated system for educational service delivery to the handicapped in rural areas and involves state education agencies, statewide regional centers, local education units,…

Emotional Intelligence: A Key to Improving Federal Chief Information Officer Management

ERIC Educational Resources Information Center

Borkowski, Tammy M.

2012-01-01

The United States Government relies on information technology to provide services to its citizens, spending more than $600 billion on its products and services in the last decade. Given the current fiscal climate, the Executive Branch of the United States Government has a renewed focus on information technology (IT) innovation, requiring federal…

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

Establishing a nurse practitioner collaborative: evolution, development, and outcomes.

PubMed

Quinn, Karen; Hudson, Peter

2014-09-01

The first Australian palliative care nurse practitioner (NP) was endorsed in 2003. In 2009 the Victoria Department of Health funded the development of the Victorian Palliative Care Nurse Practitioner Collaborative (VPCNPC). Its aim was to promote the NP role, develop resources, and provide education and mentorship to NPs, nurse practitioner candidates (NPCs), and health service managers. Four key objectives were developed: identify the demographic profile of palliative care NPCs in Victoria; develop an education curriculum and practical resources to support the training and education of palliative care NPCs and NPs; provide mentorship to NPs, NPCs, and service managers; and ensure effective communication with all key stakeholders. An NPC survey was also conducted to explore NPC demographics, models of care, the hours of study required for the role, the mentoring process, and education needs. This paper reports on the establishment of the VPCNPC, the steps taken to achieve its objectives, and the results of the survey. The NP role in palliative care in Australia continues to evolve, and the VPCNPC provides a structure and resources to clearly articulate the benefits of the role to nursing and clinical services.

Consumers’ experiences of back pain in rural Western Australia: access to information and services, and self-management behaviours

PubMed Central

2012-01-01

Background Coordinated, interdisciplinary services, supported by self-management underpin effective management for chronic low back pain (CLBP). However, a combination of system, provider and consumer-based barriers exist which limit the implementation of such models into practice, particularly in rural areas where unique access issues exist. In order to improve health service delivery for consumers with CLBP, policymakers and service providers require a more in depth understanding of these issues. The objective of this qualitative study was to explore barriers experienced by consumers in rural settings in Western Australia (WA) to accessing information and services and implementing effective self-management behaviours for CLBP. Methods Fourteen consumers with a history of CLBP from three rural sites in WA participated. Maximum variation sampling was employed to ensure a range of experiences were captured. An interviewer, blinded to quantitative pain history data, conducted semi-structured telephone interviews using a standardised schedule to explore individuals’ access to information and services for CLBP, and self-management behaviours. Interviews were digitally recorded and transcribed verbatim. Inductive analysis techniques were used to derive and refine key themes. Results Five key themes were identified that affected individuals’ experiences of managing CLBP in a rural setting, including: 1) poor access to information and services in rural settings; 2) inadequate knowledge and skills among local practitioners; 3) feelings of isolation and frustration; 4) psychological burden associated with CLBP; and 5) competing lifestyle demands hindering effective self-management for CLBP. Conclusions Consumers in rural WA experienced difficulties in knowing where to access relevant information for CLBP and expressed frustration with the lack of service delivery options to access interdisciplinary and specialist services for CLBP. Competing lifestyle demands such as work and family commitments were cited as key barriers to adopting regular self-management practices. Consumer expectations for improved health service coordination and a workforce skilled in pain management are relevant to future service planning, particularly in the contexts of workforce capacity, community health services, and enablers to effective service delivery in primary care. PMID:23057669

Customer-Provider Strategic Alignment: A Maturity Model

NASA Astrophysics Data System (ADS)

Luftman, Jerry; Brown, Carol V.; Balaji, S.

This chapter presents a new model for assessing the maturity of a ­customer-provider relationship from a collaborative service delivery perspective: the Customer-Provider Strategic Alignment Maturity (CPSAM) Model. This model builds on recent research for effectively managing the customer-provider relationship in IT service outsourcing contexts and a validated model for assessing alignment across internal IT service units and their business customers within the same organization. After reviewing relevant literature by service science and information systems researchers, the six overarching components of the maturity model are presented: value measurements, governance, partnership, communications, human resources and skills, and scope and architecture. A key assumption of the model is that all of the components need be addressed to assess and improve customer-provider alignment. Examples of specific metrics for measuring the maturity level of each component over the five levels of maturity are also presented.

A national survey of cardiac rehabilitation services in New Zealand: 2015.

PubMed

Kira, Geoff; Doolan-Noble, Fiona; Humphreys, Grace; Williams, Gina; O'Shaughnessy, Helen; Devlin, Gerry

2016-05-27

Guidelines for cardiac rehabilitation (CR) programmes inform best practice. In Aotearoa NewZealand, little information exists about the structure and services provided by CR programmes and there is a poor understanding of how existing CR programmes are delivered with respect to evidence-based national guidelines. All 46 CR providers in New Zealand were invited to participate in a national survey in 2015. The survey sought information on the following: unit structure; referral processes; patient assessment; audit (including quality assurance activity); Phase 2 CR content; and support for special populations. Simple descriptive analysis of the responses was conducted, involving forming counts and percentages. Thirty-six distinct units completed the survey and 94% provided Phase 2. Assessment tools, Phase 2 educational components, and the methods of providing the exercise component varied. Most units audited their services, 25% audited their programme six-monthly or more frequently. Just over half of the units (56%) reported key performance indicators. The survey identified variations in delivery and content of CR in New Zealand, with poor understanding of the impact on patient outcomes. This is likely due to the absence of standardised audit practices and routine collection of key performance indicators on a national basis.

Next-generation applications in healthcare digital libraries using semantic service composition and coordination.

PubMed

Möller, Thorsten; Schuldt, Heiko; Gerber, Andreas; Klusch, Matthias

2006-06-01

Healthcare digital libraries (DLs) increasingly make use of dedicated services to access functionality and/or data. Semantic (web) services enhance single services and facilitate compound services, thereby supporting advanced applications on top of a DL. The traditional process management approach tends to focus on process definition at build time rather than on actual service events in run time, and to anticipate failures in order to define appropriate strategies. This paper presents a novel approach where service coordination is distributed among a set of agents. A dedicated component plans compound semantic services on demand for a particular application. In failure, the planner is reinvoked to define contin- gency strategies. Finally, matchmaking is effected at runtime by choosing the appropriate service provider. These combined technologies will provide key support for highly flexible next-generation DL applications. Such technologies are under development within CASCOM.

The quality, safety and governance of telephone triage and advice services - an overview of evidence from systematic reviews.

PubMed

Lake, Rebecca; Georgiou, Andrew; Li, Julie; Li, Ling; Byrne, Mary; Robinson, Maureen; Westbrook, Johanna I

2017-08-30

Telephone triage and advice services (TTAS) are increasingly being implemented around the world. These services allow people to speak to a nurse or general practitioner over the telephone and receive assessment and healthcare advice. There is an existing body of research on the topic of TTAS, however the diffuseness of the evidence base makes it difficult to identify key lessons that are consistent across the literature. Systematic reviews represent the highest level of evidence synthesis. We aimed to undertake an overview of such reviews to determine the scope, consistency and generalisability of findings in relation to the governance, safety and quality of TTAS. We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library for English language systematic reviews focused on key governance, quality and safety findings related to telephone based triage and advice services, published since 1990. The search was undertaken by three researchers who reached consensus on all included systematic reviews. An appraisal of the methodological quality of the systematic reviews was independently undertaken by two researchers using A Measurement Tool to Assess Systematic Reviews. Ten systematic reviews from a potential 291 results were selected for inclusion. TTAS was examined either alone, or as part of a primary care service model or intervention designed to improve primary care. Evidence of TTAS performance was reported across nine key indicators - access, appropriateness, compliance, patient satisfaction, cost, safety, health service utilisation, physician workload and clinical outcomes. Patient satisfaction with TTAS was generally high and there is some consistency of evidence of the ability of TTAS to reduce clinical workload. Measures of the safety of TTAS tended to show that there is no major difference between TTAS and traditional care. Taken as a whole, current evidence does not provide definitive answers to questions about the quality of care provided, access and equity of the service, its costs and outcomes. The available evidence also suggests that there are many interactional factors (e.g., relationship with other health service providers) which can impact on measures of performance, and also affect the external validity of the research findings.

Opportunities, challenges and systems requirements for developing post-abortion family planning services: Perceptions of service stakeholders in China

PubMed Central

Richards, Esther; Zhang, Weihong; Hu, Lina; Wu, Shangchun; Tolhurst, Rachel

2017-01-01

Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers’ perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces—Zhejiang, Hubei and Yunnan—were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources. PMID:29045434

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.

Keeping the Vision in Front of You: Results from Smart Start Key Participant Interviews.

ERIC Educational Resources Information Center

Bryant, Donna; Adkins, Amee

Smart Start is North Carolina's partnership between state government and local leaders, service providers, and families to better serve children under 6 years of age and their families. Interviews were conducted to ascertain the impressions, attitudes, and advice of 55 key participants in the 12 pioneer Smart Start counties. The interviews were…

Student and Staff Perceptions of Key Aspects of Computer Science Engineering Capstone Projects

ERIC Educational Resources Information Center

Olarte, Juan José; Dominguez, César; Jaime, Arturo; Garcia-Izquierdo, Francisco José

2016-01-01

In carrying out their capstone projects, students use knowledge and skills acquired throughout their degree program to create a product or provide a technical service. An assigned advisor guides the students and supervises the work, and a committee assesses the projects. This study compares student and staff perceptions of key aspects of…

Perceived needs of pharmaceutical care services among healthcare professionals in South Korea: a qualitative study.

PubMed

Lee, Iyn-Hyang; Rhie, Sandy Jeong; Je, Nam Kyung; Rhew, Ki Yon; Ji, Eunhee; Oh, Jung Mi; Lee, Euni; Yoon, Jeong-Hyun

2016-10-01

Purpose To explore the need for pharmaceutical care services, key features of desirable pharmacy services, and perceived barriers for advancing the services in hospital environments with doctors and nurses who are key co-workers of the interdisciplinary team care services.Methods Semi-structured, in-depth interviews with eighteen doctors and fifteen nurses employing purposive and snowballing sampling strategies were conducted in ten hospitals in South Korea. Results The level of pharmaceutical care was varied across regions or institutions in South Korea. The concept of pharmaceutical care was insufficiently defined, and tended to be limited to some parts of medication counseling. Through pharmaceutical care services, doctors desired to acquire comprehensive drug information from and to share clinical responsibilities with pharmacists. Nurses wished to lower their burdens of medication counseling services from their daily practices. Doctors and nurses asked for pharmacists providing essential and carefully selected medication information to their patients in a patient-centered manner. The listed barriers to pharmaceutical care included the lack of appropriate systems for reward, insufficient accessibility to patient records by pharmacists, ambiguous role descriptions of pharmacist, and absence of effective communication among professionals. Conclusion A successful pharmaceutical care service model should allow efficient exchange of information among healthcare professionals to build inter-professional trust and to provide a continuity of care both in terms of time and setting. As prerequisites of such system, it was warranted to develop clinical evidence and an appropriate reward system for pharmaceutical care services.

Analysis of a librarian-mediated literature search service.

PubMed

Friesen, Carol; Lê, Mê-Linh; Cooke, Carol; Raynard, Melissa

2015-01-01

Librarian-mediated literature searching is a key service provided at medical libraries. This analysis outlines ten years of data on 19,248 literature searches and describes information on the volume and frequency of search requests, time spent per search, databases used, and professional designations of the patron requestors. Combined with information on best practices for expert searching and evaluations of similar services, these findings were used to form recommendations on the improvement and standardization of a literature search service at a large health library system.

Secure privacy-preserving biometric authentication scheme for telecare medicine information systems.

PubMed

Li, Xuelei; Wen, Qiaoyan; Li, Wenmin; Zhang, Hua; Jin, Zhengping

2014-11-01

Healthcare delivery services via telecare medicine information systems (TMIS) can help patients to obtain their desired telemedicine services conveniently. However, information security and privacy protection are important issues and crucial challenges in healthcare information systems, where only authorized patients and doctors can employ telecare medicine facilities and access electronic medical records. Therefore, a secure authentication scheme is urgently required to achieve the goals of entity authentication, data confidentiality and privacy protection. This paper investigates a new biometric authentication with key agreement scheme, which focuses on patient privacy and medical data confidentiality in TMIS. The new scheme employs hash function, fuzzy extractor, nonce and authenticated Diffie-Hellman key agreement as primitives. It provides patient privacy protection, e.g., hiding identity from being theft and tracked by unauthorized participant, and preserving password and biometric template from being compromised by trustless servers. Moreover, key agreement supports secure transmission by symmetric encryption to protect patient's medical data from being leaked. Finally, the analysis shows that our proposal provides more security and privacy protection for TMIS.

Medical Logistics Lessons Observed During Operations Enduring Freedom and Iraqi Freedom.

PubMed

Dole, Mark J; Kissane, Jonathan M

2016-01-01

Medical Logistics (MEDLOG) is a function of the Army's integrated System for Health that provides the medical products and specialized logistics services required to deliver health protection and care under all operational conditions. In unified land operations, MEDLOG is an inherent function of Health Service Support (HSS), which also includes casualty care and medical evacuation. This paper focuses on a few key lessons observed during Operations Enduring Freedom and Iraqi Freedom with direct implications for the support of HSS in future operations as envisioned in the Army Operating Concept and the Joint Concept for Health Services. It also examines a few key enablers that helped mitigate these challenges that are not yet fully acknowledged in Army Medical Department doctrine, policy, and planning.

Using EMBL-EBI Services via Web Interface and Programmatically via Web Services.

PubMed

Lopez, Rodrigo; Cowley, Andrew; Li, Weizhong; McWilliam, Hamish

2014-12-12

The European Bioinformatics Institute (EMBL-EBI) provides access to a wide range of databases and analysis tools that are of key importance in bioinformatics. As well as providing Web interfaces to these resources, Web Services are available using SOAP and REST protocols that enable programmatic access to our resources and allow their integration into other applications and analytical workflows. This unit describes the various options available to a typical researcher or bioinformatician who wishes to use our resources via Web interface or programmatically via a range of programming languages. Copyright © 2014 John Wiley & Sons, Inc.

Scientific Uses and Directions of SPDF Data Services

NASA Technical Reports Server (NTRS)

Fung, Shing

2007-01-01

From a science user's perspective, the multi-mission data and orbit services of NASA's Space Physics Data Facility (SPDF) project perform as a working and highly functional heliophysics virtual observatory. CDAWeb enables plots, listings and file downloads for current data across the boundaries of missions and instrument types (and now including data from THEMIS and STEREO), VSPO access to a wide range of distributed data sources. SSCWeb, Helioweb and our 3D Animated Orbit Viewer (TIPSOD) provide position data and query logic for most missions currently-important to heliophysics science. OMNIWeb with its new extension to 1- and 5- minute resolution provides interplanetary parameters at the Earth's bow shock as a unique value-added data product. To enable easier integrated use of our capabilities by developers and by the emerging heliophysics VxOs, our data and services are available through webservices-based APls as well as through our direct user interfaces. SPDF has also now developed draft descriptions of its holdings in SPASE-compliant XML In addition to showcasing recent enhancements to SPDF capabilities, we will use these systems and our experience in developing them: to demonstrate a few typical science use cases; to discuss key scope and design issues among users, service providers and end data providers; and to identify key areas where existing capabilities and effective interface design are still inadequate to meet community needs.

A call for differentiated approaches to delivering HIV services to key populations.

PubMed

Macdonald, Virginia; Verster, Annette; Baggaley, Rachel

2017-07-21

Key populations (KPs) are disproportionally affected by HIV and have low rates of access to HIV testing and treatment services compared to the broader population. WHO promotes the use of differentiated approaches for reaching and recruiting KP into the HIV services continuum. These approaches may help increase access to KPs who are often criminalized or stigmatized. By catering to the specific needs of each KP individual, differentiated approaches may increase service acceptability, quality and coverage, reduce costs and support KP members in leading the HIV response among their communities. WHO recommends the implementation of community-based and lay provider administered HIV testing services. Together, these approaches reduce barriers and costs associated with other testing strategies, allow greater ownership in HIV programmes for KP members and reach more people than do facility-based services. Despite this evidence availability and support for them is limited. Peer-driven interventions have been shown to be effective in engaging, recruiting and supporting clients. Some programmes employ HIV-positive or non-PLHIV "peer navigators" and other staff to provide case management, enrolment and/or re-enrolment in care and treatment services. However, a better understanding of the impact, cost effectiveness and potential burden on peer volunteers is required. Task shifting and non-facility-based service locations for antiretroviral therapy (ART) initiation and maintenance and antiretroviral (ARV) distribution are recommended in both the consolidated HIV treatment and KP guidelines of WHO. These approaches are accepted in generalized epidemics and for the general population where successful models exist; however, few organizations provide or initiate ART at KP community-based services. The application of a differentiated service approach for KP could increase the number of people who know their status and receive effective and sustained prevention and treatment for HIV. However, while community-based and lay provider testing are effective and affordable, they are not implemented to scale. Furthermore regulatory barriers to legitimizing lay and peer providers as part of healthcare delivery systems need to be overcome in many settings. WHO recommendations on task shifting and decentralization of ART treatment and care are often not applied to KP settings.

2010 Northwest Federal Market Assessment Report

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

Scanlon, Tim; Sandusky, William F.

The primary intent of this market assessment is to provide insights on the effectiveness of current energy efficiency and renewable energy program offerings available to Federal sites in the region. The level of detail, quality and currency of the data used in this market assessment varies significantly by Federal agency and energy efficiency service provider. Limited access to some Federal sites, limited availability of key points of contact, time/resource constraints, and other considerations limited the total number of Federal agencies and energy efficiency service providers participating in the survey.

DataBase on Demand

NASA Astrophysics Data System (ADS)

Gaspar Aparicio, R.; Gomez, D.; Coterillo Coz, I.; Wojcik, D.

2012-12-01

At CERN a number of key database applications are running on user-managed MySQL database services. The database on demand project was born out of an idea to provide the CERN user community with an environment to develop and run database services outside of the actual centralised Oracle based database services. The Database on Demand (DBoD) empowers the user to perform certain actions that had been traditionally done by database administrators, DBA's, providing an enterprise platform for database applications. It also allows the CERN user community to run different database engines, e.g. presently open community version of MySQL and single instance Oracle database server. This article describes a technology approach to face this challenge, a service level agreement, the SLA that the project provides, and an evolution of possible scenarios.

Community-Based Adaptation To A Changing Climate

EPA Pesticide Factsheets

This resource discusses how climate change is affecting community services, presents sample adaptation strategies, gives examples of successful community adaptation actions, and provides links to other key federal resources.

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.

Gender Differences in Rural and Urban Practice Location among Mid-Level Health Care Providers

ERIC Educational Resources Information Center

Lindsay, Sally

2007-01-01

Context: Mid-level providers comprise an increasing proportion of the health care workforce and play a key role in providing health services in rural and underserved areas. Although women comprise the majority of mid-level providers, they are less likely to work in a rural area than men. Maldistribution of health providers between urban and rural…

The Key to Me: Seniors' Perceptions of Relationship-Building with In-Home Service Providers

ERIC Educational Resources Information Center

Gantert, Thomas W.; McWilliam, Carol L.; Ward-Griffin, Catherine; Allen, Natalie J.

2008-01-01

Changing demographics and hospital downsizing have placed increasing demands on the home care sector. Many of those receiving in-home care are seniors whose chronic conditions require a collaborative approach. Both providers' paternalistic orientations toward senior clients and seniors' passivity within provider-client interactions have the…

Assistant Chef Program. Curriculum Outline, Orientation, Safety and Sanitation.

ERIC Educational Resources Information Center

Saint Augustine Coll., Chicago, IL.

Instructor materials are provided for an assistant chef program intended for English as a second language (ESL) or bilingual (Spanish speaking) students. A curriculum outline includes a listing of the tasks to be mastered in the program. Other contents include key terms from the production and service area of food service in the areas of…

Recreation economic values for estimating outdoor recreation economic benefits from the National Forest System

Treesearch

Randall S. Rosenberger; Eric M. White; Jeffrey D. Kline; Claire Cvitanovich

2017-01-01

Natural resource professionals are often tasked with weighing the benefits and costs of changes in ecosystem services associated with land management alternatives and decisions. In many cases, federal regulations even require land managers and planners to account for these values explicitly. Outdoor recreation is a key ecosystem service provided by national forests and...

Defense Logistics Agency Disposition Services Afghanistan Disposal Process Needed Improvement

DTIC Science & Technology

2013-11-08

audit, and management was proactive in correcting the deficiencies we identified. DLA DS eliminated backlogs, identified and corrected system ...problems, provided additional system training, corrected coding errors, added personnel to key positions, addressed scale issues, submitted debit...Service Automated Information System to the Reutilization Business Integration2 (RBI) solution. The implementation of RBI in Afghanistan occurred in

Engine Tune-Up Service. Unit 3: Primary Circuit. Posttests. Automotive Mechanics Curriculum.

ERIC Educational Resources Information Center

Morse, David T.

This book of posttests is designed to accompany the Engine Tune-Up Service Student Guide for Unit 3, Primary Circuit, available separately as CE 031 211. Focus of the posttests is setting the primary ignition circuit. One multiple choice posttest is provided, covering the eight performance objectives contained in the unit. (No answer key is…

Navajo Environmental Health Review by the National Environmental Health Association (Window Rock, Arizona, May 24-27, 1976).

ERIC Educational Resources Information Center

Navajo Health Authority, Window Rock, AZ.

The Indian Health Committee met with key staff of the Indian Health Service (IHS) Area Office to review the environmental health services provided on the Navajo Reservation and make recommendations for improvement or expansion of current programs, if needed. Recommendations were made regarding environmental health and institutional personnel,…

Starting a General Surgery Program at a Small Rural Critical Access Hospital: A Case Study from Southeastern Oregon

ERIC Educational Resources Information Center

Doty, Brit Cruse; Heneghan, Steven; Zuckerman, Randall

2007-01-01

Context: Surgical services are frequently unavailable in rural American communities. Therefore, rural residents often must travel long distances to receive surgical care. Rural hospitals commonly have difficulty providing surgical services despite potential economic benefits. Purpose: The purpose of this project was to identify the key challenges…

Effects of nitrogen deposition on multiple ecosystem services of the California oak savanna

Treesearch

Elise M. Tulloss; Mary L. Cadenasso

2015-01-01

The influence of enhanced nitrogen (N) deposition on key ecosystem services provided by oak woodlands was experimentally investigated. Fertilizer was applied for 2 years to paired plots in the oak understory and adjacent open grassland. Treatments simulated four N deposition levels and effects on forage productivity, biodiversity, and soil N supply were measured. At...

Decision Support Framework (DSF) For Evaluating Planned Land And Resource Use Decisions: Hypothetical Application Of The DSF To Address Nutrient Loads In The Florida Keys

EPA Science Inventory

The mission of ORD's Ecosystme Services Research Program (ESRP) is to provide the information and methods needed by decision-makers to assess the benefits of ecosystem goods and services to human well-being for inclusion in management alternatives. The Decision Support Framework...

Residential family treatment for parents with substance use disorders who are involved with child welfare: two perspectives on program design, collaboration, and sustainability.

PubMed

Hammond, Gretchen Clark; McGlone, Amanda

2013-01-01

This article discusses the service design, implementation, and evaluation findings of two residential family treatment programs: Wayside House (MN) and OnTrack (OR). Both programs specialize in family-centered services for adults with substance use disorders (SUD) who are involved with child welfare. Information on program design, services offered, and key collaborations are detailed. Implications for program sustainability are provided.

A Soil Service Index: a method for quantifying the value, vulnerability, and status of soil resources

NASA Astrophysics Data System (ADS)

Harden, J. W.; Loisel, J.; Hugelius, G.; Sulman, B. N.; Bond-Lamberty, B. P.; Abramoff, R. Z.; Malhotra, A.; Gill, A. L.

2017-12-01

Soils support ecological and human systems by providing a physical and biogeochemical basis for plant growth, ecological functions, water quality, and water storage, and by providing services and functions needed for economic development, human well-being, and conservation of natural resources. Quantitative evaluation of soil services, however, is inconsistent and poorly communicated, in part because we lack a scientific, unified basis for evaluating soils and their potential for serving our needs. We introduce an index of soil service (SSI) in which multiple services are numerically or quantitatively assessed, normalized to a unit-less scale for purposes of intercomparability, and evaluated for a given site or region. Services include organic matter and/or organic carbon storage; plant productivity; CO2 or GHG exchange with the atmosphere; water storage capacity; and nutrient storage and/or availability. The status of SSI can be evaluated by individual services or by a composite index that combines multiple services. The status can be monitored over time; and key services that are more highly valued for a given soil can be weighted accordingly in comparison to other services. As a first step, existing data for each service are captured from a literature and data review in order to establish the full range of values. A site value establishes the ranking relative to the full range. Key services are weighted according to local values. A final index is the sum of the normalized, weighted products. Metrics can be updated and adapted as new data or services are discovered or recognized. Metrics can be used to compare among sites, regions, or time periods.

The Relevance of the Affordable Care Act for Improving Mental Health Care.

PubMed

Mechanic, David; Olfson, Mark

2016-01-01

Provisions of the Affordable Care Act provide unprecedented opportunities for expanded access to behavioral health care and for redesigning the provision of services. Key to these reforms is establishing mental and substance abuse care as essential coverage, extending Medicaid eligibility and insurance parity, and protecting insurance coverage for persons with preexisting conditions and disabilities. Many provisions, including Accountable Care Organizations, health homes, and other structures, provide incentives for integrating primary care and behavioral health services and coordinating the range of services often required by persons with severe and persistent mental health conditions. Careful research and experience are required to establish the services most appropriate for primary care and effective linkage to specialty mental health services. Research providing guidance on present evidence and uncertainties is reviewed. Success in redesign will follow progress building on collaborative care and other evidence-based practices, reshaping professional incentives and practices, and reinvigorating the behavioral health workforce.

Participatory planning of a primary care service for people with severe mental disorders in rural Ethiopia

PubMed Central

Mayston, Rosie; Alem, Atalay; Habtamu, Alehegn; Shibre, Teshome; Fekadu, Abebaw; Hanlon, Charlotte

2016-01-01

Little is understood about the feasibility and acceptability of primary care-based models of task-sharing care for people with severe mental disorders (SMDs) in low- and middle-income countries (LMICs). A participatory planning approach was adopted in preparation for the transition from hospital-delivered psychiatric care for SMD to a primary care-based, task-sharing model in a rural Ethiopian community. In this article, we present findings from community consultation meetings (n = 4), focus group discussions (n = 7) and in-depth interviews (n = 11) with key stakeholders (healthcare administrators and providers, caregivers, service-users and community leaders) which were carried out over a 2-year period in the context of ongoing dialogue with the community. The principle of local delivery of mental health services was agreed upon by all stakeholder groups. Key reasons for supporting local delivery were increased access for the majority due to proximity, reduced cost and reduced stress related to transportation. However, acceptance of the new service was qualified by concerns about the competence of staff to deliver a comprehensive and dependable service of equal quality to that currently provided at the hospital. Adequate training and support, as well as ensuring consistency of medication supply were identified as key components to ensure success. Encouragingly, our results suggest that there is significant support for the service change and an interest for the mobilization of community resources to support this. One of the study strengths was that we were able to present the different perspectives of multiple stakeholder groups. By nesting the study in an ongoing community-based cohort of people with SMD we were able to interview a more representative and empowered group of caregivers and service users than is often available in LMICs. Despite this, the extent to which service-users are able to express their opinions is likely limited by their marginalized role in rural Ethiopian society. PMID:26282860

The service blueprint as a tool for designing innovative pharmaceutical services.

PubMed

Holdford, D A; Kennedy, D T

1999-01-01

To describe service blueprints, discuss their need and design, and provide examples of their use in advancing pharmaceutical care. Service blueprints are pictures or maps of service processes that permit the people involved in designing, providing, managing, and using the service to better understand them and deal with them objectively. A service blueprint simultaneously depicts the service process and the roles of consumers, service providers, and supporting services. Service blueprints can be useful in pharmacy because many of the obstacles to pharmaceutical care are a result of insufficient planning by service designers and/or poor communication between those designing services and those implementing them. One consequence of this poor design and communication is that many consumers and third party payers are uninformed about pharmacist roles. Service blueprints can be used by pharmacists to promote the value of pharmaceutical care to consumers and other decision makers. They can also assist in designing better pharmaceutical services. Blueprints are designed by identifying and mapping a process from the consumer's point of view, mapping employee actions and support activities, and adding visible evidence of service at each consumer action step. Key components of service blueprints are consumer actions, "onstage" and "backstage" employee actions, and support processes. Blueprints can help pharmacy managers identify and correct problems with the service process, provide pharmacy employees an opportunity to offer feedback in the planning stages of services, and demonstrate the value of pharmaceutical services to consumers. Service blueprints can be a valuable tool for designing, implementing, and evaluating pharmacy services.

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.

Collaboration between non-governmental organizations and public services in health – a qualitative case study from rural Ecuador

PubMed Central

Biermann, Olivia; Eckhardt, Martin; Carlfjord, Siw; Falk, Magnus; Forsberg, Birger C.

2016-01-01

Background Non-governmental organizations (NGOs) have a key role in improving health in low- and middle-income countries. Their work needs to be synergistic, complementary to public services, and rooted in community mobilization and collective action. The study explores how an NGO and its health services are perceived by the population that it serves, and how it can contribute to reducing barriers to care. Design A qualitative exploratory study was conducted in remote Ecuador, characterized by its widespread poverty and lack of official governance. An international NGO collaborated closely with the public services to deliver preventative and curative health services. Data were collected using focus group discussions and semistructured interviews with purposively sampled community members, healthcare personnel, and community health workers based on their links to the health services. Conventional qualitative content analysis was used, focusing on manifest content. Results Emerging themes relate to the public private partnership (PPP), the NGO and its services, and community participation. The population perceives the NGO positively, linking it to healthcare improvements. Their priority is to get services, irrespective of the provider's structure. The presence of an NGO in the operation may contribute to unrealistic expectations of health services, affecting perceptions of the latter negatively. Conclusions To avoid unrealistic expectations and dissatisfaction, and to increase and sustain the population's trust in the organization, an NGO should operate in a manner that is as integrated as possible within the existing structure. The NGO should work close to the population it serves, with services anchored in the community. PPP parties should develop a common platform with joint messages to the target population on the provider's structure, and regarding partners’ roles and responsibilities. Interaction between the population and the providers on service content and their expectations is key to positive outcomes of PPP operations. PMID:27852423

Treating first episode psychosis--the service users' perspective: a focus group evaluation.

PubMed

O'Toole, M S; Ohlsen, R I; Taylor, T M; Purvis, R; Walters, J; Pilowsky, L S

2004-06-01

UK national guidance has prioritized developing specialist services for first episode psychosis. Such services are in the early stages of development and a definitive treatment model has yet to be established. The aim of this study was to explore service users' experiences of a first episode intervention designed along evidence-based 'best practice' guidelines and to establish specific elements seen as effective to help inform future service planning and provision. Twelve users of a specialist first episode service participated in focus groups. These were then analyzed using Interpretative Phenomenological Analysis, a specialized form of content analysis. Key elements identified by the service users included the 'human' approach as a key to the recovery process, being involved in treatment decisions, flexibility of appointments, high nurse to patient ratio, reduction in psychotic symptoms, increased confidence and independence and the provision of daily structure. To our knowledge, this is the first systematic qualitative evaluation of users' experience of a specialist first episode treatment intervention. Our findings indicate that adherence to best practice guidelines was appreciated. Regular focus groups provide a continuous audit cycle incorporating service improvements in line with government recommendations, centrally informed by the service users' and caregivers' perspective.

Assessment of palliative care services in western Kenya.

PubMed

Zubairi, Hijab; Tulshian, Priyanka; Villegas, Sarah; Nelson, Brett D; Ouma, Kennedy; Burke, Thomas F

2017-04-01

The need for palliative care services is rapidly increasing due to the rising number of patients with non-communicable diseases. The objective of this study was to assess the current availability and barriers to palliative care and healthcare worker knowledge and perceptions on palliative pain control in western Kenya. An evidence-based 40-question assessment tool was conducted between October 2015 and February 2016 in Siaya County, western Kenya. All level 4 and 5 facilities (e.g., regional and district hospitals) were assessed, as well as a selection of lower-level facilities chosen via convenience sampling, stratified by facility level (e.g., dispensaries, health centers, and health clinics). A key informant at each of 22 facilities was surveyed and included 1 medical officer (5%), 12 clinical officers (55%), and 9 nurses (41%). Key themes included training and education, awareness of palliative care and hospice, services provided, and pain control. All 22 providers had heard of palliative care and 4 (18%) had received formal training. Fourteen (64%) providers knew that morphine was on the World Health Organization (WHO) essential medication list, 8 (36%) had previously prescribed opioids, and 5 (23%) had prescribed them for palliation. Provider concerns for opioid use included its addictive properties (59%), appropriate dosing (9%), cost (5%), side effects (9%), and availability (5%). Palliative care and hospice services were identified by providers as important components in the management of chronic illnesses in western Kenya. Further provider education as well as increased access to pain medications including opioids is necessary to improve the care of patients in western Kenya.

Using decision mapping to inform the development of a stated choice survey to elicit youth preferences for sexual and reproductive health and HIV services in rural Malawi.

PubMed

Michaels-Igbokwe, Christine; Lagarde, Mylene; Cairns, John; Terris-Prestholt, Fern

2014-03-01

The process of designing and developing discrete choice experiments (DCEs) is often under reported. The need to adequately report the results of qualitative work used to identify attributes and levels used in a DCE is recognised. However, one area that has received relatively little attention is the exploration of the choice question of interest. This paper provides a case study of the process used to design a stated preference survey to assess youth preferences for integrated sexual and reproductive health (SRH) and HIV outreach services in Malawi. Development and design consisted of six distinct but overlapping and iterative stages. Stage one was a review of the literature. Stage two involved developing a decision map to conceptualise the choice processes involved. Stage three included twelve focus group discussions with young people aged 15-24 (n = 113) and three key informant interviews (n = 3) conducted in Ntcheu District, Malawi. Stage four involved analysis of qualitative data and identification of potential attributes and levels. The choice format and experimental design were selected in stages five and six. The results of the literature review were used to develop a decision map outlining the choices that young people accessing SRH services may face. For youth that would like to use services two key choices were identified: the choice between providers and the choice of service delivery attributes within a provider type. Youth preferences for provider type are best explored using a DCE with a labelled design, while preferences for service delivery attributes associated with a particular provider are better understood using an unlabelled design. Consequently, two DCEs were adopted to jointly assess preferences in this context. Used in combination, the results of the literature review, the decision mapping process and the qualitative work provided robust approach to designing the DCEs individually and as complementary pieces of work. Copyright © 2014 Elsevier Ltd. All rights reserved.

[A functional analysis of healthcare auditors' skills in Venezuela, 2008].

PubMed

Chirinos-Muñoz, Mónica S

2010-10-01

Using functional analysis for identifying the basic, working, specific and generic skills and values which a health service auditor must have. Implementing the functional analysis technique with 10 experts, identifying specific, basic, generic skills and values by means of deductive logic. A functional map was obtained which started by establishing a key purpose based on improving healthcare and service quality from which three key functions emerged. The main functions and skills' units were then broken down into the competitive elements defining what a health service auditor is able to do. This functional map (following functional analysis methodology) shows in detail the simple and complex tasks which a healthcare auditor should apply in the workplace, adopting a forward management approach for improving healthcare and health service quality. This methodology, expressing logical-deductive awareness raising, provides expert consensual information validating each element regarding overall skills.

Impact of a broadband interactive televisit/teleconsultation service for residential and working environments.

PubMed Central

Valero, M. A.; Arredondo, M. T.; Guillén, S.; Traver, V.; Fernández, C.; Basagoiti, I.; del Nogal, F.; Gallar, P.; Insausti, J.

2001-01-01

The availability of health care attention at the point of need is one of the key benefits of telemedicine. Home environment and working place are the two scenarios selected in this article to evaluate the impact of a televisit and teleconsultation service. 31 users from four different medical and patient groups participated in this study supported by European Commission ATTRACT project. The experiences, carried out in Madrid and Valencia Spanish sites, benefited from interactive broadband access networks to provide cost-effective telecare services. Key areas analyzed encompass systems usability, clinical outcomes, patients quality of care and infoethic issues. Services advantages were verified and compared both from patients and medical staff points of view. Main benefits pointed out refer to displacement reduction, better communication doctor/patient, provision of comfort or friendliness, more precise therapy follow-up and increases in patients sense of well being. PMID:11825280

Impact of a broadband interactive televisit/teleconsultation service for residential and working environments.

PubMed

Valero, M A; Arredondo, M T; Guillén, S; Traver, V; Fernández, C; Basagoiti, I; del Nogal, F; Gallar, P; Insausti, J

2001-01-01

The availability of health care attention at the point of need is one of the key benefits of telemedicine. Home environment and working place are the two scenarios selected in this article to evaluate the impact of a televisit and teleconsultation service. 31 users from four different medical and patient groups participated in this study supported by European Commission ATTRACT project. The experiences, carried out in Madrid and Valencia Spanish sites, benefited from interactive broadband access networks to provide cost-effective telecare services. Key areas analyzed encompass systems usability, clinical outcomes, patients quality of care and infoethic issues. Services advantages were verified and compared both from patients and medical staff points of view. Main benefits pointed out refer to displacement reduction, better communication doctor/patient, provision of comfort or friendliness, more precise therapy follow-up and increases in patients sense of well being.

Design and Implementation of KSP on the Next Generation Cryptography API

NASA Astrophysics Data System (ADS)

Lina, Zhang

With good seamless connectivity and higher safety, KSP (Key Storage Providers) is the inexorable trend of security requirements and development to take the place of CSP (Cryptographic Service Provider). But the study on KSP has just started in our country, and almost no reports of its implementation can be found. Based on the analysis of function modules and the architecture of Cryptography API (Next Generation (CNG)), this paper discusses the design and implementation of KSP (key storage providers) based on smart card in detail, and an example is also presented to illustrate how to use KSP in Windows Vista.

76 FR 37307 - Rural Health Care Support Mechanism

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-27

... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 54 [WC Docket No. 02-60; FCC 11-101] Rural Health... ``grandfathered'' providers permanently eligible for discounted services under the rural health care program. Grandfathered providers do not currently qualify as ``rural,'' but play a key role in delivering health care...

A qualitative study of the use of Skype for psychotherapy consultations in the Ukraine.

PubMed

Edirippulige, Sisira; Levandovskaya, Marina; Prishutova, Anna

2013-10-01

There has been rather limited use of Skype for health and medical purposes. We investigated the use of Skype for delivering psychotherapy services in the Ukraine. A provider questionnaire was distributed to all delegates (n = 50) at the Annual Symposium of Psychotherapists. One copy of a client questionnaire was also given to each service provider and they were instructed to request their next client to complete the survey. In total, 29 providers and 23 clients responded to the questionnaire. The majority of clients (61%) and providers (72%) had used Skype for a range of services. The services they provided were related to a wide range of paradigms including psycho-analysis, psycho-drama, Gestalt therapy, cognitive behavioural therapy and existential therapy. A key reason for using Skype was to allow practitioners to contact clients who were not easily accessible, e.g. those who lived in other countries. Most practitioners (n = 24) thought their clients considered the services received on Skype were good or excellent. All 26 practitioners charged for Skype consultations. The majority of clients and providers showed high satisfaction with the use of Skype for psychotherapy services.

Predictive Systems for Customer Interactions

NASA Astrophysics Data System (ADS)

Vijayaraghavan, Ravi; Albert, Sam; Singh, Vinod Kumar; Kannan, Pallipuram V.

With the coming of age of web as a mainstream customer service channel, B2C companies have invested substantial resources in enhancing their web presence. Today customers can interact with a company, not only through the traditional phone channel but also through chat, email, SMS or web self-service. Each of these channels is best suited for some services and ill-matched for others. Customer service organizations today struggle with the challenge of delivering seamlessly integrated services through these different channels. This paper will evaluate some of the key challenges in multi-channel customer service. It will address the challenge of creating the right channel mix i.e. providing the right choice of channels for a given customer/behavior/issue profile. It will also provide strategies for optimizing the performance of a given channel in creating the right customer experience.

Weight management in community pharmacy: what do the experts think?

PubMed

Um, Irene S; Armour, Carol; Krass, Ines; Gill, Timothy; Chaar, Betty B

2013-06-01

The increasing prevalence of obesity and overweight adults creates a significant public health burden and there is great potential for pharmacists to be involved in the provision of weight management services, other than the mundane supply of commercial products. In order to provide optimal services that can be integrated into the healthcare system, a best practice model for weight management services in community pharmacy should be in place. We sought experts' and key stakeholders' opinions on this matter. (1) To identify components of a best practice model of a weight management service feasible in Australian community pharmacy. (2) To identify the role of pharmacists and the training requirements to up-skill pharmacists to competently provide weight management services. (3) To elicit any practical suggestions that would contribute to successful implementation of weight management services in pharmacy. Australian primary care sector. Semi-structured interviews were conducted with a purposive sample of 12 participants including Australian experts in obesity and representatives of main Australian professional organisations in pharmacy. Interviews were digitally recorded, transcribed verbatim and thematically analysed using the framework approach. Recommended components of pharmacy-based weight management services and training requirements. Participants perceived two potential roles for pharmacists involved in weight management: health promotion and individualised service. Multi-component interventions targeting all three areas: diet, physical activity and behaviour change were emphasised. Physical assessment (e.g. weight, waist circumference measurements), goal setting, referral to allied healthcare professionals and on-going support for weight maintenance were also proposed. Participants suggested pharmacists should undergo formal training and identified various training topics to improve pharmacists' knowledge, attributes and skills to acquire competencies necessary for delivery of this service. Some physical and financial barriers in providing these services were also identified including infrastructure, pharmacists' time and cost-effectiveness. Pharmacists are well-positioned to promote healthy weight and/or implement weight management interventions. Furthering pharmacists' role would involve training and up-skilling; and addressing key practice change facilitators such as pharmacy layout and remuneration. This study provides some insight into the design and implementation of a best practice model for pharmacy-based weight management services in Australia.

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.

SERVIR HIMALYA: Enabling Improved Environmental Management and Livelihoods in the HKH

NASA Astrophysics Data System (ADS)

Bajracharya, B.; Murthy, M. S. R.; Shrestha, B.

2014-11-01

With an overarching goal to improve environmental management and resilience to climate change, SERVIR-Himalaya is established as a collaborative initiative of USAID, NASA and ICIMOD. The SERVIR-Himalaya has been the key instrument to provide integrated and innovative geospatial solutions for generation and dissemination of information and knowledge resources on mountain environments. The SERVIR applications, products and services are viewed as essential cross-cutting elements to achieve the greater impacts on addressing Himalayan livelihood challenges. The broad thematic areas which are also subset of the societal benefit areas of Global Earth Observation (GEO), namely - agriculture and food security, ecosystems and sustainable landscapes, and disaster risk management are addressed. On the cross-cutting theme, SERVIR Himalaya is also focusing on developing regional level applications providing key information systems and services on multiple themes of regional significance. The regional level science applications include use of MODIS satellite information products and services for environmental and natural resources monitoring in the Himalayan region. Regional and national training and workshops, on-the-job training, internships and exchange programs and technical backstopping are key capacity building components to enhance the capacity of partners from national institutions in the regional member countries. These efforts are also seen as receiving feedback on the science applications, identify additional needs, and increase synergy by exploring opportunities for collaboration.

A mobile network-based multimedia teleconference system for homecare services.

PubMed

Zhang, Zhaomin; He, Aiguo; Wei, Daming

2008-03-01

Because most research and development for homecare services have focused on providing connections between home and service centers, the goal of the present work is to develop techniques and create realtime communications to connect service centers and homecare workers in mobile environments. A key technical issue for this research is how to overcome the limitation of bandwidth in mobile media and networks. An effort has been made to balance performance of communication and basic demands in telehealth through optimized system design and technical implementation. Implementations using third generation (3G) Freedom Of Mobile multimedia Access (FOMA) and Personal Handyphone System (PHS) were developed and evaluated. We conclude that the system we developed based on 3G FOMA provides sufficient and satisfactory functions for use in homecare services.

A discussion of key values to inform the design and delivery of services for HIV-affected women and couples attempting pregnancy in resource-constrained settings.

PubMed

Heffron, Renee; Davies, Natasha; Cooke, Ian; Kaida, Angela; Mergler, Reid; van der Poel, Sheryl; Cohen, Craig R; Mmeje, Okeoma

2015-01-01

HIV-affected women and couples often desire children and many accept HIV risk in order to attempt pregnancy and satisfy goals for a family. Risk reduction strategies to mitigate sexual and perinatal HIV transmission include biomedical and behavioural approaches. Current efforts to integrate HIV and reproductive health services offer prime opportunities to incorporate strategies for HIV risk reduction during pregnancy attempts. Key client and provider values about services to optimize pregnancy in the context of HIV risk provide insights for the design and implementation of large-scale "safer conception" programmes. Through our collective experience and discussions at a multi-disciplinary international World Health Organization-convened workshop to initiate the development of guidelines and an algorithm of care to support the delivery of services for HIV-affected women and couples attempting pregnancy, we identified four values that are key to the implementation of these programmes: (1) understanding fertility care and an ability to identify potential fertility problems; (2) providing equity of access to resources enabling informed decision-making about reproductive choices; (3) creating enabling environments that reduce stigma associated with HIV and infertility; and (4) creating enabling environments that encourage disclosure of HIV status and fertility status to partners. Based on these values, recommendations for programmes serving HIV-affected women and couples attempting pregnancy include the following: incorporation of comprehensive reproductive health counselling; training to support the transfer and exchange of knowledge between providers and clients; care environments that reduce the stigma of childbearing among HIV-affected women and couples; support for safe and voluntary disclosure of HIV and fertility status; and increased efforts to engage men in reproductive decision-making at times that align with women's desires. Programmes, policies and guidelines that integrate HIV treatment and prevention, sexual and reproductive health and fertility care services in a manner responsive to user values and preferences offer opportunities to maximize demand for and use of these services. For HIV-affected women and couples attempting pregnancy, the provision of comprehensive services using available tools - and the development of new tools that are adaptable to many settings and follow consensus recommendations - is a public health imperative. The impetus now is to design and deliver value-driven inclusive programming to achieve the greatest coverage and impact to reduce HIV transmission during pregnancy attempts.

An efficient chaotic maps-based authentication and key agreement scheme using smartcards for telecare medicine information systems.

PubMed

Lee, Tian-Fu

2013-12-01

A smartcard-based authentication and key agreement scheme for telecare medicine information systems enables patients, doctors, nurses and health visitors to use smartcards for secure login to medical information systems. Authorized users can then efficiently access remote services provided by the medicine information systems through public networks. Guo and Chang recently improved the efficiency of a smartcard authentication and key agreement scheme by using chaotic maps. Later, Hao et al. reported that the scheme developed by Guo and Chang had two weaknesses: inability to provide anonymity and inefficient double secrets. Therefore, Hao et al. proposed an authentication scheme for telecare medicine information systems that solved these weaknesses and improved performance. However, a limitation in both schemes is their violation of the contributory property of key agreements. This investigation discusses these weaknesses and proposes a new smartcard-based authentication and key agreement scheme that uses chaotic maps for telecare medicine information systems. Compared to conventional schemes, the proposed scheme provides fewer weaknesses, better security, and more efficiency.

Facilitating Secure Sharing of Personal Health Data in the Cloud.

PubMed

Thilakanathan, Danan; Calvo, Rafael A; Chen, Shiping; Nepal, Surya; Glozier, Nick

2016-05-27

Internet-based applications are providing new ways of promoting health and reducing the cost of care. Although data can be kept encrypted in servers, the user does not have the ability to decide whom the data are shared with. Technically this is linked to the problem of who owns the data encryption keys required to decrypt the data. Currently, cloud service providers, rather than users, have full rights to the key. In practical terms this makes the users lose full control over their data. Trust and uptake of these applications can be increased by allowing patients to feel in control of their data, generally stored in cloud-based services. This paper addresses this security challenge by providing the user a way of controlling encryption keys independently of the cloud service provider. We provide a secure and usable system that enables a patient to share health information with doctors and specialists. We contribute a secure protocol for patients to share their data with doctors and others on the cloud while keeping complete ownership. We developed a simple, stereotypical health application and carried out security tests, performance tests, and usability tests with both students and doctors (N=15). We developed the health application as an app for Android mobile phones. We carried out the usability tests on potential participants and medical professionals. Of 20 participants, 14 (70%) either agreed or strongly agreed that they felt safer using our system. Using mixed methods, we show that participants agreed that privacy and security of health data are important and that our system addresses these issues. We presented a security protocol that enables patients to securely share their eHealth data with doctors and nurses and developed a secure and usable system that enables patients to share mental health information with doctors.

Quantum key distribution in multicore fibre for secure radio access networks

NASA Astrophysics Data System (ADS)

Llorente, Roberto; Provot, Antoine; Morant, Maria

2018-01-01

Broadband access in optical domain usually focuses in providing a pervasive cost-effective high bitrate communication in a given area. Nowadays, it is of utmost interest also to be able to provide a secure communication to the costumers in the area. Wireless access networks rely on optical domain for both fronthaul and backhaul of the radio access network (C-RAN). Multicore fiber (MCF) has been proposed as a promising candidate for the optical media of choice in nextgeneration wireless. The capacity demand of next-generation 5G networks makes interesting the use of high-capacity optical solutions as space-division multiplexing of different signals over MCF media. This work addresses secure MCF communication supporting C-RAN architectures. The paper proposes the use of one core in the MCF to transport securely an optical quantum key encoding altogether with end-to-end wireless signal transmitted in the remaining cores in radio-over-fiber (RoF). The RoF wireless signals are suitable for radio access fronthaul and backhaul. The theoretical principle and simulation analysis of quantum key distribution (QKD) are presented in this paper. The potential impact of optical RoF transmission crosstalk impairments is assessed experimentally considering different cellular signals on the remaining optical cores in the MCF. The experimental results report fronthaul performance over a four-core optical fiber with RoF transmission of full-standard CDMA signals providing 3.5G services in one core, HSPA+ signals providing 3.9G services in the second core and 3GPP LTEAdvanced signals providing 4G services in the third core, considering that the QKD signal is allocated in the fourth core.

Provider perceptions of reproductive health service quality in jordanian public community health centers.

PubMed

Al-Qutob, Raeda; Nasir, Laeth S

2008-05-01

Enhancing the quality of reproductive health care delivery in developing countries is a key prerequisite to increased utilization and sustainability of these services in the target population. Our objective was to assess the perception of quality of reproductive health (RH) care services provided by Jordanian Ministry of Health community-based centers from the perspective of service providers in these settings. A purposeful nationwide sample of 50 primary health care providers took part in five focus group discussions with the purpose of exploring their perceptions of the quality of care provided by their centers and perceived barriers to the provision of quality RH care. Health care providers felt that the quality of RH care provided by their centers was suboptimal. Focus group participants reported numerous barriers to the provision of high quality-care in the clinical setting. These included issues related to patient overload, patient and physician characteristics, as well as problems inherent to supervisory and administrative functions. Exploring and aligning goals and expectations of RH care providers and administrators may result in improvements in the quality of RH care service delivery and morale in public health settings in Jordan, which is a requirement for public sector reform.

The Alabama Coalition for a Healthier Black belt: a proof of concept project.

PubMed

Savage, Robert M; Dillon, Jacqueline M; Hammel, Jacinda C; Lewis, Tonia C; Johnson, Natasha C; Barlow, Lafon M; Brooms, Molly M; Moore, Patricia M; Parker, Henry E; Rodney, Kanini Z

2013-02-01

The Alabama Coalition for a Healthier Black was a demonstration of concept project. This paper is a descriptive and qualitative overview of this 2.5 year project. Limited key project results are reported here. Located in the rural Black Belt region of Alabama this coalition had several key aims: to develop a collaboration between primary care and mental health care through co-location of services; use of video-conferencing capability to provide mental health services more efficiently; enhanced training in rural healthcare; and development of stigma reduction campaigns along with other coalition partner specific initiatives. Co-location and telepsychiatry implementation produced the major challenges and resulting adaptations to original aims. Despite many challenges these new service patterns were put into place and appear to be sustainable.

Creating a vision for the future: key competencies and strategies for culturally competent practice with lesbian, gay, bisexual, and transgender (LGBT) older adults in the health and human services.

PubMed

Fredriksen-Goldsen, Karen I; Hoy-Ellis, Charles P; Goldsen, Jayn; Emlet, Charles A; Hooyman, Nancy R

2014-01-01

Sexual orientation and gender identity are not commonly addressed in health and human service delivery, or in educational degree programs. Based on findings from Caring and Aging with Pride: The National Health, Aging and Sexuality Study (CAP), the first national federally-funded research project on LGBT health and aging, this article outlines 10 core competencies and aligns them with specific strategies to improve professional practice and service development to promote the well-being of LGBT older adults and their families. The articulation of key competencies is needed to provide a blueprint for action for addressing the growing needs of LGBT older adults, their families, and their communities.

Creating a Vision for the Future: Key Competencies and Strategies for Culturally Competent Practice With Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults in the Health and Human Services

PubMed Central

FREDRIKSEN-GOLDSEN, KAREN I.; HOY-ELLIS, CHARLES P.; GOLDSEN, JAYN; EMLET, CHARLES A.; HOOYMAN, NANCY R.

2014-01-01

Sexual orientation and gender identity are not commonly addressed in health and human service delivery, or in educational degree programs. Based on findings from Caring and Aging with Pride: The National Health, Aging and Sexuality Study (CAP), the first national federally-funded research project on LGBT health and aging, this article outlines 10 core competencies and aligns them with specific strategies to improve professional practice and service development to promote the well-being of LGBT older adults and their families. The articulation of key competencies is needed to provide a blueprint for action for addressing the growing needs of LGBT older adults, their families, and their communities. PMID:24571387

Are consumer surveys valuable as a service improvement tool in health services? A critical appraisal.

PubMed

Patwardhan, Anjali; Patwardhan, Prakash

2009-01-01

In the recent climate of consumerism and consumer focused care, health and social care needs to be more responsive than ever before. Consumer needs and preferences can be elicited with accepted validity and reliability only by strict methodological control, customerisation of the questionnaire and skilled interpretation. To construct, conduct, interpret and implement improved service provision, requires a trained work force and infrastructure. This article aims to appraise various aspects of consumer surveys and to assess their value as effective service improvement tools. The customer is the sole reason organisations exist. Consumer surveys are used worldwide as service and quality of care improvement tools by all types of service providers including health service providers. The article critically appraises the value of consumer surveys as service improvement tools in health services tool and its future applications. No one type of survey is the best or ideal. The key is the selection of the correct survey methodology, unique and customised for the particular type/aspect of care being evaluated. The method used should reflect the importance of the information required. Methodological rigor is essential for the effectiveness of consumer surveys as service improvement tools. Unfortunately so far there is no universal consensus on superiority of one particular methodology over another or any benefit of one specific methodology in a given situation. More training and some dedicated resource allocation is required to develop consumer surveys. More research is needed to develop specific survey methodology and evaluation techniques for improved validity and reliability of the surveys as service improvement tools. Measurement of consumer preferences/priorities, evaluation of services and key performance scores, is not easy. Consumer surveys seem impressive tools as they provide the customer a voice for change or modification. However, from a scientific point-of-view their credibility in service improvement in terms of reproducibility, reliability and validity, has remained debatable. This artcile is a critical appraisal of the value of consumer surveys as a service improvement tool in health services--a lesson which needs to be learnt.

Enhanced smartcard-based password-authenticated key agreement using extended chaotic maps.

PubMed

Lee, Tian-Fu; Hsiao, Chia-Hung; Hwang, Shi-Han; Lin, Tsung-Hung

2017-01-01

A smartcard based password-authenticated key agreement scheme enables a legal user to log in to a remote authentication server and access remote services through public networks using a weak password and a smart card. Lin recently presented an improved chaotic maps-based password-authenticated key agreement scheme that used smartcards to eliminate the weaknesses of the scheme of Guo and Chang, which does not provide strong user anonymity and violates session key security. However, the improved scheme of Lin does not exhibit the freshness property and the validity of messages so it still fails to withstand denial-of-service and privileged-insider attacks. Additionally, a single malicious participant can predetermine the session key such that the improved scheme does not exhibit the contributory property of key agreements. This investigation discusses these weaknesses and proposes an enhanced smartcard-based password-authenticated key agreement scheme that utilizes extended chaotic maps. The session security of this enhanced scheme is based on the extended chaotic map-based Diffie-Hellman problem, and is proven in the real-or-random and the sequence of games models. Moreover, the enhanced scheme ensures the freshness of communicating messages by appending timestamps, and thereby avoids the weaknesses in previous schemes.

Enhanced smartcard-based password-authenticated key agreement using extended chaotic maps

PubMed Central

Lee, Tian-Fu; Hsiao, Chia-Hung; Hwang, Shi-Han

2017-01-01

A smartcard based password-authenticated key agreement scheme enables a legal user to log in to a remote authentication server and access remote services through public networks using a weak password and a smart card. Lin recently presented an improved chaotic maps-based password-authenticated key agreement scheme that used smartcards to eliminate the weaknesses of the scheme of Guo and Chang, which does not provide strong user anonymity and violates session key security. However, the improved scheme of Lin does not exhibit the freshness property and the validity of messages so it still fails to withstand denial-of-service and privileged-insider attacks. Additionally, a single malicious participant can predetermine the session key such that the improved scheme does not exhibit the contributory property of key agreements. This investigation discusses these weaknesses and proposes an enhanced smartcard-based password-authenticated key agreement scheme that utilizes extended chaotic maps. The session security of this enhanced scheme is based on the extended chaotic map-based Diffie-Hellman problem, and is proven in the real-or-random and the sequence of games models. Moreover, the enhanced scheme ensures the freshness of communicating messages by appending timestamps, and thereby avoids the weaknesses in previous schemes. PMID:28759615

The White Mountain Apache Child Protection Service Training Curriculum. Nohwii Chaghashe Baa da gontzaa (Protect Our Apache Children).

ERIC Educational Resources Information Center

Gonzalez-Santin, Edwin, Comp.

This curriculum manual provides 8 days of training for child protective services (CPS) personnel (social workers and administrators) working in the White Mountain Apache tribal community. Each of the first seven units in the manual contains a brief description of contents, course objectives, time required, key concepts, possible discussion topics,…

Using PulpMotion Videos as Instructional Anchors for Pre-Service Teachers Learning about Early Childhood Special Education

ERIC Educational Resources Information Center

Chapman, Denise N. J.

2014-01-01

Providing pre-service early childhood general educators with a strong knowledge base of key aspects of early childhood special education is essential in the United States as US federal law mandates it. Specifically, the Individuals with Disabilities Education Act (IDEA) stipulates that children with special needs must to be placed in the least…

Availability of Diagnostic and Treatment Services for Acute Stroke in Frontier Counties in Montana and Northern Wyoming

ERIC Educational Resources Information Center

Okon, Nicholas J.; Rodriguez, Daniel V.; Dietrich, Dennis W.; Oser, Carrie S.; Blades, Lynda L.; Burnett, Anne M.; Russell, Joseph A.; Allen, Martha J.; Chasson, Linda; Helgerson, Steven D.; Gohdes, Dorothy; Harwell, Todd S.

2006-01-01

Context: Rapid diagnosis and treatment of ischemic stroke can lead to improved patient outcomes. Hospitals in rural and frontier counties, however, face unique challenges in providing diagnostic and treatment services for acute stroke. Purpose: The aim of this study was to assess the availability of key diagnostic technology and programs for acute…

Engine Tune-up Service. Unit 2: Charging System. Posttests. Automotive Mechanics Curriculum.

ERIC Educational Resources Information Center

Richardson, Roger L.; Bacon, E. Miles

This book of posttests is designed to accompany the Engine Tune-Up Service Student Guide for Unit 2, Charging System, available separately as CE 031 208. Focus of the posttest is on the testing of the charging system. One multiple choice posttest is provided, that covers the three performance objectives contained in the unit. (No answer key is…

Exceeding Parents' Expectations in Ear-Nose-Throat Outpatient Facilities: The Development and Analysis of a Questionnaire

ERIC Educational Resources Information Center

Margaritis, Eleftherios; Katharaki, Maria; Katharakis, George

2012-01-01

The study attempts to develop an outpatient service quality scale by investigating the key dimensions which assess parental satisfaction and provides a recommendation on an improved health service delivery system. The survey was conducted in an Ear-Nose-Throat outpatient clinic of a Greek public pediatric hospital. A total of 127 parents in…

The Views of International Students Regarding University Support Services in Australia: A Case Study

ERIC Educational Resources Information Center

Roberts, Pam; Boldy, Duncan; Dunworth, Katie

2015-01-01

This paper reports on a study aimed at developing an improved understanding of the support needs of international students. Using a case study approach at one Australian university, a three stage data collection process was adopted: interviews with key support service providers in the university, student focus groups, and a large-scale survey.…

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…

Watch the lights. A visual communication system.

PubMed

Rahtz, S K

1989-01-01

The trend for hospitals to market their emergency care services results in a greater demand on radiology departments, states Ms. Rahtz. Radiology must provide efficient service to both departments, even when it is difficult to predict patient flow in the emergency care center. Improved communication is the key, and a light system installed at Morton Plant Hospital is one alternative for solving the problem.

Developing a Marketing Orientation in Hospital Library Services: A Case Report.

PubMed

Delawska-Elliott, Basia; Grinstead, Carrie; Martin, Heather J

2015-01-01

When the four Providence Health & Services libraries in Oregon regionalized services and resources, the transition, which was originally met with apprehension from some library users, turned out to be a resounding success. Despite a loss of two-thirds of the professional staff and a decreased budget, the new regionalized library experienced an increase in business and recognition. While many factors contributed to the success, a creative marketing and outreach campaign was a key component. This column describes the steps taken to promote regionalized library reference services and online resources.

The BGAN extension programme

NASA Astrophysics Data System (ADS)

Rivera, Juan J.; Trachtman, Eyal; Richharia, Madhavendra

2005-11-01

Mobile satellite telecommunications systems have undergone an enormous evolution in the last decades, with the interest in having advanced telecommunications services available on demand, anywhere and at any time, leading to incredible advances. The demand for braodband data is therefore rapidly gathering pace, but current solutions are finding it increasingly difficult to combine large bandwidth with ubiquitous coverage, reliability and portability. The BGAN (Broadband Global Area Network) system, designed to operate with the Inmarsat-4 satellites, provides breakthrough services that meet all of these requirements. It will enable broadband connection on the move, delivering all the key tools of the modern office. Recognising the great impact that Inmarsat's BGAN system will have on the European satellite communications industry, and the benefits that it will bring to a wide range of European industries, in 2003 ESA initiated the "BGAN Extension" project. Its primary goals are to provide the full range of BGAN services to truly mobile platforms, operating in aeronautical, vehicular and maritime environments, and to introduce a multicast service capability. The project is supported by the ARTES Programme which establishes a collaboration agreement between ESA, Inmarsat and a group of key industrial and academic institutions which includes EMS, Logica, Nera and the University of Surrey (UK).

77 FR 34434 - Self-Regulatory Organizations; BATS Exchange, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-11

... introducing broker proprietary accounts along with key personnel to Apex Clearing (the ``Transferring Accounts... Member, will provide the clearing and execution services currently provided to the Transferring Accounts... the Transferring Accounts, Apex Clearing has requested that the Exchange temporarily suspend its new...

A Quality Framework for Personalised Residential Supports for Adults with Developmental Disabilities

ERIC Educational Resources Information Center

Cocks, E.; Boaden, R.

2011-01-01

Background: The Personalised Residential Supports (PRS) Project provided detailed information about the nature, purposes and outcomes of PRS from the perspectives of key stakeholder groups including people with developmental disabilities, family members and service providers. Although these forms of support have developed over the past two…

Exploring Organizational Characteristics Associated with Practice Changes Following a Mentored Online Educational Module

ERIC Educational Resources Information Center

Rappolt, Susan; Pearce, Kristine; McEwen, Sara; Polatajko, Helene J.

2005-01-01

Introduction: Studies of health professionals' perceptions of barriers to and facilitators of research utilization in clinical practices suggest that structural and resource characteristics of service provider organizations are key determinants of the capacity of individual practitioners to provide evidence-based practices. In this pilot study, we…

Good intentions, increased inequities: developing social care services in Emergency Departments in the UK.

PubMed

Bywaters, Paul; McLeod, Eileen; Fisher, Joanne; Cooke, Matthew; Swann, Garry

2011-09-01

Addressing the quality of services provided in Emergency Departments (EDs) has been a central area of development for UK government policy since 1997. Amongst other aspects of this concern has been the recognition that EDs constitute a critical boundary between the community and the hospital and a key point for the identification of social care needs. Consequently, EDs have become the focus for a variety of service developments which combine the provision of acute medical and nursing assessment and care with a range of activities in which social care is a prominent feature. One approach to this has been the establishment of multidisciplinary teams aiming to prevent re-attendance or admission, re-direct patients to other services, or speed patients through EDs with the aim of providing improved quality of care. This study, carried out between September 2007 and April 2008, was the first UK national survey of social care initiatives based in EDs and aimed to determine the objectives, organisation, extent, functions, funding and evidence on outcomes of such interventions. Eighty-three per cent of UK Type I and II EDs responded to the survey. Approximately, one-third of EDs had embedded social care teams, with two-thirds relying on referrals to external social care services. These teams varied in their focus, size and composition, leadership, availability, funding and permanence. As a result, the unintended effect has been to increase inequities in access to social care services through EDs. Three further conclusions are drawn about policy led, locally-based service development. This survey adds to international evidence pointing to the potential benefits of a variety of social care interventions being based in EDs and justifies the establishment of a research programme which can provide answers to key outstanding questions. © 2011 Blackwell Publishing Ltd.

The Effect of Community on Distributed Bio-inspired Service Composition

NASA Astrophysics Data System (ADS)

Carroll, Raymond; Balasubramaniam, Sasitharan; Botvich, Dmitri; Donnelly, William

The Future Internet is expected to cater for both a larger number and variety of services, which in turn will make basic tasks such as service lifecycle management increasingly important and difficult. At the same time, the ability for users to efficiently discover and compose these services will become a key factor for service providers to differentiate themselves in a competitive market. In previous work, we examined the effect adding biological mechanisms to services had on service management and discovery. In this paper we examine the effects of community on services, specifically in terms of composing services in a distributed fashion. By introducing aspects of community we aim to demonstrate that services can further improve their sustainability and indeed their efficiency.

Quality management in home care: models for today's practice.

PubMed

Verhey, M P

1996-01-01

In less than a decade, home care providers have been a part of two major transitions in health care delivery. First, because of the advent of managed care and a shift from inpatient to community-based services, home care service delivery systems have experienced tremendous growth. Second, the principles and practices of total quality management and continuous quality improvement have permeated the organization, administration, and practice of home health care. Based on the work of Deming, Juran, and Crosby, the basic tenets of the new quality management philosophy involve a focus on the following five key areas: (1) systems and processes rather than individual performance; (2) involvement, collaboration, and empowerment; (3) internal and external "customers"; (4) data and measurement; and (5) standards, guidelines, and outcomes of care. Home care providers are among those in the forefront who are developing and implementing programs that integrate these foci into the delivery of quality home care services. This article provides a summary of current home care programs that address these five key areas of quality management philosophy and provide models for innovative quality management practice in home care. For further information about each program, readers are referred to the original reports in the home care and quality management journal literature, as cited herein.

Exploring Zen Marketing: A Strategic Experiment in Leveraging End User Intellectual Capital to Stimulate Primary Market Demand

NASA Astrophysics Data System (ADS)

Gilbert, Raymond

2003-10-01

Recently the Telecom Industry experienced an economic boom & bust cycle that hampered new service development & deployment. Consequently, there are significant problems in capturing key requirements for new network-based services and in educating CIO-IT leaders so they can promote investment proposals with their enterprise business leadership. This paper outlines a multi-functional initiative that Lucent Technologies established to engage and exchange with key Enterprises & their Telecom Suppliers views of future network technologies. This experiment is unique because it is facilitated by the corporate CIO-IT leadership & is focused on the latest 3G wireless technologies. CIO-IT provides externally facing resources that collaborate directly with Enterprises, and Service Providers while facilitating internal interactions with Bell Labs, Business Units and Sales teams. This program embodies a Zen Marketing approach since it seeks to create flashes of enlightenment with IT & business leaders by exercising all the knowledge, culture & behaviors available to an IT end user. The paper summarizes several organizational challenges & benefits uncovered by a program that is focused on transforming Mobility Provider relationships with their customers and expanding the overall awareness of the latest 3G wireless technologies.

Relay Telecommunications for the Coming Decade of Mars Exploration

NASA Technical Reports Server (NTRS)

Edwards, C.; DePaula, R.

2010-01-01

Over the past decade, an evolving network of relay-equipped orbiters has advanced our capabilities for Mars exploration. NASA's Mars Global Surveyor, 2001 Mars Odyssey, and Mars Reconnaissance Orbiter (MRO), as well as ESA's Mars Express Orbiter, have provided telecommunications relay services to the 2003 Mars Exploration Rovers, Spirit and Opportunity, and to the 2007 Phoenix Lander. Based on these successes, a roadmap for continued Mars relay services is in place for the coming decade. MRO and Odyssey will provide key relay support to the 2011 Mars Science Laboratory (MSL) mission, including capture of critical event telemetry during entry, descent, and landing, as well as support for command and telemetry during surface operations, utilizing new capabilities of the Electra relay payload on MRO and the Electra-Lite payload on MSL to allow significant increase in data return relative to earlier missions. Over the remainder of the decade a number of additional orbiter and lander missions are planned, representing new orbital relay service providers and new landed relay users. In this paper we will outline this Mars relay roadmap, quantifying relay performance over time, illustrating planned support scenarios, and identifying key challenges and technology infusion opportunities.

Data on the key performance indicators for quality of service of GSM networks in Nigeria.

PubMed

Popoola, Segun I; Atayero, Aderemi A; Faruk, Nasir; Badejo, Joke A

2018-02-01

In this data article, the Key Performance Indicators (KPIs) for Quality of Service (QoS) of Global System for Mobile Communications (GSM) networks in Nigeria are provided and analyzed. The data provided in this paper contain the Call Setup Success Rate (CSSR), Drop Call Rate (DCR), Stand-alone Dedicated Channel (SDCCH) congestion, and Traffic Channel (TCH) congestion for the four GSM network operators in Nigeria (Airtel, Etisalat, Glo, and MTN). These comprehensive data were obtained from the Nigerian Communications Commission (NCC). Significant differences in each of the KPIs for the four quarters of each year were presented based on Analysis of Variance (ANOVA). The values of the KPIs were plotted against the months of the year for better visualization and understanding of data trends across the four quarters. Multiple comparisons of the mean-quarterly differences of the KPIs were also presented using Tukey's Post Hoc test. Public availability and further interpretation and discussion of these useful information will assist the network providers, Nigerian government, local and international regulatory bodies, policy makers, and other stakeholders in ensuring access of people, machines, and things to high quality telecommunications services.

Mapping Ecological Processes and Ecosystem Services for Prioritizing Restoration Efforts in a Semi-arid Mediterranean River Basin

NASA Astrophysics Data System (ADS)

Trabucchi, Mattia; O'Farrell, Patrick J.; Notivol, Eduardo; Comín, Francisco A.

2014-06-01

Semi-arid Mediterranean regions are highly susceptible to desertification processes which can reduce the benefits that people obtain from healthy ecosystems and thus threaten human wellbeing. The European Union Biodiversity Strategy to 2020 recognizes the need to incorporate ecosystem services into land-use management, conservation, and restoration actions. The inclusion of ecosystem services into restoration actions and plans is an emerging area of research, and there are few documented approaches and guidelines on how to undertake such an exercise. This paper responds to this need, and we demonstrate an approach for identifying both key ecosystem services provisioning areas and the spatial relationship between ecological processes and services. A degraded semi-arid Mediterranean river basin in north east Spain was used as a case study area. We show that the quantification and mapping of services are the first step required for both optimizing and targeting of specific local areas for restoration. Additionally, we provide guidelines for restoration planning at a watershed scale; establishing priorities for improving the delivery of ecosystem services at this scale; and prioritizing the sub-watersheds for restoration based on their potential for delivering a combination of key ecosystem services for the entire basin.

Mapping ecological processes and ecosystem services for prioritizing restoration efforts in a semi-arid Mediterranean river basin.

PubMed

Trabucchi, Mattia; O'Farrell, Patrick J; Notivol, Eduardo; Comín, Francisco A

2014-06-01

Semi-arid Mediterranean regions are highly susceptible to desertification processes which can reduce the benefits that people obtain from healthy ecosystems and thus threaten human wellbeing. The European Union Biodiversity Strategy to 2020 recognizes the need to incorporate ecosystem services into land-use management, conservation, and restoration actions. The inclusion of ecosystem services into restoration actions and plans is an emerging area of research, and there are few documented approaches and guidelines on how to undertake such an exercise. This paper responds to this need, and we demonstrate an approach for identifying both key ecosystem services provisioning areas and the spatial relationship between ecological processes and services. A degraded semi-arid Mediterranean river basin in north east Spain was used as a case study area. We show that the quantification and mapping of services are the first step required for both optimizing and targeting of specific local areas for restoration. Additionally, we provide guidelines for restoration planning at a watershed scale; establishing priorities for improving the delivery of ecosystem services at this scale; and prioritizing the sub-watersheds for restoration based on their potential for delivering a combination of key ecosystem services for the entire basin.

Fall prevention services for older Aboriginal people: investigating availability and acceptability.

PubMed

Lukaszyk, Caroline; Coombes, Julieann; Keay, Lisa; Sherrington, Catherine; Tiedemann, Anne; Broe, Tony; Lovitt, Lorraine; Ivers, Rebecca

2016-12-14

Falls and fall-related injury are emerging issues for older Aboriginal people. Despite this, it is unknown whether older Aboriginal people access available fall prevention programs, or whether these programs are effective or acceptable to this population. To investigate the use of available fall prevention services by older Aboriginal people and identify features that are likely to contribute to program acceptability for Aboriginal communities in New South Wales (NSW), Australia. A questionnaire was distributed to Aboriginal and mainstream health and community services across NSW to identify the fall prevention and healthy ageing programs currently used by older Aboriginal people. Services with experience in providing fall prevention interventions for Aboriginal communities, and key Aboriginal health services that delivered programs specifically for older Aboriginal people, were followed up and staff members were nominated from within each service to be interviewed. Service providers offered their suggestions as to how a fall prevention program could be designed and delivered to meet the health and social needs of their older Aboriginal clients. Of the 131 services that completed the questionnaire, four services (3%) had past experience in providing a mainstream fall prevention program to Aboriginal people; however, there were no programs being offered at the time of data collection. From these four services, and from a further five key Aboriginal health services, 10 staff members experienced in working with older Aboriginal people were interviewed. Barriers preventing services from offering appropriate fall prevention programs to their older Aboriginal clients were identified, including limited funding, a lack of available Aboriginal staff, and communication difficulties between health services and sectors. According to the service providers, an effective and acceptable fall prevention intervention would be evidence based, flexible, community-oriented and social, held in a familiar and culturally safe location and delivered free of cost. This study identified a gap in the availability of acceptable fall prevention programs designed for, and delivered to, older Aboriginal people in NSW. Further consultation with older Aboriginal people is necessary to determine how an appropriate and effective program can be designed and delivered. Terminology: The authors recognise the two distinctive Indigenous populations of Australia: Aboriginal and Torres Strait Islander people. Because the vast majority of the NSW Aboriginal and Torres Strait Islander population is Aboriginal (95.4%)1, this population will be referred to as 'Aboriginal' in this manuscript.

How well do services for young people with long term conditions deliver features proposed to improve transition?

PubMed

Colver, A; Pearse, R; Watson, R M; Fay, M; Rapley, T; Mann, K D; Le Couteur, A; Parr, J R; McConachie, H

2018-05-08

For young people with long-term conditions, transition from child to adult-oriented health services is a critical period which, if not managed well, may lead to poor outcomes. There are features of transition services which guidance and research suggest improve outcomes. We studied nine such features, calling them 'proposed beneficial features': age-banded clinic; meet adult team before transfer; promotion of health self-efficacy; written transition plan; appropriate parent involvement; key worker; coordinated team; holistic life-skills training; transition manager for clinical team. We aimed to describe the extent to which service providers offer these nine features, and to compare this with young people's reported experience of them. A longitudinal, mixed methods study followed 374 young people as their care moved from child to adult health services. Participants had type 1 diabetes, cerebral palsy or autism spectrum disorder with additional mental health difficulties. Data are reported from the first two visits, one year apart. Three hundred four (81.3%) of the young people took part in the second visit (128 with diabetes, 91 with autism, 85 with cerebral palsy). Overall, the nine proposed beneficial features of transition services were poorly provided. Fewer than half of services stated they provided an age-banded clinic, written transition plan, transition manager for clinical team, a protocol for promotion of health self-efficacy, or holistic life-skills training. To varying degrees, young people reported that they had not experienced the features which services said they provided. For instance, the agreement for written transition plan, holistic life-skills training and key worker, was 30, 43 and 49% respectively. Agreement was better for appropriate parent involvement, age-banded clinic, promotion of health self-efficacy and coordinated team at 77, 77, 80 and 69% respectively. Variation in the meaning of the features as experienced by young people and families was evident from qualitative interviews and observations. UK services provide only some of the nine proposed beneficial features for supporting healthcare transition of young people with long term conditions. Observational studies or trials which examine the influence of features of transition services on outcomes should ensure that the experiences of young people and families are captured, and not rely on service specifications.

An employee assistance program for caregiver support.

PubMed

Mains, Douglas A; Fairchild, Thomas J; René, Antonio A

2006-01-01

The Comprehensive Caregiver Choices Program provided support for employee caregivers of elderly people for employees at a hospital in Fort Worth, Texas. Key informant interviews and focus groups provided direction for program development and implementation. A full-time MSW and professionals with expertise in gerontology/geriatrics provided education and care coordination services to caregivers. Approximately 4% of the hospital's workforce participated in the program. Attendees evaluated educational sessions and follow-up interviews were conducted with program participants. Caregiver support programs must continue to seek innovative and creative marketing and service delivery methods to reach out and assist working caregivers in need of support.

Toward a North American Standard for Mobile Data Services

NASA Technical Reports Server (NTRS)

Dean, Richard A.; Levesque, Allen H.

1991-01-01

The rapid introduction of digital mobile communications systems is an important part of the emerging digital communications scene. These developments pose both a potential problem and a challenge. On one hand, these separate market driven developments can result in an uncontrolled mixture of analog and digital links which inhibit data modem services across the mobile/Public Switched network (PSTN). On the other hand, the near coincidence of schedules for development of some of these systems, i.e., Digital Cellular, Mobile Satellite, Land Mobile Radio, and ISDN, provides an opportunity to address interoperability problems by defining interfaces, control, and service standards that are compatible among these new services. In this paper we address the problem of providing data services interoperation between mobile terminals and data devices on the PSTN. The expected data services include G3 Fax, asynchronous data, and the government's STU-3 secure voice system, and future data services such as ISDN. We address a common architecture and a limited set of issues that are key to interoperable mobile data services. We believe that common mobile data standards will both improve the quality of data service and simplify the systems for manufacturers, data users, and service providers.

Toward a North American standard for mobile data services

NASA Astrophysics Data System (ADS)

Dean, Richard A.; Levesque, Allen H.

1991-09-01

The rapid introduction of digital mobile communications systems is an important part of the emerging digital communications scene. These developments pose both a potential problem and a challenge. On one hand, these separate market driven developments can result in an uncontrolled mixture of analog and digital links which inhibit data modem services across the mobile/Public Switched network (PSTN). On the other hand, the near coincidence of schedules for development of some of these systems, i.e., Digital Cellular, Mobile Satellite, Land Mobile Radio, and ISDN, provides an opportunity to address interoperability problems by defining interfaces, control, and service standards that are compatible among these new services. In this paper we address the problem of providing data services interoperation between mobile terminals and data devices on the PSTN. The expected data services include G3 Fax, asynchronous data, and the government's STU-3 secure voice system, and future data services such as ISDN. We address a common architecture and a limited set of issues that are key to interoperable mobile data services. We believe that common mobile data standards will both improve the quality of data service and simplify the systems for manufacturers, data users, and service providers.

Using attachment theory to inform the design and delivery of mental health services: a systematic review of the literature.

PubMed

Bucci, Sandra; Roberts, Nicola H; Danquah, Adam N; Berry, Katherine

2015-03-01

The aim of this review was to propose and describe the design and delivery of an attachment-informed general mental health service. We systematically searched the PsycINFO, MEDLINE, Web of Knowledge, COPAC, CINAHL, and Science Direct databases from 1960 to 2013. We also searched reference lists of relevant papers and directly contacted authors in the field. Literature describing attachment theory and its applicability in designing and delivering general mental health services was synthesized using thematic analysis. Papers published in English, books or chapters in edited books that described applying attachment theory in designing and delivering mental health services for adults and adolescents were included in the review. Of the 1,105 articles identified, 14 met inclusion criteria for the review. Eight key themes, and four subthemes, were extracted and organized to reflect the experience of a service user moving through the mental health system. Key themes extracted were as follows: service policy and evaluation; referrals; assessment and formulation; intervention; support for staff; support for carers; moving on; and potential service benefits. Papers reviewed suggested that service users with severe mental health problems have attachment needs that should be met in general mental health services. Attachment theory provides a useful framework to inform the design and delivery of general mental health services. The resource implications for services are discussed, as are limitations of the review and recommendations for future research. Attachment theory should be used to inform the design and delivery of general mental health services. Mental health services should evaluate the extent to which they meet service users' attachment needs. Attachment-informed mental health services should assess outcomes, including cost-effectiveness over time. Papers included in this review focus on long-stay residential care or secure services and there is a limited experimental evidence base to show that providing an attachment-informed service improves patient outcomes. © 2014 The British Psychological Society.

Space-based observatories providing key data for climate change applications

NASA Astrophysics Data System (ADS)

Lecomte, J.; Juillet, J. J.

2016-12-01

The Sentinel-1 & 3 mission are part of the Copernicus program, previously known as GMES (Global Monitoring for Environment and Security), whose overall objective is to support Europe's goals regarding sustainable development and global governance of the environment by providing timely and quality data, information, services and knowledge. This European Earth Observation program is led by the European Commission and the space infrastructure is developed under the European Space Agency leadership. Many services will be developed through the Copernicus program among different thematic areas. The climate change is one of this thematic area and the Sentinel-1 & 3 satellites will provide key space-based observations in this area. The Sentinel-1 mission is based on a constellation of 2 identical satellites each one embarking C-SAR Instrument and provides capability for continuous radar mapping of the Earth with enhanced revisit frequency, coverage, timeliness and reliability for operational services and applications requiring long time series. In particular, Sentinel 1 provides all-weather, day-and-night estimates of soil moisture, wind speed and direction, sea ice, continental ice sheets and glaciers. The Sentinel-3 mission will mainly be devoted to the provision of Ocean observation data in routine, long term (20 years of operations) and continuous fashion with a consistent quality and a very high level of availability. Among these data, very accurate surface temperatures and topography measurements will be provided and will constitute key indicators, once ingested in climate change models, for identifying climate drivers and expected climate impacts. The paper will briefly recall the satellite architectures, their main characteristics and performance. The inflight performance and key features of their images or data of the 3 satellites namely Sentinel 1A, 1B and 3A will be reviewed to demonstrate the quality and high scientific potential of the data as well as their availability to the user community. The short, medium and long term will be described. The first satellites are now in operation in orbit. Long-term plan foresees 2 add't recurrent satellites currently under prod, then a new gen in long term. Long term is crucial for climate change analysis & forecast, which is the goal of the Copernicus program.

Relationships, expertise, incentives, and governance: supporting care home residents' access to health care. An interview study from England.

PubMed

Goodman, Claire; Davies, Sue L; Gordon, Adam L; Meyer, Julienne; Dening, Tom; Gladman, John R F; Iliffe, Steve; Zubair, Maria; Bowman, Clive; Victor, Christina; Martin, Finbarr C

2015-05-01

To explore what commissioners of care, regulators, providers, and care home residents in England identify as the key mechanisms or components of different service delivery models that support the provision of National Health Service (NHS) provision to independent care homes. Qualitative, semistructured interviews with a purposive sample of people with direct experience of commissioning, providing, and regulating health care provision in care homes and care home residents. Data from interviews were augmented by a secondary analysis of previous interviews with care home residents on their personal experience of and priorities for access to health care. Analysis was framed by the assumptions of realist evaluation and drew on the constant comparative method to identify key themes about what is required to achieve quality health care provision to care homes and resident health. Participants identified 3 overlapping approaches to the provision of NHS that they believed supported access to health care for older people in care homes: (1) Investment in relational working that fostered continuity and shared learning between visiting NHS staff and care home staff, (2) the provision of age-appropriate clinical services, and (3) governance arrangements that used contractual and financial incentives to specify a minimum service that care homes should receive. The 3 approaches, and how they were typified as working, provide a rich picture of the stakeholder perspectives and the underlying assumptions about how service delivery models should work with care homes. The findings inform how evidence on effective working in care homes will be interrogated to identify how different approaches, or specifically key elements of those approaches, achieve different health-related outcomes in different situations for residents and associated health and social care organizations. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems

PubMed Central

Taylor, Tatiana L; Killaspy, Helen; Wright, Christine; Turton, Penny; White, Sarah; Kallert, Thomas W; Schuster, Mirjam; Cervilla, Jorge A; Brangier, Paulette; Raboch, Jiri; Kališová, Lucie; Onchev, Georgi; Dimitrov, Hristo; Mezzina, Roberto; Wolf, Kinou; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitri; Gonidakis, Fragiskos; Caldas-de-Almeida, José; Cardoso, Graça; King, Michael B

2009-01-01

Background A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. Methods We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. Results We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). Conclusion Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening. PMID:19735562

A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems.

PubMed

Taylor, Tatiana L; Killaspy, Helen; Wright, Christine; Turton, Penny; White, Sarah; Kallert, Thomas W; Schuster, Mirjam; Cervilla, Jorge A; Brangier, Paulette; Raboch, Jiri; Kalisová, Lucie; Onchev, Georgi; Dimitrov, Hristo; Mezzina, Roberto; Wolf, Kinou; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitri; Gonidakis, Fragiskos; Caldas-de-Almeida, José; Cardoso, Graça; King, Michael B

2009-09-07

A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.

'It's risky to walk in the city with syringes': understanding access to HIV/AIDS services for injecting drug users in the former Soviet Union countries of Ukraine and Kyrgyzstan

PubMed Central

2011-01-01

Background Despite massive scale up of funds from global health initiatives including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other donors, the ambitious target agreed by G8 leaders in 2005 in Gleneagles to achieve universal access to HIV/AIDS treatment by 2010 has not been reached. Significant barriers to access remain in former Soviet Union (FSU) countries, a region now recognised as a priority area by policymakers. There have been few empirical studies of access to HIV/AIDS services in FSU countries, resulting in limited understanding and implementation of accessible HIV/AIDS interventions. This paper explores the multiple access barriers to HIV/AIDS services experienced by a key risk group-injecting drug users (IDUs). Methods Semi-structured interviews were conducted in two FSU countries-Ukraine and Kyrgyzstan-with clients receiving Global Fund-supported services (Ukraine n = 118, Kyrgyzstan n = 84), service providers (Ukraine n = 138, Kyrgyzstan n = 58) and a purposive sample of national and subnational stakeholders (Ukraine n = 135, Kyrgyzstan n = 86). Systematic thematic analysis of these qualitative data was conducted by country teams, and a comparative synthesis of findings undertaken by the authors. Results Stigmatisation of HIV/AIDS and drug use was an important barrier to IDUs accessing HIV/AIDS services in both countries. Other connected barriers included: criminalisation of drug use; discriminatory practices among government service providers; limited knowledge of HIV/AIDS, services and entitlements; shortages of commodities and human resources; and organisational, economic and geographical barriers. Conclusions Approaches to thinking about universal access frequently assume increased availability of services means increased accessibility of services. Our study demonstrates that while there is greater availability of HIV/AIDS services in Ukraine and Kyrgyzstan, this does not equate with greater accessibility because of multiple, complex, and interrelated barriers to HIV/AIDS service utilisation at the service delivery level. Factors external to, as well as within, the health sector are key to understanding the access deficit in the FSU where low or concentrated HIV/AIDS epidemics are prevalent. Funders of HIV/AIDS programmes need to consider how best to tackle key structural and systemic drivers of access including prohibitionist legislation on drugs use, limited transparency and low staff salaries within the health sector. PMID:21752236

Experiences of girls with hearing impairment in accessing reproductive health care services in Ibadan, Nigeria.

PubMed

Arulogun, Oyedunni S; Titiloye, Musibau A; Afolabi, Nathanael B; Oyewole, Oyediran E; Nwaorgu, Onyekwere G B

2013-03-01

Delivery of health services to people with hearing impairment is poorly understood in Nigeria and limited research has been done to throw more light on the process involved. This study described experiences of 167 girls with hearing impairment in accessing reproductive health services in Ibadan using a validated questionnaire. Descriptive statistics and binary logistic regression were used to analyze the data. Almost 95.0% of respondents had ever visited health facility for reproductive health issues. Of these 6.2% and 4.6% went for treatment of STIs and pregnancy termination respectively; 36.7% were embarrassed to ask questions in the presence of an interpreter, communication (40.5%) and cost (10.8%) were key barriers to access and 85.6% would use facility if hearing impairment-friendly services are provided. Respondents who were currently working were 20 times more likely to receive services they wanted (OR = 20.29, CI = 1.05-392.16). Availability of certified interpreters and ensuring confidentiality are key to effective service delivery for the hearing impaired.

The architecture of smart surveys: core issues in why and how to collect patient and referring physician satisfaction data.

PubMed

Lexa, Frank J; Berlin, Jonathan W

2009-02-01

Radiology practices are facing challenges on many fronts. As the field becomes more competitive, leaders must pay more attention to the quality of the service that groups provide to their customers. This need is also being driven by higher expectations from customers, particularly patients, who will likely act much more like consumers in the 21st century. For practices to succeed in providing exemplary service, they must pay attention to the voices of their key customer groups. It is dismaying to see practices that are struggling or even dissolving over issues created by poor service. As much as we are experts in imaging, we are unlikely to be able to provide superlative service by reading books, talking among ourselves, or hiring consultants. Rather, we must do what should be obvious, which is to actually ask our customers how we are doing. Surveys are one of the important tools that can be brought to bear on this issue. For many groups, surveying is the starting point for understanding what their patients, referring physicians, and other key stakeholders want. Groups can also find out what customers like and dislike about their experiences, and how groups compare with their competitors. This article provides a guide on how to get off to a good start in designing and deploying surveys that can help optimize the way groups take care of their patients and help their referring physicians.

Entropy-as-a-Service: Unlocking the Full Potential of Cryptography.

PubMed

Vassilev, Apostol; Staples, Robert

2016-09-01

Securing the Internet requires strong cryptography, which depends on the availability of good entropy for generating unpredictable keys and accurate clocks. Attacks abusing weak keys or old inputs portend challenges for the Internet. EaaS is a novel architecture providing entropy and timestamps from a decentralized root of trust, scaling gracefully across diverse geopolitical locales and remaining trustworthy unless much of the collective is compromised.

Telehealth services in rural and remote Australia: a systematic review of models of care and factors influencing success and sustainability.

PubMed

Bradford, Natalie K; Caffery, Liam J; Smith, Anthony C

2016-01-01

With the escalating costs of health care, issues with recruitment and retention of health practitioners in rural areas, and poor economies of scale, the question of delivering people to services or services to people is a dilemma for health authorities around the world. People living in rural areas have poorer health outcomes compared to their urban counterparts, and the problem of how to provide health care and deliver services in rural locations is an ongoing challenge. Telehealth services can efficiently and effectively improve access to healthcare for people living in rural and remote areas of Australia. However, telehealth services are not mainstream or routinely available in many rural and remote locations. The barriers to integration of telehealth into mainstream practice have been well described, but not the factors that may influence the success and sustainability of a service. Our aim was to collate, review and synthesise the available literature regarding telehealth services in rural and remote locations of Australia, and to identify the factors associated with their sustained success. A systematic literature review of peer-reviewed and grey literature was undertaken. Electronic databases were searched for potentially relevant articles. Reference lists of retrieved articles and the grey literature were also searched. Searches identified 970 potentially eligible articles published between 1988 and 2015. Studies and manuscripts of any type were included if they described telehealth services (store-and-forward or real-time videoconferencing) to provide clinical service or education and training related to health care in rural or remote locations of Australia. Data were extracted according to pre-defined criteria and checked for completeness and accuracy by a second reviewer. Any disagreements were resolved with discussion with a third researcher. All articles were appraised for quality and levels of evidence. Data were collated and grouped into categories including clinical speciality, disciplines involved, geographical location and the role of the service. Data relating to the success or sustainability of services were grouped thematically. Inclusion criteria were met by 116 articles that described 72 discrete telehealth services. Telehealth services in rural and remote Australia are described and we have identified six key factors associated with the success and sustainability of services: vision, ownership, adaptability, economics, efficiency and equipment. Telehealth has the potential to address many of the key challenges to providing health in Australia, with its substantial land area and widely dispersed population. This review collates information regarding the telehealth services in Australia and describes models of care and characteristics of successful and sustainable services. We identified a wide variety of telehealth services being provided in rural and remote areas of Australia. There is great potential to increase this number by scaling up and replicating successful services. This review provides information for policy makers, governments and public and private health services that wish to integrate telehealth into routine practice and for telehealth providers to enhance the sustainability of their service.

Exploring Service Providers' Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia.

PubMed

Cyril, Sheila; Green, Julie; Nicholson, Jan M; Agho, Kingsley; Renzaho, Andre M N

2016-01-01

Childhood obesity rates have been increasing disproportionately among disadvantaged communities including culturally and linguistically diverse (CALD) migrant groups in Australia due to their poor participation in the available obesity prevention initiatives. We sought to explore service providers' perceptions of the key factors influencing the participation of CALD communities in the existing obesity prevention services and the service requirements needed to improve CALD communities' participation in these services. We conducted a qualitative study using focus group discussions involving fifty-nine service providers from a range of services, who are involved in the health and wellbeing of children from CALD groups living in four socioeconomically disadvantaged areas in Victoria, Australia. Thematic analysis of the data showed three major themes including community-level barriers to CALD engagement in childhood obesity prevention services; service-level barriers to the delivery of these services; and proposed changes to current childhood obesity prevention approaches. Integrating obesity prevention messages within existing programs, better coordination between prevention and treatment services and the establishment of a childhood obesity surveillance system, were some of the important changes suggested by service providers. This study has found that low CALD health literacy, lack of knowledge of cultural barriers among service providers and co-existing deficiencies in the structure and delivery of obesity prevention services negatively impacted the participation of CALD communities in obesity prevention services. Cultural competency training of service providers would improve their understanding of the cultural influences of childhood obesity and incorporate them into the design and development of obesity prevention initiatives. Service providers need to be educated on the pre-migratory health service experiences and health conditions of CALD communities to ensure equitable delivery of care. Collaborative approaches between health systems, immigrant services, early years' services and community health services are urgently needed to address obesity-related disparities in Australia.

On the Security of a Two-Factor Authentication and Key Agreement Scheme for Telecare Medicine Information Systems.

PubMed

Arshad, Hamed; Teymoori, Vahid; Nikooghadam, Morteza; Abbassi, Hassan

2015-08-01

Telecare medicine information systems (TMISs) aim to deliver appropriate healthcare services in an efficient and secure manner to patients. A secure mechanism for authentication and key agreement is required to provide proper security in these systems. Recently, Bin Muhaya demonstrated some security weaknesses of Zhu's authentication and key agreement scheme and proposed a security enhanced authentication and key agreement scheme for TMISs. However, we show that Bin Muhaya's scheme is vulnerable to off-line password guessing attacks and does not provide perfect forward secrecy. Furthermore, in order to overcome the mentioned weaknesses, we propose a new two-factor anonymous authentication and key agreement scheme using the elliptic curve cryptosystem. Security and performance analyses demonstrate that the proposed scheme not only overcomes the weaknesses of Bin Muhaya's scheme, but also is about 2.73 times faster than Bin Muhaya's scheme.

Scaling-up HIV responses with key populations in West Africa.

PubMed

Wheeler, Tisha; Wolf, R Cameron; Kapesa, Laurent; Cheng Surdo, Alison; Dallabetta, Gina

2015-03-01

Despite decades of HIV responses in pockets of West and Central Africa (WCA), the HIV response with key populations remains an understudied area. Recently, there has been a proliferation of studies highlighting epidemiologic and behavioral data that challenge attitudes of complacency among donors and country governments uncomfortable in addressing key populations. The articles in this series highlight new studies that provide a better understanding of the epidemiologic and structural burden facing key populations in the WCA region and how to improve responses through more effective targeting. Key populations face pervasive structural barriers including institutional and sexual violence and an intersection of stigma, criminalization, and marginalization as sexual minorities. Despite decades of smaller interventions that have shown the importance of integrated services for key populations, there remains incongruent provision of outreach or testing or family planning pointing to sustained risk. There remains an incongruent resource provision for key populations where they shoulder the burden of HIV and their access to services alone could turn around HIV epidemics within the region. These proximal and distal determinants must be addressed in regional efforts, led by the community, and resourced for scale, targeting those most at risk for the acquisition and transmission of HIV. This special issue builds the knowledge base for the region focusing on interventions that remove barriers to service access including treatment uptake for those living with HIV. Better analysis and use of data for strategic planning are shown to lead to more effective targeting of prevention, care, and HIV treatment programs with key populations. These articles further demonstrate the immediate need for comprehensive action to address HIV among key populations throughout the WCA region.

Barriers and facilitators to provide quality TIA care in the Veterans Healthcare Administration

PubMed Central

Miech, Edward J.; Sico, Jason J.; Phipps, Michael S.; Arling, Greg; Ferguson, Jared; Austin, Charles; Myers, Laura; Baye, Fitsum; Luckhurst, Cherie; Keating, Ava B.; Moran, Eileen; Bravata, Dawn M.

2017-01-01

Objective: To identify key barriers and facilitators to the delivery of guideline-based care of patients with TIA in the national Veterans Health Administration (VHA). Methods: We conducted a cross-sectional, observational study of 70 audiotaped interviews of multidisciplinary clinical staff involved in TIA care at 14 VHA hospitals. We de-identified and analyzed all transcribed interviews. We identified emergent themes and patterns of barriers to providing TIA care and of facilitators applied to overcome these barriers. Results: Identified barriers to providing timely acute and follow-up TIA care included difficulties accessing brain imaging, a constantly rotating pool of housestaff, lack of care coordination, resource constraints, and inadequate staff education. Key informants revealed that both stroke nurse coordinators and system-level factors facilitated the provision of TIA care. Few facilities had specific TIA protocols. However, stroke nurse coordinators often expanded upon their role to include TIA. They facilitated TIA care by (1) coordinating patient care across services, communicating across service lines, and educating clinical staff about facility policies and evidence-based practices; (2) tracking individual patients from emergency departments to inpatient settings and to discharge for timely follow-up care; (3) providing and referring TIA patients to risk factor management programs; and (4) performing regular audit and feedback of quality performance data. System-level facilitators included clinical service leadership engagement and use of electronic tools for continuous care across services. Conclusions: The local organization within a health care facility may be targeted to cultivate internal facilitators and a systemic infrastructure to provide evidence-based TIA care. PMID:29117959

Emerging models for facilitating contact between people genetically related through donor conception: a preliminary analysis and discussion.

PubMed

Crawshaw, Marilyn; Daniels, Ken; Adams, Damian; Bourne, Kate; van Hooff, J A P; Kramer, Wendy; Pasch, Lauri; Thorn, Petra

2015-12-01

Previous research indicates interest among some donor-conceived people, donors and recipient parents in having contact. Outcomes of such contact appear largely, but not universally, positive. This paper seeks to understand better the characteristics of associated support services. Information gathered using the authors' direct experiences and professional and personal networks in different parts of the world indicates the emergence of four main groupings: (i) publically funded services outside of treatment centers; (ii) services provided by fertility treatment or gamete bank services; (iii) services provided privately by independent psychosocial or legal practitioners; and (4) services organized by offspring and/or recipient parents. Key operational features examined were: (i) who can access such services and when; (ii) what professional standards and funding are in place to provide them; and (iii) how 'matching' and contact processes are managed. Differences appear influenced variously by the needs of those directly affected, local policies, national legislation and the interests of the fertility services which recruit gamete donors and/or deliver donor conception treatments. The paper is intended to inform fuller debate about how best to meet the needs of those seeking information and contact, the implications for the way that fertility treatment and gametes donation services are currently provided and future research needs.

Netchain coordinator services in pork supply chains including inspections according to the AMOR principle.

PubMed

O'Hagan, Juliane; Ellebrecht, Susanne; Petersen, Brigitte

2013-11-01

This paper presents a mutual inspection concept between livestock production and processing, coordinated by a netchain coordinator acting as the service provider. The concept is based on an analysis of demand and offer with respect to the coordination of livestock health status certificates. Surveys have been conducted amongst piglet producers and pig fatteners (nfarmers=206) to reflect the demand for coordination services. Another survey amongst service providers (nproviders=21) determines the availability of these services. The results show a clear demand amongst farmers for the netchain coordinator services of livestock health status certificates. It has also been found that some service providers offer audit and monitoring procedures to enable certification with highly varying degrees of service quality. Based on the surveys, the joint organisation of livestock health status certificates between producer, fattener and service provider will be presented. It will be shown that for greater efficiency, coordination should be based on the principles of Alliances for the Mutual Organisation of Risk oriented inspection strategies (AMOR). To enable the mutual organisation of inspections, four key steps have been identified to develop and test AMOR as an innovative form of cooperation: (i) inspection design, (ii) responsibilities and tasks, (iii) information and communication structures, and (iv) shared cost and benefit model. Copyright © 2013 Elsevier Ltd. All rights reserved.

Exploring decision-making for environmental health services: perspectives from four cities.

PubMed

Hunt, C; Lewin, S

2000-01-01

Increasing resources are being allocated to environmental health monitoring, especially for developing methods and collecting data to construct environmental health indicators (EHIs). Yet, little research has focused on understanding how communities and service providers make decisions with regard to environmental health priorities and the role of indicators in this process. This paper presents insights regarding local decision-making that arose from a project to test the feasibility of using community-based EHIs to facilitate communication between the providers and the recipients of environmental services in four developing-country cities. The results of the study indicate that decision-making for environmental health services is complex and iterative rather than rational and linear. Contextual and process factors play an important role. These factors include the morale of service providers, the extent of collaboration between service agencies, the priorities of different community groups and relations between service providers and communities. Scientific information, in the form of EHIs, did not appear to be a key element of decision-making in the settings studied. As tools, EHIs are unlikely to become part of the decision-making process unless they are integrated with local agendas and backed by strong local representation.

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.

Use of electronic clinical reminders to increase preventive screenings in a primary care setting: blueprint from a successful process in Kodiak, Alaska.

PubMed

Onders, Robert; Spillane, James; Reilley, Brigg; Leston, Jessica

2014-01-01

The Kodiak Area Native Association (KANA) provides primary health care in Kodiak, Alaska and 6 outlying villages. KANA sought to actively improve key preventive screening rates for its patients. KANA adopted an electronic health record in 2008 and deployed national clinical reminders from the Indian Health Service for 5 key preventive screenings: tobacco use, alcohol use, depression, intimate partner violence, and a comprehensive cardiovascular exam. Clinical reminders were deployed in a 5-step process: (a) establish clinical demand, (b) pilot test reminder, (c) expand reminder to all providers, (d) measure outcomes and share results, and (e) delegate clinical reminder follow-up (primarily to nurses). Data from 2007-2011 show screening rates for all 5 measures improved considerably, to levels significantly above the national average for Indian Health Service facilities. Clinical reminders have been a key part of a multistep process to improve screening for depression, tobacco cessation, intimate partner violence, alcohol use, and cardiovascular disease. If deployed correctly, reminders are valuable tools in identifying patients who are overdue for preventive health screenings.

[Web-based support system for medical device maintenance].

PubMed

Zhao, Jinhai; Hou, Wensheng; Chen, Haiyan; Tang, Wei; Wang, Yihui

2015-01-01

A Web-based technology system was put forward aiming at the actual problems of the long maintenance cycle and the difficulties of the maintenance and repairing of medical equipments. Based on analysis of platform system structure and function, using the key technologies such as search engine, BBS, knowledge base and etc, a platform for medical equipment service technician to use by online or offline was designed. The platform provides users with knowledge services and interactive services, enabling users to get a more ideal solution.

Paediatric International Nursing Study: using person-centred key performance indicators to benchmark children's services.

PubMed

McCance, Tanya; Wilson, Val; Kornman, Kelly

2016-07-01

The aim of the Paediatric International Nursing Study was to explore the utility of key performance indicators in developing person-centred practice across a range of services provided to sick children. The objective addressed in this paper was evaluating the use of these indicators to benchmark services internationally. This study builds on primary research, which produced indicators that were considered novel both in terms of their positive orientation and use in generating data that privileges the patient voice. This study extends this research through wider testing on an international platform within paediatrics. The overall methodological approach was a realistic evaluation used to evaluate the implementation of the key performance indicators, which combined an integrated development and evaluation methodology. The study involved children's wards/hospitals in Australia (six sites across three states) and Europe (seven sites across four countries). Qualitative and quantitative methods were used during the implementation process, however, this paper reports the quantitative data only, which used survey, observations and documentary review. The findings demonstrate the quality of care being delivered to children and their families across different international sites. The benchmarking does, however, highlight some differences between paediatric and general hospitals, and between the different key performance indicators across all the sites. The findings support the use of the key performance indicators as a novel method to benchmark services internationally. Whilst the data collected across 20 paediatric sites suggest services are more similar than different, benchmarking illuminates variations that encourage a critical dialogue about what works and why. The transferability of the key performance indicators and measurement framework across different settings has significant implications for practice. The findings offer an approach to benchmarking and celebrating the successes within practice, while learning from partners across the globe in further developing person-centred cultures. © 2016 John Wiley & Sons Ltd.

Sexual and reproductive health services for women with disability: a qualitative study with service providers in the Philippines.

PubMed

Lee, Kira; Devine, Alexandra; Marco, Ma Jesusa; Zayas, Jerome; Gill-Atkinson, Liz; Vaughan, Cathy

2015-10-15

The Philippines has ratified the United Nations Convention on the Rights of Persons with Disabilities and recently passed domestic legislation protecting the sexual and reproductive rights of people with disability. However women in the Philippines continue to report barriers to sexual and reproductive health services, and there is limited empirical evidence available to inform policy makers' efforts to respond. This study aims to contribute to the available evidence by examining service providers' perceptions of disability and their experiences providing sexual and reproductive health services to women with disability. The study was conducted as part of a larger three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disabilities in the Philippines. Fourteen in-depth interviews and two focus group discussions were conducted with a total of thirty-two sexual and reproductive health service providers in Quezon City and Ligao. Qualitative data were analysed to identify key themes in participants' discussion of service provision to women with disability. Analysis of service providers' accounts suggests a range of factors undermine provision of high quality sexual and reproductive health services to women with disability. Service providers often have limited awareness of the sexual and reproductive health needs of women with disability and inadequate understanding of their rights. Service providers have had very little training in relation to disability, and limited access to the resources that would enable them to provide a disability inclusive service. Some service providers hold prejudiced attitudes towards women with disability seeking sexual and reproductive health services, resulting in disability-based discrimination. Service providers are also often unaware of specific factors undermining the health of women with disability, such as violence and abuse. Recent legislative change in the Philippines opens a window of opportunity to strengthen sexual and reproductive health service provision across the country. However the development of services that are disability-inclusive will require substantial efforts to address supply-side barriers such as prejudiced service provider attitudes and limited capacity. Disability inclusion must be prioritised for the national goal of responsible parenthood and reproductive health to be realised for all.

Three-Factor User Authentication and Key Agreement Using Elliptic Curve Cryptosystem in Wireless Sensor Networks.

PubMed

Park, YoHan; Park, YoungHo

2016-12-14

Secure communication is a significant issue in wireless sensor networks. User authentication and key agreement are essential for providing a secure system, especially in user-oriented mobile services. It is also necessary to protect the identity of each individual in wireless environments to avoid personal privacy concerns. Many authentication and key agreement schemes utilize a smart card in addition to a password to support security functionalities. However, these schemes often fail to provide security along with privacy. In 2015, Chang et al. analyzed the security vulnerabilities of previous schemes and presented the two-factor authentication scheme that provided user privacy by using dynamic identities. However, when we cryptanalyzed Chang et al.'s scheme, we found that it does not provide sufficient security for wireless sensor networks and fails to provide accurate password updates. This paper proposes a security-enhanced authentication and key agreement scheme to overcome these security weaknesses using biometric information and an elliptic curve cryptosystem. We analyze the security of the proposed scheme against various attacks and check its viability in the mobile environment.

Three-Factor User Authentication and Key Agreement Using Elliptic Curve Cryptosystem in Wireless Sensor Networks

PubMed Central

Park, YoHan; Park, YoungHo

2016-01-01

Secure communication is a significant issue in wireless sensor networks. User authentication and key agreement are essential for providing a secure system, especially in user-oriented mobile services. It is also necessary to protect the identity of each individual in wireless environments to avoid personal privacy concerns. Many authentication and key agreement schemes utilize a smart card in addition to a password to support security functionalities. However, these schemes often fail to provide security along with privacy. In 2015, Chang et al. analyzed the security vulnerabilities of previous schemes and presented the two-factor authentication scheme that provided user privacy by using dynamic identities. However, when we cryptanalyzed Chang et al.’s scheme, we found that it does not provide sufficient security for wireless sensor networks and fails to provide accurate password updates. This paper proposes a security-enhanced authentication and key agreement scheme to overcome these security weaknesses using biometric information and an elliptic curve cryptosystem. We analyze the security of the proposed scheme against various attacks and check its viability in the mobile environment. PMID:27983616

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.

Queueing for healthcare.

PubMed

Palvannan, R Kannapiran; Teow, Kiok Liang

2012-04-01

Patient queues are prevalent in healthcare and wait time is one measure of access to care. We illustrate Queueing Theory-an analytical tool that has provided many insights to service providers when designing new service systems and managing existing ones. This established theory helps us to quantify the appropriate service capacity to meet the patient demand, balancing system utilization and the patient's wait time. It considers four key factors that affect the patient's wait time: average patient demand, average service rate and the variation in both. We illustrate four basic insights that will be useful for managers and doctors who manage healthcare delivery systems, at hospital or department level. Two examples from local hospitals are shown where we have used queueing models to estimate the service capacity and analyze the impact of capacity configurations, while considering the inherent variation in healthcare.

Improving the interface between informal carers and formal health and social services: a qualitative study.

PubMed

McPherson, K M; Kayes, N K; Moloczij, N; Cummins, C

2014-03-01

Reports about the impact of caring vary widely, but a consistent finding is that the role is influenced (for better or worse) by how formal services respond to, and work with informal carers and of course the cared for person. We aimed to explore the connection between informal and formal cares and identify how a positive connection or interface might be developed and maintained. We undertook a qualitative descriptive study with focus groups and individual interviews with informal carers, formal care service providers and representatives from carer advocacy groups. Content analysis was used to identify key factors impacting on the interface between informal and formal carers and propose specific recommendations for service development. Community setting including urban and rural areas of New Zealand. Seventy participants (the majority informal carers) took part in 13 focus groups and 22 individual interviews. Four key themes were derived: Quality of care for the care recipient; Knowledge exchange (valuing carer perspectives); One size does not fit all (creating flexible services); and A constant struggle (reducing the burden services add). An optimum interface to address these key areas was proposed. In addition to ensuring quality care for the care recipient, specific structures and processes to support a more positive interface appear warranted if informal carers and services are to work well together. An approach recognising the caring context and carer expertise may decrease the additional burden services contribute, and reduce conflicting information and resultant confusion and/or frustration many carers experience. Copyright © 2013 Elsevier Ltd. All rights reserved.

Towards understanding the availability of physiotherapy services in rural Australia.

PubMed

Adams, Robyn; Jones, Anne; Lefmann, Sophie; Sheppard, Lorraine

2016-01-01

A recent exploration of factors affecting rural physiotherapy service provision revealed considerable variation in services available between communities of the study. Multiple factors combined to influence local service provision, including macro level policy and funding decisions, service priorities and fiscal constraints of regional health services and capacity and capabilities at the physiotherapy service level. The aim of this article is to describe the variation in local service provision, the factors influencing service provision and the impact on availability of physiotherapy services. A priority-sequence mixed methods design structured the collection and integration of qualitative and quantitative data. The investigation area, a large part of one Australian state, was selected for the number of physiotherapy services and feasibility of conducting site visits. Stratified purposive sampling permitted exploration of rural physiotherapy with subgroups of interest, including physiotherapists, their colleagues, managers, and other key decision makers. Participant recruitment commenced with public sector physiotherapists and progressed to include private practitioners, team colleagues and managers. Surveys were mailed to key physiotherapy contacts in each public sector service in the area for distribution to physiotherapists, their colleagues and managers within their facility. Private physiotherapist principals working in the same communities were invited by the researcher to complete the physiotherapy survey. The survey collected demographic data, rural experience, work setting and number of colleagues, services provided, perspectives on factors influencing service provision and decisions about service provision. Semi-structured interviews were conducted with consenting physiotherapists and other key decision makers identified by local physiotherapists. Quantitative survey data were recorded in spreadsheets and analysed using descriptive statistics. Interviews were recorded and transcribed verbatim, with transcripts provided to participants for review. Open-ended survey questions and interview transcripts were analysed thematically. Surveys were received from 11/25 (44%) of facilities in the investigation area, with a response rate of 29.4% (16/54) from public sector physiotherapists. A further 18 surveys were received: five from principals of private physiotherapy practices and 13 from colleagues and managers. Nineteen interviews were conducted: with 14 physiotherapists (nine public, five private), four other decision makers and one colleague. Three decision makers declined an interview. The variation in physiotherapy service availability between the 11 communities of this study prompted the researchers to consider how such variation could be reflected. The influential factors that emerged from participant comments included rurality and population, size and funding model of public hospitals, the number of public sector physiotherapists and private practices, and the availability of specialised paediatric and rehabilitation services. The factors described by participants were used to develop a conceptual framework or index of rural physiotherapy availability. It is important to make explicit the link between workforce maldistribution, the resultant rural workforce shortages and the implications for local service availability. This study sought to do so by investigating physiotherapy service provision within the rural communities of the investigation area. In doing so, varying levels of availability emerged within local communities. A conceptual framework combining key influencing factors is offered as a way to reflect the availability of physiotherapy services.

Brain injury and health policy: twenty-five years of progress.

PubMed

Reid-Arndt, Stephanie A; Frank, Robert G; Hagglund, Kristofer J

2010-01-01

Legislative advocacy is a prerequisite for the development of research and community services benefiting individuals with traumatic brain injury (TBI). Dr Mitchell Rosenthal and other leaders in rehabilitation began the process of advocating for TBI services more than 25 years ago, before many in the field fully appreciated the necessity of these efforts. Since that time, substantial gains have been made through advocacy efforts on behalf of individuals with TBI and their families. This article provides an overview of the TBI advocacy movement, highlighting federal legislation resulting in appropriations for TBI services and protecting the rights of individuals with TBI. Key government entities engaged in developing states' TBI infrastructure and providing services to individuals with TBI and their families are also discussed. In addition to celebrating some of the successes that were initiated by the efforts of Dr Rosenthal and other visionaries, select shortcoming of current legislation is noted to provide insights regarding future advocacy needs.

Development and validation of a child health workforce competence framework.

PubMed

Smith, Lynda; Hawkins, Jean; McCrum, Anita

2011-05-01

Providing high quality, effective services is fundamental to the delivery of key health outcomes for children and young people. This requires a competent workforce. This paper reports on the development of a validated competence framework tool for the children and young people's health workforce. The framework brings together policy, strategic agendas and existing workforce competences. The framework will contribute to the improvement of children's physical and mental wellbeing by identifying competences required to provide proactive services that respond to children and young people with acute, continuing and complex needs. It details five core competences for the workforce, the functions that underpin them and levels of competence required to deliver a particular service. The framework will be of value to commissioners to inform contracting, to providers to ensure services are delivered by a workforce with relevant competences to meet identified needs, and to the workforce to assess existing capabilities and identify gaps in competence.

Assessing and comparing risk to climate changes among forested locations: implications for ecosystem services

Treesearch

Stephen N. Matthews; Louis R. Iverson; Matthew P. Peters; Anantha M. Prasad; Sakthi Subburayalu

2014-01-01

Forests provide key ecosystem services (ES) and the extent to which the ES are realized varies spatially, with forest composition and cultural context, and in breadth, depending on the dominant tree species inhabiting an area. We address the question of how climate change may impact ES within the temperate and diverse forests of the eastern United States. We quantify...

Misconceptions on Buying A Computer! [and]"But, We Don't Have the Money..." (Or as It Should Be "The Check's in the Mail..."). Key Notes.

ERIC Educational Resources Information Center

Access Group, Atlanta, GA.

Two brief information pamphlets for families of children with disabilities provide: (1) consideration of common misconceptions in buying a computer, and (2) suggestions of ways that parents can obtain assistive technology devices and services from various service delivery systems despite their claims of lack of funds. In the first information…

Research-Based Responses to Key Questions about the 2010 Head Start Impact Study. Early Childhood Highlights. Volume 2, Issue 1

ERIC Educational Resources Information Center

Child Trends, 2011

2011-01-01

Since 1965, Head Start has provided comprehensive services to help prepare the nation's most disadvantaged three- to five-year-old children for school and to strengthen their families. In 1998 Congress instructed the Department of Health and Human Services (DHHS) to conduct an evaluation of Head Start to determine its impact on child development…

Military Service Member and Veteran Reintegration: A Conceptual Analysis, Unified Definition, and Key Domains

PubMed Central

Elnitsky, Christine A.; Fisher, Michael P.; Blevins, Cara L.

2017-01-01

Returning military service members and veterans (MSMVs) may experience a variety of stress-related disorders and challenges when reintegrating from the military to the community. Facilitating the reintegration, transition, readjustment and coping, and community integration, of MSMVs is a societal priority. To date, research addressing MSMV reintegration has not identified a comprehensive definition of the term or defined the broader context within which the process of reintegration occurs although both are needed to promote valid and reliable measurement of reintegration and clarify related challenges, processes, and their impact on outcomes. Therefore, this principle-based concept analysis sought to review existing empirical reintegration measurement instruments and identify the problems and needs of MSMV reintegration to provide a unified definition of reintegration to guide future research, clinical practice, and related services. We identified 1,459 articles in the health and social sciences literature, published between 1990 and 2015, by searching multiple electronic databases. Screening of abstracts and full text review based on our inclusion/exclusion criteria, yielded 117 articles for review. Two investigators used constant conceptual comparison to evaluate relevant articles independently. We examined the term reintegration and related terms (i.e., transition, readjustment, community integration) identifying trends in their use over time, analyzed the eight reintegration survey instruments, and synthesized service member and veteran self-reported challenges and needs for reintegration. More reintegration research was published during the last 5 years (n = 373) than in the previous 10 years combined (n = 130). The research suggests coping with life stresses plays an integral role in military service member and veteran post-deployment reintegration. Key domains of reintegration include individual, interpersonal, community organizations, and societal factors that may facilitate or challenge successful reintegration, and results suggest that successful coping with life stressors plays an integral role in post-deployment reintegration. Overall, the literature does not provide a comprehensive representation of reintegration among MSMVs. Although, previous research describes military service member and veteran reintegration challenges, this concept analysis provides a unified definition of the phenomenon and identifies key domains of reintegration that may broaden our understanding and guide reintegration research and practice. PMID:28352240

Military Service Member and Veteran Reintegration: A Conceptual Analysis, Unified Definition, and Key Domains.

PubMed

Elnitsky, Christine A; Fisher, Michael P; Blevins, Cara L

2017-01-01

Returning military service members and veterans (MSMVs) may experience a variety of stress-related disorders and challenges when reintegrating from the military to the community. Facilitating the reintegration, transition, readjustment and coping, and community integration, of MSMVs is a societal priority. To date, research addressing MSMV reintegration has not identified a comprehensive definition of the term or defined the broader context within which the process of reintegration occurs although both are needed to promote valid and reliable measurement of reintegration and clarify related challenges, processes, and their impact on outcomes. Therefore, this principle-based concept analysis sought to review existing empirical reintegration measurement instruments and identify the problems and needs of MSMV reintegration to provide a unified definition of reintegration to guide future research, clinical practice, and related services. We identified 1,459 articles in the health and social sciences literature, published between 1990 and 2015, by searching multiple electronic databases. Screening of abstracts and full text review based on our inclusion/exclusion criteria, yielded 117 articles for review. Two investigators used constant conceptual comparison to evaluate relevant articles independently. We examined the term reintegration and related terms (i.e., transition, readjustment, community integration) identifying trends in their use over time, analyzed the eight reintegration survey instruments, and synthesized service member and veteran self-reported challenges and needs for reintegration. More reintegration research was published during the last 5 years ( n = 373) than in the previous 10 years combined ( n = 130). The research suggests coping with life stresses plays an integral role in military service member and veteran post-deployment reintegration. Key domains of reintegration include individual, interpersonal, community organizations, and societal factors that may facilitate or challenge successful reintegration, and results suggest that successful coping with life stressors plays an integral role in post-deployment reintegration. Overall, the literature does not provide a comprehensive representation of reintegration among MSMVs. Although, previous research describes military service member and veteran reintegration challenges, this concept analysis provides a unified definition of the phenomenon and identifies key domains of reintegration that may broaden our understanding and guide reintegration research and practice.

Security Analysis and Improvement of an Anonymous Authentication Scheme for Roaming Services

PubMed Central

Lee, Youngsook; Paik, Juryon

2014-01-01

An anonymous authentication scheme for roaming services in global mobility networks allows a mobile user visiting a foreign network to achieve mutual authentication and session key establishment with the foreign-network operator in an anonymous manner. In this work, we revisit He et al.'s anonymous authentication scheme for roaming services and present previously unpublished security weaknesses in the scheme: (1) it fails to provide user anonymity against any third party as well as the foreign agent, (2) it cannot protect the passwords of mobile users due to its vulnerability to an offline dictionary attack, and (3) it does not achieve session-key security against a man-in-the-middle attack. We also show how the security weaknesses of He et al.'s scheme can be addressed without degrading the efficiency of the scheme. PMID:25302330

Security analysis and improvement of an anonymous authentication scheme for roaming services.

PubMed

Lee, Youngsook; Paik, Juryon

2014-01-01

An anonymous authentication scheme for roaming services in global mobility networks allows a mobile user visiting a foreign network to achieve mutual authentication and session key establishment with the foreign-network operator in an anonymous manner. In this work, we revisit He et al.'s anonymous authentication scheme for roaming services and present previously unpublished security weaknesses in the scheme: (1) it fails to provide user anonymity against any third party as well as the foreign agent, (2) it cannot protect the passwords of mobile users due to its vulnerability to an offline dictionary attack, and (3) it does not achieve session-key security against a man-in-the-middle attack. We also show how the security weaknesses of He et al.'s scheme can be addressed without degrading the efficiency of the scheme.

A Semantic Cooperation and Interoperability Platform for the European Chambers of Commerce

NASA Astrophysics Data System (ADS)

Missikoff, Michele; Taglino, Francesco

The LD-CAST project aims at developing a semantic cooperation and interoperability platform for the European Chambers of Commerce. Some of the key issues that this platform addresses are: The variety and number of different kinds of resources (i.e., business processes, concrete services) that concur to achieve a business service The diversity of cultural and procedural models emerging when composing articulated cross-country services The limited possibility of reusing similar services in different contexts (for instance, supporting the same service between different countries: an Italian-Romanian cooperation is different from an Italian-Polish one) The objective of the LD-CAST platform, and in particular of the semantic services provided therein, is to address the above problems with flexible solutions. We aim at introducing high levels of flexibility, both at the time of development of business processes and concrete services (i.e., operational services offered by service providers), with the possibility of dynamically binding c-services to the selected BP, according to user needs. To this end, an approach based on semantic services and a reference ontology has been proposed.

RUASN: a robust user authentication framework for wireless sensor networks.

PubMed

Kumar, Pardeep; Choudhury, Amlan Jyoti; Sain, Mangal; Lee, Sang-Gon; Lee, Hoon-Jae

2011-01-01

In recent years, wireless sensor networks (WSNs) have been considered as a potential solution for real-time monitoring applications and these WSNs have potential practical impact on next generation technology too. However, WSNs could become a threat if suitable security is not considered before the deployment and if there are any loopholes in their security, which might open the door for an attacker and hence, endanger the application. User authentication is one of the most important security services to protect WSN data access from unauthorized users; it should provide both mutual authentication and session key establishment services. This paper proposes a robust user authentication framework for wireless sensor networks, based on a two-factor (password and smart card) concept. This scheme facilitates many services to the users such as user anonymity, mutual authentication, secure session key establishment and it allows users to choose/update their password regularly, whenever needed. Furthermore, we have provided the formal verification using Rubin logic and compare RUASN with many existing schemes. As a result, we found that the proposed scheme possesses many advantages against popular attacks, and achieves better efficiency at low computation cost.

Getting the Patients' Perspective: A Survey of Diabetes Services on Guam

PubMed Central

Rubio, Joel Marc C; Luces, Patrick S; Zabala, Rose V; Roberto, J Peter

2010-01-01

The prevention and control of diabetes is a major public health priority for the US Territory of Guam. As part of a strategic planning process, a survey of diabetes patients was conducted to determine patients' perceptions of the availability and adequacy of preventive and clinical services to control diabetes. A total of 125 survey questionnaires were distributed to diabetes patients attending either one of the Guam Department of Public Health and Social Services Community Health Centers or a private Internal Medicine/Endocrinology clinical practice of the only endocrinologist on the island. All 125 questionnaires were returned. Respondents were highly aware of the duration of their diabetes, and almost 75% have had the opportunity to discuss the chronic nature of the illness and the importance of key lifestyle changes to help prevent or retard the progression of the disease. However, almost 40% of patients were not aware of the type of diabetes they had, and one in five have not received diabetes self-management education from their health care providers. Key interventions, such as nutritional counseling, brief tobacco cessation interventions, regular eye and foot examinations and immunization services were not being provided to 30 to 60% of patients, despite clinical practice guidelines that recommend these interventions for all diabetics. While over half of respondents were generally satisfied with the quality of preventive and routine medical care that they receive from their service providers, they identified the need for better quality diabetes self-management education, preventive services, enhanced access to specialists and specialized care, especially for diabetes-related complications, and better financial support to assist them in meeting the costs of chronic care and medications. The feedback from these respondents should provide guidance regarding service gaps and needs as the Department of Public Health and Social Services and its community partners collaboratively develop a strategic plan to better address diabetes prevention and control on Guam. The information should also serve to direct quality improvement efforts to enhance existing diabetes services on the island. PMID:20540002

Toward an Immodest Experiment in Cable Television: Modestly Produced.

ERIC Educational Resources Information Center

Crichton, Judy

The new capability of cable television (CATV) to provide relevant programming to local communities should be recognized so that inner city consumers can be provided with direct, personal information--warning, comparative prices, and the sense that someone cares. At least one channel should be devoted as a key to these services, with other channels…

Interlibrary Loan, the Key to Resource Sharing: A Manual of Procedures and Protocols.

ERIC Educational Resources Information Center

Alaska State Dept. of Education, Juneau. Div. of State Libraries.

Intended for use by librarians in Alaska, this manual provides general guidelines for the maximum utilization of library resources through interlibrary loan service. The first of four major sections describes the Alaska Library Network (ALN), which provides protocols and procedures to libraries for resource sharing; points out that new protocols…

Experience in running relational databases on clustered storage

NASA Astrophysics Data System (ADS)

Gaspar Aparicio, Ruben; Potocky, Miroslav

2015-12-01

For past eight years, CERN IT Database group has based its backend storage on NAS (Network-Attached Storage) architecture, providing database access via NFS (Network File System) protocol. In last two and half years, our storage has evolved from a scale-up architecture to a scale-out one. This paper describes our setup and a set of functionalities providing key features to other services like Database on Demand [1] or CERN Oracle backup and recovery service. It also outlines possible trend of evolution that, storage for databases could follow.

NAPNAP Position Statement. Position Statement on Pediatric Health Care/Medical Home: Key Issues on Care Coordination, Transitions, and Leadership.

PubMed

2016-01-01

The National Association of Pediatric Nurse Practitioners (NAPNAP) affirms that the delivery of children's health care should be family-centered, accessible, comprehensive, coordinated, culturally appropriate, compassionate, and focused on the overall well-being of children and families. All qualified pediatric health care providers should collaborate in providing health care services for children in pediatric health care/medical homes. Interventions must address the concepts of family-centered partnerships, community-based systems, and transitional care from pediatric to adult services.

What counts as a health service? Weight loss companies through the looking glass of New Zealand's Code of Patients' Rights.

PubMed

Neill, Megan J

2013-03-01

In New Zealand, the Code of Health and Disability Services Consumer's Rights is a key innovative piece of legislation for the protection of health and disability service users. It provides rights to consumers and imposes duties on the providers of such services, complemented by a cost-free statutory complaints process for the resolution of breakdowns in the relationship between the two. The Code has a potentially liberal application and is theoretically capable of applying to all manner of services through the generalised definitions of the Health and Disability Commissioner Act 1994 (NZ). As the facilitator of the Code, the Health and Disability Commissioner has a correspondingly wide discretion in determining whether to further investigate complaints of Code breaches. This article considers the extent to which the Code's apparent breadth of application could incorporate commercial weight loss companies as providers and the likelihood of the Commissioner using the discretion to investigate complaints against such companies.

[Satisfaction survey of CatSalut-PLAENSA(©). Strategies to incorporate citizens' perception of the quality of the service in health policies].

PubMed

Aguado-Blázquez, Hortensia; Cerdà-Calafat, Ismael; Argimon-Pallàs, Josep Maria; Murillo-Fort, Carles; Canela-Soler, Jaume

2011-12-01

The aim of this work is to present the strategies, activities and results of satisfaction surveys Plan CatSalut- PLAENSA(©) 2003-2010 that are making progress in improving the quality of health services. Since 2003, CatSalut has at its disposal the plan known as PLAENSA(©) Satisfaction Surveys, a tool for assessment and improvement proposals addressed to the insurance services provided by contracted public entities. The plan follows 3 key strategies: systematic and objective policyholders' satisfaction measurement, related to the services received; release of improvement proposals according to a standardized model, including standardized monitoring, and promotion of equity through propagation among health centres and territories. Current assessment provided by the insured about most health services has been already collected, leading to more tan 2,500 projects of improvement which are being developed by the providers of the 7 health regions of Catalonia. Copyright © 2011 Elsevier España S.L. All rights reserved.

Ambulatory surgery center joint ventures involving tax-exempt entities.

PubMed

Becker, S; Pristave, R J; McConnell, W

1999-01-01

This article provides an overview of the tax-exempt related issues for ambulatory surgery center joint ventures involving tax-exempt entities. The article analyzes the key points of analysis of the guidance released by the IRS, in particular General Counsel Memorandum 39862, Revenue Ruling 98-15, and Redlands Surgical Services v. Commissioner of the Internal Revenue Service. These key points include whether the venture results in private inurement to insiders and whether the venture furthers the charitable purposes of the tax-exempt entity. The article also provides practical guidance to analyze the documents and structure of the joint venture to ensure compliance with the IRS guidance. These practical considerations include, among other things, whether the charitable purposes of the tax-exempt entity are clearly expressed in the documents and whether the tax-exempt entity has sufficient control over the joint venture to ensure the charitable purposes are being adhered to.

Entropy-as-a-Service: Unlocking the Full Potential of Cryptography

PubMed Central

Vassilev, Apostol; Staples, Robert

2016-01-01

Securing the Internet requires strong cryptography, which depends on the availability of good entropy for generating unpredictable keys and accurate clocks. Attacks abusing weak keys or old inputs portend challenges for the Internet. EaaS is a novel architecture providing entropy and timestamps from a decentralized root of trust, scaling gracefully across diverse geopolitical locales and remaining trustworthy unless much of the collective is compromised. PMID:28003687

Exploring Service Providers' Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia

PubMed Central

Cyril, Sheila; Green, Julie; Nicholson, Jan M.; Agho, Kingsley; Renzaho, Andre M. N.

2016-01-01

Background Childhood obesity rates have been increasing disproportionately among disadvantaged communities including culturally and linguistically diverse (CALD) migrant groups in Australia due to their poor participation in the available obesity prevention initiatives. We sought to explore service providers’ perceptions of the key factors influencing the participation of CALD communities in the existing obesity prevention services and the service requirements needed to improve CALD communities’ participation in these services. Methods We conducted a qualitative study using focus group discussions involving fifty-nine service providers from a range of services, who are involved in the health and wellbeing of children from CALD groups living in four socioeconomically disadvantaged areas in Victoria, Australia. Results Thematic analysis of the data showed three major themes including community-level barriers to CALD engagement in childhood obesity prevention services; service-level barriers to the delivery of these services; and proposed changes to current childhood obesity prevention approaches. Integrating obesity prevention messages within existing programs, better coordination between prevention and treatment services and the establishment of a childhood obesity surveillance system, were some of the important changes suggested by service providers. Conclusion This study has found that low CALD health literacy, lack of knowledge of cultural barriers among service providers and co-existing deficiencies in the structure and delivery of obesity prevention services negatively impacted the participation of CALD communities in obesity prevention services. Cultural competency training of service providers would improve their understanding of the cultural influences of childhood obesity and incorporate them into the design and development of obesity prevention initiatives. Service providers need to be educated on the pre-migratory health service experiences and health conditions of CALD communities to ensure equitable delivery of care. Collaborative approaches between health systems, immigrant services, early years’ services and community health services are urgently needed to address obesity-related disparities in Australia. PMID:27736864

Education and training column: the learning collaborative.

PubMed

MacDonald-Wilson, Kim L; Nemec, Patricia B

2015-03-01

This column describes the key components of a learning collaborative, with examples from the experience of 1 organization. A learning collaborative is a method for management, learning, and improvement of products or processes, and is a useful approach to implementation of a new service design or approach. This description draws from published material on learning collaboratives and the authors' experiences. The learning collaborative approach offers an effective method to improve service provider skills, provide support, and structure environments to result in lasting change for people using behavioral health services. This approach is consistent with psychiatric rehabilitation principles and practices, and serves to increase the overall capacity of the mental health system by structuring a process for discovering and sharing knowledge and expertise across provider agencies. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Robust planning of sanitation services in urban informal settlements: An analytical framework.

PubMed

Schmitt, Rafael J P; Morgenroth, Eberhard; Larsen, Tove A

2017-03-01

New types of sanitation services are emerging to tackle the sanitation crisis in informal settlements. These services link toilet facilities to semi-decentralized treatment plants via frequent, road-based transport of excreta. However, information for the planning of such sanitation services is scarce, and their future operating conditions are highly uncertain. The key questions of this paper are therefore: a) what are the drivers behind success or failure of a service-based sanitation system in informal settlements and b) on what scales and under which conditions can such a system operate successfully? To answer these questions, already at an early stage of the planning process, we introduce a stochastic model to analyze a wide range of system designs under varying technical designs, socio-economic factors, and spatial condition. Based on these initial results, we design a sanitation service and use the numeric model to study its reliability and costs over a wide range of scales, i.e., system capacities, from very few to many hundred users per semi-decentralized treatment unit. Key findings are that such a system can only operate within a narrow, but realistic range of conditions. Key requirements are toilet facilities, which can be serviced rapidly, and a flexible workforce. A high density of facilities will also lower the costs. Under these premises, we develop a road-based sanitation service and model its functionality in different settings and under many scenarios. Results show that the developed sanitation system using a single vehicle is scalable (100-700 users), can provide reliable service, and can be cheap (<1.5 c/p/day). Hence, this paper demonstrates opportunities for road-based sanitation in informal settlements and presents a quantitative framework for designing such systems. Copyright © 2016 Elsevier Ltd. All rights reserved.

Navigation Architecture For A Space Mobile Network

NASA Technical Reports Server (NTRS)

Valdez, Jennifer E.; Ashman, Benjamin; Gramling, Cheryl; Heckler, Gregory W.; Carpenter, Russell

2016-01-01

The Tracking and Data Relay Satellite System (TDRSS) Augmentation Service for Satellites (TASS) is a proposed beacon service to provide a global, space-based GPS augmentation service based on the NASA Global Differential GPS (GDGPS) System. The TASS signal will be tied to the GPS time system and usable as an additional ranging and Doppler radiometric source. Additionally, it will provide data vital to autonomous navigation in the near Earth regime, including space weather information, TDRS ephemerides, Earth Orientation Parameters (EOP), and forward commanding capability. TASS benefits include enhancing situational awareness, enabling increased autonomy, and providing near real-time command access for user platforms. As NASA Headquarters Space Communication and Navigation Office (SCaN) begins to move away from a centralized network architecture and towards a Space Mobile Network (SMN) that allows for user initiated services, autonomous navigation will be a key part of such a system. This paper explores how a TASS beacon service enables the Space Mobile Networking paradigm, what a typical user platform would require, and provides an in-depth analysis of several navigation scenarios and operations concepts.

A qualitative description of service providers' experiences of ethical issues in HIV care.

PubMed

Sabone, Motshedisi B; Mogobe, Keitshokile Dintle; Matshediso, Ellah; Shaibu, Sheila; Ntsayagae, Esther I; Corless, Inge B; Cuca, Yvette P; Holzemer, William L; Dawson-Rose, Carol; Baez, Solymar S Soliz; Rivero-Mendz, Marta; Webel, Allison R; Eller, Lucille Sanzero; Reid, Paula; Johnson, Mallory O; Kemppainen, Jeanne; Reyes, Darcel; Nokes, Kathleen; Wantland, Dean; Nicholas, Patrice K; Lingren, Teri; Portillo, Carmen J; Sefcik, Elizabeth; Long-Middleton, Ellen

2018-01-01

Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

Pelvic floor and anal sphincter trauma should be key performance indicators of maternity services.

PubMed

Dietz, H P; Pardey, J; Murray, H

2015-01-01

There is an increasing awareness of maternal somatic birth trauma, which affects many more women than previously thought, primarily in the form of anal sphincter and levator ani tears. Given that such trauma occurs in about one-third of all women giving birth vaginally for the first time, and given that it has serious long-term consequences, it should be audited by all maternity services with a view to providing remedial therapy to delay or prevent subsequent morbidity, and to facilitate practice improvement. The increasing availability of modern imaging equipment and the skills of using it for pelvic floor assessment means that it is now becoming possible to provide such services postnatally.

Oral Health Services within Community-Based Organizations for Young Children with Special Health Care Needs

PubMed Central

Cruz, S; Chi, DL; Huebner, CE

2016-01-01

Purpose To identify the types of oral health services offered by community-based organizations to young children with special health care needs (CSHCN) and the barriers and facilitators to the provision of these in a non-fluoridated community. Methods Thirteen key informant interviews with representatives from early intervention agencies, advocacy groups, and oral health programs who provide services to CSHCN in Spokane county, Washington. We used a content analysis to thematically identify oral health services as proactive or incidental and the barriers and facilitators to their provision. Results We identified four types of oral health services: screenings, parent education, preventive dental care, and dental referrals. Barriers to providing all four services included limited agency resources, restrictive administrative and system-level policies, and low demand from parents. A barrier to providing education and preventive dental care was community disagreement regarding fluoride. A barrier to providing dental referrals was the perceived lack of dentists who could treat CSHCN. Facilitators included community partnerships among the organizations and utilization of the statewide oral health program. Conclusions Oral health services for young CSHCN are limited and often delivered in response to oral health problems. Coordinated efforts between community-based organizations, health providers, and advocates are necessary to ensure the provision of comprehensive care, including preventive and restorative services, to all young CSHCN. PMID:27028954

Quality evaluation in health care services based on customer-provider relationships.

PubMed

Eiriz, Vasco; Figueiredo, José António

2005-01-01

To develop a framework for evaluating the quality of Portuguese health care organisations based on the relationship between customers and providers, to define key variables related to the quality of health care services based on a review of the available literature, and to establish a conceptual framework in order to test the framework and variables empirically. Systematic review of the literature. Health care services quality should not be evaluated exclusively by customers. Given the complexity, ambiguity and heterogeneity of health care services, the authors develop a framework for health care evaluation based on the relationship between customers (patients, their relatives and citizens) and providers (managers, doctors, other technical staff and non-technical staff), and considering four quality items (customer service orientation, financial performance, logistical functionality and level of staff competence). This article identifies important changes in the Portuguese health care industry, such as the ownership of health care providers. At the same time, customers are changing their attitudes towards health care, becoming much more concerned and demanding of health services. These changes are forcing Portuguese private and public health care organisations to develop more marketing-oriented services. This article recognises the importance of quality evaluation of health care services as a means of increasing customer satisfaction and organisational efficiency, and develops a framework for health care evaluation based on the relationship between customers and providers.

Oral health services within community-based organizations for young children with special health care needs.

PubMed

Cruz, Stephanie; Chi, Donald L; Huebner, Colleen E

2016-09-01

To identify the types of oral health services offered by community-based organizations to young children with special health care needs (CSHCN) and the barriers and facilitators to the provision of these in a nonfluoridated community. Thirteen key informant interviews with representatives from early intervention agencies, advocacy groups, and oral health programs who provide services to CSHCN in Spokane county, Washington. We used a content analysis to thematically identify oral health services as proactive or incidental and the barriers and facilitators to their provision. We identified four types of oral health services: screenings, parent education, preventive dental care, and dental referrals. Barriers to providing all four services included limited agency resources, restrictive administrative and system-level policies, and low demand from parents. A barrier to providing education and preventive dental care was community disagreement regarding fluoride. A barrier to providing dental referrals was the perceived lack of dentists who could treat CSHCN. Facilitators included community partnerships among the organizations and utilization of the statewide oral health program. Oral health services for young CSHCN are limited and often delivered in response to oral health problems. Coordinated efforts between community-based organizations, health providers, and advocates are necessary to ensure the provision of comprehensive care, including preventive and restorative services, to all young CSHCN. © 2016 Special Care Dentistry Association and Wiley Periodicals, Inc.

"If You Tell People That You Had Sex with a Fellow Man, It Is Hard to Be Helped and Treated": Barriers and Opportunities for Increasing Access to HIV Services among Men Who Have Sex with Men in Uganda.

PubMed

Wanyenze, Rhoda K; Musinguzi, Geofrey; Matovu, Joseph K B; Kiguli, Juliet; Nuwaha, Fred; Mujisha, Geoffrey; Musinguzi, Joshua; Arinaitwe, Jim; Wagner, Glenn J

2016-01-01

Despite the high HIV prevalence among men who have sex with men (MSM) in sub-Saharan Africa, little is known about their access to HIV services. This study assessed barriers and opportunities for expanding access to HIV services among MSM in Uganda. In October-December 2013, a cross-sectional qualitative study was conducted in 12 districts of Uganda. Semi-structured in-depth interviews were conducted with 85 self-identified MSM by snowball sampling and 61 key informants including HIV service providers and policy makers. Data were analysed using manifest content analysis and Atlas.ti software. Three quarters of the MSM (n = 62, 72.9%) were not comfortable disclosing their sexual orientation to providers and 69 (81.1%) felt providers did not respect MSM. Half (n = 44, 51.8%) experienced difficulties in accessing health services. Nine major barriers to access were identified, including: (i) unwelcoming provider behaviours; (ii) limited provider skills and knowledge; (iii) negative community perceptions towards MSM; (iv) fear of being exposed as MSM; (v) limited access to MSM-specific services; (vi) high mobility of MSM, (vii) lack of guidelines on MSM health services; viii) a harsh legal environment; and ix) HIV related stigma. Two-thirds (n = 56, 66%) participated in MSM social networks and 86% of these (48) received support from the networks to overcome barriers to accessing services. Negative perceptions among providers and the community present barriers to service access among MSM. Guidelines, provider skills building and use of social networks for mobilization and service delivery could expand access to HIV services among MSM in Uganda.

A Multiple Case Study of Mental Health Interventions in Middle Income Countries: Considering the Science of Delivery.

PubMed

Kidd, Sean A; Madan, Athena; Rallabandi, Susmitha; Cole, Donald C; Muskat, Elisha; Raja, Shoba; Wiljer, David; Aylward, David; McKenzie, Kwame

2016-01-01

In the debate in global mental health about the most effective models for developing and scaling interventions, there have been calls for the development of a more robust literature regarding the "non-specific", science of delivery aspects of interventions that are locally, contextually, and culturally relevant. This study describes a rigorous, exploratory, qualitative examination of the key, non-specific intervention strategies of a diverse group of five internationally-recognized organizations addressing mental illness in middle income countries (MICs). A triangulated approach to inquiry was used with semi-structured interviews conducted with service recipients, service providers and leaders, and key community partners (N = 159). The interview focus was upon processes of implementation and operation. A grounded theory-informed analysis revealed cross cutting themes of: a holistic conceptualization of mental health problems, an intensive application of principles of leverage and creating the social, cultural, and policy "space" within which interventions could be applied and resourced. These findings aligned with key aspects of systems dynamic theory suggesting that it might be a helpful framework in future studies of mental health service implementation in MICs.

Promoting successful collaborations between domestic violence and substance abuse treatment service sectors: a review of the literature.

PubMed

Macy, Rebecca J; Goodbourn, Melissa

2012-10-01

Women who experience intimate partner violence (IPV) victimization are more likely to struggle with substance abuse problems than are women who do not experience IPV. Given the connection between IPV victimization and substance abuse, recommended practices urge collaboration between domestic violence service agencies and substance abuse treatment agencies to provide comprehensive services for women with these co-occurring problems. However, domestic violence and substance abuse services have unique histories of development that have led to distinct ways of service delivery. To promote successful collaborations, service providers and researchers are developing strategies to foster relationships across the two service sectors. The authors conducted a review of this emerging body of knowledge with the aim of assembling recommendations for strategies to foster collaboration between domestic violence and substance abuse services. The authors identified 15 documents for review inclusion and our analysis established 5 categories of documents. Findings yield key collaboration strategies and recommended service models. In addition, the review determined the existence of considerable challenges to promoting collaborative relationships between domestic violence and substance abuse treatment service sectors.

Services and supports for young children with Down syndrome: parent and provider perspectives.

PubMed

Marshall, J; Tanner, J P; Kozyr, Y A; Kirby, R S

2015-05-01

As individuals with Down syndrome are living longer and more socially connected lives, early access to supports and services for their parents will ensure an optimal start and improved outcomes. The family's journey begins at the child's diagnosis, and cumulative experiences throughout infancy and childhood set the tone for a lifetime of decisions made by the family regarding services, supports and activities. This study utilized focus groups and interviews with seven nurses, five therapists, 25 service co-ordinators, and 10 English- and three Spanish-speaking parents to better understand family experiences and perceptions on accessing Down syndrome-related perinatal, infant and childhood services and supports. Parents and providers reflected on key early life issues for children with Down syndrome and their families in five areas: prenatal diagnosis; perinatal care; medical and developmental services; care co-ordination and services; and social and community support. Systems of care are not consistently prepared to provide appropriate family-centred services to individuals with Down syndrome and their families. Individuals with disabilities require formal and informal supports from birth to achieve and maintain a high quality of life. © 2014 John Wiley & Sons Ltd.

Universal coverage and its impact on reproductive health services in Thailand.

PubMed

Tangcharoensathien, Viroj; Tantivess, Sripen; Teerawattananon, Yot; Auamkul, Nanta; Jongudoumsuk, Pongpisut

2002-11-01

Thailand has recently introduced universal health care coverage for 45 million of its people, financed by general tax revenue. A capitation contract model was adopted to purchase ambulatory and hospital care, and preventive care and promotion, including reproductive health services, from public and private service providers. This paper describes the health financing system prior to universal coverage, and the extent to which Thailand has achieved reproductive health objectives prior to this reform. It then analyses the potential impact of universal coverage on reproductive health services. Whether there are positive or negative effects on reproductive health services will depend on the interaction between three key aspects: awareness of entitlement on the part of intended beneficiaries of services, the response of health care providers to capitation, and the capacity of purchasers to monitor and enforce contracts. In rural areas, the district public health system is the sole service provider and the contractual relationship requires trust and positive engagement with purchasers. We recommend an evidence-based approach to fine-tune the reproductive health services benefits package under universal coverage, as well as improved institutional capacity for purchasers and the active participation of civil society and other partners to empower beneficiaries.

Alcohol use and the Traveller community in the west of Ireland.

PubMed

Van Hout, Marie Claire

2010-01-01

The Traveller community as ethnic minority is vulnerable to problematic alcohol use, because of social exclusion, discrimination, lack of awareness and difficulties in engaging with addiction treatment protocols. This research yielded an exploratory account of Travellers and alcohol use according to the perspectives of the Travellers and key service providers in the west of Ireland, within the context of a large-scale study on Travellers and substance use. The research consisted of 12 peer-accompanied focus groups of Traveller men and women (n = 57) and 45 semistructured interviews with a self-selecting sample of key service agencies. The research themes related to Traveller culture and alcohol use, sex differences, reasons for consuming alcohol, attitude to alcohol use, problematic alcohol use, levels of alcohol harm-related knowledge, perceptions of alcohol-related risk and experiences of addiction services. A thematic analysis of the information garnered guided this comparative analysis. The Traveller community, and in particular Traveller men, are presenting with increasingly problematic alcohol use, because of dissipation of their culture and their experiences of marginalisation, discrimination, depression, illiteracy and poverty. Difficulties engaging with law enforcement, community health and addiction services compromise their efforts to deal with this problem and home detoxification attempts are common. Services must aim to take into consideration the cultural needs of Travellers and provide appropriate educational materials, peer education programs and flexible treatment approaches for those Travellers experiencing problematic alcohol use.

Qualitative investigation of barriers to accessing care by people who inject drugs in Saskatoon, Canada: perspectives of service providers

PubMed Central

2013-01-01

Background People who inject drugs (PWID) often encounter barriers when attempting to access health care and social services. In our previous study conducted to identify barriers to accessing care from the perspective of PWIDs in Saskatoon, Canada: poverty, lack of personal support, discrimination, and poor knowledge and coordination of service providers among other key barriers were identified. The purpose of the present investigation was to explore what service providers perceive to be the greatest barriers for PWIDs to receive optimal care. This study is an exploratory investigation with a purpose to enrich the literature and to guide community action. Methods Data were collected through focus groups with service providers in Saskatoon. Four focus groups were held with a total of 27 service providers. Data were transcribed and qualitative analysis was performed. As a result, concepts were identified and combined into major themes. Results Four barriers to care were identified by service providers: inefficient use of resources, stigma and discrimination, inadequate education and the unique and demanding nature of PWIDs. Participants also identified many successful services. Conclusion The results from this investigation suggest poor utilization of resources, lack of continuing education of health care providers on addictions and coping skills with such demanding population, and social stigma and disparity. We recommend improvements in resource utilization through, for example, case management. In addition, sensitivity training and more comprehensive service centers designed to meet PWID’s complex needs may improve care. However, community-wide commitment to addressing injection drug issues will also be required for lasting solutions. PMID:24079946

Survey of core medical trainees in the United Kingdom 2013 - inconsistencies in training experience and competing with service demands.

PubMed

Tasker, Fiona; Newbery, Nina; Burr, Bill; Goddard, Andrew F

2014-04-01

There is currently considerable concern about the attractiveness of hospital medicine as a career and experiences in core medical training (CMT) are a key determinant of whether trainees continue in the medical specialties. Little is understood about the quality and impact of the current CMT programme and this survey was designed to assess this. Three key themes emerged. Firstly, the demands of providing service have led to considerable loss of training opportunities, particularly in outpatients and formal teaching sessions. Trainees spend a lot of this service time doing menial tasks and over 90% report that service takes up 80-100% of their time. Secondly, clinical and educational supervision is variable, with trainees sometimes getting little consultant feedback on their clinical performance. Finally, 44% of trainees report that CMT has not prepared them to be a medical registrar and many trainees are put off acute medical specialties by their experiences in CMT.

Service Level Decision-making in Rural Physiotherapy: Development of Conceptual Models.

PubMed

Adams, Robyn; Jones, Anne; Lefmann, Sophie; Sheppard, Lorraine

2016-06-01

Understanding decision-making about health service provision is increasingly important in an environment of increasing demand and constrained resources. Multiple factors are likely to influence decisions about which services will be provided, yet workforce is the most noted factor in the rural physiotherapy literature. This paper draws together results obtained from exploration of service level decision-making (SLDM) to propose 'conceptual' models of rural physiotherapy SLDM. A prioritized qualitative approach enabled exploration of participant perspectives about rural physiotherapy decision-making. Stakeholder perspectives were obtained through surveys and in-depth interviews. Interviews were transcribed verbatim and reviewed by participants. Participant confidentiality was maintained by coding both participants and sites. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of regional, rural and remote communities. Thirty-nine surveys were received from participants in 11 communities. Nineteen in-depth interviews were conducted with physiotherapists and key decision-makers. Results reveal the complexity of factors influencing rural physiotherapy service provision and the value of a systems approach when exploring decision-making about rural physiotherapy service provision. Six key features were identified that formed the rural physiotherapy SLDM system: capacity and capability; contextual influences; layered decision-making; access issues; value and beliefs; and tensions and conflict. Rural physiotherapy SLDM is not a one-dimensional process but results from the complex interaction of clusters of systems issues. Decision-making about physiotherapy service provision is influenced by both internal and external factors. Similarities in influencing factors and the iterative nature of decision-making emerged, which enabled linking physiotherapy SLDM with clinical decision-making and placing both within the broader healthcare context. The conceptual models provide a way of thinking about decisions informing rural physiotherapy service provision. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

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.

Methodological reporting in qualitative, quantitative, and mixed methods health services research articles.

PubMed

Wisdom, Jennifer P; Cavaleri, Mary A; Onwuegbuzie, Anthony J; Green, Carla A

2012-04-01

Methodologically sound mixed methods research can improve our understanding of health services by providing a more comprehensive picture of health services than either method can alone. This study describes the frequency of mixed methods in published health services research and compares the presence of methodological components indicative of rigorous approaches across mixed methods, qualitative, and quantitative articles. All empirical articles (n = 1,651) published between 2003 and 2007 from four top-ranked health services journals. All mixed methods articles (n = 47) and random samples of qualitative and quantitative articles were evaluated to identify reporting of key components indicating rigor for each method, based on accepted standards for evaluating the quality of research reports (e.g., use of p-values in quantitative reports, description of context in qualitative reports, and integration in mixed method reports). We used chi-square tests to evaluate differences between article types for each component. Mixed methods articles comprised 2.85 percent (n = 47) of empirical articles, quantitative articles 90.98 percent (n = 1,502), and qualitative articles 6.18 percent (n = 102). There was a statistically significant difference (χ(2) (1) = 12.20, p = .0005, Cramer's V = 0.09, odds ratio = 1.49 [95% confidence interval = 1,27, 1.74]) in the proportion of quantitative methodological components present in mixed methods compared to quantitative papers (21.94 versus 47.07 percent, respectively) but no statistically significant difference (χ(2) (1) = 0.02, p = .89, Cramer's V = 0.01) in the proportion of qualitative methodological components in mixed methods compared to qualitative papers (21.34 versus 25.47 percent, respectively). Few published health services research articles use mixed methods. The frequency of key methodological components is variable. Suggestions are provided to increase the transparency of mixed methods studies and the presence of key methodological components in published reports. © Health Research and Educational Trust.

Methodological Reporting in Qualitative, Quantitative, and Mixed Methods Health Services Research Articles

PubMed Central

Wisdom, Jennifer P; Cavaleri, Mary A; Onwuegbuzie, Anthony J; Green, Carla A

2012-01-01

Objectives Methodologically sound mixed methods research can improve our understanding of health services by providing a more comprehensive picture of health services than either method can alone. This study describes the frequency of mixed methods in published health services research and compares the presence of methodological components indicative of rigorous approaches across mixed methods, qualitative, and quantitative articles. Data Sources All empirical articles (n = 1,651) published between 2003 and 2007 from four top-ranked health services journals. Study Design All mixed methods articles (n = 47) and random samples of qualitative and quantitative articles were evaluated to identify reporting of key components indicating rigor for each method, based on accepted standards for evaluating the quality of research reports (e.g., use of p-values in quantitative reports, description of context in qualitative reports, and integration in mixed method reports). We used chi-square tests to evaluate differences between article types for each component. Principal Findings Mixed methods articles comprised 2.85 percent (n = 47) of empirical articles, quantitative articles 90.98 percent (n = 1,502), and qualitative articles 6.18 percent (n = 102). There was a statistically significant difference (χ2(1) = 12.20, p = .0005, Cramer's V = 0.09, odds ratio = 1.49 [95% confidence interval = 1,27, 1.74]) in the proportion of quantitative methodological components present in mixed methods compared to quantitative papers (21.94 versus 47.07 percent, respectively) but no statistically significant difference (χ2(1) = 0.02, p = .89, Cramer's V = 0.01) in the proportion of qualitative methodological components in mixed methods compared to qualitative papers (21.34 versus 25.47 percent, respectively). Conclusion Few published health services research articles use mixed methods. The frequency of key methodological components is variable. Suggestions are provided to increase the transparency of mixed methods studies and the presence of key methodological components in published reports. PMID:22092040

What Factors Do Allied Health Take Into Account When Making Resource Allocation Decisions?

PubMed

Lane, Haylee; Sturgess, Tamica; Philip, Kathleen; Markham, Donna; Martin, Jennifer; Walsh, Jill; Hubbard, Wendy; Haines, Terry

2017-09-12

Allied health comprises multiple professional groups including dietetics, medical radiation practitioners, occupational therapists, optometrists and psychologists. Different to medical and nursing, Allied health are often organized in discipline specific departments and allocate budgets within these to provide services to a range of clinical areas. Little is known of how managers of allied health go about allocating these resources, the factors they consider when making these decisions, and the sources of information they rely upon. The purpose of this study was to identify the key factors that allied health consider when making resource allocation decisions and the sources of information they are based upon. Four forums were conducted each consisting of case studies, a large group discussion and two hypothetical scenarios to elicit data. A thematic content analysis commenced during post-forum discussions of key factors by forum facilitators. These factors were then presented to an expert working party for further discussion and refinement. Transcripts were generated of all data recordings and a detailed thematic analysis was undertaken by one author to ensure coded data matched the initial thematic analysis. Twelve factors affecting the decision-making of allied health managers and clinicians were identified. One of these factors was disendorsed by the expert working party. The 11 remaining factors can be considered to be key decision-making principles that should be consistently applied to resource allocation. These principles were clustered into three overarching themes of readiness, impact and appropriateness. Understanding these principles now means further research can be completed to more effectively integrate research evidence into health policy and service delivery, create partnerships among policy-makers, managers, service providers and researchers, and to provide support to answer difficult questions that policy-makers, managers and service providers face. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Overview of harm reduction in prisons in seven European countries.

PubMed

Sander, Gen; Scandurra, Alessio; Kamenska, Anhelita; MacNamara, Catherine; Kalpaki, Christina; Bessa, Cristina Fernandez; Laso, Gemma Nicolás; Parisi, Grazia; Varley, Lorraine; Wolny, Marcin; Moudatsou, Maria; Pontes, Nuno Henrique; Mannix-McNamara, Patricia; Libianchi, Sandro; Antypas, Tzanetos

2016-10-07

While the last decade has seen a growth of support for harm reduction around the world, the availability and accessibility of quality harm reduction services in prison settings is uneven and continues to be inadequate compared to the progress achieved in the broader community. This article provides a brief overview of harm reduction in prisons in Catalonia (Spain), Greece, Ireland, Italy, Latvia, Poland, and Portugal. While each country provides a wide range of harm reduction services in the broader community, the majority fail to provide these same services or the same quality of these services, in prison settings, in clear violation of international human rights law and minimum standards on the treatment of prisoners. Where harm reduction services have been available and easily accessible in prison settings for some time, better health outcomes have been observed, including significantly reduced rates of HIV and HCV incidence. While the provision of harm reduction in each of these countries' prisons varies considerably, certain key themes and lessons can be distilled, including around features of an enabling environment for harm reduction, resource allocation, collection of disaggregated data, and accessibility of services.

Towards social inclusion through lifelong learning in mental health: analysis of change in the lives of the EMILIA project service users.

PubMed

Ramon, Shulamit; Griffiths, Christopher A; Nieminen, Irja; Pedersen, Marialouise; Dawson, Ian

2011-05-01

The application of formal lifelong learning to enhance social inclusion in mental health is rarely investigated in terms of change in the lives of service users on a cross-country comparative scale. This study was aimed at examining changes in key areas of the lives of mental health service users across eight European mental health sites. A before and after case study design was applied. Users of mental health services who participated in the lifelong leaning interventions reviewed the changes in key areas of their lives at baseline and 10 months later, through the thematic analysis of qualitative data collected in semi-structured interviews (27 and 21, respectively) and self-reports (138 and 99, respectively). In-depth examples from one site are provided. Most users reported positive changes in the areas of training and social networks, with a sizeable minority moving onto unpaid and paid employment. In addition most users reported active planning for job search and other goals. Obstacles that were highlighted included the negative effects of having a mental illness, difficulties in close relationships and economic disadvantages. The lifelong learning intervention offered within an EU Framework 6 project to mental health service users in eight demonstration sites had a largely positive impact on key areas of their lives at 10 months, though obstacles remained which may be less amenable to change by social interventions.

Improving healthcare for Aboriginal Australians through effective engagement between community and health services.

PubMed

Durey, Angela; McEvoy, Suzanne; Swift-Otero, Val; Taylor, Kate; Katzenellenbogen, Judith; Bessarab, Dawn

2016-07-07

Effectively addressing health disparities between Aboriginal and non-Aboriginal Australians is long overdue. Health services engaging Aboriginal communities in designing and delivering healthcare is one way to tackle the issue. This paper presents findings from evaluating a unique strategy of community engagement between local Aboriginal people and health providers across five districts in Perth, Western Australia. Local Aboriginal community members formed District Aboriginal Health Action Groups (DAHAGs) to collaborate with health providers in designing culturally-responsive healthcare. The purpose of the strategy was to improve local health service delivery for Aboriginal Australians. The evaluation aimed to identify whether the Aboriginal community considered the community engagement strategy effective in identifying their health service needs, translating them to action by local health services and increasing their trust in these health services. Participants were recruited using purposive sampling. Qualitative data was collected from Aboriginal participants and health service providers using semi-structured interviews or yarning circles that were recorded, transcribed and independently analysed by two senior non-Aboriginal researchers. Responses were coded for key themes, further analysed for similarities and differences between districts and cross-checked by the senior lead Aboriginal researcher to avoid bias and establish reliability in interpreting the data. Three ethics committees approved conducting the evaluation. Findings from 60 participants suggested the engagement process was effective: it was driven and owned by the Aboriginal community, captured a broad range of views and increased Aboriginal community participation in decisions about their healthcare. It built community capacity through regular community forums and established DAHAGs comprising local Aboriginal community members and health service representatives who met quarterly and were supported by the Aboriginal Health Team at the local Population Health Unit. Participants reported health services improved in community and hospital settings, leading to increased access and trust in local health services. The evaluation concluded that this process of actively engaging the Aboriginal community in decisions about their health care was a key element in improving local health services, increasing Aboriginal people's trust and access to care.

Creating an inclusive leisure space: strategies used to engage children with and without disabilities in the arts-mediated program Spiral Garden.

PubMed

Smart, Eric; Edwards, Brydne; Kingsnorth, Shauna; Sheffe, Sarah; Curran, C J; Pinto, Madhu; Crossman, Shannon; King, Gillian

2018-01-01

This article describes how service providers use a set of practical strategies to create an inclusive leisure space in Spiral Garden, an arts-mediated outdoor summer day program for children with and without disabilities. This study was guided by an interpretive qualitative approach. Fourteen Spiral Garden service providers participated in semi-structured interviews. Nine had extensive experience with the program and had been present during key phases of program development spanning over a 26-year period and five were service providers during the summer of 2013. Transcript data were analyzed using inductive thematic analysis. The analysis produced eight strategies organized under three larger categories that service providers perceived to be essential in creating an inclusive leisure space: (1) engaging children in collective experiences; (2) encouraging peer interactions and friendships; and (3) facilitating collaborative child-directed experiences. Service providers working across different inclusive settings can use findings from this study to contribute to program design and implementation. Presented strategies enable children to experience opportunities for spontaneous free play, individualized structured support, and meaningful social participation. Overall, service providers are encouraged to enhance supportive child and service provider relationships and reciprocal child and environment relationships in group-based programs. Implications for Rehabilitation Exploring and facilitating reciprocal relationships between children and their environment is essential to creating inclusive leisure spaces. Transforming program intentions of meaningful social participation into practice requires learning about and affecting change in children's individual social contexts. Service providers can engage themselves as full participants in inclusive leisure spaces through playful negotiations, internal reflections, and artistic expressions.

Using the "customer service framework" to successfully implement patient- and family-centered care.

PubMed

Rangachari, Pavani; Bhat, Anita; Seol, Yoon-Ho

2011-01-01

Despite the growing momentum toward patient- and family-centered care at the federal policy level, the organizational literature remains divided on its effectiveness, especially in regard to its key dimension of involving patients and families in treatment decisions and safety practices. Although some have argued for the universal adoption of patient involvement, others have questioned both the effectiveness and feasibility of patient involvement. In this article, we apply a well-established theoretical perspective, that is, the Service Quality Model (SQM) (also known as the "customer service framework") to the health care context, to reconcile the debate related to patient involvement. The application helps support the case for universal adoption of patient involvement and also question the arguments against it. A key contribution of the SQM lies in highlighting a set of fundamental service quality determinants emanating from basic consumer service needs. It also provides a simple framework for understanding how gaps between consumer expectations and management perceptions of those expectations can affect the gap between "expected" and "perceived" service quality from a consumer's perspective. Simultaneously, the SQM also outlines "management requirements" for the successful implementation of a customer service strategy. Applying the SQM to the health care context therefore, in addition to reconciling the debate on patient involvement, helps identify specific steps health care managers could take to successfully implement patient- and family-centered care. Correspondingly, the application also provides insights into strategies for the successful implementation of policy recommendations related to patient- and family-centered care in health care organizations.

Consumer-led demand side financing in health and education and its relevance for low and middle income countries.

PubMed

Ensor, Tim

2004-01-01

There is increasing awareness that supply subsidies for health and education services often fail to benefit those that are most vulnerable in a community. This recognition has led to a growing interest in and experimentation with, consumer-led demand side financing systems (CL-DSF). These mechanisms place purchasing power in the hands of consumers to spend on specific services at accredited facilities. International evidence in education and health sectors suggest a limited success of CL-DSF in raising the consumption of key services amongst priority groups. There is also some evidence that vouchers can be used to improve targeting of vulnerable groups. There is very little positive evidence on the effect of CL-DSF on service quality as a consequence of greater competition. Location of services relative to population means that areas with more provider choice, particularly in the private sector, tend to be dominated by higher and middle-income households. Extending CL-DSF in low-income countries requires the development of capacity in administering these financing schemes and also accrediting providers. Schemes could focus primarily on fixed packages of key services aimed at easily identifiable groups. Piloting and robust evaluation is required to fill the evidence gap on the impact of these mechanisms. Extending demand financing to less predictable services, such as hospital coverage for the population, is likely to require the development of a voucher scheme to purchase insurance. This suggests an already developed insurance market and is unlikely to be appropriate in most low-income countries for some time.

Biodiesel fuel management best practices for transit

DOT National Transportation Integrated Search

2007-11-27

Public transportation systems play a key role throughout the country not only in providing vital services to citizens but also in the environmental quality of our communities. Transit systems nationwide are seeking out new technologies in order to in...

Idaho Transportation Department 2009 customer satisfaction survey.

DOT National Transportation Integrated Search

2010-02-01

In the summer and fall of 2009, the Idaho Transportation Department (ITD) commissioned a statewide customer satisfaction survey of Idaho residents in order to assess the overall level of satisfaction with several key areas of service provided by the ...

Sustainable business models: systematic approach toward successful ambulatory care pharmacy practice.

PubMed

Sachdev, Gloria

2014-08-15

This article discusses considerations for making ambulatory care pharmacist services at least cost neutral and, ideally, generate a margin that allows for service expansion. The four pillars of business sustainability are leadership, staffing, information technology, and compensation. A key facet of leadership in ambulatory care pharmacy practice is creating and expressing a clear vision for pharmacists' services. Staffing considerations include establishing training needs, maximizing efficiencies, and minimizing costs. Information technology is essential for efficiency in patient care delivery and outcomes assessment. The three domains of compensation are cost savings, pay for performance, and revenue generation. The following eight steps for designing and implementing an ambulatory care pharmacist service are discussed: (1) prepare a needs assessment, (2) analyze existing strengths, weaknesses, opportunities, and threats, (3) analyze service gaps and feasibility, (4) consider financial opportunities, (5) consider stakeholders' interests, (6) develop a business plan, (7) implement the service, and (8) measure outcomes. Potential future changes in national healthcare policy (such as pharmacist provider status and expanded pay for performance) could enhance the opportunities for sustainable ambulatory care pharmacy practice. The key challenges facing ambulatory care pharmacists are developing sustainable business models, determining which services yield a positive return on investment, and demanding payment for value-added services. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

A discussion of key values to inform the design and delivery of services for HIV-affected women and couples attempting pregnancy in resource-constrained settings

PubMed Central

Heffron, Renee; Davies, Natasha; Cooke, Ian; Kaida, Angela; Mergler, Reid; van der Poel, Sheryl; Cohen, Craig R; Mmeje, Okeoma

2015-01-01

Introduction HIV-affected women and couples often desire children and many accept HIV risk in order to attempt pregnancy and satisfy goals for a family. Risk reduction strategies to mitigate sexual and perinatal HIV transmission include biomedical and behavioural approaches. Current efforts to integrate HIV and reproductive health services offer prime opportunities to incorporate strategies for HIV risk reduction during pregnancy attempts. Key client and provider values about services to optimize pregnancy in the context of HIV risk provide insights for the design and implementation of large-scale “safer conception” programmes. Discussion Through our collective experience and discussions at a multi-disciplinary international World Health Organization–convened workshop to initiate the development of guidelines and an algorithm of care to support the delivery of services for HIV-affected women and couples attempting pregnancy, we identified four values that are key to the implementation of these programmes: (1) understanding fertility care and an ability to identify potential fertility problems; (2) providing equity of access to resources enabling informed decision-making about reproductive choices; (3) creating enabling environments that reduce stigma associated with HIV and infertility; and (4) creating enabling environments that encourage disclosure of HIV status and fertility status to partners. Based on these values, recommendations for programmes serving HIV-affected women and couples attempting pregnancy include the following: incorporation of comprehensive reproductive health counselling; training to support the transfer and exchange of knowledge between providers and clients; care environments that reduce the stigma of childbearing among HIV-affected women and couples; support for safe and voluntary disclosure of HIV and fertility status; and increased efforts to engage men in reproductive decision-making at times that align with women's desires. Conclusions Programmes, policies and guidelines that integrate HIV treatment and prevention, sexual and reproductive health and fertility care services in a manner responsive to user values and preferences offer opportunities to maximize demand for and use of these services. For HIV-affected women and couples attempting pregnancy, the provision of comprehensive services using available tools – and the development of new tools that are adaptable to many settings and follow consensus recommendations – is a public health imperative. The impetus now is to design and deliver value-driven inclusive programming to achieve the greatest coverage and impact to reduce HIV transmission during pregnancy attempts. PMID:26643454

Examining maintenance responsibilities.

PubMed

Lam, K C

2001-06-01

This paper has examined the important responsibilities of the two organisations involved in the provision of maintenance service for the vital building services in many of our highly serviced buildings. The issues raised could be put to beneficial use in both clients and maintenance providers. All in all, the clients should work closely with their maintenance providers. Engineering services in buildings will not perform satisfactorily and efficiently if both parties do not work together and understand the maintenance tasks based on a business partnering mode. Put forward is the view that the management of the activities involved in the operation and maintenance process is a "shared commitment/involvement" between the client and the maintenance provider. It is obvious that many factors can influence the continued effectiveness of a quality maintenance scheme set up by client and provider. Some of these factors are: Change in key personnel Updates in technology Amendments to engineering practice Implementation of legislative requirements Changes in operation by client or provider Change of use of building Passage of time These factors must be fully reviewed by both parties from time to time, and necessary actions taken. A cooperative team working relationship and improved communication should be fostered by the client and his provider for the best management of services maintenance. This arrangement will contribute to better building services systems with continuous improvement; improved value for clients and higher return for the maintenance provider.

History in health and health services: exploring the possibilities.

PubMed

Sheard, S

2008-08-01

Historical skills--especially the methodologies involved in interpreting a wide range of sources--can provide a useful analysis of the structure and function of health services, and be used as a means of improving public understanding of the expectations and experiences of health and health care. This paper discusses some key examples of different strategies used by historians to show how they can collaborate effectively with health professionals.

Divergence of ecosystem services in U.S. National Forests and Grasslands under a changing climate

Treesearch

Kai Duan; Ge Sun; Shanlei Sun; Peter V. Caldwell; Erika Cohen Mack; Steve McNulty; Heather D. Aldridge; Yang Zhang

2016-01-01

The 170 National Forests and Grasslands (NFs) in the conterminous United States are public lands that provide important ecosystem services such as clean water and timber supply to the American people. This study investigates the potential impacts of climate change on two key ecosystem functions (i.e., water yield and ecosystem productivity) using the most recent...

Strategies for improved French-language health services: Perspectives of family physicians in northeastern Ontario.

PubMed

Gauthier, Alain P; Timony, Patrick E; Serresse, Suzanne; Goodale, Natalie; Prpic, Jason

2015-08-01

To identify strategies to improve the quality of health services for Francophone patients. A series of semistructured key informant interviews. Northeastern Ontario. Participants A total of 18 physicians were interviewed. Ten physicians were interviewed in French, 7 physicians were women, and 10 physicians were located in urban communities. Purposive and snowball sampling strategies were used to conduct a series of semistructured key informant interviews with family physicians practising in communities with a large Francophone population. Principles of grounded theory were applied, guided by a framework for patient-professional communication. Results were inductively derived following an iterative data collection–data analysis process and were analyzed using a detailed thematic approach. Respondents identified several strategies for providing high-quality French-language health services. Some were unique to non–French-speaking physicians (eg, using appropriate interpreter services), some were unique to French-speaking physicians (eg, using a flexible dialect), and some strategies were common to all physicians serving French populations (eg, hiring bilingual staff or having pamphlets and posters in both French and English). Physicians interviewed for this study provided high-quality health care by attributing substantial importance to effective communication. While linguistic patient-to-physician concordance is ideal, it might not always be possible. Thus, conscious efforts to attenuate communication barriers are necessary, and several effective strategies exist.

Supporting youth involved in domestic minor sex trafficking: Divergent perspectives on youth agency.

PubMed

Sapiro, Beth; Johnson, Laura; Postmus, Judy L; Simmel, Cassandra

2016-08-01

Domestic-minor sex trafficking (DMST) continues to affect youth in the United States; however, lack of empirical evidence for interventions and the complex sociopolitical discourses surrounding sex trafficking and the commercial sexual exploitation of children (CSEC) hamper delivery of effective services to this population. To explore perspectives on best practices with these young people, 20 in-depth interviews were conducted with key stakeholders whose work provides them with a unique vantage point on the needs and experiences of survivors of DMST in New Jersey. Notes from interviews were coded and analyzed for emergent themes. While key stakeholders generally agreed on best practices, there were several important areas of dispute that emerged regarding how best to serve youth involved in DMST, specifically with regard to youth running away from services, models of service provision, and the use of technology by these youth. Findings suggest that professionals from diverse backgrounds may disagree about the extent to which youth involved in DMST possess agency in their decision-making capacities as adolescents. This study explores these areas of dispute, and discusses the implications for the many different professionals and systems that must work together in providing services to this population. Copyright © 2016 Elsevier Ltd. All rights reserved.

An overview of health forecasting.

PubMed

Soyiri, Ireneous N; Reidpath, Daniel D

2013-01-01

Health forecasting is a novel area of forecasting, and a valuable tool for predicting future health events or situations such as demands for health services and healthcare needs. It facilitates preventive medicine and health care intervention strategies, by pre-informing health service providers to take appropriate mitigating actions to minimize risks and manage demand. Health forecasting requires reliable data, information and appropriate analytical tools for the prediction of specific health conditions or situations. There is no single approach to health forecasting, and so various methods have often been adopted to forecast aggregate or specific health conditions. Meanwhile, there are no defined health forecasting horizons (time frames) to match the choices of health forecasting methods/approaches that are often applied. The key principles of health forecasting have not also been adequately described to guide the process. This paper provides a brief introduction and theoretical analysis of health forecasting. It describes the key issues that are important for health forecasting, including: definitions, principles of health forecasting, and the properties of health data, which influence the choices of health forecasting methods. Other matters related to the value of health forecasting, and the general challenges associated with developing and using health forecasting services are discussed. This overview is a stimulus for further discussions on standardizing health forecasting approaches and methods that will facilitate health care and health services delivery.

QaaS (quality as a service) model for web services using big data technologies

NASA Astrophysics Data System (ADS)

Ahmad, Faisal; Sarkar, Anirban

2017-10-01

Quality of service (QoS) determines the service usability and utility and both of which influence the service selection process. The QoS varies from one service provider to other. Each web service has its own methodology for evaluating QoS. The lack of transparent QoS evaluation model makes the service selection challenging. Moreover, most QoS evaluation processes do not consider their historical data which not only helps in getting more accurate QoS but also helps for future prediction, recommendation and knowledge discovery. QoS driven service selection demands a model where QoS can be provided as a service to end users. This paper proposes a layered QaaS (quality as a service) model in the same line as PaaS and software as a service, where users can provide QoS attributes as inputs and the model returns services satisfying the user's QoS expectation. This paper covers all the key aspects in this context, like selection of data sources, its transformation, evaluation, classification and storage of QoS. The paper uses server log as the source for evaluating QoS values, common methodology for its evaluation and big data technologies for its transformation and analysis. This paper also establishes the fact that Spark outperforms the Pig with respect to evaluation of QoS from logs.

Lessons from sexual and reproductive health voucher program design and function: a comprehensive review.

PubMed

Grainger, Corinne; Gorter, Anna; Okal, Jerry; Bellows, Ben

2014-04-29

Developing countries face challenges in financing healthcare; often the poor do not receive the most basic services. The past decade has seen a sharp increase in the number of voucher programs, which target output-based subsidies for specific services to poor and underserved groups. The dearth of literature that examines lessons learned risks the wheel being endlessly reinvented. This paper examines commonalities and differences in voucher design and implementation, highlighting lessons learned for the design of new voucher programmes. The methodology comprised: discussion among key experts to develop inclusion/exclusion criteria; up-dating the literature database used by the DFID systematic review of voucher programs; and networking with key contacts to identify new programs and obtain additional program documents. We identified 40 programs for review and extracted a dataset of more than 120 program characteristics for detailed analysis. All programs aimed to increase utilisation of healthcare, particularly maternal health services, overwhelmingly among low-income populations. The majority contract(ed) private providers, or public and private providers, and all facilitate(d) access to services that are well defined, time-limited and reflect the country's stated health priorities. All voucher programs incorporate a governing body, management agency, contracted providers and target population, and all share the same incentive structure: the transfer of subsidies from consumers to service providers, resulting in a strong effect on both consumer and provider behaviour. Vouchers deliver subsidies to individuals, who in the absence of the subsidy would likely not have sought care, and in all programs a positive behavioural response is observed, with providers investing voucher revenue to attract more clients. A large majority of programs studied used targeting mechanisms. While many programs remain too small to address national-level need among the poor, large programs are being developed at a rate of one every two years, with further programs in the pipeline. The importance of addressing inequalities in access to basic services is recognized as an important component in the drive to achieve universal health coverage; vouchers are increasingly acknowledged as a promising targeting mechanism in this context, particularly where social health insurance is not yet feasible.

Lessons from sexual and reproductive health voucher program design and function: a comprehensive review

PubMed Central

2014-01-01

Background Developing countries face challenges in financing healthcare; often the poor do not receive the most basic services. The past decade has seen a sharp increase in the number of voucher programs, which target output-based subsidies for specific services to poor and underserved groups. The dearth of literature that examines lessons learned risks the wheel being endlessly reinvented. This paper examines commonalities and differences in voucher design and implementation, highlighting lessons learned for the design of new voucher programmes. Methodology The methodology comprised: discussion among key experts to develop inclusion/exclusion criteria; up-dating the literature database used by the DFID systematic review of voucher programs; and networking with key contacts to identify new programs and obtain additional program documents. We identified 40 programs for review and extracted a dataset of more than 120 program characteristics for detailed analysis. Results All programs aimed to increase utilisation of healthcare, particularly maternal health services, overwhelmingly among low-income populations. The majority contract(ed) private providers, or public and private providers, and all facilitate(d) access to services that are well defined, time-limited and reflect the country’s stated health priorities. All voucher programs incorporate a governing body, management agency, contracted providers and target population, and all share the same incentive structure: the transfer of subsidies from consumers to service providers, resulting in a strong effect on both consumer and provider behaviour. Vouchers deliver subsidies to individuals, who in the absence of the subsidy would likely not have sought care, and in all programs a positive behavioural response is observed, with providers investing voucher revenue to attract more clients. A large majority of programs studied used targeting mechanisms. Conclusions While many programs remain too small to address national-level need among the poor, large programs are being developed at a rate of one every two years, with further programs in the pipeline. The importance of addressing inequalities in access to basic services is recognized as an important component in the drive to achieve universal health coverage; vouchers are increasingly acknowledged as a promising targeting mechanism in this context, particularly where social health insurance is not yet feasible. PMID:24779653

Universal Keyword Classifier on Public Key Based Encrypted Multikeyword Fuzzy Search in Public Cloud

PubMed Central

Munisamy, Shyamala Devi; Chokkalingam, Arun

2015-01-01

Cloud computing has pioneered the emerging world by manifesting itself as a service through internet and facilitates third party infrastructure and applications. While customers have no visibility on how their data is stored on service provider's premises, it offers greater benefits in lowering infrastructure costs and delivering more flexibility and simplicity in managing private data. The opportunity to use cloud services on pay-per-use basis provides comfort for private data owners in managing costs and data. With the pervasive usage of internet, the focus has now shifted towards effective data utilization on the cloud without compromising security concerns. In the pursuit of increasing data utilization on public cloud storage, the key is to make effective data access through several fuzzy searching techniques. In this paper, we have discussed the existing fuzzy searching techniques and focused on reducing the searching time on the cloud storage server for effective data utilization. Our proposed Asymmetric Classifier Multikeyword Fuzzy Search method provides classifier search server that creates universal keyword classifier for the multiple keyword request which greatly reduces the searching time by learning the search path pattern for all the keywords in the fuzzy keyword set. The objective of using BTree fuzzy searchable index is to resolve typos and representation inconsistencies and also to facilitate effective data utilization. PMID:26380364

Third sector primary health care in New Zealand.

PubMed

Crampton, P; Dowell, A C; Bowers, S

2000-03-24

To describe key organisational characteristics of selected third sector (non-profit and non-government) primary health care organisations. Data were collected, in 1997 and 1998, from 15 third sector primary care organisations that were members of a network of third sector primary care providers, Health Care Aotearoa (HCA). Data were collected by face-to-face interviews of managers and key informants using a semi-structured interview schedule, and from practice computer information systems. Overall the populations served were young: only 4% of patients were aged 65 years or older, and the ethnicity profile was highly atypical, with 21.8% European, 36% Maori, 22.7% Pacific Island, 12% other, and 7.5% not stated. Community services card holding rates were higher than recorded in other studies, and registered patients tended to live in highly deprived areas. HCA organisations had high patient to doctor ratios, in general over 2000:1, and there were significant differences in management structures between HCA practices and more traditional general practice. Third sector organisations provide services for populations that are disadvantaged in many respects. It is likely that New Zealand will continue to develop a diverse range of primary care organisational arrangements. Effort is now required to measure quality and effectiveness of services provided by different primary care organisations serving comparable populations.

Layered stigma among health-care and social service providers toward key affected populations in Jamaica and The Bahamas.

PubMed

Rogers, S J; Tureski, K; Cushnie, A; Brown, A; Bailey, A; Palmer, Q

2014-01-01

While considerable research has documented stigma toward key populations affected by HIV and AIDS - men who have sex with men (MSM), sex workers (SWs) - it provided limited empirical evidence on the presence of layered stigma among health-care professionals providing services for these populations. C-Change conducted a survey among 332 staff of health-care and social service agencies in Jamaica and The Bahamas to understand the levels of stigma toward people living with HIV (PLHIV), including MSM and SWs and factors associated with stigma. While most health-care professionals responding to the survey said that PLHIV, MSM, and SWs deserved quality care, they expressed high levels of blame and negative judgments, especially toward MSM and SWs. Across a stigma assessment involving eight vignette characters, the highest levels of stigma were expressed toward PLHIV who were also MSM or SWs, followed by PLHIV, MSM, and SWs. Differences were assessed by gender, country, type of staff, type of agency, and exposure to relevant training. Findings indicate higher reported stigma among nonclinical vs. clinical staff, staff who worked in general vs. MSM/SW-friendly health facilities, and among untrained vs. training staff. This implies the need for targeted staff capacity strengthening as well as improved facility environments that are MSM/SW-friendly.

Universal Keyword Classifier on Public Key Based Encrypted Multikeyword Fuzzy Search in Public Cloud.

PubMed

Munisamy, Shyamala Devi; Chokkalingam, Arun

2015-01-01

Cloud computing has pioneered the emerging world by manifesting itself as a service through internet and facilitates third party infrastructure and applications. While customers have no visibility on how their data is stored on service provider's premises, it offers greater benefits in lowering infrastructure costs and delivering more flexibility and simplicity in managing private data. The opportunity to use cloud services on pay-per-use basis provides comfort for private data owners in managing costs and data. With the pervasive usage of internet, the focus has now shifted towards effective data utilization on the cloud without compromising security concerns. In the pursuit of increasing data utilization on public cloud storage, the key is to make effective data access through several fuzzy searching techniques. In this paper, we have discussed the existing fuzzy searching techniques and focused on reducing the searching time on the cloud storage server for effective data utilization. Our proposed Asymmetric Classifier Multikeyword Fuzzy Search method provides classifier search server that creates universal keyword classifier for the multiple keyword request which greatly reduces the searching time by learning the search path pattern for all the keywords in the fuzzy keyword set. The objective of using BTree fuzzy searchable index is to resolve typos and representation inconsistencies and also to facilitate effective data utilization.

Investigating the potential for students to provide dental services in community settings.

PubMed

Huynh-Vo, Linda; Rosenbloom, Joel M; Aslanyan, Garry; Leake, James L

2002-01-01

Some dental educational institutions in North America have incorporated community-oriented programs into their curriculum. The purpose of this study was to investigate the potential for the clinical placement of Ontario's dental and dental hygiene students in community-based settings. Key informant interviews were used to collect data. The study group consisted of 15 key informants from 9 potential placement sites and 4 educational institutions in Toronto and London, Ontario. The textual data were analyzed qualitatively to identify important issues regarding a clinical placement program. Results showed that there is strong support for the placement of students in community-based clinics; however, the degree to which health centres can accommodate students varies. The majority would not set any limit on the types of dental services that students could provide as long as the services were within the students' competencies. Funding was identified as a barrier to the implementation of such a program, with most of the organizations not able to contribute financially. None would be able to provide sufficient supervision without additional funding. These results indicate that a clinical placement program would be a welcome addition to the training of dental and dental hygiene students, but that external funding for supervision and operational expenses must be available before a program can be instituted.

Barriers and facilitators to provide quality TIA care in the Veterans Healthcare Administration.

PubMed

Damush, Teresa M; Miech, Edward J; Sico, Jason J; Phipps, Michael S; Arling, Greg; Ferguson, Jared; Austin, Charles; Myers, Laura; Baye, Fitsum; Luckhurst, Cherie; Keating, Ava B; Moran, Eileen; Bravata, Dawn M

2017-12-12

To identify key barriers and facilitators to the delivery of guideline-based care of patients with TIA in the national Veterans Health Administration (VHA). We conducted a cross-sectional, observational study of 70 audiotaped interviews of multidisciplinary clinical staff involved in TIA care at 14 VHA hospitals. We de-identified and analyzed all transcribed interviews. We identified emergent themes and patterns of barriers to providing TIA care and of facilitators applied to overcome these barriers. Identified barriers to providing timely acute and follow-up TIA care included difficulties accessing brain imaging, a constantly rotating pool of housestaff, lack of care coordination, resource constraints, and inadequate staff education. Key informants revealed that both stroke nurse coordinators and system-level factors facilitated the provision of TIA care. Few facilities had specific TIA protocols. However, stroke nurse coordinators often expanded upon their role to include TIA. They facilitated TIA care by (1) coordinating patient care across services, communicating across service lines, and educating clinical staff about facility policies and evidence-based practices; (2) tracking individual patients from emergency departments to inpatient settings and to discharge for timely follow-up care; (3) providing and referring TIA patients to risk factor management programs; and (4) performing regular audit and feedback of quality performance data. System-level facilitators included clinical service leadership engagement and use of electronic tools for continuous care across services. The local organization within a health care facility may be targeted to cultivate internal facilitators and a systemic infrastructure to provide evidence-based TIA care. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

A policy analysis of the implementation of a Reproductive Health Vouchers Program in Kenya.

PubMed

Abuya, Timothy; Njuki, Rebecca; Warren, Charlotte E; Okal, Jerry; Obare, Francis; Kanya, Lucy; Askew, Ian; Bellows, Ben

2012-07-23

Innovative financing strategies such as those that integrate supply and demand elements like the output-based approach (OBA) have been implemented to reduce financial barriers to maternal health services. The Kenyan government with support from the German Development Bank (KfW) implemented an OBA voucher program to subsidize priority reproductive health services. Little evidence exists on the experience of implementing such programs in different settings. We describe the implementation process of the Kenyan OBA program and draw implications for scale up. Policy analysis using document review and qualitative data from 10 in-depth interviews with facility in-charges and 18 with service providers from the contracted facilities, local administration, health and field managers in Kitui, Kiambu and Kisumu districts as well as Korogocho and Viwandani slums in Nairobi. The OBA implementation process was designed in phases providing an opportunity for learning and adapting the lessons to local settings; the design consisted of five components: a defined benefit package, contracting and quality assurance; marketing and distribution of vouchers and claims processing and reimbursement. Key implementation challenges included limited feedback to providers on the outcomes of quality assurance and accreditation and budgetary constraints that limited effective marketing leading to inadequate information to clients on the benefit package. Claims processing and reimbursement was sophisticated but required adherence to time consuming procedures and in some cases private providers complained of low reimbursement rates for services provided. OBA voucher schemes can be implemented successfully in similar settings. For effective scale up, strong partnership will be required between the public and private entities. The government's role is key and should include provision of adequate funding, stewardship and looking for opportunities to utilize existing platforms to scale up such strategies.

A Policy Analysis of the implementation of a Reproductive Health Vouchers Program in Kenya

PubMed Central

2012-01-01

Background Innovative financing strategies such as those that integrate supply and demand elements like the output-based approach (OBA) have been implemented to reduce financial barriers to maternal health services. The Kenyan government with support from the German Development Bank (KfW) implemented an OBA voucher program to subsidize priority reproductive health services. Little evidence exists on the experience of implementing such programs in different settings. We describe the implementation process of the Kenyan OBA program and draw implications for scale up. Methods Policy analysis using document review and qualitative data from 10 in-depth interviews with facility in-charges and 18 with service providers from the contracted facilities, local administration, health and field managers in Kitui, Kiambu and Kisumu districts as well as Korogocho and Viwandani slums in Nairobi. Results The OBA implementation process was designed in phases providing an opportunity for learning and adapting the lessons to local settings; the design consisted of five components: a defined benefit package, contracting and quality assurance; marketing and distribution of vouchers and claims processing and reimbursement. Key implementation challenges included limited feedback to providers on the outcomes of quality assurance and accreditation and budgetary constraints that limited effective marketing leading to inadequate information to clients on the benefit package. Claims processing and reimbursement was sophisticated but required adherence to time consuming procedures and in some cases private providers complained of low reimbursement rates for services provided. Conclusions OBA voucher schemes can be implemented successfully in similar settings. For effective scale up, strong partnership will be required between the public and private entities. The government’s role is key and should include provision of adequate funding, stewardship and looking for opportunities to utilize existing platforms to scale up such strategies. PMID:22823923

Response to: 'Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies' by Schuklenk and Smalling.

PubMed

Lyus, Richard John

2017-04-01

Bioethicists commenting on conscientious objection and abortion should consider the empirical data on abortion providers. Abortion providers do not fall neatly into groups of providers and objectors, and ambivalence is a key theme in their experience. Practical details of abortion services further upset the dichotomy. These empirical facts are important because they demonstrate that the way the issue is described in analytical bioethics does not reflect reality. Addressing conscientious objection as a barrier to patient access requires engaging with those who provide the service and those who are able to but do not. The experiences of doctors facing these decisions potentially challenge and expand our understanding of the issue as an ethical concern. 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/.

The Individuals With Disabilities Education Act (IDEA) for Children With Special Educational Needs.

PubMed

Lipkin, Paul H; Okamoto, Jeffrey

2015-12-01

The pediatric health care provider has a critical role in supporting the health and well-being of children and adolescents in all settings, including early intervention (EI), preschool, and school environments. It is estimated that 15% of children in the United States have a disability. The Individuals with Disabilities Education Act entitles every affected child in the United States from infancy to young adulthood to a free appropriate public education through EI and special education services. These services bolster development and learning of children with various disabilities. This clinical report provides the pediatric health care provider with a summary of key components of the most recent version of this law. Guidance is also provided to ensure that every child in need receives the EI and special education services to which he or she is entitled. Copyright © 2015 by the American Academy of Pediatrics.

Health care and social service professionals' perceptions of a home-visit program for young, first-time mothers.

PubMed

Li, S A; Jack, S M; Gonzalez, A; Duku, E; MacMillan, H L

2015-01-01

Little is known about health care and social service professionals' perspective on the acceptability of long-term home-visit programs serving low-income, first-time mothers. This study describes the experiences and perspectives of these community care providers involved with program referrals or service delivery to mothers who participated in the Nurse-Family Partnership (NFP), a targeted nurse home-visit program. The study included two phases. Phase I was a secondary qualitative data analysis used to analyze a purposeful sample of 24 individual interviews of community care providers. This was part of a larger case study examining adaptations required to increase acceptability of the NFP in Hamilton, Ontario, Canada. In Phase II (n = 4), themes identified from Phase I were further explored through individual, semi-structured interviews with community health care and social service providers, giving qualitative description. Overall, the NFP was viewed as addressing an important service gap for first-time mothers. Providers suggested that frequent communication between the NFP and community agencies serving these mothers could help improve the referral process, avoid service duplication, and streamline the flow of service access. The findings can help determine key components required to enhance the success of integrating a home-visit program into an existing network of community services. The function of home-visit programs should not be viewed in isolation. Rather, their potential can be maximized when they collaborate and share information with other agencies to provide better services for first-time mothers.

Issues with medication supply and management in a rural community in Queensland.

PubMed

Tan, Amy C W; Emmerton, Lynne M; Hattingh, H Laetitia

2012-06-01

To identify the key issues reported by rural health-care providers in their provision of medication supply and related cognitive services, and in order to advise health workforce and role development and thus improve the quality use of medicines in rural communities. Exploratory semistructured interview research. A rural community comprising four towns in a rural health service district in Queensland, Australia.   Forty-nine health-care providers (medical practitioners, pharmacists, nurses and others) with medication-related roles who serviced the study community, identified through databases and local contacts. Medication-related roles undertaken by the health-care providers, focusing on medication supply and cognitive services; challenges in undertaking these roles. Medical and nursing providers reported challenges in ensuring continuity in supply of medications due to their existing medical workload demands. Local pharmacists were largely involved in medication supply, with limited capacity for extended cognitive roles. Participants identified a lack of support for their medication roles and the potential value of clinically focused pharmacists in medication management services. Medication supply may become more efficient with extended roles for certain health-care providers. The need for cognitive medication management services suggests potential for clinical pharmacists' role development in rural areas. © 2012 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

A New Look at Data Usage by Using Metadata Attributes as Indicators of Data Quality

NASA Astrophysics Data System (ADS)

Won, Y. I.; Wanchoo, L.; Behnke, J.

2016-12-01

NASA's Earth Observing System Data and Information System (EOSDIS) stores and distributes data from EOS satellites, as well as ancillary, airborne, in-situ, and socio-economic data. Twelve EOSDIS data centers support different scientific disciplines by providing products and services tailored to specific science communities. Although discipline oriented, these data centers provide common data management functions of ingest, archive and distribution, as well as documentation of their data and services on their web-sites. The Earth Science Data and Information System (ESDIS) Project collects these metrics from the EOSDIS data centers on a daily basis through a tool called the ESDIS Metrics System (EMS). These metrics are used in this study. The implementation of the Earthdata Login - formerly known as the User Registration System (URS) - across the various NASA data centers provides the EMS additional information about users obtaining data products from EOSDIS data centers. These additional user attributes collected by the Earthdata login, such as the user's primary area of study can augment the understanding of data usage, which in turn can help the EOSDIS program better understand the users' needs. This study will review the key metrics (users, distributed volume, and files) in multiple ways to gain an understanding of the significance of the metadata. Characterizing the usability of data by key metadata elements such as discipline and study area, will assist in understanding how the users have evolved over time. The data usage pattern based on version numbers may also provide some insight into the level of data quality. In addition, the data metrics by various services such as the Open-source Project for a Network Data Access Protocol (OPeNDAP), Web Map Service (WMS), Web Coverage Service (WCS), and subsets, will address how these services have extended the usage of data. Over-all, this study will present the usage of data and metadata by metrics analyses and will assist data centers in better supporting the needs of the users.

Service line structure and decision-maker attention in three health systems: Implications for patient-centered care.

PubMed

Louis, Christopher J; Clark, Jonathan R; Gray, Barbara; Brannon, Diane; Parker, Victoria

2017-06-15

Scholars have noted a disconnect between the level at which structure is typically examined (the organization) and the level at which the relevant coordination takes place (service delivery). Accordingly, our understanding of the role structure plays in care coordination is limited. In this article, we explore service line structure, with an aim of advancing our understanding of the role service line structure plays in producing coordinated, patient-centered care. We do so by giving special attention to the cognitive roots of patient-centeredness. Our exploratory study relied on comparative case studies of the breast cancer service lines in three health systems. Nonprobability discriminative snowball sampling was used to identify the final sample of key informants. We employed a grounded approach to analyzing and interpreting the data. We found substantial variation across the three service lines in terms of their structure. We also found corresponding variation across the three case sites in terms of where informant attention was primarily focused in the process of coordinating care. Drawing on the attention-based view of the firm, our results draw a clear connection between structural characteristics and the dominant focus of attention (operational tactics, provider roles and relationships, or patient needs and engagement) in health care service lines. Our exploratory results suggest that service line structures influence attention in two ways: (a) by regulating the type and intensity of the problems facing service line participants and (b) by encouraging (or discouraging) a shared purpose around patient needs. Patient-centered attention-a precursor to coordinated, patient-centered care-depends on the internal choices organizations make around service line structure. Moreover, a key task for organizational and service line leaders is to structure service lines to create a context that minimizes distractions and enables care providers to focus their attention on the needs of their patients.

Exploring Systems That Support Good Clinical Care in Indigenous Primary Health-care Services: A Retrospective Analysis of Longitudinal Systems Assessment Tool Data from High-Improving Services.

PubMed

Woods, Cindy; Carlisle, Karen; Larkins, Sarah; Thompson, Sandra Claire; Tsey, Komla; Matthews, Veronica; Bailie, Ross

2017-01-01

Continuous Quality Improvement is a process for raising the quality of primary health care (PHC) across Indigenous PHC services. In addition to clinical auditing using plan, do, study, and act cycles, engaging staff in a process of reflecting on systems to support quality care is vital. The One21seventy Systems Assessment Tool (SAT) supports staff to assess systems performance in terms of five key components. This study examines quantitative and qualitative SAT data from five high-improving Indigenous PHC services in northern Australia to understand the systems used to support quality care. High-improving services selected for the study were determined by calculating quality of care indices for Indigenous health services participating in the Audit and Best Practice in Chronic Disease National Research Partnership. Services that reported continuing high improvement in quality of care delivered across two or more audit tools in three or more audits were selected for the study. Precollected SAT data (from annual team SAT meetings) are presented longitudinally using radar plots for quantitative scores for each component, and content analysis is used to describe strengths and weaknesses of performance in each systems' component. High-improving services were able to demonstrate strong processes for assessing system performance and consistent improvement in systems to support quality care across components. Key strengths in the quality support systems included adequate and orientated workforce, appropriate health system supports, and engagement with other organizations and community, while the weaknesses included lack of service infrastructure, recruitment, retention, and support for staff and additional costs. Qualitative data revealed clear voices from health service staff expressing concerns with performance, and subsequent SAT data provided evidence of changes made to address concerns. Learning from the processes and strengths of high-improving services may be useful as we work with services striving to improve the quality of care provided in other areas.

A Review of Commonly-Used State Employment Measures in Intellectual and Developmental Disability Services. Policy Research Brief. Volume 22, Number 1

ERIC Educational Resources Information Center

Nord, Derek

2012-01-01

This "Policy Research Brief" summarizes publicly-available data sources that provide information about the employment of people with intellectual and developmental disabilities. It provides important information about these data sources, including their purposes, key definitions, and where to access the public data. Using these data…

Planning Issues in Providing Research and Development Services in the Northeast.

ERIC Educational Resources Information Center

Weinman, Janice

This paper is intended to provide data and analysis on three general questions: What are the significant existing programs and agencies related to educational research and development (R&D) in the Northeast and what are key unmet needs for the National Institute of Education (NIE) to consider in planning for a new institution? What are various…

Quality and Improvement in Scottish Education: Trends in Inspection Findings 2008-2011

ERIC Educational Resources Information Center

Education Scotland, 2012

2012-01-01

The findings of Education Scotland's sectoral programme of inspections, which sample the providers of education at every stage from the early years to adult learning, provide a key source of evidence on how effectively one of its core public services is performing. The last published summary of inspection findings was produced in 2009 when Her…

Challenges Addressing Unmet Need for Contraception: Voices of Family Planning Service Providers in Rural Tanzania.

PubMed

Baraka, Jitihada; Rusibamayila, Asinath; Kalolella, Admirabilis; Baynes, Colin

2015-12-01

Provider perspectives have been overlooked in efforts to address the challenges of unmet need for family planning (FP). This qualitative study was undertaken in Tanzania, using 22 key informant interviews and 4 focus group discussions. The research documents perceptions of healthcare managers and providers in a rural district on the barriers to meeting latent demand for contraception. Social-ecological theory is used to interpret the findings, illustrating how service capability is determined by the social, structural and organizational environment. Providers' efforts to address unmet need for FP services are constrained by unstable reproductive preferences, low educational attainment, and misconceptions about contraceptive side effects. Societal and organizational factors--such as gender dynamics, economic conditions, religious and cultural norms, and supply chain bottlenecks, respectively--also contribute to an adverse environment for meeting needs for care. Challenges that healthcare providers face interact and produce an effect which hinders efforts to address unmet need. Interventions to address this are not sufficient unless the supply of services is combined with systems strengthening and social engagement strategies in a way that reflects the multi-layered, social institutional problems.

Key populations and human rights in the context of HIV services rendition in Ghana.

PubMed

Laar, Amos; DeBruin, Debra

2017-08-02

In line with its half century old penal code, Ghana currently criminalizes and penalizes behaviors of some key populations - populations deemed to be at higher risk of acquiring or transmitting Human Immunodeficiency Virus (HIV). Men who have sex with men (MSM), and sex workers (SWs) fit into this categorization. This paper provides an analysis of how enactment and implementation of rights-limiting laws not only limit rights, but also amplify risk and vulnerability to HIV in key and general populations. The paper derives from a project that assessed the ethics sensitivity of key documents guiding Ghana's response to its HIV epidemic. Assessment was guided by leading frameworks from public health ethics, and relevant articles from the international bill of rights. Ghana's response to her HIV epidemic does not adequately address the rights and needs of key populations. Even though the national response has achieved some public health successes, palpable efforts to address rights issues remain nascent. Ghana's guiding documents for HIV response include no advocacy for decriminalization, depenalization or harm reduction approaches for these key populations. The impact of rights-restricting codes on the nation's HIV epidemic is real: criminalization impedes key populations' access to HIV prevention and treatment services. Given that they are bridging populations, whatever affects the Ghanaian key populations directly, affects the general population indirectly. The right to the highest attainable standard of health, without qualification, is generally acknowledged as a fundamental human right. Unfortunately, this right currently eludes the Ghanaian SW and MSM. The paper endorses decriminalization as a means of promoting this right. In the face of opposition to decriminalization, the paper proposes specific harm reduction strategies as approaches to promote health and uplift the diminished rights of key populations. Thus the authors call on Ghana to remove impediments to public health services provision to these populations. Doing so will require political will and sufficient planning toward prioritizing HIV prevention, care and treatment programming for key populations.

Perspectives for Web Service Intermediaries: How Influence on Quality Makes the Difference

NASA Astrophysics Data System (ADS)

Scholten, Ulrich; Fischer, Robin; Zirpins, Christian

In the service-oriented computing paradigm and the Web service architecture, the broker role is a key facilitator to leverage technical capabilities of loose coupling to achieve organizational capabilities of dynamic customer-provider-relationships. In practice, this role has quickly evolved into a variety of intermediary concepts that refine and extend the basic functionality of service brokerage with respect to various forms of added value like platform or market mechanisms. While this has initially led to a rich variety of Web service intermediaries, many of these are now going through a phase of stagnation or even decline in customer acceptance. In this paper we present a comparative study on insufficient service quality that is arguably one of the key reasons for this phenomenon. In search of a differentiation with respect to quality monitoring and management patterns, we categorize intermediaries into Infomediaries, e-Hubs, e-Markets and Integrators. A mapping of quality factors and control mechanisms to these categories depicts their respective strengths and weaknesses. The results show that Integrators have the highest overall performance, followed by e-Markets, e-Hubs and lastly Infomediaries. A comparative market survey confirms the conceptual findings.

"Be kind to young people so they feel at home": a qualitative study of adolescents' and service providers' perceptions of youth-friendly sexual and reproductive health services in Vanuatu.

PubMed

Kennedy, Elissa C; Bulu, Siula; Harris, Jennifer; Humphreys, David; Malverus, Jayline; Gray, Natalie J

2013-10-31

Sexual activity during adolescence is common in Vanuatu, however many adolescents lack access to sexual and reproductive health (SRH) services and subsequently suffer a disproportionate burden of poor SRH. There is limited peer-reviewed research describing adolescents' SRH service delivery preferences in Vanuatu to inform policy and programs. The aim of this qualitative study was to explore the barriers preventing adolescents from accessing SRH services in Vanuatu and the features of a youth-friendly health service as defined by adolescents. Sixty-six focus group discussions were conducted with 341 male and female adolescents aged 15-19 years in rural and urban communities. Additionally, 12 semi-structured interviews were undertaken with policymakers and service providers. Data were analysed using thematic analysis. Socio-cultural norms and taboos regarding adolescent sexual behaviour were the most significant factors preventing adolescents from accessing services. These contributed to adolescents' own fear and shame, judgmental attitudes of service providers, and disapproval from parents and community gate-keepers. Lack of confidentiality and privacy, costs, and adolescents' lack of SRH knowledge were also important barriers. Adolescents and service providers identified opportunities to make existing services more youth-friendly. The most important feature of a youth-friendly health service described by adolescents was a friendly service provider. Free or affordable services, reliable commodity supply, confidentiality and privacy were also key features. The need to address socio-cultural norms and community knowledge and attitudes was also highlighted. There are significant demand and supply-side barriers contributing to low utilisation of SRH services by adolescents in Vanuatu. However, there are many opportunities to make existing SRH services more youth-friendly, such as improving service provider training. Investment is also required in strategies that aim to create a more supportive environment for adolescent SRH.

Innovation in mental health services: what are the key components of success?

PubMed

Brooks, Helen; Pilgrim, David; Rogers, Anne

2011-10-26

Service development innovation in health technology and practice is viewed as a pressing need within the field of mental health yet is relatively poorly understood. Macro-level theories have been criticised for their limited explanatory power and they may not be appropriate for understanding local and fine-grained uncertainties of services and barriers to the sustainability of change. This study aimed to identify contextual influences inhibiting or promoting the acceptance and integration of innovations in mental health services in both National Health Service (NHS) and community settings. A comparative study using qualitative and case study data collection methods, including semi-structured interviews with key stakeholders and follow-up telephone interviews over a one-year period. The analysis was informed by learning organisation theory. Drawn from 11 mental health innovation projects within community, voluntary and NHS settings, 65 participants were recruited including service users, commissioners, health and non-health professionals, managers, and caregivers. The methods deployed in this evaluation focused on process-outcome links within and between the 11 projects. Key barriers to innovation included resistance from corporate departments and middle management, complexity of the innovation, and the availability and access to resources on a prospective basis within the host organisation. The results informed the construction of a proposed model of innovation implementation within mental health services. The main components of which are context, process, and outcomes. The study produced a model of conducive and impeding factors drawn from the composite picture of 11 innovative mental health projects, and this is discussed in light of relevant literature. The model provides a rich agenda to consider for services wanting to innovate or adopt innovations from elsewhere. The evaluation suggested the importance of studying innovation with a focus on context, process, and outcomes.

Innovation in mental health services: what are the key components of success?

PubMed Central

2011-01-01

Background Service development innovation in health technology and practice is viewed as a pressing need within the field of mental health yet is relatively poorly understood. Macro-level theories have been criticised for their limited explanatory power and they may not be appropriate for understanding local and fine-grained uncertainties of services and barriers to the sustainability of change. This study aimed to identify contextual influences inhibiting or promoting the acceptance and integration of innovations in mental health services in both National Health Service (NHS) and community settings. Methods A comparative study using qualitative and case study data collection methods, including semi-structured interviews with key stakeholders and follow-up telephone interviews over a one-year period. The analysis was informed by learning organisation theory. Drawn from 11 mental health innovation projects within community, voluntary and NHS settings, 65 participants were recruited including service users, commissioners, health and non-health professionals, managers, and caregivers. The methods deployed in this evaluation focused on process-outcome links within and between the 11 projects. Results Key barriers to innovation included resistance from corporate departments and middle management, complexity of the innovation, and the availability and access to resources on a prospective basis within the host organisation. The results informed the construction of a proposed model of innovation implementation within mental health services. The main components of which are context, process, and outcomes. Conclusions The study produced a model of conducive and impeding factors drawn from the composite picture of 11 innovative mental health projects, and this is discussed in light of relevant literature. The model provides a rich agenda to consider for services wanting to innovate or adopt innovations from elsewhere. The evaluation suggested the importance of studying innovation with a focus on context, process, and outcomes. PMID:22029930

Family violence and maternal mortality in the south Asian community: the role of obstetrical care providers.

PubMed

Janssen, Patricia A; Henderson, Angela D; MacKay, Kathleen L

2009-11-01

South Asian women face multiple barriers to accessing information and support if they are experiencing spousal abuse. We conducted a study among South Asian women in Surrey, British Columbia, to define a role for obstetrical care providers in assisting women who experience family violence. South Asian women survivors of abuse participated with representatives of family and victim services agencies in a workshop to identify key opportunities for violence prevention and intervention by obstetrical care providers. Participants grouped issues affecting women's vulnerability to violence into four themes and identified strategies to address them. Themes focused on cultural issues, services and supports, education and prevention, and policy and advocacy. Participants highlighted challenges posed by the patriarchal nature of their culture and, for many families, by recent immigration. They emphasized the importance of routine assessment for family violence by obstetrical care providers and stressed the need to treat the entire family, not just the identified victim. They focused on the role of the caregiver as a conduit of information about social services and other resources. Community-level interventions to address abuse were endorsed, including the use of lay media to deliver key messages about health and safety. Pregnancy offers caregivers an opportunity to be advocates and to provide information and referrals for women in the South Asian community who may be at risk of violence. Obstetrical caregivers may be an important influence in protecting women from lethal harm.

Challenges in accessing sexual and reproductive health services by people with physical disabilities in Kampala, Uganda

PubMed Central

2014-01-01

Introduction Despite the universal right to access the same range, quality and standard of free or affordable health care and programs as provided to other persons, people with physical disabilities (PWPDs) continue to experience challenges in accessing these services. This article presents the challenges faced by PWPDs in accessing sexual and reproductive health (SRH) services in Kampala, Uganda. Methods This was a qualitative study that was conducted with male and female PWPDs in Kampala in 2007. Data on the challenges experienced by PWPDs in accessing SRH services were collected using in-depth interviews with 40 PWPDs and key informant interviews with 10 PWPDs’ representatives, staff of agencies supporting PWPDs and health workers. All data were captured verbatim using an audio-tape recorder, entered into a Microsoft Word computer program and analyzed manually following a content thematic approach. Results The study findings show that PWPDs face a multitude of challenges in accessing SRH services including negative attitudes of service providers, long queues at health facilities, distant health facilities, high costs of services involved, unfriendly physical structures and the perception from able-bodied people that PWPDs should be asexual. Conclusion People with physical disabilities (PWPDs) face health facility-related (service provider and facility-related challenges), economic and societal challenges in accessing SRH services. These findings call for a need to sensitize service providers on SRH needs of PWPDs for better support and for the government to enforce the provision of PWPD-friendly services in all health facilities. PMID:25086444

Challenges in accessing sexual and reproductive health services by people with physical disabilities in Kampala, Uganda.

PubMed

Ahumuza, Sharon Eva; Matovu, Joseph K B; Ddamulira, John Bosco; Muhanguzi, Florence Kyoheirwe

2014-08-02

Despite the universal right to access the same range, quality and standard of free or affordable health care and programs as provided to other persons, people with physical disabilities (PWPDs) continue to experience challenges in accessing these services. This article presents the challenges faced by PWPDs in accessing sexual and reproductive health (SRH) services in Kampala, Uganda. This was a qualitative study that was conducted with male and female PWPDs in Kampala in 2007. Data on the challenges experienced by PWPDs in accessing SRH services were collected using in-depth interviews with 40 PWPDs and key informant interviews with 10 PWPDs' representatives, staff of agencies supporting PWPDs and health workers. All data were captured verbatim using an audio-tape recorder, entered into a Microsoft Word computer program and analyzed manually following a content thematic approach. The study findings show that PWPDs face a multitude of challenges in accessing SRH services including negative attitudes of service providers, long queues at health facilities, distant health facilities, high costs of services involved, unfriendly physical structures and the perception from able-bodied people that PWPDs should be asexual. People with physical disabilities (PWPDs) face health facility-related (service provider and facility-related challenges), economic and societal challenges in accessing SRH services. These findings call for a need to sensitize service providers on SRH needs of PWPDs for better support and for the government to enforce the provision of PWPD-friendly services in all health facilities.

Lost Keys: Understanding Service Providers' Impressions of Frequent Visitors to Psychiatric Emergency Services in Singapore.

PubMed

Poremski, Daniel; Kunjithapatham, Ganesh; Koh, Doris; Lim, Xin Ya; Alexander, Mark; Lee, Cheng

2017-04-01

This study used administrative data to identify characteristics of frequent users of Singapore's largest specialized psychiatric emergency department (ED). Qualitative interviews were conducted to understand staff opinions of frequent visitors. Data were from administrative records of all adult visits to the ED (N=16,123 visits of 10,108 individual users) in 2014. Random-effects logistic regressions were used to identify demographic and diagnostic characteristics of frequent visitors. To facilitate interpretation of administrative data in a convergent mixed-methods study design, interviews were conducted with 26 service providers who worked in the ED. Frequent use was defined as five or more visits in 2014. This cutoff distinguished the top 3% of users (N=331), and this group accounted for 16% of service use. Frequent users were more likely to have a diagnosis of a psychotic disorder, personality disorder, or alcohol use disorder. Service provider groups (for example, physicians, nurses, and assistants) described similar groups of frequent users and noted that frequent use was related to lack of social supports outside the hospital and feelings of belonging within it. The most frequently cited challenges were managing intoxicated service seekers, managing expectations for admission, and dealing with threats of self-harm. The profiles of frequent ED users in Singapore resembled those reported in other large urban centers. The opinions of service providers and their reactions to difficult situations were similar to those of providers in nonpsychiatric settings. The service providers' perspectives highlight how societal pressures influence the way in which individuals with mental illnesses use services.

75 FR 20364 - Public Buildings Service; Key Largo Beacon Annex Site; Key Largo, FL; Transfer of Property

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-19

... GENERAL SERVICES ADMINISTRATION [Wildlife Order 187; 4-D-FL-1218] Public Buildings Service; Key Largo Beacon Annex Site; Key Largo, FL; Transfer of Property Pursuant to section 2 of Public Law 537, 80th Congress, approved May 19, 1948 (16 U.S.C. 667c), notice is hereby given that: 1. The General...

A qualitative study of the role of workplace and interpersonal trust in shaping service quality and responsiveness in Zambian primary health centres

PubMed Central

Topp, Stephanie M; Chipukuma, Julien M

2016-01-01

Background: Human decisions, actions and relationships that invoke trust are at the core of functional and productive health systems. Although widely studied in high-income settings, comparatively few studies have explored the influence of trust on health system performance in low- and middle-income countries. This study examines how workplace and inter-personal trust impact service quality and responsiveness in primary health services in Zambia. Methods: This multi-case study included four health centres selected for urban, peri-urban and rural characteristics. Case data included provider interviews (60); patient interviews (180); direct observation of facility operations (two weeks/centre) and key informant interviews (14) that were recorded and transcribed verbatim. Case-based thematic analysis incorporated inductive and deductive coding. Results: Findings demonstrated that providers had weak workplace trust influenced by a combination of poor working conditions, perceptions of low pay and experiences of inequitable or inefficient health centre management. Weak trust in health centre managers’ organizational capacity and fairness contributed to resentment amongst many providers and promoted a culture of blame-shifting and one-upmanship that undermined teamwork and enabled disrespectful treatment of patients. Although patients expressed a high degree of trust in health workers’ clinical capacity, repeated experiences of disrespectful or unresponsive care undermined patients’ trust in health workers’ service values and professionalism. Lack of patient–provider trust prompted some patients to circumvent clinic systems in an attempt to secure better or more timely care. Conclusion: Lack of resourcing and poor leadership were key factors leading to providers’ weak workplace trust and contributed to often-poor quality services, driving a perverse cycle of negative patient–provider relations across the four sites. Findings highlight the importance of investing in both structural factors and organizational management to strengthen providers’ trust in their employer(s) and colleagues, as an entry-point for developing both the capacity and a work culture oriented towards respectful and patient-centred care. PMID:25999586

Port resilience: overcoming threats to maritime infrastructure and operations from climate change : final report.

DOT National Transportation Integrated Search

2015-12-01

In the coastal zone, seaports and their intermodal connectors are key types of infrastructure that support the global : supply chain, provide regional economic activity, local transportation system services, and community jobs. The : protection of co...

Highway user expectations for ITD winter maintenance.

DOT National Transportation Integrated Search

2014-07-01

Providing a high Level of Service (LOS) to ensure the safety and mobility for the traveling public is a key objective for winter : maintenance operations. The goal of this research was to obtain a better understanding of Idaho highway users expect...

Defense transportation : more reliable information key to managing airlift services more efficiently

DOT National Transportation Integrated Search

2000-02-01

The Department of Defense's (DOD) guidance provides that the Air Mobility Command's airlift costs associated with its peacetime mission (operations and maintenance) are to be funded through a transportation working capital fund. Under the working cap...

Data Management for Effective Condition Assessment of Collection Systems

EPA Science Inventory

Condition assessment provides critical information for assessment of an asset’s physical condition, remaining useful service life, and long-term performance. This paper will describe data management issues integral to a successful condition assessment program. Key points will b...

Position of the American Dietetic Association, Society for Nutrition Education, and American School Food Service Association--Nutrition services: an essential component of comprehensive school health programs.

PubMed

Briggs, Marilyn; Safaii, SeAnne; Beall, Deborah Lane

2003-04-01

It is the position of the American Dietetic Association (ADA), the Society for Nutrition Education (SNE), and the American School Food Service Association (ASFSA) that comprehensive nutrition services must be provided to all of the nation's preschool through grade twelve students. These nutrition services shall be integrated with a coordinated, comprehensive school health program and implemented through a school nutrition policy. The policy should link comprehensive, sequential nutrition education; access to and promotion of child nutrition programs providing nutritious meals and snacks in the school environment; and family, community, and health services' partnerships supporting positive health outcomes for all children. Childhood obesity has reached epidemic proportions and is directly attributed to physical inactivity and diet. Schools can play a key role in reversing this trend through coordinated nutrition services that promote policies linking comprehensive, sequential nutrition education programs, access to and marketing of child nutrition programs, a school environment that models healthy food choices, and community partnerships. This position paper provides information and resources for nutrition professionals to use in developing and supporting comprehensive school health programs. J Am Diet Assoc. 2003;103:505-514.

18. Interior view, 'Inside Key Route Inspection Bldg.', view to ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

18. Interior view, 'Inside Key Route Inspection Bldg.', view to east, August 16, 1939. Note inspection pits and work areas beneath tracks. The Key Route and Interurban Electric Railway Bridge Yard Shop buildings were identical, and this view provides an in-service look at the well-lit interior. While Key Route articulated cars were quite different in design from the Interurban Electric Railway cars, the maintenance requirements were quite similar. The Key Route Bridge Yard Shop building was demolished in the 1970s. Its last use was storage of much of the historic railway equipment now on display at the California State Railroad Museum in Sacramento. - Interurban Electric Railway Bridge Yard Shop, Interstate 80 at Alameda County Postmile 2.0, Oakland, Alameda County, CA

Assessment of policy and access to HIV prevention, care, and treatment services for men who have sex with men and for sex workers in Burkina Faso and Togo.

PubMed

Duvall, Sandra; Irani, Laili; Compaoré, Cyrille; Sanon, Patrice; Bassonon, Dieudonne; Anato, Simplice; Agounke, Jeannine; Hodo, Ama; Kugbe, Yves; Chaold, Gertrude; Nigobora, Berry; MacInnis, Ron

2015-03-01

In Burkina Faso and Togo, key populations of men who have sex with men (MSM) and sex workers (SW) have a disproportionately higher HIV prevalence. This study analyzed the 2 countries' policies impacting MSM and SW; to what extent the policies and programs have been implemented; and the role of the enabling environment, country leadership, and donor support. The Health Policy Project's Policy Assessment and Advocacy Decision Model methodology was used to analyze policy and program documents related to key populations, conduct key informant interviews, and hold stakeholder meetings to validate the findings. Several policy barriers restrict MSM/SW from accessing services. Laws criminalizing MSM/SW, particularly anti-solicitation laws, result in harassment and arrests of even nonsoliciting MSM/SW. Policy gaps exist, including few MSM/SW-supportive policies and HIV prevention measures, e.g., lubricant not included in the essential medicines list. The needs of key populations are generally not met due to policy gaps around MSM/SW participation in decision-making and funding allocation for MSM/SW-specific programming. Misaligned policies, eg, contradictory informed consent laws and protocols, and uneven policy implementation, such as stockouts of sexually transmitted infection kits, HIV testing materials, and antiretrovirals, undermine evidence-based policies. Even in the presence of a supportive donor and political community, public stigma and discrimination (S&D) create a hostile enabling environment. Policies are needed to address S&D, particularly health care provider and law enforcement training, and to authorize, fund, guide, and monitor services for key populations. MSM/SW participation and development of operational guidelines can improve policy implementation and service uptake.

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

Consumer-perceived value: the key to a successful business strategy in the healthcare marketplace.

PubMed

Ettinger, W H

1998-01-01

The Medicare market is becoming increasingly competitive and uncertain. To compete successfully for a share of the Medicare market, providers must: Have a cogent strategy that defines their customers and the value proposition for those customers Design their services to maximize the benefits of outcomes and service process that are important to consumers Determine the needed structure and infrastructure to put those services in place Marketing research is critical in this regard, as is effectiveness tracking. This approach is different from that usually taken by healthcare providers in the marketplace. It means being strategic rather than tactical and proactive rather than reactive. Most importantly, providers must shift their focus externally to the consumer's needs rather than their own. Finally, this approach requires working together in an integrated organization with common goals.

‘Scared of going to the clinic’: Contextualising healthcare access for men who have sex with men, female sex workers and people who use drugs in two South African cities

PubMed Central

2018-01-01

Background Men who have sex with men (MSM), sex workers (SW) and people who use drugs (PWUD) are at increased risk for HIV because of multiple socio-structural barriers and do not have adequate access to appropriate HIV prevention, diagnosis and treatment services. Objective To examine the context of access to healthcare experienced by these three ‘Key Populations’, we conducted a qualitative study in two South African cities: Bloemfontein in the Free State province and Mafikeng in the North West province. Method We carried out in-depth interviews to explore healthcare workers’ perceptions, beliefs and attitudes towards Key Populations. Focus group discussions were also conducted with members of Key Populations exploring their experiences of accessing healthcare. Results Healthcare workers described their own attitudes towards Key Populations and demonstrated a lack of relevant knowledge, skills and training to manage the particular health needs and vulnerabilities facing Key Populations. Female SW, MSM and PWUD described their experiences of stigmatisation, and of being made to feel guilt, shame and a loss of dignity as a result of the discrimination by healthcare providers and other community. members. Our findings suggest that the uptake and effectiveness of health services amongst Key Populations in South Africa is limited by internalised stigma, reluctance to seek care, unwillingness to disclose risk behaviours to healthcare workers, combined with a lack of knowledge and understanding on the part of the broader community members, including healthcare workers. Conclusion This research highlights the need to address the broader healthcare provision environment, improving alignment of policies and programming in order to strengthen provision of effective health services that people from Key Populations will be able to access. PMID:29568645

Facilitating Secure Sharing of Personal Health Data in the Cloud

PubMed Central

Nepal, Surya; Glozier, Nick

2016-01-01

Background Internet-based applications are providing new ways of promoting health and reducing the cost of care. Although data can be kept encrypted in servers, the user does not have the ability to decide whom the data are shared with. Technically this is linked to the problem of who owns the data encryption keys required to decrypt the data. Currently, cloud service providers, rather than users, have full rights to the key. In practical terms this makes the users lose full control over their data. Trust and uptake of these applications can be increased by allowing patients to feel in control of their data, generally stored in cloud-based services. Objective This paper addresses this security challenge by providing the user a way of controlling encryption keys independently of the cloud service provider. We provide a secure and usable system that enables a patient to share health information with doctors and specialists. Methods We contribute a secure protocol for patients to share their data with doctors and others on the cloud while keeping complete ownership. We developed a simple, stereotypical health application and carried out security tests, performance tests, and usability tests with both students and doctors (N=15). Results We developed the health application as an app for Android mobile phones. We carried out the usability tests on potential participants and medical professionals. Of 20 participants, 14 (70%) either agreed or strongly agreed that they felt safer using our system. Using mixed methods, we show that participants agreed that privacy and security of health data are important and that our system addresses these issues. Conclusions We presented a security protocol that enables patients to securely share their eHealth data with doctors and nurses and developed a secure and usable system that enables patients to share mental health information with doctors. PMID:27234691

Database on Demand: insight how to build your own DBaaS

NASA Astrophysics Data System (ADS)

Gaspar Aparicio, Ruben; Coterillo Coz, Ignacio

2015-12-01

At CERN, a number of key database applications are running on user-managed MySQL, PostgreSQL and Oracle database services. The Database on Demand (DBoD) project was born out of an idea to provide CERN user community with an environment to develop and run database services as a complement to the central Oracle based database service. The Database on Demand empowers the user to perform certain actions that had been traditionally done by database administrators, providing an enterprise platform for database applications. It also allows the CERN user community to run different database engines, e.g. presently three major RDBMS (relational database management system) vendors are offered. In this article we show the actual status of the service after almost three years of operations, some insight of our new redesign software engineering and near future evolution.

Mobile-PKI Service Model for Ubiquitous Environment

NASA Astrophysics Data System (ADS)

Jeun, Inkyung; Chun, Kilsoo

One of the most important things in PKI(Public Key Infrastructure) is the private key management issue. The private key must be deal with safely for secure PKI service. Even though PKI service is usually used for identification and authentication of user in e-commerce, PKI service has many inconvenient factors. Especially, the fact that storage media of private key for PKI service is limited to PC hard disk drive or smart card users must always carry, gives an inconvenience to user and is not suitable in ubiquitous network. This paper suggests the digital signature service using a mobile phone(m-PKI service) which is suitable in future network. A mobile phone is the most widely used for personal communication means and has a characteristic of high movability. We can use the PKI service anytime and anywhere using m-PKI.

Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review

PubMed Central

Hudon, Catherine; Chouinard, Maud-Christine; Lambert, Mireille; Diadiou, Fatoumata; Bouliane, Danielle; Beaudin, Jérémie

2017-01-01

Objective The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness. Design Thematic analysis review of CM studies. Methods We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004–December 2015 period, then updated to July 2017, with the keywords ‘CM’ and ‘frequent use’. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir’s implementation of health innovations framework was used to organise results into four broad levels of factors: (1) environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level. Results Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration. Conclusions CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts. PMID:29061623

An Improved and Secure Anonymous Biometric-Based User Authentication with Key Agreement Scheme for the Integrated EPR Information System.

PubMed

Jung, Jaewook; Kang, Dongwoo; Lee, Donghoon; Won, Dongho

2017-01-01

Nowadays, many hospitals and medical institutes employ an authentication protocol within electronic patient records (EPR) services in order to provide protected electronic transactions in e-medicine systems. In order to establish efficient and robust health care services, numerous studies have been carried out on authentication protocols. Recently, Li et al. proposed a user authenticated key agreement scheme according to EPR information systems, arguing that their scheme is able to resist various types of attacks and preserve diverse security properties. However, this scheme possesses critical vulnerabilities. First, the scheme cannot prevent off-line password guessing attacks and server spoofing attack, and cannot preserve user identity. Second, there is no password verification process with the failure to identify the correct password at the beginning of the login phase. Third, the mechanism of password change is incompetent, in that it induces inefficient communication in communicating with the server to change a user password. Therefore, we suggest an upgraded version of the user authenticated key agreement scheme that provides enhanced security. Our security and performance analysis shows that compared to other related schemes, our scheme not only improves the security level, but also ensures efficiency.

An Improved and Secure Anonymous Biometric-Based User Authentication with Key Agreement Scheme for the Integrated EPR Information System

PubMed Central

Kang, Dongwoo; Lee, Donghoon; Won, Dongho

2017-01-01

Nowadays, many hospitals and medical institutes employ an authentication protocol within electronic patient records (EPR) services in order to provide protected electronic transactions in e-medicine systems. In order to establish efficient and robust health care services, numerous studies have been carried out on authentication protocols. Recently, Li et al. proposed a user authenticated key agreement scheme according to EPR information systems, arguing that their scheme is able to resist various types of attacks and preserve diverse security properties. However, this scheme possesses critical vulnerabilities. First, the scheme cannot prevent off-line password guessing attacks and server spoofing attack, and cannot preserve user identity. Second, there is no password verification process with the failure to identify the correct password at the beginning of the login phase. Third, the mechanism of password change is incompetent, in that it induces inefficient communication in communicating with the server to change a user password. Therefore, we suggest an upgraded version of the user authenticated key agreement scheme that provides enhanced security. Our security and performance analysis shows that compared to other related schemes, our scheme not only improves the security level, but also ensures efficiency. PMID:28046075

Secure Cryptographic Key Management System (CKMS) Considerations for Smart Grid Devices

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

Abercrombie, Robert K; Sheldon, Frederick T; Aldridge, Hal

2011-01-01

In this paper, we examine some unique challenges associated with key management in the Smart Grid and concomitant research initiatives: 1) effectively model security requirements and their implementations, and 2) manage keys and key distribution for very large scale deployments such as Smart Meters over a long period of performance. This will set the stage to: 3) develop innovative, low cost methods to protect keying material, and 4) provide high assurance authentication services. We will present our perspective on key management and will discuss some key issues within the life cycle of a cryptographic key designed to achieve the following:more » 1) control systems designed, installed, operated, and maintained to survive an intentional cyber assault with no loss of critical function, and 2) widespread implementation of methods for secure communication between remote access devices and control centers that are scalable and cost-effective to deploy.« less

Secondary Use of Clinical Data: the Vanderbilt Approach

PubMed Central

Danciu, Ioana; Cowan, James D.; Basford, Melissa; Wang, Xiaoming; Saip, Alexander; Osgood, Susan; Shirey-Rice, Jana; Kirby, Jacqueline; Harris, Paul A.

2014-01-01

The last decade has seen an exponential growth in the quantity of clinical data collected nationwide, triggering an increase in opportunities to reuse the data for biomedical research. The Vanderbilt research data warehouse framework consists of identified and de-identified clinical data repositories, fee-for-service custom services, and tools built atop the data layer to assist researchers across the enterprise. Providing resources dedicated to research initiatives benefits not only the research community, but also clinicians, patients and institutional leadership. This work provides a summary of our approach in the secondary use of clinical data for research domain, including a description of key components and a list of lessons learned, designed to assist others assembling similar services and infrastructure. PMID:24534443

Universal Health Coverage and Primary Healthcare: Lessons From Japan

PubMed Central

Bloom, Gerald

2017-01-01

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

The structure of service quality perceptions for multiple-encounter services.

PubMed

Andaleeb, Syed Saad; Kara, Ali

2013-01-01

The objective of this study was to examine a complex service environment-hospitals-to suggest how service quality could be reframed and measured for multiple-encounter service situations more effectively. In this cross-sectional study, a sample of 371 patients completed the survey instrument. Service quality measures were guided by the literature but allowed to flow from the respondents at the preliminary stage. Confirmatory factor analysis, along with structural equation modeling, was used to test the hypothesized relationships among key actors' performance metrics (KAPMs). Patient satisfaction is significantly influenced by perceived service quality based on KAPMs. For multiple-encounter services, service quality dimensions and measures ought to be tied to KAPMs. Primary actors-ie, doctors-need knowledge and skills about patient psychology, negotiation, handling difficult patients, and, importantly, "putting the customer first." Sensitivity training on such matters should be provided. The secondary actors are the nurses who have more frequent contact with the patients. Nurses need to be perceived as "patient advocates." Effective advocacy begins with prompt and caring services to build trust. The tertiary actors in their support role also ought to be integrated into becoming vital part of the service provided.

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.

Towards a Location-based Service for Early Mental Health Interventions in Disaster Response Using Minimalistic Tele-operated Android Robots Technology

NASA Astrophysics Data System (ADS)

Vahidi, H.; Mobasheri, A.; Alimardani, M.; Guan, Q.; Bakillah, M.

2014-04-01

Providing early mental health services during disaster is a great challenge in the disaster response phase. Lack of access to adequate mental-health professionals in the early stages of large-scale disasters dramatically influences the trend of a successful mental health aid. In this paper, a conceptual framework has been suggested for adopting cellphone-type tele-operated android robots in the early stages of disasters for providing the early mental health services for disaster survivors by developing a locationbased and participatory approach. The techniques of enabling GI-services in a Peer-to-Peer (P2P) environment were studied to overcome the limitations of current centralized services. Therefore, the aim of this research study is to add more flexibility and autonomy to GI web services (WMS, WFS, WPS, etc.) and alleviate to some degree the inherent limitations of these centralized systems. A P2P system Architecture is presented for the location-based service using minimalistic tele-operated android robots, and some key techniques of implementing this service using BestPeer were studied for developing this framework.

Using the UKROC dataset to make the case for resources to improve cost-efficiency in neurological rehabilitation

PubMed Central

2012-01-01

Purpose A key challenge for providers and commissioners of rehabilitation services is to find optimal balance between service costs and outcomes. This article presents a “real-lifeâ application of the UK Rehabilitation Outcomes Collaborative (UKROC) dataset. We undertook a comparative cohort analysis of case-episode data (n = 173) from two specialist neurological rehabilitation units (A and B), to compare the cost-efficiency of two service models. Key messages (i) Demographics, casemix and levels of functional dependency on admission and discharge were broadly similar for the two units. (ii) The mean length of stay for Unit A was 1.5 times longer than Unit B, which had 85% higher levels of therapy staffing in relation to occupied bed days so despite higher bed-day costs, Unit B was 20% more cost-efficient overall, for similar gain. (iii) Following analysis, engagement with service commissioners led to successful negotiation of a business plan for service reconfiguration with increased staffing levels for Unit A and further development of local community rehabilitation services. Conclusion (i) Lower front-end service costs do not always signify optimal cost-efficiency. (ii) Analysis of routinely collected clinical data can be used to engage commissioners and to make the case for resources to maximise efficiency and improve patient care. PMID:22506504

Balancing ecosystem function, services and disservices resulting from expanding goose populations.

PubMed

Buij, Ralph; Melman, Theodorus C P; Loonen, Maarten J J E; Fox, Anthony D

2017-03-01

As goose populations increase in abundance, their influence on ecological processes is increasing. We review the evidence for key ecological functions of wild goose populations in Eurasia and North America, including aquatic invertebrate and plant propagule transport, nutrient deposition in terrestrial and aquatic ecosystems, the influence of goose populations on vegetation biomass, carbon storage and methane emission, species diversity and disease transmission. To estimate the implications of their growing abundance for humans, we explore how these functions contribute to the provision of ecosystem services and disservices. We assess the weight, extent and trends among such impacts, as well as the balance of their value to society. We examine key unresolved issues to enable a more balanced assessment of the economic costs or benefits of migratory geese along their flyways, including the spatial and temporal variation in services and their contrasting value to different user groups. Many ecological functions of geese are concluded to provide neither services nor disservices and, ecosystem disservices currently appear to outweigh services, although this varies between regions. We consider an improved quantification of ecosystem services and disservices, and how these vary along population flyways with respect to variation in valuing certain cultural services, and under different management scenarios aimed at reducing their disservices, essential for a more balanced management of goose populations.

Challenges in immunisation service delivery for refugees in Australia: A health system perspective.

PubMed

Mahimbo, A; Seale, H; Smith, M; Heywood, A

2017-09-12

Refugees are at risk of being under-immunised in their countries of origin, in transit and post-resettlement in Australia. Whilst studies have focused on identifying barriers to accessibility of health services among refugees, few focus on providers' perspectives on immunisation service delivery to this group. Health service providers are well placed to provide insights into the pragmatic challenges associated with refugee health service delivery, which can be useful in identifying strategies aimed at improving immunisation coverage among this group. A qualitative study involving 30 semi-structured interviews was undertaken with key stakeholders in immunisation service delivery across all States and Territories in Australia between December 2014 and December 2015. Thematic analysis was undertaken. Variability in accessing program funding and vaccines, lack of a national policy for catch-up vaccination, unclear roles and responsibilities for catch-up, a lack of a central immunisation register and insufficient training among general practitioners were seen as the main challenges impacting on immunisation service delivery for refugees. This study provides insight into the challenges that impact on effective immunisation service delivery for refugees. Deliberate strategies such as national funding for relevant vaccines, improved data collection nationally and increased guidance for general practitioners on catch-up immunisation for refugees would help to ensure equitable access across all age groups. Copyright © 2017 Elsevier Ltd. All rights reserved.

Barriers to utilization of childbirth services of a rural birthing center in Nepal: A qualitative study.

PubMed

Khatri, Resham Bahadur; Dangi, Tara Prasad; Gautam, Rupesh; Shrestha, Khadka Narayan; Homer, Caroline S E

2017-01-01

Maternal mortality and morbidity are public health problems in Nepal. In rural communities, many women give birth at home without the support of a skilled birth attendant, despite the existence of rural birthing centers. The aim of this study was to explore the barriers and provide pragmatic recommendations for better service delivery and use of rural birthing centers. We conducted 26 in-depth interviews with service users and providers, and three focus group discussions with community key informants in a rural community of Rukum district. We used the Adithya Cattamanchi logic model as a guiding framework for data analysis. Irregular and poor quality services, inadequate human and capital resources, and poor governance were health system challenges which prevented service delivery. Contextual barriers including difficult geography, poor birth preparedness practices, harmful culture practices and traditions and low level of trust were also found to contribute to underutilization of the birthing center. The rural birthing center was not providing quality services when women were in need, which meant women did not use the available services properly because of systematic and contextual barriers. Approaches such as awareness-raising activities, local resource mobilization, ensuring access to skilled providers and equipment and other long-term infrastructure development works could improve the quality and utilization of childbirth services in the rural birthing center. This has resonance for other centers in Nepal and similar countries.

Insurance-related Practices at Title X-funded Family Planning Centers under the Affordable Care Act: Survey and Interview Findings.

PubMed

Zolna, Mia R; Kavanaugh, Megan L; Hasstedt, Kinsey

Given the recent reforms in the United States health care system, including the passage and implementation of the Affordable Care Act, as well as anticipated upcoming changes to health care coverage, it is critical that publicly funded health care providers understand how to effectively work with their states' Medicaid programs and the private health insurance plans in their service areas to provide high-quality contraceptive care to the millions of women relying on services at these sites annually. We collected survey data from a nationally representative sample of 535 clinics providing family planning services that received Title X funding and conducted semistructured interviews with 23 administrators at a subsample of surveyed clinics to explore provider-reported experiences working with health plans and to identify barriers to, and practices that lead to, adequate reimbursement for services provided. Providers report that knowledgeable staff are crucial to securing contracts with both public and private insurance plan issuers, and that the contracts they secure often include coverage restrictions on methods or services clinics offer their clients. Good staff relationships with issuers are key to obtaining adequate and consistent reimbursement for all covered services. Providers are trying to understand how insurance programs in their area knit together. Regardless of how U.S. health policies and delivery systems may change in the coming years, it is imperative that publicly funded family planning centers continue to work with health plans and maximize their third-party revenue to provide services to those in need. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Insurance-related Practices at Title X-funded Family Planning Centers under the Affordable Care Act: Survey and Interview Findings

PubMed Central

Zolna, Mia R.; Kavanaugh, Megan L.; Hasstedt, Kinsey

2018-01-01

Introduction Given the recent reforms in the United States health care system, including the passage and implementation of the Affordable Care Act, as well as anticipated upcoming changes to health care coverage, it is critical that publicly funded health care providers understand how to effectively work with their states’ Medicaid programs and the private health insurance plans in their service areas to provide high-quality contraceptive care to the millions of women relying on services at these sites annually. Methods We collected survey data from a nationally representative sample of 535 clinics providing family planning services that received Title X funding and conducted semistructured interviews with 23 administrators at a subsample of surveyed clinics to explore provider-reported experiences working with health plans and to identify barriers to, and practices that lead to, adequate reimbursement for services provided. Results Providers report that knowledgeable staff are crucial to securing contracts with both public and private insurance plan issuers, and that the contracts they secure often include coverage restrictions on methods or services clinics offer their clients. Good staff relationships with issuers are key to obtaining adequate and consistent reimbursement for all covered services. Conclusions Providers are trying to understand how insurance programs in their area knit together. Regardless of how U.S. health policies and delivery systems may change in the coming years, it is imperative that publicly funded family planning centers continue to work with health plans and maximize their third-party revenue to provide services to those in need. PMID:29108987

Stakeholder engagement and public policy evaluation: factors contributing to the development and implementation of a regional network for geriatric care.

PubMed

Glover, Catherine; Hillier, Loretta M; Gutmanis, Iris

2007-01-01

The development and implementation of a regional network that provides universally accessible and consistent services to the frail elderly living in Southwestern Ontario is described. Through continuous stakeholder engagement, clear network goals were identified and operationalized. Stakeholder commitment to the integration of expertise and specialized services, to evidence-based public policy and to iterative evaluation cycles were key to network success.

Chiropractic Health Care: A National Study of Cost of Education, Service Utilization, Number of Practicing Doctors of Chiropractic, and Other Key Policy Issues. Volumes I-II.

ERIC Educational Resources Information Center

von Kuster, Thomas, Jr.

Results from the first federally sponsored study of the chiropractic health care profession are presented, and a broad range of facts and issues of concern to policy-makers, the profession, and the public are described. The two-year project included three national surveys of: service providers (doctors of chiropractic in practice more than two…

Keys to the Future: A Handbook for Parents of Children with Disabilities [and] Las Llaves para el Futuro: Un Libro para los Padres de Ninos con Problemas de Desarrollo.

ERIC Educational Resources Information Center

Idaho State Council on Developmental Disabilities.

Designed for parents of children with disabilities, this handbook (in both English and Spanish versions) provides information about services available in Idaho, how to use these services, and how to approach the job of parenting a child with disabilities. Chapters include: (1) "Beginnings: Understanding Your Family and Your Child with a…

TAS::89 0927::TAS RECOVERY - The Lean Green Energy Controller Machine

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

Teeter, John; Wang, Gene; Moss, David

Achieving efficiency improvements and providing demand-response programs have been identified as key elements of our national energy initiative. The residential market is the largest, yet most difficult, segment to engage in efforts to meet these objectives. This project developed Energy Management System that engages the consumer and enables Smart Grid services, applications, and business processes to address this need. Our innovative solution provides smart controller providing dynamic optimization of energy consumption for the residential energy consumer. Our solution extends the technical platform to include a cloud based Internet of Things (IoT) aggregation of data sensors and actuators the go beyondmore » energy management and extend to life style services provided through compelling mobile and console based user experiences.« less

Contracting and Procurement for Evidence-Based Interventions in Public-Sector Human Services: A Case Study.

PubMed

Willging, Cathleen E; Aarons, Gregory A; Trott, Elise M; Green, Amy E; Finn, Natalie; Ehrhart, Mark G; Hecht, Debra B

2016-09-01

Sustainment of evidence-based interventions (EBIs) in human services depends on the inner context of community-based organizations (CBOs) that provide services and the outer context of their broader environment. Increasingly, public officials are experimenting with contracting models from for-profit industries to procure human services. In this case study, we conducted qualitative interviews with key government and CBO stakeholders to examine implementation of the Best Value-Performance Information Procurement System to contract for EBIs in a child welfare system. Findings suggest that stakeholder relationships may be compromised when procurement disregards local knowledge, communication, collaboration, and other factors supporting EBIs and public health initiatives.

A qualitative study of the role of workplace and interpersonal trust in shaping service quality and responsiveness in Zambian primary health centres.

PubMed

Topp, Stephanie M; Chipukuma, Julien M

2016-03-01

Human decisions, actions and relationships that invoke trust are at the core of functional and productive health systems. Although widely studied in high-income settings, comparatively few studies have explored the influence of trust on health system performance in low- and middle-income countries. This study examines how workplace and inter-personal trust impact service quality and responsiveness in primary health services in Zambia. This multi-case study included four health centres selected for urban, peri-urban and rural characteristics. Case data included provider interviews (60); patient interviews (180); direct observation of facility operations (two weeks/centre) and key informant interviews (14) that were recorded and transcribed verbatim. Case-based thematic analysis incorporated inductive and deductive coding. Findings demonstrated that providers had weak workplace trust influenced by a combination of poor working conditions, perceptions of low pay and experiences of inequitable or inefficient health centre management. Weak trust in health centre managers' organizational capacity and fairness contributed to resentment amongst many providers and promoted a culture of blame-shifting and one-upmanship that undermined teamwork and enabled disrespectful treatment of patients. Although patients expressed a high degree of trust in health workers' clinical capacity, repeated experiences of disrespectful or unresponsive care undermined patients' trust in health workers' service values and professionalism. Lack of patient-provider trust prompted some patients to circumvent clinic systems in an attempt to secure better or more timely care. Lack of resourcing and poor leadership were key factors leading to providers' weak workplace trust and contributed to often-poor quality services, driving a perverse cycle of negative patient-provider relations across the four sites. Findings highlight the importance of investing in both structural factors and organizational management to strengthen providers' trust in their employer(s) and colleagues, as an entry-point for developing both the capacity and a work culture oriented towards respectful and patient-centred care. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Marketing concepts for pharmaceutical service development.

PubMed

Grauer, D W

1981-02-01

Marketing concepts as a mechanism to help pharmacy develop, communicate, and sell future pharmaceutical services to consumers are discussed. Pharmacy as a profession must define itself broadly to take advantage of future growth opportunities. These growth opportunities will be realized from unmet health-care needs and changing consumer life style trends and values. New services must therefore be oriented toward consumers (i.e., patients, health professionals, and third-party agencies) to gain acceptance. Dispensing and drug-knowledge-distribution pharmaceutical services are reviewed by a product life cycle analysis of sales profits versus time. A marketing mix for new pharmaceutical services is developed consisting of service, price, distribution, and promotion strategies. Marketing can encompass those key elements necessary to meet the organizational goals of pharmacy and provide a systematic, disciplined approach for presenting a new service to consumers.

In-flight food delivery and waste collection service: the passengers’ perspective and potential improvement

NASA Astrophysics Data System (ADS)

Romli, F. I.; Rahman, K. Abdul; Ishak, F. D.

2016-10-01

Increased competition in the commercial air transportation industry has made service quality of the airlines as one of the key competitive measures to attract passengers against their rivals. In-flight services, particularly food delivery and waste collection, have a notable impact on perception of the overall airline's service quality because they are directly and interactively provided to passengers during flight. An online public survey is conducted to explore general passengers' perception of current in-flight food delivery and waste collection services, and to identify potential rooms for improvement. The obtained survey results indicate that in-flight service does have an effect on passengers' choice of airlines. Several weaknesses of the current service method and possible improvements have been established from the collected responses.

HIV service delivery models towards 'Zero AIDS-related Deaths': a collaborative case study of 6 Asia and Pacific countries.

PubMed

Fujita, Masami; Poudel, Krishna C; Green, Kimberly; Wi, Teodora; Abeyewickreme, Iyanthi; Ghidinelli, Massimo; Kato, Masaya; Vun, Mean Chhi; Sopheap, Seng; San, Khin Ohnmar; Bollen, Phavady; Rai, Krishna Kumar; Dahal, Atul; Bhandari, Durga; Boas, Peniel; Yaipupu, Jessica; Sirinirund, Petchsri; Saonuam, Pairoj; Duong, Bui Duc; Nhan, Do Thi; Thu, Nguyen Thi Minh; Jimba, Masamine

2015-04-24

In the Asia-Pacific region, limited systematic assessment has been conducted on HIV service delivery models. Applying an analytical framework of the continuum of prevention and care, this study aimed to assess HIV service deliveries in six Asia and Pacific countries from the perspective of service availability, linking approaches and performance monitoring for maximizing HIV case detection and retention. Each country formed a review team that provided published and unpublished information from the national HIV program. Four types of continuum were examined: (i) service linkages between key population outreach and HIV diagnosis (vertical-community continuum); (ii) chronic care provision across HIV diagnosis and treatment (chronological continuum); (iii) linkages between HIV and other health services (horizontal continuum); and (iv) comprehensive care sites coordinating care provision (hub and heart of continuum). Regarding the vertical-community continuum, all districts had voluntary counselling and testing (VCT) in all countries except for Myanmar and Vietnam. In these two countries, limited VCT availability was a constraint for referring key populations reached. All countries monitored HIV testing coverage among key populations. Concerning the chronological continuum, the proportion of districts/townships having antiretroviral treatment (ART) was less than 70% except in Thailand, posing a barrier for accessing pre-ART/ART care. Mechanisms for providing chronic care and monitoring retention were less developed for VCT/pre-ART process compared to ART process in all countries. On the horizontal continuum, the availability of HIV testing for tuberculosis patients and pregnant women was limited and there were sub-optimal linkages between tuberculosis, antenatal care and HIV services except for Cambodia and Thailand. These two countries indicated higher HIV testing coverage than other countries. Regarding hub and heart of continuum, all countries had comprehensive care sites with different degrees of community involvement. The analytical framework was useful to identify similarities and considerable variations in service availability and linking approaches across the countries. The study findings would help each country critically adapt and adopt global recommendations on HIV service decentralization, linkages and integration. Especially, the findings would inform cross-fertilization among the countries and national HIV program reviews to determine county-specific measures for maximizing HIV case detection and retention.

An Assessment of the Service Quality Provided to Foreign Students at U.S. Business Schools.

ERIC Educational Resources Information Center

Tomkovick, Chuck; And Others

1996-01-01

From a national sample of 625 foreign students in U.S. business schools, 282 identified key quality dimensions in enhancing their satisfaction: facilities and equipment, faculty ability to interact with them, reliability, empathy, and responsiveness. (SK)

FTA real-time transit information assessment : white paper on literature review of real-time transit information systems.

DOT National Transportation Integrated Search

Real-time transit information systems are key technology applications within the transit industry designed to provide better customer service by disseminating timely and accurate information. Riders use this information to make various decisions abou...

Critical Issues: Keys to Successful Contracting

ERIC Educational Resources Information Center

Zopf, Michael

2010-01-01

In today's restrictive school-funding environment, many school districts are evaluating different strategies for providing noninstructional support services to preserve financial resources for the classroom. Among the strategies they are considering on a wide scale is the contracting of support functions, including pupil transportation, custodial…

CCTV Data Management for Effective Condition Assessment of Wastewater Collection Systems

EPA Science Inventory

Condition assessment provides critical information for determining an asset’s physical condition, remaining useful service life, and long-term performance. Data management issues integral to a successful condition assessment program are described in this paper. Key points are i...

Adaptive governance to promote ecosystem services in urban green spaces

EPA Science Inventory

Managing urban green space as part of an ongoing social-ecological transformationposes novel governance issues, particularly in post-industrial settings. Urban green spaces operate as small-scale nodes in larger networks of ecological reserves that provide and maintain key ecosys...

Paying for obesity: a changing landscape.

PubMed

Simpson, Lisa A; Cooper, Julie

2009-06-01

Coverage for obesity related services is highly variable. Despite this, health plans, purchasers, and states have mounted numerous recent initiatives. To identify the range of approaches being used to address coverage and reimbursement for childhood obesity services. Key informant interviews were conducted using a semi-structured protocol to identify the types of activities they or their organization were engaged in to address childhood obesity, to learn about private payer policies and procedures, to identify best practices, potential resources and/or other key informants. Domains addressed in the protocol included scope of the respondent's organization's activities, the rationale for supporting obesity activities, the degree to which obesity services were a covered benefit and what if any barriers or challenges were encountered in implementation, the policy climate within which the organization operates (e.g. state legislation, initiatives or task forces), and any assessment of the impact and/or cost of implementing their initiatives. The individuals interviewed represented respondents from each of the following categories: employer, health plan, and state insurance programs and conducted by phone between November 2007 and March 2008. In addition to the information gathered by the key informant interviews we conducted a search of the relevant peer review and grey literature between 2005 and 2008 and input from a national expert advisory group. Significant variation, as well as recent changes, were identified in both the private and public sector. Approaches included new benefits and incentives for parents and providers. Only anecdotal evidence of impact of the recent changes was available. There is important forward movement in how public and private players are addressing paying for obesity related services. Medicaid and SCHIP programs have an opportunity to provide additional leadership. Substantial investments in evaluation and research are needed to learn which approaches are most effective.

Network Hardware Virtualization for Application Provisioning in Core Networks

DOE PAGES

Gumaste, Ashwin; Das, Tamal; Khandwala, Kandarp; ...

2017-02-03

We present that service providers and vendors are moving toward a network virtualized core, whereby multiple applications would be treated on their own merit in programmable hardware. Such a network would have the advantage of being customized for user requirements and allow provisioning of next generation services that are built specifically to meet user needs. In this article, we articulate the impact of network virtualization on networks that provide customized services and how a provider's business can grow with network virtualization. We outline a decision map that allows mapping of applications with technology that is supported in network-virtualization - orientedmore » equipment. Analogies to the world of virtual machines and generic virtualization show that hardware supporting network virtualization will facilitate new customer needs while optimizing the provider network from the cost and performance perspectives. A key conclusion of the article is that growth would yield sizable revenue when providers plan ahead in terms of supporting network-virtualization-oriented technology in their networks. To be precise, providers have to incorporate into their growth plans network elements capable of new service deployments while protecting network neutrality. Finally, a simulation study validates our NV-induced model.« less

Network Hardware Virtualization for Application Provisioning in Core Networks

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

Gumaste, Ashwin; Das, Tamal; Khandwala, Kandarp

We present that service providers and vendors are moving toward a network virtualized core, whereby multiple applications would be treated on their own merit in programmable hardware. Such a network would have the advantage of being customized for user requirements and allow provisioning of next generation services that are built specifically to meet user needs. In this article, we articulate the impact of network virtualization on networks that provide customized services and how a provider's business can grow with network virtualization. We outline a decision map that allows mapping of applications with technology that is supported in network-virtualization - orientedmore » equipment. Analogies to the world of virtual machines and generic virtualization show that hardware supporting network virtualization will facilitate new customer needs while optimizing the provider network from the cost and performance perspectives. A key conclusion of the article is that growth would yield sizable revenue when providers plan ahead in terms of supporting network-virtualization-oriented technology in their networks. To be precise, providers have to incorporate into their growth plans network elements capable of new service deployments while protecting network neutrality. Finally, a simulation study validates our NV-induced model.« less

Assessing Ecosystem Service Provision Under Climate Change to Support Conservation and Development Planning in Myanmar

NASA Technical Reports Server (NTRS)

Mandle, Lisa; Wolny, Stacie; Bhagabati, Nirmal; Helsingen, Hanna; Hamel, Perrine; Bartlett, Ryan; Dixon, Adam; Horton, Radley M.; Lesk, Corey; Manley, Danielle;

RUASN: A Robust User Authentication Framework for Wireless Sensor Networks

PubMed Central

Kumar, Pardeep; Choudhury, Amlan Jyoti; Sain, Mangal; Lee, Sang-Gon; Lee, Hoon-Jae

2011-01-01

In recent years, wireless sensor networks (WSNs) have been considered as a potential solution for real-time monitoring applications and these WSNs have potential practical impact on next generation technology too. However, WSNs could become a threat if suitable security is not considered before the deployment and if there are any loopholes in their security, which might open the door for an attacker and hence, endanger the application. User authentication is one of the most important security services to protect WSN data access from unauthorized users; it should provide both mutual authentication and session key establishment services. This paper proposes a robust user authentication framework for wireless sensor networks, based on a two-factor (password and smart card) concept. This scheme facilitates many services to the users such as user anonymity, mutual authentication, secure session key establishment and it allows users to choose/update their password regularly, whenever needed. Furthermore, we have provided the formal verification using Rubin logic and compare RUASN with many existing schemes. As a result, we found that the proposed scheme possesses many advantages against popular attacks, and achieves better efficiency at low computation cost. PMID:22163888

Quality pharmacy services and key performance indicators in Polish NICUs: a Delphi approach.

PubMed

Krzyżaniak, Natalia; Pawłowska, Iga; Bajorek, Beata

2018-03-31

Background Currently, there is no literature describing what a quality level of practice entails in Polish neonatal intensive care units (NICUs), nor are there any means of currently measuring the quality of pharmaceutical care provided to NICU patients. Objective To identify a set of essential pharmacist roles and pharmacy-relevant key performance indicators (KPI's) suitable for Polish neonatal intensive units (NICUs). Setting Polish hospital pharmacies and NICUs. Method Using a modified Delphi technique, potential KPI's structured along Donabedian's domains as well as pharmacy services were presented to an expert panel of stakeholders. Two online, consecutive Delphi rounds, were completed by panellists between August and September 2017. Main outcome measure To identify the minimum level of pharmacy services that should be consistently provided to NICU patients. Results A total of 16 panellists contributed to the expert panel. Overall, consensus of 75% was reached for 23 indicators and for 28 roles. When considering pharmacy services for the NICU, the experts were found to highly value traditional pharmacy roles, such as dispensing and extemporaneous compounding, however, they were still eager for roles in the other domains, such as educational and clinical services, to be listed as essential for NICU practice. Panellists were found to positively value the list of indicators presented, and excluded only 9 out of the total list. Conclusion There is a need for future research to establish a minimum standard of practice for Polish pharmacists to encourage the progression and standardisation of hospital pharmacy services to meet the level of practice seen in NICUs worldwide.

The 2017 International Joint Working Group White Paper by INDUSEM, the Emergency Medicine Association and the Academic College of Emergency Experts on Establishing Standardized Regulations, Operational Mechanisms, and Accreditation Pathways for Education and Care Provided by the Prehospital Emergency Medical Service Systems in India

PubMed Central

Sikka, Veronica; Gautam, V.; Galwankar, Sagar; Guleria, Randeep; Stawicki, Stanislaw P.; Paladino, Lorenzo; Chauhan, Vivek; Menon, Geetha; Shah, Vijay; Srivastava, R. P.; Rana, B. K.; Batra, Bipin; Kalra, OP.; Aggarwal, P.; Bhoi, Sanjeev; Krishnan, S. Vimal

2017-01-01

The government of India has done remarkable work on commissioning a government funded prehospital emergency ambulance service in India. This has both public health implications and an economic impact on the nation. With the establishment of these services, there is an acute need for standardization of education and quality assurance regarding prehospital care provided. The International Joint Working Group has been actively involved in designing guidelines and establishing a comprehensive framework for ensuring high-quality education and clinical standards of care for prehospital services in India. This paper provides an independent expert opinion and a proposed framework for general operations and administration of a standardized, national prehospital emergency medical systems program. Program implementation, operational details, and regulations will require close collaboration between key stakeholders, including local, regional, and national governmental agencies of India. PMID:28855780

Educating Healthcare Providers Regarding LGBT Patients and Health Issues: The Special Case of Physician Assistants

ERIC Educational Resources Information Center

Compton, David A.; Whitehead, Michael B.

2015-01-01

Much is written about the availability of healthcare services among elements of the U.S. population, with a large proportion of the literature focusing on access. Although physical access is an overarching issue for many, educators must remember that a key factor in providing complete and competent healthcare is to understand the patient and any…

Forest Inventory and Analysis National Data Quality Assessment Report for 2000 to 2003

Treesearch

James E. Pollard; James A. Westfall; Paul L. Patterson; David L. Gartner; Mark Hansen; Olaf Kuegler

2006-01-01

The Forest Inventory and Analysis program (FIA) is the key USDA Forest Service (USFS) program that provides the information needed to assess the status and trends in the environmental quality of the Nation's forests. The goal of the FIA Quality Assurance (QA) program is to provide a framework to assure the production of complete, accurate and unbiased forest...

Evidence-based treatment and supervision practices for co-occurring mental and substance use disorders in the criminal justice system.

PubMed

Peters, Roger H; Young, M Scott; Rojas, Elizabeth C; Gorey, Claire M

2017-07-01

Over seven million persons in the United States are supervised by the criminal justice system, including many who have co-occurring mental and substance use disorders (CODs). This population is at high risk for recidivism and presents numerous challenges to those working in the justice system. To provide a contemporary review of the existing research and examine key issues and evidence-based treatment and supervision practices related to CODs in the justice system. We reviewed COD research involving offenders that has been conducted over the past 20 years and provide an analysis of key findings. Several empirically supported frameworks are available to guide services for offenders who have CODs, including Integrated Dual Disorders Treatment (IDDT), the Risk-Need-Responsivity (RNR) model, and Cognitive-Behavioral Therapy (CBT). Evidence-based services include integrated assessment that addresses both sets of disorders and the risk for criminal recidivism. Although several evidence-based COD interventions have been implemented at different points in the justice system, there remains a significant gap in services for offenders who have CODs. Existing program models include Crisis Intervention Teams (CIT), day reporting centers, specialized community supervision teams, pre- and post-booking diversion programs, and treatment-based courts (e.g., drug courts, mental health courts, COD dockets). Jail-based COD treatment programs provide stabilization of acute symptoms, medication consultation, and triage to community services, while longer-term prison COD programs feature Modified Therapeutic Communities (MTCs). Despite the availability of multiple evidence-based interventions that have been implemented across diverse justice system settings, these services are not sufficiently used to address the scope of treatment and supervision needs among offenders with CODs.

Confronting data requirements and data provision in Space Weather: The Contribution of Long Term Archives. Part 1.

NASA Astrophysics Data System (ADS)

Heynderickx, Daniel; Glover, Alexi

Operational space weather services rely heavily on reliable data streams from spacecraft and ground-based facilities, as well as from services providing processed data products. This event focuses on an unusual solar maximum viewed from several different perspectives, and as such highlights the important contribution of long term archives in supporting space weather studies and services. We invite the space weather community to contribute to a discussion on the key topics listed below, with the aim of formulating recommendations and guidelines for policy makers, stakeholders, data and service providers: - facilitating access to and awareness of existing data resources - establishing clear guidelines for space weather data archives including data quality, interoperability and metadata standards - ensuring data ownership and terms of (re)use are clearly identified such that this information can be taken into account when (potentially commercial) services are developed based on data provided without charge for scientific purposes only All participants are invited to submit input for the discussion to the authors ahead of the Assembly. The outcome of the session will be formulated as a set of proposed panel recommendations.

Confronting data requirements and data provision in Space Weather: The Contribution of Long Term Archives. Part 2.

NASA Astrophysics Data System (ADS)

Glover, Alexi; Heynderickx, Daniel

Operational space weather services rely heavily on reliable data streams from spacecraft and ground-based facilities, as well as from services providing processed data products. This event focuses on an unusual solar maximum viewed from several different perspectives, and as such highlights the important contribution of long term archives in supporting space weather studies and services. We invite the space weather community to contribute to a discussion on the key topics listed below, with the aim of formulating recommendations and guidelines for policy makers, stakeholders, data and service providers: - facilitating access to and awareness of existing data resources - establishing clear guidelines for space weather data archives including data quality, interoperability and metadata standards - ensuring data ownership and terms of (re)use are clearly identified such that this information can be taken into account when (potentially commercial) services are developed based on data provided without charge for scientific purposes only All participants are invited to submit input for the discussion to the authors ahead of the Assembly. The outcome of the session will be formulated as a set of proposed panel recommendations.

A fuzzy multi-objective model for capacity allocation and pricing policy of provider in data communication service with different QoS levels

NASA Astrophysics Data System (ADS)

Pan, Wei; Wang, Xianjia; Zhong, Yong-guang; Yu, Lean; Jie, Cao; Ran, Lun; Qiao, Han; Wang, Shouyang; Xu, Xianhao

2012-06-01

Data communication service has an important influence on e-commerce. The key challenge for the users is, ultimately, to select a suitable provider. However, in this article, we do not focus on this aspect but the viewpoint and decision-making of providers for order allocation and pricing policy when orders exceed service capacity. It is a multiple criteria decision-making problem such as profit and cancellation ratio. Meanwhile, we know realistic situations in which much of the input information is uncertain. Thus, it becomes very complex in a real-life environment. In this situation, fuzzy sets theory is the best tool for solving this problem. Our fuzzy model is formulated in such a way as to simultaneously consider the imprecision of information, price sensitive demand, stochastic variables, cancellation fee and the general membership function. For solving the problem, a new fuzzy programming is developed. Finally, a numerical example is presented to illustrate the proposed method. The results show that it is effective for determining the suitable order set and pricing policy of provider in data communication service with different quality of service (QoS) levels.

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.

Contract management in USA hospitals: service duplication and access within local markets.

PubMed

Carey, Kathleen; Dor, Avi

2008-08-01

This paper examines the extent to which hospitals that are under external contract management engage in service duplication, as well as the degree to which the various services they offer contribute to or detract from community access. The study incorporates all USA hospitals using data from the American Hospital Association Annual Survey Database, supplemented by county level measures obtained from the area resource file (ARF). Using data on the 3794 hospitals classified as acute care facilities in 2002, we performed a set of logistic regressions that analyzed whether a hospital offered each of 74 distinct services. For each service (regression), key independent variables measured the number of other hospitals in the local market area that also offered the service. Local area market definitions are the areas circumscribed by the hospital within distances of 10 and 20 miles. Results suggest that contract-managed (CM) hospitals display a more competitive pattern (service duplication) than hospitals in general, but CM hospitals that are the sole provider of services locally are less likely to offer services than traditionally managed sole hospital providers. Contract management does not appear to offer any particular advantages in improving access to hospital services.

Spatial services grid

NASA Astrophysics Data System (ADS)

Cao, Jian; Li, Qi; Cheng, Jicheng

2005-10-01

This paper discusses the concept, key technologies and main application of Spatial Services Grid. The technologies of Grid computing and Webservice is playing a revolutionary role in studying the spatial information services. The concept of the SSG (Spatial Services Grid) is put forward based on the SIG (Spatial Information Grid) and OGSA (open grid service architecture). Firstly, the grid computing is reviewed and the key technologies of SIG and their main applications are reviewed. Secondly, the grid computing and three kinds of SIG (in broad sense)--SDG (spatial data grid), SIG (spatial information grid) and SSG (spatial services grid) and their relationships are proposed. Thirdly, the key technologies of the SSG (spatial services grid) is put forward. Finally, three representative applications of SSG (spatial services grid) are discussed. The first application is urban location based services gird, which is a typical spatial services grid and can be constructed on OGSA (Open Grid Services Architecture) and digital city platform. The second application is region sustainable development grid which is the key to the urban development. The third application is Region disaster and emergency management services grid.

Is an ecosystem services-based approach developed for setting specific protection goals for plant protection products applicable to other chemicals?

PubMed

Maltby, Lorraine; Jackson, Mathew; Whale, Graham; Brown, A Ross; Hamer, Mick; Solga, Andreas; Kabouw, Patrick; Woods, Richard; Marshall, Stuart

2017-02-15

Clearly defined protection goals specifying what to protect, where and when, are required for designing scientifically sound risk assessments and effective risk management of chemicals. Environmental protection goals specified in EU legislation are defined in general terms, resulting in uncertainty in how to achieve them. In 2010, the European Food Safety Authority (EFSA) published a framework to identify more specific protection goals based on ecosystem services potentially affected by plant protection products. But how applicable is this framework to chemicals with different emission scenarios and receptor ecosystems? Four case studies used to address this question were: (i) oil refinery waste water exposure in estuarine environments; (ii) oil dispersant exposure in aquatic environments; (iii) down the drain chemicals exposure in a wide range of ecosystems (terrestrial and aquatic); (iv) persistent organic pollutant exposure in remote (pristine) Arctic environments. A four-step process was followed to identify ecosystems and services potentially impacted by chemical emissions and to define specific protection goals. Case studies demonstrated that, in principle, the ecosystem services concept and the EFSA framework can be applied to derive specific protection goals for a broad range of chemical exposure scenarios. By identifying key habitats and ecosystem services of concern, the approach offers the potential for greater spatial and temporal resolution, together with increased environmental relevance, in chemical risk assessments. With modifications including improved clarity on terminology/definitions and further development/refinement of the key concepts, we believe the principles of the EFSA framework could provide a methodical approach to the identification and prioritization of ecosystems, ecosystem services and the service providing units that are most at risk from chemical exposure. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Towards improving service delivery in screening and intervention services in community pharmacies: a case study of an alcohol IBA service.

PubMed

Mackridge, A J; Krska, J; Stokes, E C; Heim, D

2016-03-01

Previous studies have demonstrated positive outcomes from a range of pharmacy public health services, but barriers to delivery remain. This paper explores the processes of delivering an alcohol screening and intervention service, with a view to improving service delivery. A mixed-methods, multi-perspective approach was used, comprising in-pharmacy observations and recording of service provision, follow-up interviews with service users and interactive feedback sessions with service providers. Observations and recordings indicate that staff missed opportunities to offer the service and that both availability and delivery of the service were inconsistent, partly owing to unavailability of trained staff and service restrictions. Most service users gave positive accounts of the service and considered pharmacies to be appropriate places for this service. Respondents also described positive impacts, ranging from thinking more about alcohol consumption generally to substantial reductions in consumption. Key facilitators to service provision included building staff confidence and service champions. Barriers included commissioning issues and staff perception of alcohol as a sensitive topic. Findings support expansion of pharmacies' role in delivering public health services and highlight benefits of providing feedback to pharmacy staff on their service provision as a possible avenue for service improvement. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Place and provision: mapping mental health advocacy services in London.

PubMed

Foley, Ronan; Platzer, Hazel

2007-02-01

The National Health Service (NHS) Executive for London carried out an investigation in 2002 as part of their wider mental health strategy to establish whether existing mental health advocacy provision in the city was meeting need. The project took a two-part approach, with an emphasis on, (a) mapping the provision of advocacy services and, (b) cartographic mapping of service location and catchments. Data were collected through a detailed questionnaire with service providers in collaboration with the Greater London Mental Health Advocacy Network (GLMHAN) and additional health and government sources. The service mapping identified some key statistics on funding, caseloads and models of service provision with an additional emphasis on coverage, capacity, and funding stability. The questionnaire was augmented by interviews and focus groups with commissioners, service providers and service users and identified differing perspectives and problems, which informed the different perspectives of each of these groups. The cartographic mapping exercise demonstrated a spatially-even provision of mental health advocacy services across the city with each borough being served by at least one local service as well as by London wide specialist schemes. However, at local level, no one borough had the full range of specialist provision to match local demographic need. Ultimately the research assisted the Advisory Group in providing commissioning agencies with clear information on the current status of city-wide mental health advocacy services, and on gaps in existing advocacy provision alongside previously unconsidered geographical and service dimensions of that provision.

Security on Cloud Revocation Authority using Identity Based Encryption

NASA Astrophysics Data System (ADS)

Rajaprabha, M. N.

2017-11-01

As due to the era of cloud computing most of the people are saving there documents, files and other things on cloud spaces. Due to this security over the cloud is also important because all the confidential things are there on the cloud. So to overcome private key infrastructure (PKI) issues some revocable Identity Based Encryption (IBE) techniques are introduced which eliminates the demand of PKI. The technique introduced is key update cloud service provider which is having two issues in it and they are computation and communication cost is high and second one is scalability issue. So to overcome this problem we come along with the system in which the Cloud Revocation Authority (CRA) is there for the security which will only hold the secret key for each user. And the secret key was send with the help of advanced encryption standard security. The key is encrypted and send to the CRA for giving the authentication to the person who wants to share the data or files or for the communication purpose. Through that key only the other user will able to access that file and if the user apply some invalid key on the particular file than the information of that user and file is send to the administrator and administrator is having rights to block that person of black list that person to use the system services.

Experts by experience; the views of service user educators providing feedback on medical students' work based assessments.

PubMed

Muir, Delia; Laxton, Julie Clare

2012-02-01

Assessment tools were designed to provide health and social care students with multi-sourced, interprofessional feedback in practice. This includes feedback from service users. Third year medical students at the University of Leeds were given accesses to 4 assessment tools whilst in practice. Completed assessments were then sent to the university where service users and carers worked with university tutors to give further feedback and comment on the overall development of students. Three service users then took part in a focus group and one provided written feedback. Four key themes were identified from the focus group: • Preparation and support • The design of the tools • The process of using the tools in practice • Feedback. We found that the project provided both challenges and rewards for all involved. The service user educators involved were able to bring a different and valuable perspective to formative feedback. The combination of their personal and professional experiences, along with the preparation they had received, helped bridge the gap between service users in practice and university based tutors. The findings from this study went on to inform a review of the assessment tools and revised versions are now being used. Copyright © 2011 Elsevier Ltd. All rights reserved.

A service user co-facilitated intervention to reduce mental illness stigma among primary healthcare workers: Utilizing perspectives of family members and caregivers.

PubMed

Rai, Sauharda; Gurung, Dristy; Kaiser, Bonnie N; Sikkema, Kathleen J; Dhakal, Manoj; Bhardwaj, Anvita; Tergesen, Cori; Kohrt, Brandon A

2018-06-01

Service users' involvement as cofacilitators of mental health trainings is a nascent endeavor in low- and middle-income countries, and the role of families on service user participation in trainings has received limited attention. This study examined how caregivers perceive and facilitate service user's involvement in an antistigma program that was added to mental health Gap Action Program (mhGAP) trainings for primary care workers in Nepal. Service users were trained as cofacilitators for antistigma and mhGAP trainings delivered to primary care workers through the REducing Stigma among HealthcAre ProvidErs (RESHAPE) program. Key informant interviews (n = 17) were conducted with caregivers and service users in RESHAPE. Five themes emerged: (a) Caregivers' perceived benefits of service user involvement included reduced caregiver burden, learning new skills, and opportunities to develop support groups. (b) Caregivers' fear of worsening stigma impeded RESHAPE participation. (c) Lack of trust between caregivers and service users jeopardized participation, but it could be mitigated through family engagement with health workers. (d) Orientation provided to caregivers regarding RESHAPE needed greater attention, and when information was provided, it contributed to stigma reduction in families. (e) Time management impacted caregivers' ability to facilitate service user participation. Engagement with families allows for greater identification of motivational factors and barriers impacting optimal program performance. Caregiver involvement in all program elements should be considered best practice for service user-facilitated antistigma initiatives, and service users reluctant to include caregivers should be provided with health staff support to address barriers to including family. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

[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.

Multi-Level Factors Affecting Entry into and Engagement in the HIV Continuum of Care in Iringa, Tanzania

PubMed Central

Layer, Erica H.; Kennedy, Caitlin E.; Beckham, Sarah W.; Mbwambo, Jessie K.; Likindikoki, Samuel; Davis, Wendy W.; Kerrigan, Deanna L.; Brahmbhatt, Heena

2014-01-01

Progression through the HIV continuum of care, from HIV testing to lifelong retention in antiretroviral therapy (ART) care and treatment programs, is critical to the success of HIV treatment and prevention efforts. However, significant losses occur at each stage of the continuum and little is known about contextual factors contributing to disengagement at these stages. This study sought to explore multi-level barriers and facilitators influencing entry into and engagement in the continuum of care in Iringa, Tanzania. We used a mixed-methods study design including facility-based assessments and interviews with providers and clients of HIV testing and treatment services; interviews, focus group discussions and observations with community-based providers and clients of HIV care and support services; and longitudinal interviews with men and women living with HIV to understand their trajectories in care. Data were analyzed using narrative analysis to identify key themes across levels and stages in the continuum of care. Participants identified multiple compounding barriers to progression through the continuum of care at the individual, facility, community and structural levels. Key barriers included the reluctance to engage in HIV services while healthy, rigid clinic policies, disrespectful treatment from service providers, stock-outs of supplies, stigma and discrimination, alternate healing systems, distance to health facilities and poverty. Social support from family, friends or support groups, home-based care providers, income generating opportunities and community mobilization activities facilitated engagement throughout the HIV continuum. Findings highlight the complex, multi-dimensional dynamics that individuals experience throughout the continuum of care and underscore the importance of a holistic and multi-level perspective to understand this process. Addressing barriers at each level is important to promoting increased engagement throughout the continuum. PMID:25119665

Well-Child Care Practice Redesign for Low-Income Children: The Perspectives of Health Plans, Medical Groups, and State Agencies

PubMed Central

Coker, Tumaini R.; DuPlessis, Helen M.; Davoudpour, Ramona; Moreno, Candice; Rodriguez, Michael A.; Chung, Paul J.

2015-01-01

Objective The aim of this study was to examine the views of key stakeholders in health care payer organizations on the use of practice redesign strategies to improve the delivery of well-child care (WCC) to low-income children aged 0 to 3 years. Methods We conducted semistructured interviews with 18 key stakeholders (eg, chief medical officers, medical directors) in 11 California health plans and 2 medical group organizations serving low-income children, as well as the 2 state agencies that administer the 2 largest low-income insurance programs for California children. Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Results Participants reported that nonphysicians were underutilized as WCC providers, and group visits and Internet services were likely a more effective way to provide anticipatory guidance and behavioral/developmental services. Participants described barriers to redesign, including the start-up costs required to implement redesign as well as a lack of financial incentives to support innovation in WCC delivery. Participants suggested solutions to these barriers, including using pay-for-performance programs to reward practices that expanded WCC services, and providing practices with start-up grants to implement pilot redesign projects that would eventually become self-sustaining. State-level barriers included poor Medicaid reimbursement rates and disincentives to innovation created by current Healthcare Effectiveness Data and Information Set measures. Conclusions All stakeholders will ultimately be needed to support WCC redesign; however, California payers may need to provide logistic, design, and financial support to practices, whereas state agencies may need to reshape the incentives to reward innovation around child preventive health and developmental services. PMID:22075467

A Multiple Case Study of Mental Health Interventions in Middle Income Countries: Considering the Science of Delivery

PubMed Central

Cole, Donald C.; Muskat, Elisha; Raja, Shoba; Wiljer, David; Aylward, David

2016-01-01

In the debate in global mental health about the most effective models for developing and scaling interventions, there have been calls for the development of a more robust literature regarding the "non-specific", science of delivery aspects of interventions that are locally, contextually, and culturally relevant. This study describes a rigorous, exploratory, qualitative examination of the key, non-specific intervention strategies of a diverse group of five internationally-recognized organizations addressing mental illness in middle income countries (MICs). A triangulated approach to inquiry was used with semi-structured interviews conducted with service recipients, service providers and leaders, and key community partners (N = 159). The interview focus was upon processes of implementation and operation. A grounded theory-informed analysis revealed cross cutting themes of: a holistic conceptualization of mental health problems, an intensive application of principles of leverage and creating the social, cultural, and policy “space” within which interventions could be applied and resourced. These findings aligned with key aspects of systems dynamic theory suggesting that it might be a helpful framework in future studies of mental health service implementation in MICs. PMID:27011053

Focusing on customer service.

PubMed

1996-01-01

This booklet is devoted to a consideration of how good customer service in family planning programs can generate demand for products and services, bring customers back, and reduce costs. Customer service is defined as increasing client satisfaction through continuous concern for client preferences, staff accountability to clients, and respect for the rights of clients. Issues discussed include the introduction of a customer service approach and gaining staff commitment. The experience of PROSALUD in Bolivia in recruiting appropriate staff, supervising staff, soliciting client feedback, and marketing services is offered as an example of a successful customer service approach. The key customer service functions are described as 1) establishing a welcoming atmosphere, 2) streamlining client flow, 3) personalizing client services, and 4) organizing and providing clear information to clients. The role of the manager in developing procedures is explored, and the COPE (Client-Oriented Provider-Efficient) process is presented as a good way to begin to make improvements. Techniques in staff training in customer service include brainstorming, role playing, using case studies (examples of which are provided), and engaging in practice sessions. Training also leads to the development of effective customer service attitudes, and the differences between these and organizational/staff-focused attitudes are illustrated in a chart. The use of communication skills (asking open-ended questions, helping clients express their concerns, engaging in active listening, and handling difficult situations) is considered. Good recovery skills are important when things go wrong. Gathering and using client feedback is the next topic considered. This involves identifying, recording, and discussing customer service issues as well as taking action on these issues and evaluating the results. The booklet ends by providing a sample of customer service indicators, considering the maintenance of a customer service focus, and reporting comments from the reviewers of the booklet.

Engaging fathers in child protection services: A review of factors and strategies across ecological systems

PubMed Central

Gordon, Derrick M.; Oliveros, Arazais; Hawes, Samuel W.; Iwamoto, Derek K.; Rayford, Brett S.

2014-01-01

Current policy regarding child protection services places increasing demands for providers to engage fathers whose children are involved in the child protection process. This requisite brings to the fore the ongoing challenges that fathers have historically faced in working within these systems. Despite this need, there is little empirical evidence regarding the factors and strategies that impact the engagement of fathers in interventions relevant to child protection services. This comprehensive and systemic review synthesizes the available literature regarding factors and strategies that may foster paternal involvement in the child protection system and their services. We organize the literature concerning paternal engagement in child and family services around an ecological model that examines paternal engagement from individual, family, service provider, program, community, and policy levels. We consider factors and strategies along a continuum of engagement through intent to enroll, enrollment, and retention. This review advances theory by elucidating key factors that foster father engagement. The review also highlights the gaps in the literature and provides strategies for how researchers can address these areas. Future directions in the arenas of practice and policy are discussed. PMID:25232202

Effect of Organic Enrichment and Hypoxia on the Biodiversity of Benthic Communities in Narragansett Bay

EPA Science Inventory

Excessive input of nitrogen to coastal waters leads to eutrophication and hypoxia that reduce biodiversity and impair key ecosystem services provided by benthic communities; for example, fish and shellfish production, bioturbation, nutrient cycling, and water filtration. Hypoxia ...

Technology Issues for Mobile Ka-band Communications

NASA Technical Reports Server (NTRS)

Satorius, E.; Jedrey, T.; Davarian, F.; Divsalar, D.

1993-01-01

The key to success of any future telecommunications System is its ability to provide many users with a diversity of services in a cost-effective manner. An important consideration is system capacity which is requred to suport a large pool of users and their varied demands.

78 FR 21116 - Superior Supplier Incentive Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-09

... (Quality of Product). Schedule. Cost Control. Management Responsiveness. Management of Key Personnel... unit can only be rated in either the goods or services category. In the event a contractor is within... will provide contractors with the greatest motivation to achieve SSS? 3. What contract terms and...

Nanotechnology Characterization Laboratory Unveils New Technical Services for Drug Developers | Frederick National Laboratory for Cancer Research

Cancer.gov

FREDERICK, Md. -- Drug developers now have access to a shared analytical technology, developed and provided by the Frederick National Laboratory for Cancer Research, that helps fine-tune nanomedicine formulations and overcomes a key hurdle on the pat

Leveraging the private health sector to enhance HIV service delivery in lower-income countries.

PubMed

Rao, Pamela; Gabre-Kidan, Tesfai; Mubangizi, Deus Bazira; Sulzbach, Sara

2011-08-01

Evidence that the private health sector is a key player in delivering health services and impacting health outcomes, including those related to HIV/AIDS, underscores the need to optimize the role of the private health sector to scale up national HIV responses in lower-income countries. This article reviews findings on the types of HIV/AIDS services provided by the private health sector in developing countries and elaborates on the role of private providers of HIV services in Ethiopia. Drawing on data from the nation's innovative Private Health Sector Project, a pilot project that has demonstrated the feasibility of public-private partnerships in this area, the article highlights the potential for national governments to scale up HIV/AIDS services by leveraging private health sector resources, innovations, and expertise while working to regulate quality and cost of services. Although concerns about uneven quality and affordability of private sector health services must be addressed through regulation, policy, or other innovative approaches, we argue that the benefits of leveraging the private sector outweigh these challenges, particularly in light of finite donor and public domestic resources.

E-Governance and Service Oriented Computing Architecture Model

NASA Astrophysics Data System (ADS)

Tejasvee, Sanjay; Sarangdevot, S. S.

2010-11-01

E-Governance is the effective application of information communication and technology (ICT) in the government processes to accomplish safe and reliable information lifecycle management. Lifecycle of the information involves various processes as capturing, preserving, manipulating and delivering information. E-Governance is meant to transform of governance in better manner to the citizens which is transparent, reliable, participatory, and accountable in point of view. The purpose of this paper is to attempt e-governance model, focus on the Service Oriented Computing Architecture (SOCA) that includes combination of information and services provided by the government, innovation, find out the way of optimal service delivery to citizens and implementation in transparent and liable practice. This paper also try to enhance focus on the E-government Service Manager as a essential or key factors service oriented and computing model that provides a dynamically extensible structural design in which all area or branch can bring in innovative services. The heart of this paper examine is an intangible model that enables E-government communication for trade and business, citizen and government and autonomous bodies.

Ecosystem Services from Edible Insects in Agricultural Systems: A Review

PubMed Central

Payne, Charlotte L. R.; Van Itterbeeck, Joost

2017-01-01

Many of the most nutritionally and economically important edible insects are those that are harvested from existing agricultural systems. Current strategies of agricultural intensification focus predominantly on increasing crop yields, with no or little consideration of the repercussions this may have for the additional harvest and ecology of accompanying food insects. Yet such insects provide many valuable ecosystem services, and their sustainable management could be crucial to ensuring future food security. This review considers the multiple ecosystem services provided by edible insects in existing agricultural systems worldwide. Directly and indirectly, edible insects contribute to all four categories of ecosystem services as outlined by the Millennium Ecosystem Services definition: provisioning, regulating, maintaining, and cultural services. They are also responsible for ecosystem disservices, most notably significant crop damage. We argue that it is crucial for decision-makers to evaluate the costs and benefits of the presence of food insects in agricultural systems. We recommend that a key priority for further research is the quantification of the economic and environmental contribution of services and disservices from edible insects in agricultural systems. PMID:28218635

Ecosystem Services from Edible Insects in Agricultural Systems: A Review.

PubMed

Payne, Charlotte L R; Van Itterbeeck, Joost

2017-02-17

Many of the most nutritionally and economically important edible insects are those that are harvested from existing agricultural systems. Current strategies of agricultural intensification focus predominantly on increasing crop yields, with no or little consideration of the repercussions this may have for the additional harvest and ecology of accompanying food insects. Yet such insects provide many valuable ecosystem services, and their sustainable management could be crucial to ensuring future food security. This review considers the multiple ecosystem services provided by edible insects in existing agricultural systems worldwide. Directly and indirectly, edible insects contribute to all four categories of ecosystem services as outlined by the Millennium Ecosystem Services definition: provisioning, regulating, maintaining, and cultural services. They are also responsible for ecosystem disservices, most notably significant crop damage. We argue that it is crucial for decision-makers to evaluate the costs and benefits of the presence of food insects in agricultural systems. We recommend that a key priority for further research is the quantification of the economic and environmental contribution of services and disservices from edible insects in agricultural systems.

Providing patient care in community pharmacies in Australia.

PubMed

Benrimoj, Shalom I; Roberts, Alison S

2005-11-01

To describe Australia's community pharmacy network in the context of the health system and outline the provision of services. The 5000 community pharmacies form a key component of the healthcare system for Australians, for whom health expenditures represent 9% of the Gross Domestic Product. A typical community pharmacy dispenses 880 prescriptions per week. Pharmacists are key partners in the Government's National Medicines Policy and contribute to its objectives through the provision of cognitive pharmaceutical services (CPS). The Third Community Pharmacy Agreement included funding for CPS including medication review and the provision of written drug information. Funding is also provided for a quality assurance platform with which the majority of pharmacies are accredited. Fifteen million dollars (Australian) have been allocated to research in community pharmacy, which has focused on achieving quality use of medicines (QUM), as well as developing new CPS and facilitating change. Elements of the Agreements have taken into account QUM principles and are now significant drivers of practice change. Although accounting for 10% of remuneration for community pharmacy, the provision of CPS represents a significant shift in focus to view pharmacy as a service provider. Delivery of CPS through the community pharmacy network provides sustainability for primary health care due to improvement in quality presumably associated with a reduction in healthcare costs. Australian pharmacy practice is moving strongly in the direction of CPS provision; however, change does not occur easily. The development of a change management strategy is underway to improve the uptake of professional and business opportunities in community pharmacy.

Development of a Rural Health Framework: Implications for Program Service Planning and Delivery

PubMed Central

White, Deanna

2013-01-01

Purpose: To describe the development and application of an evidence-based Rural Health Framework to guide rural health program, policy and service planning. Methods: A literature review of rural health programs, focusing on health promotion, chronic disease prevention and population health, was conducted using several bibliographic databases. Findings: Thirty papers met the criteria for review, describing chronic disease interventions and public health policies in rural settings. Twenty-one papers demonstrated effective intervention programs and highlighted potential good practices for rural health programs, which were used to define key elements of a Rural Health Framework. Conclusions: The Rural Health Framework was applied to an influenza immunization program to demonstrate its utility in assisting public health providers to increase uptake of the vaccine. This Rural Health Framework provides an opportunity for program planners to reflect on the key issues facing rural communities to ensure the development of policies and strategies that will prudently and effectively meet population health needs. PMID:23968625

Assessing Iranian adolescent girls' needs for sexual and reproductive health information.

PubMed

Mosavi, Seyed Abbas; Babazadeh, Raheleh; Najmabadi, Khadijeh Mirzaii; Shariati, Mohammad

2014-07-01

To explore the views and experiences of adolescent girls and key adults regarding the necessity of providing sexual and reproductive health (SRH) information and services for adolescent girls in Iran. This was a qualitative study; the data were coded and categorized in content analysis by MAXQDA10 and were gathered through focus groups with adolescent girls and their mothers and semi-structured interviews with school counselors, sociologists, health providers, state and nongovernmental directors of health programs, clergy, and health policy makers in the Iranian cities of Mashhad, Tehran, Shahroud, and Qom. There were six main reasons for the need to provide SRH services for adolescent girls: a lack of adequate knowledge about SRH, easy access to inaccurate information sources, cultural and social changes, increasing risky sexual behaviors among adolescents, religion's emphasis on sex training of children and adolescents, and the existence of cultural taboos. Most participants confirmed the necessity of providing SRH services for adolescent girls, so instead of talking about provision or non-provision of these services, it is important for policy makers to plan and provide SRH services that can be consistent with cultural and religious values for adolescent girls. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

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.

Child obesity service provision: a cross-sectional survey of physiotherapy practice trends and professional needs.

PubMed

Milne, Nikki; Choy, Nancy Low; Leong, Gary M; Hughes, Roger; Hing, Wayne

2016-01-01

This study explored current physiotherapy practice trends for management of children who are overweight or obese. The professional needs of physiotherapists working with this population were also assessed, including the perceived need for physiotherapy clinical guidelines for prevention and management of children with obesity. A cross-sectional survey design was used, with questionnaires purposefully distributed through 13 key physiotherapy services throughout Australia. Snowball sampling resulted in completed questionnaires from 64 physiotherapists who provided services to children. Half (n=33, 52%) of respondents provided services specifically to overweight or obese children. Of those providing services, one-quarter had prior training specific to working with this population. Most used multi-disciplinary models (n=16, 76%) and provided under 5h of obesity-related services each week (n=29, 88%). Half (n=16, 49%) used body mass index as an outcome measure but more (n=25, 76%) used bodyweight. Only 14 (42%) assessed motor skills. The majority of respondents (n=57, 89%) indicated a need for physiotherapy guidelines to best manage overweight and obese children. Professional development priorities included: 'Educating children and families', 'Assessment methods' and 'Exercise prescription' for overweight and obese children. This data provides workforce intelligence to guide future professional training and inform development of clinical guidelines for physiotherapists in prevention and management of children with obesity and related chronic disease.

Impact of the World Health Organization's Decision-Making Tool for Family Planning Clients and Providers on the quality of family planning services in Iran.

PubMed

Farrokh-Eslamlou, Hamidreza; Aghlmand, Siamak; Eslami, Mohammad; Homer, Caroline S E

2014-04-01

We investigated whether use of the World Health Organization's (WHO's) Decision-Making Tool (DMT) for Family Planning Clients and Providers would improve the process and outcome quality indicators of family planning (FP) services in Iran. The DMT was adapted for the Iranian setting. The study evaluated 24 FP quality key indicators grouped into two main areas, namely process and outcome. The tool was implemented in 52 urban and rural public health facilities in four selected and representative provinces of Iran. A pre-post methodology was undertaken to examine whether use of the tool improved the quality of FP services and client satisfaction with the services. Quantitative data were collected through observations of counselling and exit interviews with clients using structured questionnaires. Different numbers of FP clients were recruited during the baseline and the post-intervention rounds (n=448 vs 547, respectively). The DMT improved many client-provider interaction indicators, including verbal and non-verbal communication (p<0.05). The tool also impacted positively on the client's choice of contraceptive method, providers' technical competence, and quality of information provided to clients (p<0.05). Use of the tool improved the clients' satisfaction with FP services (from 72% to 99%; p<0.05). The adapted WHO's DMT has the potential to improve the quality of FP services.

Soft optics in intelligent optical networks

NASA Astrophysics Data System (ADS)

Shue, Chikong; Cao, Yang

2001-10-01

In addition to the recent advances in Hard-optics that pushes the optical transmission speed, distance, wave density and optical switching capacity, Soft-optics provides the necessary intelligence and control software that reduces operational costs, increase efficiency, and enhances revenue generating services by automating optimal optical circuit placement and restoration, and enabling value-added new services like Optical VPN. This paper describes the advances in 1) Overall Hard-optics and Soft-optics 2) Layered hierarchy of Soft-optics 3) Component of Soft-optics, including hard-optics drivers, Management Soft-optics, Routing Soft-optics and System Soft-optics 4) Key component of Routing and System Soft-optics, namely optical routing and signaling (including UNI/NNI and GMPLS signaling). In summary, the soft-optics on a new generation of OXC's enables Intelligent Optical Networks to provide just-in-time service delivery and fast restoration, and real-time capacity management that eliminates stranded bandwidth. It reduces operational costs and provides new revenue opportunities.

Strategies for improved French-language health services

PubMed Central

Gauthier, Alain P.; Timony, Patrick E.; Serresse, Suzanne; Goodale, Natalie; Prpic, Jason

2015-01-01

Abstract Objective To identify strategies to improve the quality of health services for Francophone patients. Design A series of semistructured key informant interviews. Setting Northeastern Ontario. Participants A total of 18 physicians were interviewed. Ten physicians were interviewed in French, 7 physicians were women, and 10 physicians were located in urban communities. Methods Purposive and snowball sampling strategies were used to conduct a series of semistructured key informant interviews with family physicians practising in communities with a large Francophone population. Principles of grounded theory were applied, guided by a framework for patient-professional communication. Results were inductively derived following an iterative data collection–data analysis process and were analyzed using a detailed thematic approach. Main findings Respondents identified several strategies for providing high-quality French-language health services. Some were unique to non–French-speaking physicians (eg, using appropriate interpreter services), some were unique to French-speaking physicians (eg, using a flexible dialect), and some strategies were common to all physicians serving French populations (eg, hiring bilingual staff or having pamphlets and posters in both French and English). Conclusion Physicians interviewed for this study provided high-quality health care by attributing substantial importance to effective communication. While linguistic patient-to-physician concordance is ideal, it might not always be possible. Thus, conscious efforts to attenuate communication barriers are necessary, and several effective strategies exist. PMID:26505060

A qualitative study of diverse providers' behaviour in response to commissioners, patients and innovators in England: research protocol.

PubMed

Sheaff, Rod; Halliday, Joyce; Exworthy, Mark; Allen, Pauline; Mannion, Russell; Asthana, Sheena; Gibson, Alex; Clark, Jonathan

2016-05-13

The variety of organisations providing National Health Service (NHS)-funded services in England is growing. Besides NHS hospitals and general practitioners (GPs), they include corporations, social enterprises, voluntary organisations and others. The degree to which these organisational types vary, however, in the ways they manage and provide services and in the outcomes for service quality, patient experience and innovation, remains unclear. This research will help those who commission NHS services select among the different types of organisation for different tasks. The main research questions are how organisationally diverse NHS-funded service providers vary in their responsiveness to patient choice, NHS commissioning and policy changes; and their patterns of innovation. We aim to assess the implications for NHS commissioning and managerial practice which follow from these differences. Systematic qualitative comparison across a purposive sample (c.12) of providers selected for maximum variety of organisational type, with qualitative studies of patient experience and choice (in the same sites). We focus is on NHS services heavily used by older people at high risk of hospital admission: community health services; out-of-hours primary care; and secondary care (planned orthopaedics or ophthalmology). The expected outputs will be evidence-based schemas showing how patterns of service development and delivery typically vary between different organisational types of provider. We will ensure informants' organisational and individual anonymity when dealing with high profile case studies and a competitive health economy. The frail elderly is a key demographic sector with significant policy and financial implications. For NHS commissioners, patients, doctors and other stakeholders, the main outcome will be better knowledge about the relative merits of different kinds of healthcare provider. Dissemination will make use of strategies suggested by patient and public involvement, as well as DH and service-specific outlets. 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/

Conducting Outreach to Transition-Aged Youth: Strategies for Reaching out to Youth with Disabilities, Their Families, and Agencies that Serve Them. Policy and Practice Brief

ERIC Educational Resources Information Center

Sheldon, James R., Jr.; Golden, Thomas P.

2012-01-01

The purpose of this policy and practice brief is to provide readers with a resource for planning outreach to transition-aged youth, their parents, and the service providers who work with them (i.e., the authors' "target group"). The authors will first provide a summary of the laws governing how three key agencies--school districts, state…

Mercury- Distributed Metadata Management, Data Discovery and Access System

NASA Astrophysics Data System (ADS)

Palanisamy, Giri; Wilson, Bruce E.; Devarakonda, Ranjeet; Green, James M.

2007-12-01

Mercury is a federated metadata harvesting, search and retrieval tool based on both open source and ORNL- developed software. It was originally developed for NASA, and the Mercury development consortium now includes funding from NASA, USGS, and DOE. Mercury supports various metadata standards including XML, Z39.50, FGDC, Dublin-Core, Darwin-Core, EML, and ISO-19115 (under development). Mercury provides a single portal to information contained in disparate data management systems. It collects metadata and key data from contributing project servers distributed around the world and builds a centralized index. The Mercury search interfaces then allow the users to perform simple, fielded, spatial and temporal searches across these metadata sources. This centralized repository of metadata with distributed data sources provides extremely fast search results to the user, while allowing data providers to advertise the availability of their data and maintain complete control and ownership of that data. Mercury supports various projects including: ORNL DAAC, NBII, DADDI, LBA, NARSTO, CDIAC, OCEAN, I3N, IAI, ESIP and ARM. The new Mercury system is based on a Service Oriented Architecture and supports various services such as Thesaurus Service, Gazetteer Web Service and UDDI Directory Services. This system also provides various search services including: RSS, Geo-RSS, OpenSearch, Web Services and Portlets. Other features include: Filtering and dynamic sorting of search results, book-markable search results, save, retrieve, and modify search criteria.

Outpatient alcohol withdrawal management for Aboriginal and Torres Strait Islander peoples.

PubMed

Brett, Jonathan; Lawrence, Leanne; Ivers, Rowena; Conigrave, Kate

2014-08-01

There is concern from within Aboriginal and Torres Strait Islander communities about the lack of access to alcohol withdrawal management ('detox') services. Outpatient detox is described within national Australian guidelines as a safe option for selected drinkers. However, uncertainly exists as to how suited Aboriginal and Torres Strait Islander peoples are to this approach. 
 Consultations were conducted with stakeholders of four health services providing outpatient detox for Aboriginal and Torres Strait Islander peoples in NSW. Thematic analysis was performed to determine elements perceived as important for success. Key themes that emerged were individual engagement, flexibility, assessment of suitability, Aboriginal staff and community engagement, practical support, counselling, staff education and support, coping with relapse and contingency planning. 
 There is a need to improve access to alcohol detox services for Aboriginal and Torres Strait Islander peoples. The outpatient setting seems to be a feasible and safe environment to provide this kind of service for selected drinkers.

Business Models of E-Government: Research on Dynamic E-Government Based on Web Services

NASA Astrophysics Data System (ADS)

Li, Yan; Yang, Jiumin

Government transcends all sectors in a society. It provides not only the legal, political and economic infrastructure to support other sectors, but also exerts significant influence on the social factors that contribute to their development. With its maturity of technologies and management, e-government will eventually enter into the time of 'one-stop' services. Among others, the technology of Web services is the major contributor to this achievement. Web services provides a new way of standard-based software technology, letting programmers combine existing computer system in new ways over the Internet within one business or across many, and would thereby bring about profound and far-reaching impacts on e-government. This paper introduced the business modes of e-government, architecture of dynamic e-government and its key technologies. Finally future prospect of dynamic e-government was also briefly discussed.

Achieving QoS for TCP Traffic in Satellite Networks with Differentiated Services

NASA Technical Reports Server (NTRS)

Durresi, Arjan; Kota, Sastri; Goyal, Mukul; Jain, Raj; Bharani, Venkata

2001-01-01

Satellite networks play an indispensable role in providing global Internet access and electronic connectivity. To achieve such a global communications, provisioning of quality of service (QoS) within the advanced satellite systems is the main requirement. One of the key mechanisms of implementing the quality of service is traffic management. Traffic management becomes a crucial factor in the case of satellite network because of the limited availability of their resources. Currently, Internet Protocol (IP) only has minimal traffic management capabilities and provides best effort services. In this paper, we presented a broadband satellite network QoS model and simulated performance results. In particular, we discussed the TCP flow aggregates performance for their good behavior in the presence of competing UDP flow aggregates in the same assured forwarding. We identified several factors that affect the performance in the mixed environments and quantified their effects using a full factorial design of experiment methodology.

CMEMS (Copernicus Marine Environment Monitoring Service) In Situ Thematic Assembly Centre: A service for operational Oceanography

NASA Astrophysics Data System (ADS)

Manzano Muñoz, Fernando; Pouliquen, Sylvie; Petit de la Villeon, Loic; Carval, Thierry; Loubrieu, Thomas; Wedhe, Henning; Sjur Ringheim, Lid; Hammarklint, Thomas; Tamm, Susanne; De Alfonso, Marta; Perivoliotis, Leonidas; Chalkiopoulos, Antonis; Marinova, Veselka; Tintore, Joaquin; Troupin, Charles

2016-04-01

Copernicus, previously known as GMES (Global Monitoring for Environment and Security), is the European Programme for the establishment of a European capacity for Earth Observation and Monitoring. Copernicus aims to provide a sustainable service for Ocean Monitoring and Forecasting validated and commissioned by users. From May 2015, the Copernicus Marine Environment Monitoring Service (CMEMS) is working on an operational mode through a contract with services engagement (result is regular data provision). Within CMEMS, the In Situ Thematic Assembly Centre (INSTAC) distributed service integrates in situ data from different sources for operational oceanography needs. CMEMS INSTAC is collecting and carrying out quality control in a homogeneous manner on data from providers outside Copernicus (national and international networks), to fit the needs of internal and external users. CMEMS INSTAC has been organized in 7 regional Dissemination Units (DUs) to rely on the EuroGOOS ROOSes. Each DU aggregates data and metadata provided by a series of Production Units (PUs) acting as an interface for providers. Homogeneity and standardization are key features to ensure coherent and efficient service. All DUs provide data in the OceanSITES NetCDF format 1.2 (based on NetCDF 3.6), which is CF compliant, relies on SeaDataNet vocabularies and is able to handle profile and time-series measurements. All the products, both near real-time (NRT) and multi-year (REP), are available online for every CMEMS registered user through an FTP service. On top of the FTP service, INSTAC products are available through Oceanotron, an open-source data server dedicated to marine observations dissemination. It provides services such as aggregation on spatio-temporal coordinates and observed parameters, and subsetting on observed parameters and metadata. The accuracy of the data is checked on various levels. Quality control procedures are applied for the validity of the data and correctness tests for the metadata of each NetCDF file. The quality control procedures for the data include different routines for NRT and REP products. Key Performance Indicators (KPI) for monitoring purposes are also used in Copernicus. They allow a periodic monitoring of the availability, quantity and quality of the INSTAC data integrated in the NRT products. Statistical reports are generated on quarterly and yearly basis to provide more visibility on the coverage in space and time of the INSTAC NRT and REP products, as well as information on their quality. These reports are generated using Java and Python procedures developed within the INSTAC group. One of the most critical tasks for the DUs is to generate NetCDF files compliant with the agreed format. Many tools and programming libraries have been developed for that purpose, for instance Unidata Java Library. These tools provide NetCDF data management capabilities including creation, reading and modification. Some DUs have also developed regional data portals which offer useful information for the users including data charts, platforms availability through interactive maps, KPI and statistical figures and direct access to the FTP service. The proposed presentation will detail Copernicus in situ data service and the monitoring tools that have been developed by the INSTAC group.

The Urban Exploitation Platform - An instrument for the global provision of indicators related to sustainable cities and communities

NASA Astrophysics Data System (ADS)

Esch, Thomas; Asamer, Hubert; Hirner, Andreas; Marconcini, Mattia; Metz, Annekatrin; Uereyen, Soner; Zeidler, Julian; Boettcher, Martin; Permana, Hans; Boissier, Enguerran; Mathot, Emmanuel; Soukop, Tomas; Balhar, Jakub; Svaton, Vaclav; Kuchar, Stepan

2017-04-01

The Sentinel fleet will provide a so-far unique coverage with Earth Observation (EO) data and therewith new opportunities for the implementation of methodologies to generate innovative geo-information products and services supporting the SDG targets. It is here where the TEP Urban project is supposed to initiate a step change by providing an open and participatory platform that allows any interested user to easily exploit large-volume EO data pools, in particular those of the European Sentinel and the US Landsat missions, and derive thematic geo-information, metrics and indicators related to the status and development of the built environment. Key component of TEP Urban initiative is the implementation of a web-based platform (https://urban-tep.eo.esa.int) employing distributed high-level computing infrastructures and providing key functionalities for i) high-performance access to satellite imagery and other data sources such as statistics or topographic data, ii) state-of-the-art pre-processing, analysis, and visualization techniques, iii) customized development and dissemination of algorithms, products and services, and iv) networking and communication. This contribution introduces the main facts about the TEP Urban platform, including a description of the general objectives, the platform systems design and functionalities, and the available portfolio of products and services that can directly serve the global provision of indicators for SDG targets, in particular related to SDG 11.

Description of the pig production systems, biosecurity practices and herd health providers in two provinces with high swine density in the Philippines.

PubMed

Alawneh, J I; Barnes, T S; Parke, C; Lapuz, E; David, E; Basinang, V; Baluyut, A; Villar, E; Lopez, E L; Blackall, P J

2014-05-01

A cross-sectional study was conducted between October 2011 and March 2012 in two major pig producing provinces in the Philippines. Four hundred and seventy one pig farms slaughtering finisher pigs at government operated abattoirs participated in this study. The objectives of this study were to group: (a) smallholder (S) and commercial (C) production systems into patterns according to their herd health providers (HHPs), and obtain descriptive information about the grouped S and C production systems; and (b) identify key HHPs within each production system using social network analysis. On-farm veterinarians, private consultants, pharmaceutical company representatives, government veterinarians, livestock and agricultural technicians, and agricultural supply stores were found to be actively interacting with pig farmers. Four clusters were identified based on production system and their choice of HHPs. Differences in management and biosecurity practices were found between S and C clusters. Private HHPs provided a service to larger C and some larger S farms, and have little or no interaction with the other HHPs. Government HHPs provided herd health service mainly to S farms and small C farms. Agricultural supply stores were identified as a dominant solitary HHP and provided herd health services to the majority of farmers. Increased knowledge of the routine management and biosecurity practices of S and C farmers and the key HHPs that are likely to be associated with those practices would be of value as this information could be used to inform a risk-based approach to disease surveillance and control. Copyright © 2014 Elsevier B.V. All rights reserved.

Bridging the Gap between Health and Social Care for Rare Diseases: Key Issues and Innovative Solutions.

PubMed

Castro, Raquel; Senecat, Juliette; de Chalendar, Myriam; Vajda, Ildikó; Dan, Dorica; Boncz, Béata

2017-01-01

Bridging the gaps between health and social care for rare diseases is not only necessary but crucial to increase the life expectancy, quality of life and autonomy of people living with a rare disease, supporting them in the full realisation of their fundamental human rights.The complexity of rare diseases, their strong relation to disability and the current unmet social and daily life needs of people living with a rare disease must not be underestimated and require urgent attention from all stakeholders involved in care provision, from healthcare to social and community services.The Commission Expert Group Recommendations to Support the Incorporation of Rare Diseases into Social Services and Policies, adopted unanimously in April 2016, by the representatives of European Member States and the other rare disease stakeholders, clearly set the tone for the need to promote measures that facilitate multidisciplinary, holistic, continuous, person-centred and participative care provision to people living with rare diseases.These recommendations, sided by other recent policy developments at European and national levels, represent an important policy step into approaching rare diseases' complex challenges in regards to holistic care provision.Innovative approaches aiming at bridging the gap between health, social and community service and support providers are currently being developed and tested in different European countries: standards of care, networks of expertise, case management services, one-stop-shop services, amongst others.These ongoing pilot approaches, presented in this chapter, have the power to inspire future policies and the effective and efficient implementation of holistic care pathways for people living with a rare disease, bringing about significant changes for patients, carers, care providers, competent authorities and the society at large.Nonetheless, the challenges to fully address this issue remain numerous and other key issues will also need to be taken into account when moving forward with the implementation of measures that aim at bridging the gaps between care providers and providing holistic care to people living with a rare disease.