Variables in Effective Interagency Relationships.

ERIC Educational Resources Information Center

Bayer, Darryl Lee

The sytems view of organizations recognizes that all parts of the organization, including people and organizations within networks, affect all the other parts. This study examines the interorganizational relationships of a rural community human service delivery system in northern Minnesota. The coordination and integration of human services appear…

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

PubMed

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

2015-03-24

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

An Integrated Model for Identifying Linkages Between the Management of Fuel Treatments, Fire and Ecosystem Services

NASA Astrophysics Data System (ADS)

Bart, R. R.; Anderson, S.; Moritz, M.; Plantinga, A.; Tague, C.

2015-12-01

Vegetation fuel treatments (e.g. thinning, prescribed burning) are a frequent tool for managing fire-prone landscapes. However, predicting how fuel treatments may affect future wildfire risk and associated ecosystem services, such as forest water availability and streamflow, remains a challenge. This challenge is in part due to the large range of conditions under which fuel treatments may be implemented, as response is likely to vary with species type, rates of vegetation regrowth, meteorological conditions and physiographic properties of the treated site. It is also due to insufficient understanding of how social factors such as political pressure, public demands and economic constraints affect fuel management decisions. To examine the feedbacks between ecological and social dimensions of fuel treatments, we present an integrated model that links a biophysical model that simulates vegetation and hydrology (RHESSys), a fire spread model (WMFire) and an empirical fuel treatment model that accounts for agency decision-making. We use this model to investigate how management decisions affect landscape fuel loads, which in turn affect fire severity and ecosystem services, which feedback to management decisions on fuel treatments. We hypothesize that this latter effect will be driven by salience theory, which predicts that fuel treatments are more likely to occur following major wildfire events. The integrated model provides a flexible framework for answering novel questions about fuel treatments that span social and ecological domains, areas that have previously been treated separately.

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

PubMed

Lin, Y J; Wan, T T

2001-02-01

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

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

USGS Publications Warehouse

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

2018-05-07

Executive Summary—OverviewNatural resource managers must make decisions that affect broad-scale ecosystem processes involving large spatial areas, complex biophysical interactions, numerous competing stakeholder interests, and highly uncertain outcomes. Natural and social science information and analyses are widely recognized as important for informing effective management. Chief among the systematic approaches for improving the integration of science into natural resource management are two emergent science concepts, adaptive management and ecosystem services. Adaptive management (also referred to as “adaptive decision making”) is a deliberate process of learning by doing that focuses on reducing uncertainties about management outcomes and system responses to improve management over time. Ecosystem services is a conceptual framework that refers to the attributes and outputs of ecosystems (and their components and functions) that have value for humans.This report explores how ecosystem services can be moved from concept into practice through connection to a decision framework—adaptive management—that accounts for inherent uncertainties. Simultaneously, the report examines the value of incorporating ecosystem services framing and concepts into adaptive management efforts.Adaptive management and ecosystem services analyses have not typically been used jointly in decision making. However, as frameworks, they have a natural—but to date underexplored—affinity. Both are policy and decision oriented in that they attempt to represent the consequences of resource management choices on outcomes of interest to stakeholders. Both adaptive management and ecosystem services analysis take an empirical approach to the analysis of ecological systems. This systems orientation is a byproduct of the fact that natural resource actions affect ecosystems—and corresponding societal outcomes—often across large geographic scales. Moreover, because both frameworks focus on resource systems, both must confront the analytical challenges of systems modeling—in terms of complexity, dynamics, and uncertainty.Given this affinity, the integration of ecosystem services analysis and adaptive management poses few conceptual hurdles. In this report, we synthesize discussions from two workshops that considered ways in which adaptive management approaches and ecosystem service concepts may be complementary, such that integrating them into a common framework may lead to improved natural resource management outcomes. Although the literature on adaptive management and ecosystem services is vast and growing, the report focuses specifically on the integration of these two concepts rather than aiming to provide new definitions or an indepth review or primer of the concepts individually.Key issues considered include the bidirectional links between adaptive decision making and ecosystem services, as well as the potential benefits and inevitable challenges arising in the development and use of an integrated framework. Specifically, the workshops addressed the following questions:How can application of ecosystem service analysis within an adaptive decision process improve the outcomes of management and advance understanding of ecosystem service identification, production, and valuation?How can these concepts be integrated in concept and practice?What are the constraints and challenges to integrating adaptive management and ecosystem services?And, should the integration of these concepts be moved forward to wider application—and if so, how?

Establishing a Cloud Computing Success Model for Hospitals in Taiwan.

PubMed

Lian, Jiunn-Woei

2017-01-01

The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality and system quality directly affect cloud computing satisfaction, whereas service quality indirectly affects the satisfaction through trust. In other words, trust serves as the mediator between service quality and satisfaction. This cloud computing success model will help hospitals evaluate or achieve success after adopting private cloud computing health care services.

Establishing a Cloud Computing Success Model for Hospitals in Taiwan

PubMed Central

Lian, Jiunn-Woei

2017-01-01

The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality and system quality directly affect cloud computing satisfaction, whereas service quality indirectly affects the satisfaction through trust. In other words, trust serves as the mediator between service quality and satisfaction. This cloud computing success model will help hospitals evaluate or achieve success after adopting private cloud computing health care services. PMID:28112020

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

PubMed Central

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

2017-01-01

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

Integrative model of caregiving: how macro and micro factors affect caregivers of adults with severe and persistent mental illness.

PubMed

Mak, Winnie W S

2005-01-01

The study tested an integrative model of caregiving by examining the effects of sociocultural characteristics, interpersonal relations, mental health service structure, consumers' symptoms, objective burden, and evaluation of service systems on the subjective experiences of caregivers. The sample consisted of 428 caregivers of adults with severe and persistent mental illness. Results from multiple regression analyses indicated that ethnicity was the most significant sociocultural factor on caregivers' worry, personal growth, and benefits. Caregivers enrolled in managed care plans worried more about their consumers' welfare and felt less gratified by their experiences than their counterparts from fee-for-service plans. Implications to and partnerships among caregivers and mental health service systems were discussed.

Toward Integration of Reading and Service Learning through an Interdisciplinary Program

ERIC Educational Resources Information Center

Ho, Shun-yee; Lee, Vivien Man-wai

2012-01-01

This study examined the effect of an interdisciplinary program of reading and service learning on the cognitive and affective development of university students in Hong Kong. As Nussbaum (1997) stated, literature plays a vital role in educating citizens of the world through its narrative imagination and its power of promoting understanding and…

A Case for Ubiquitous, Integrated Computing in Teacher Education

ERIC Educational Resources Information Center

Kay, Robin H.; Knaack, Liesel

2005-01-01

The purpose of this study was to evaluate the effect of an integrated, laptop-based approach on pre-service teachers' computer attitudes, ability and use. Pre-post program analysis revealed significant differences in behavioural attitudes and perceived control (self-efficacy), but not in affective and cognitive attitudes. In addition, there was a…

Better and more efficient care through ICT-enabled integration of social care and healthcare services: experiences from two European projects

PubMed Central

Müller, Sonja; Meyer, Ingo; Kubitschke, Lutz; Delaney, Sarah

2012-01-01

Unsynchronised social and health care service delivery leads to inefficiencies, duplication of resources and reduced levels of quality of care. Older people are particularly affected by this situation. They often need both types of services, such as support with daily living activities and chronic disease management. ICT has the potential to support integrated service delivery to achieve high quality independent living and wellbeing for older people across Europe and elsewhere. Against this background, the presentation will demonstrate experiences and results derived from the development and piloting of ICT-supported integrated care services in eight sites across Europe, namely Dublin, Hull, Milton Keynes, Malaga, Veldhoven, Geldrop, Eindhoven and Bielefeld. Through innovative usage of ICT, current ‘silos’ in service delivery are broken up to allow for cooperation across relevant care sectors and participation of family members. The integrated services are to support the effective management of chronic diseases, and to address issues which affect independence, such as reduced agility, vision or hearing, in order to significantly improve the quality of life for older people and their carers. A dedicated programme of service process innovation complemented by adaptation of technology is being pursued in order to develop an integrated digital support infrastructure and related services: using appropriate existing technology to provide as many older people as possible with digital access to support services they needaugmenting and opening sectoral care platforms to enable coordinated cross-sector support deliveryadopting a clearly demand-driven inclusive approach and avoiding a technology ‘push’. Wider deployment of the services is supported by a dedicated programme of socio-economic service evaluation. The evaluation framework utilises a multi-method and multi-perspective approach, involving end users, family carers, service provider staff and key informants at corporate level. Triangulation is used to cross-reference data from different sources in order to maximize the reliability and robustness of conclusions drawn from the evaluation. Based on an overall framework taking into account themes such as integration, user outcomes, staff impact, organisational impact, technology, implementation and overall satisfaction, the specifics of each site are taken into account in operationally applying the overall framework in each case. The designs to be employed at each site have been developed to be as robust as possible, taking into account the constraints of the realities of the interventions. The evaluation is accompanied by a business case modelling approach that builds largely on a cost-benefit analysis covering the service development and implementation activities as well as the pilots and modelling the further deployment of services in each of the pilot sites. The presentation builds upon experiences gained within the framework of two European projects, CommonWell and INDEPENDENT. They are both co-funded under the EU’s Competitiveness and Innovation Framework Programme (CIP) focus on better joining-up of formal social/healthcare services and strengthening participation of the so-called ‘third sector’.

Rotorcraft air transportation

NASA Technical Reports Server (NTRS)

Gilbert, G. A.

1983-01-01

Intermodal relationships and the particular ways in which they affect public transportation applications of rotorcraft are addressed. Some aspects of integrated services and general comparisons with other transportation modes are reviewed. Two potential application scenarios are discussed: down-to-downtown rotorcraft service and urban public transport rotorcraft service. It is concluded that to integrate well with ground access modes community rotorcraft service should be limited stop service with published schedules, and operate on a few specific routes between a few specific destinations. For downtown-to-downtown service, time savings favorable to rotorcraft are benefits that reflect its more direct access, relatively higher line-haul travel speeds, and less circuitous travel. For the scenario of public transport within urban areas, first, improving cruise speeds has a limited potential due to allowing for a ""station spacing'' effect. Secondly, public acceptance of higher acceleration/deceleration rates may be just as effective as a technological innovation as achieving higher cruise speeds.

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

PubMed

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

2018-06-14

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

Regional Approach for Linking Ecosystem Services and Livelihood Strategies Under Climate Change of Pastoral Communities in the Mongolian Steppe Ecosystem

NASA Astrophysics Data System (ADS)

Ojima, D. S.; Galvin, K.; Togtohyn, C.

2012-12-01

Dramatic changes due to climate and land use dynamics in the Mongolian Plateau affecting ecosystem services and agro-pastoral systems in Mongolia. Recently, market forces and development strategies are affecting land and water resources of the pastoral communities which are being further stressed due to climatic changes. Evaluation of pastoral systems, where humans depend on livestock and grassland ecosystem services, have demonstrated the vulnerability of the social-ecological system to climate change. Current social-ecological changes in ecosystem services are affecting land productivity and carrying capacity, land-atmosphere interactions, water resources, and livelihood strategies. The general trend involves greater intensification of resource exploitation at the expense of traditional patterns of extensive range utilization. Thus we expect climate-land use-land cover relationships to be crucially modified by the social-economic forces. The analysis incorporates information about the social-economic transitions taking place in the region which affect land-use, food security, and ecosystem dynamics. The region of study extends from the Mongolian plateau in Mongolia. Our research indicate that sustainability of pastoral systems in the region needs to integrate the impact of climate change on ecosystem services with socio-economic changes shaping the livelihood strategies of pastoral systems in the region. Adaptation strategies which incorporate integrated analysis of landscape management and livelihood strategies provides a framework which links ecosystem services to critical resource assets. Analysis of the available livelihood assets provides insights to the adaptive capacity of various agents in a region or in a community. Sustainable development pathways which enable the development of these adaptive capacity elements will lead to more effective adaptive management strategies for pastoral land use and herder's living standards. Pastoralists will have the opportunity to utilize seasonal resources and enhance their ability to process and manufacture products from the available ecosystem services in these dynamic social-ecological systems.

'It is not a quick fix' structural and contextual issues that affect implementation of integrated health and well-being services: a qualitative study from North East England.

PubMed

Cheetham, M; Visram, S; Rushmer, R; Greig, G; Gibson, E; Khazaeli, B; Wiseman, A

2017-11-01

The objective of this article is to examine the factors affecting the design, commissioning and delivery of integrated health and well-being services (IHWSs), which seek to address multiple health-related behaviours, improve well-being and tackle health inequalities using holistic approaches. Qualitative studies embedded within iterative process evaluations. Semi-structured interviews conducted with 16 key informants as part of two separate evaluations of IHWSs in North East England, supplemented by informal observations of service delivery. Transcripts and fieldnotes were analysed thematically. The study findings identify a challenging organisational context in which to implement innovative service redesign, as a result of budget cuts and changes in NHS and local authority capacity. Pressures to demonstrate outcomes affected the ability to negotiate the practicalities of joint working. Progress is at risk of being undermined by pressures to disinvest before the long-term benefits to population health and well-being are realised. The findings raise important questions about contract management and relationships between commissioners and providers involved in implementing these new ways of working. These findings provide useful learning in terms of the delivery and commissioning of similar IHWSs, contributing to understanding of the benefits and challenges of this model of working. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Biodiversity, ecosystem functions and services in environmental risk assessment: introduction to the special issue.

PubMed

Schäfer, Ralf B

2012-01-15

This Special Issue focuses on the questions if and how biodiversity, ecosystem functions and resulting services could be incorporated into the Ecological Risk Assessment (ERA). Therefore, three articles provide a framework for the integration of ecosystem services into ERA of soils, sediments and pesticides. Further articles demonstrate ways how stakeholders can be integrated into an ecosystem service-based ERA for soils and describe how the current monitoring could be adapted to new assessment endpoints that are directly linked to ecosystem services. Case studies show that the current ERA may not be protective for biodiversity, ecosystem functions and resulting services and that both pesticides and salinity currently adversely affect ecosystem functions in the field. Moreover, ecological models can be used for prediction of new protection goals and could finally support their implementation into the ERA. Overall, the Special Issue stresses the urgent need to enhance current procedures of ERA if biodiversity, ecosystem functions and resulting services are to be protected. Copyright © 2011 Elsevier B.V. All rights reserved.

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

PubMed

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

2017-11-01

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

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

PubMed

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

2018-06-19

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

Agreement between Self-Report and Archival Public Service Utilization Data among Chronically Homeless Individuals with Severe Alcohol Problems

ERIC Educational Resources Information Center

Clifasefi, Seema L.; Collins, Susan E.; Tanzer, Kenneth; Burlingham, Bonnie; Hoang, Sara E.; Larimer, Mary E.

2011-01-01

Public service utilization data are often used as key outcomes in studies on homelessness. Although self-report data on these outcomes are accessible and cost-effective, various factors may affect retrospective recall in homeless populations. It is therefore necessary to establish validity of self-report to ensure the integrity of studies…

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.

Does Integrating Family Planning into HIV Services Improve Gender Equitable Attitudes? Results from a Cluster Randomized Trial in Nyanza, Kenya.

PubMed

Newmann, Sara J; Rocca, Corinne H; Zakaras, Jennifer M; Onono, Maricianah; Bukusi, Elizabeth A; Grossman, Daniel; Cohen, Craig R

2016-09-01

This study investigated whether integrating family planning (FP) services into HIV care was associated with gender equitable attitudes among HIV-positive adults in western Kenya. Surveys were conducted with 480 women and 480 men obtaining HIV services from 18 clinics 1 year after the sites were randomized to integrated FP/HIV services (N = 12) or standard referral for FP (N = 6). We used multivariable regression, with generalized estimating equations to account for clustering, to assess whether gender attitudes (range 0-12) were associated with integrated care and with contraceptive use. Men at intervention sites had stronger gender equitable attitudes than those at control sites (adjusted mean difference in scores = 0.89, 95 % CI 0.03-1.74). Among women, attitudes did not differ by study arm. Gender equitable attitudes were not associated with contraceptive use among men (AOR = 1.06, 95 % CI 0.93-1.21) or women (AOR = 1.03, 95 % CI 0.94-1.13). Further work is needed to understand how integrating FP into HIV care affects gender relations, and how improved gender equity among men might be leveraged to improve contraceptive use and other reproductive health outcomes.

An ecosystem service approach to support integrated pond management: a case study using Bayesian belief networks--highlighting opportunities and risks.

PubMed

Landuyt, Dries; Lemmens, Pieter; D'hondt, Rob; Broekx, Steven; Liekens, Inge; De Bie, Tom; Declerck, Steven A J; De Meester, Luc; Goethals, Peter L M

2014-12-01

Freshwater ponds deliver a broad range of ecosystem services (ESS). Taking into account this broad range of services to attain cost-effective ESS delivery is an important challenge facing integrated pond management. To assess the strengths and weaknesses of an ESS approach to support decisions in integrated pond management, we applied it on a small case study in Flanders, Belgium. A Bayesian belief network model was developed to assess ESS delivery under three alternative pond management scenarios: intensive fish farming (IFF), extensive fish farming (EFF) and nature conservation management (NCM). A probabilistic cost-benefit analysis was performed that includes both costs associated with pond management practices and benefits associated with ESS delivery. Whether or not a particular ESS is included in the analysis affects the identification of the most preferable management scenario by the model. Assessing the delivery of a more complete set of ecosystem services tends to shift the results away from intensive management to more biodiversity-oriented management scenarios. The proposed methodology illustrates the potential of Bayesian belief networks. BBNs facilitate knowledge integration and their modular nature encourages future model expansion to more encompassing sets of services. Yet, we also illustrate the key weaknesses of such exercises, being that the choice whether or not to include a particular ecosystem service may determine the suggested optimal management practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

PubMed

Reynolds, Heidi W; Sutherland, Elizabeth G

2013-05-06

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

Population Accessibility to Radiotherapy Services in New South Wales Region of Australia: a methodological contribution

NASA Astrophysics Data System (ADS)

Shukla, Nagesh; Wickramasuriya, Rohan; Miller, Andrew; Perez, Pascal

2015-05-01

This paper proposes an integrated modelling process to assess the population accessibility to radiotherapy treatment services in future based on future cancer incidence and road network-based accessibility. Previous research efforts assessed travel distance/time barriers affecting access to cancer treatment services, as well as epidemiological studies that showed that cancer incidence rates vary with population demography. It is established that travel distances to treatment centres and demographic profiles of the accessible regions greatly influence the demand for cancer radiotherapy (RT) services. However, an integrated service planning approach that combines spatially-explicit cancer incidence projections, and the RT services accessibility based on patient road network have never been attempted. This research work presents this novel methodology for the accessibility assessment of RT services and demonstrates its viability by modelling New South Wales (NSW) cancer incidence rates for different age-sex groups based on observed cancer incidence trends; estimating the road network-based access to current NSW treatment centres; and, projecting the demand for RT services in New South Wales, Australia from year 2011 to 2026.

Factors Affecting the Transportability of the State Consultant Model to Another Region: The Mutual Adaptation of the State Consultant Model and of the Structure of AEL's Educational Services Office.

ERIC Educational Resources Information Center

Sanders, Jack

The Educational Services Office (ESO) of the Appalachia Educational Laboratory (AEL) sought an organizational strategy that would improve its ability to meet client demand without sacrificing the integrity of its programs or the fulfillment of its institutional responsibilities. Three alternative organizational strategies were identified:…

Receptivity of Librarians to Optical Information Technologies and Products.

ERIC Educational Resources Information Center

Eaton, Nancy

1986-01-01

Examines factors which may affect the receptivity of librarians to the use of optical disk technologies, including hardware and software issues, the content of currently available databases, and the integration of optical technologies into existing library services. (CLB)

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

Dale, Virginia H; Kline, Keith L; Kaffka, Stephen R

Landscape sustainability of agricultural systems considers effects of farm activities on social, economic, and ecosystem services at local and regional scales. Sustainable agriculture entails: defining sustainability, developing easily measured indicators of sustainability, moving toward integrated agricultural systems, and offering incentives or imposing regulations to affect farmer behavior. A landscape perspective is useful because landscape ecology provides theory and methods for dealing with spatial heterogeneity, scaling, integration, and complexity. To implement agricultural sustainability, we propose adopting a systems perspective, recognizing spatial heterogeneity, addressing the influences of context, and integrating landscape-design principles. Topics that need further attention at local and regional scalesmore » include (1) protocols for quantifying material and energy flows; (2) effects of management practices; (3) incentives for enhancing social, economic, and ecosystem services; (4) integrated landscape planning and management; (5) monitoring and assessment; (6) effects of societal demand; and (7) consistent and holistic policies for promoting agricultural sustainability.« less

The Personal Emergency Response System as a Technology Innovation in Primary Health Care Services: An Integrative Review.

PubMed

Stokke, Randi

2016-07-14

Most western countries are experiencing greater pressure on community care services due to increased life expectancy and changes in policy toward prioritizing independent living. This has led to a demand for change and innovation in caring practices with an expected increased use of technology. Despite numerous attempts, it has proven surprisingly difficult to implement and adopt technological innovations. The main established technological innovation in home care services for older people is the personal emergency response system (PERS), which is widely adopted and used throughout most western countries aiming to support "aging safely in place." This integrative review examines how research literature describes use of the PERS focusing on the users' perspective, thus exploring how different actors experience the technology in use and how it affects the complex interactions between multiple actors in caring practices. The review presents an overview of the body of research on this well-established telecare solution, indicating what is important for different actors in regard to accepting and using this technology in community care services. An integrative review, recognized by a systematic search in major databases followed by a review process, was conducted. The search resulted in 33 included studies describing different actors' experiences with the PERS in use. The overall focus was on the end users' experiences and the consequences of having and using the alarm, and how the technology changes caring practices and interactions between the actors. The PERS contributes to safety and independent living for users of the alarm, but there are also unforeseen consequences and possible improvements in the device and the integrated service. This rather simple and well-established telecare technology in use interacts with the actors involved, creating changes in daily living and even affecting their identities. This review argues for an approach to telecare in which the complexity of practice is accounted for and shows how the plug-and-play expectations producers tend to generate is a simplification of the reality. This calls for a recognition that place and actors matter, as does a sensitivity to technology as an integrated part of complex caring practices.

The Personal Emergency Response System as a Technology Innovation in Primary Health Care Services: An Integrative Review

PubMed Central

2016-01-01

Background Most western countries are experiencing greater pressure on community care services due to increased life expectancy and changes in policy toward prioritizing independent living. This has led to a demand for change and innovation in caring practices with an expected increased use of technology. Despite numerous attempts, it has proven surprisingly difficult to implement and adopt technological innovations. The main established technological innovation in home care services for older people is the personal emergency response system (PERS), which is widely adopted and used throughout most western countries aiming to support “aging safely in place.” Objective This integrative review examines how research literature describes use of the PERS focusing on the users’ perspective, thus exploring how different actors experience the technology in use and how it affects the complex interactions between multiple actors in caring practices. Methods The review presents an overview of the body of research on this well-established telecare solution, indicating what is important for different actors in regard to accepting and using this technology in community care services. An integrative review, recognized by a systematic search in major databases followed by a review process, was conducted. Results The search resulted in 33 included studies describing different actors’ experiences with the PERS in use. The overall focus was on the end users’ experiences and the consequences of having and using the alarm, and how the technology changes caring practices and interactions between the actors. Conclusions The PERS contributes to safety and independent living for users of the alarm, but there are also unforeseen consequences and possible improvements in the device and the integrated service. This rather simple and well-established telecare technology in use interacts with the actors involved, creating changes in daily living and even affecting their identities. This review argues for an approach to telecare in which the complexity of practice is accounted for and shows how the plug-and-play expectations producers tend to generate is a simplification of the reality. This calls for a recognition that place and actors matter, as does a sensitivity to technology as an integrated part of complex caring practices. PMID:27417422

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

PubMed

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

2017-03-23

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

Final ecosystem goods and services enhance societal relevance of contaminated-site remediation

EPA Science Inventory

Background/Question/Methods Exposure to environmental stressors can adversely affect both human health and ecological receptors and impacts on the latter influence the community's overall vulnerability. Risk assessment guidance promotes conceptual site models to integrate multip...

Medical records in equine veterinary practice.

PubMed

Werner, Susan H

2009-12-01

Quality medical records are the cornerstone of successful equine veterinary practice. The scope and integrity of the information contained in a practice's medical records influence the quality of patient care and client service and affect liability risk, practice productivity, and overall practice value.

An HL7/CDA Framework for the Design and Deployment of Telemedicine Services

DTIC Science & Technology

2001-10-25

schemes and prescription databases. Furthermore, interoperability with the Electronic Health Re- cord ( EHR ) facilitates automatic retrieval of relevant...local EHR system or the integrated electronic health record (I- EHR ) [9], which indexes all medical contacts of a patient in the regional net- work...suspected medical problem. Interoperability with middleware services of the HII and other data sources such as the local EHR sys- tem affects

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

A Community-Based, Technology-Supported Health Service for Detecting and Preventing Frailty among Older Adults: A Participatory Design Development Process.

PubMed

van Velsen, Lex; Illario, Maddalena; Jansen-Kosterink, Stephanie; Crola, Catherine; Di Somma, Carolina; Colao, Annamaria; Vollenbroek-Hutten, Miriam

2015-01-01

Frailty is a multifaceted condition that affects many older adults and marks decline on areas such as cognition, physical condition, and nutritional status. Frail individuals are at increased risk for the development of disability, dementia, and falls. There are hardly any health services that enable the identification of prefrail individuals and that focus on prevention of further functional decline. In this paper, we discuss the development of a community-based, technology-supported health service for detecting prefrailty and preventing frailty and further functional decline via participatory design with a wide range of stakeholders. The result is an innovative service model in which an online platform supports the integration of traditional services with novel, Information Communication Technology supported tools. This service is capable of supporting the different phases of screening and offers training services, by also integrating them with community-based services. The service model can be used as a basis for developing similar services within a wide range of healthcare systems. We present the service model, the general functioning of the technology platform, and the different ways in which screening for and prevention of frailty has been localized. Finally, we reflect on the added value of participatory design for creating such health services.

Women and Private Pensions.

ERIC Educational Resources Information Center

Benson, Helene A.

This speech focuses on women and private pension plans, such as private pension coverage and smaller benefit amounts. Pension issues affecting women as employees include participation in plans, vesting, break-in service, benefit accruals, integration with Social Security, sex-based actuarial tables, portability, inflation, and individual…

Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa.

PubMed

Mathibe, Maphuthego D; Hendricks, Stephen J H; Bergh, Anne-Marie

2015-10-02

Primary Health Care (PHC) clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration. This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics. An exploratory, qualitative study was conducted in four city of Tshwane PHC facilities. Two urban and two rural facilities following different models of integration were included. A self-administered questionnaire with open-ended items was completed by 35 clinicians and four focus group interviews were conducted with HIV-positive patients. The data were coded and categories were grouped into sub-themes and themes. Workload, staff development and support for integration affected clinicians' performance and viewpoints. They perceived promotion of privacy, reduced discrimination and increased access to comprehensive care as benefits of service integration. Delays, poor patient care and patient dissatisfaction were viewed as negative aspects of integration. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, whilst the reverse was true in the facility with separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation was viewed negatively, as well as poor staff attitudes, poor communication and long waiting times. Although a fully integrated service model is preferable, aspects that need further attention are management support from health authorities for health facilities, improved working conditions and appropriate staff development opportunities.

Visioning services for children affected by HIV and AIDS through a family lens.

PubMed

Richter, Linda; Beyrer, Chris; Kippax, Susan; Heidari, Shirin

2010-06-23

The HIV epidemic continues to place a great burden on children, from loss of parents and income to severe disruptions of their homes and families. Underpinned by the understanding that a healthy family constitutes the foundation for a child's wellbeing, the importance of family-centred care and services for children is increasingly recognized. It is not enough to merely provide antiretrovirals: it is of pivotal importance that treatment and care for children are integrated into the broader context of family-support schemes. However, despite growing evidence of the benefits of family-centred services, reforms in favour of family oriented HIV interventions have been slow to emerge. Treatment, prevention and care interventions often target individuals, and not families and communities.For the first time, this supplement to the Journal of the International AIDS Society brings together in one place the rationale for family-centred services for children affected by HIV and AIDS and some of the available evidence for the effectiveness of doing so. We hope this constitutes a beginning of what could be a groundswell of interest in family-centred services for children affected by HIV and AIDS.

Visioning services for children affected by HIV and AIDS through a family lens

PubMed Central

2010-01-01

The HIV epidemic continues to place a great burden on children, from loss of parents and income to severe disruptions of their homes and families. Underpinned by the understanding that a healthy family constitutes the foundation for a child's wellbeing, the importance of family-centred care and services for children is increasingly recognized. It is not enough to merely provide antiretrovirals: it is of pivotal importance that treatment and care for children are integrated into the broader context of family-support schemes. However, despite growing evidence of the benefits of family-centred services, reforms in favour of family oriented HIV interventions have been slow to emerge. Treatment, prevention and care interventions often target individuals, and not families and communities. For the first time, this supplement to the Journal of the International AIDS Society brings together in one place the rationale for family-centred services for children affected by HIV and AIDS and some of the available evidence for the effectiveness of doing so. We hope this constitutes a beginning of what could be a groundswell of interest in family-centred services for children affected by HIV and AIDS. PMID:20573282

Improving consistency and quality of service delivery: implications for the addiction treatment field.

PubMed

Knott, Anne Marie; Corredoira, Rafael; Kimberly, John

2008-09-01

Addiction treatment providers face serious problems in delivering consistent, high-quality services over time. Among those providers with multiple treatment sites, there is also intersite variability. This is a serious problem in the addiction field, likely to be made worse as new technologies are introduced and/or as there is industry consolidation (Corredoira, R., Kimberly, J. (2006) Industry evolution through consolidation: Implications for addiction treatment. Journal of Substance Abuse Treatment 31, 255-265.). Although serious, these problems in managing and monitoring to assure consistent service quality have been faced by many other industries. Here, we review evidence from research in other industries regarding three different forms of management (vertical integration, franchising, and licensing) across a chain of individual service providers. We show how each management form affects the level, consistency, and improvement of service delivery over time. In addition, we discuss how such performance advantages affect customer demand as well as regulatory endorsement of the consolidated firm and its approach.

'What makes an excellent mental health doctor?' A response integrating the experiences and views of service users with critical reflections of psychiatrists.

PubMed

Gunasekara, Imani; Patterson, Sue; Scott, James G

2017-11-01

While therapeutic relationships are appropriately recognised as the foundation of mental health service, service users commonly report suboptimal experiences. With shared understanding critical to improvement in practice, we explored service users' experiences and expectations of psychiatrists and consultations, engaging psychiatrists throughout the process. Using an iterative qualitative approach we co-produced a response to the question 'what makes an excellent mental health doctor?' Experiences and expectations of psychiatrists were explored in interviews with 22 service users. Data collection, analysis and interpretation were informed by consultation with peer workers. Findings were contextualised in formal consultations with psychiatrists. As 'masters of their craft', excellent mental health doctors engage authentically with service users as people (not diagnoses). They listen, validate experiences and empathise affectively and cognitively. They demonstrate phronesis, applying clinical knowledge compassionately. Psychiatrists share service users' aspiration of equitable partnership but competing demands and 'professional boundaries' constrain engagement. Consistent delivery of the person-centred, recovery-oriented care promoted by policy and sought by service users will require substantial revision of the structure and priorities of mental health services. The insights and experiences of service users must be integral to medical education, and systems must provide robust support to psychiatrists. © 2017 John Wiley & Sons Ltd.

Role of innovative institutional structures in integrated governance. A case study of integrating health and nutrition programs in Chhattisgarh, India.

PubMed

Kalita, Anuska; Mondal, Shinjini

2012-01-01

The aim of this paper is to highlight the significance of integrated governance in bringing about community participation, improved service delivery, accountability of public systems and human resource rationalisation. It discusses the strategies of innovative institutional structures in translating such integration in the areas of public health and nutrition for poor communities. The paper draws on experience of initiating integrated governance through innovations in health and nutrition programming in the resource-poor state of Chhattisgarh, India, at different levels of governance structures--hamlets, villages, clusters, blocks, districts and at the state. The study uses mixed methods--i.e. document analysis, interviews, discussions and quantitative data from facilities surveys--to present a case study analyzing the process and outcome of integration. The data indicate that integrated governance initiatives improved convergence between health and nutrition departments of the state at all levels. Also, innovative structures are important to implement the idea of integration, especially in contexts that do not have historical experience of such partnerships. Integration also contributed towards improved participation of communities in self-governance, community monitoring of government programs, and therefore, better services. As governments across the world, especially in developing countries, struggle towards achieving better governance, integration can serve as a desirable process to address this. Integration can affect the decentralisation of power, inclusion, efficiency, accountability and improved service quality in government programs. The institutional structures detailed in this paper can provide models for replication in other similar contexts for translating and sustaining the idea of integrated governance. This paper is one of the few to investigate innovative public institutions of a and community mobilisation to explore this important, and under-researched, topic.

Linking water quality and well-being for improved assessment and valuation of ecosystem services

PubMed Central

Keeler, Bonnie L.; Polasky, Stephen; Brauman, Kate A.; Johnson, Kris A.; Finlay, Jacques C.; O’Neill, Ann; Kovacs, Kent; Dalzell, Brent

2012-01-01

Despite broad recognition of the value of the goods and services provided by nature, existing tools for assessing and valuing ecosystem services often fall short of the needs and expectations of decision makers. Here we address one of the most important missing components in the current ecosystem services toolbox: a comprehensive and generalizable framework for describing and valuing water quality-related services. Water quality is often misrepresented as a final ecosystem service. We argue that it is actually an important contributor to many different services, from recreation to human health. We present a valuation approach for water quality-related services that is sensitive to different actions that affect water quality, identifies aquatic endpoints where the consequences of changing water quality on human well-being are realized, and recognizes the unique groups of beneficiaries affected by those changes. We describe the multiple biophysical and economic pathways that link actions to changes in water quality-related ecosystem goods and services and provide guidance to researchers interested in valuing these changes. Finally, we present a valuation template that integrates biophysical and economic models, links actions to changes in service provision and value estimates, and considers multiple sources of water quality-related ecosystem service values without double counting. PMID:23091018

Linking water quality and well-being for improved assessment and valuation of ecosystem services.

PubMed

Keeler, Bonnie L; Polasky, Stephen; Brauman, Kate A; Johnson, Kris A; Finlay, Jacques C; O'Neill, Ann; Kovacs, Kent; Dalzell, Brent

2012-11-06

Despite broad recognition of the value of the goods and services provided by nature, existing tools for assessing and valuing ecosystem services often fall short of the needs and expectations of decision makers. Here we address one of the most important missing components in the current ecosystem services toolbox: a comprehensive and generalizable framework for describing and valuing water quality-related services. Water quality is often misrepresented as a final ecosystem service. We argue that it is actually an important contributor to many different services, from recreation to human health. We present a valuation approach for water quality-related services that is sensitive to different actions that affect water quality, identifies aquatic endpoints where the consequences of changing water quality on human well-being are realized, and recognizes the unique groups of beneficiaries affected by those changes. We describe the multiple biophysical and economic pathways that link actions to changes in water quality-related ecosystem goods and services and provide guidance to researchers interested in valuing these changes. Finally, we present a valuation template that integrates biophysical and economic models, links actions to changes in service provision and value estimates, and considers multiple sources of water quality-related ecosystem service values without double counting.

21 CFR 211.170 - Reserve samples.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Reserve samples. 211.170 Section 211.170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL... of deterioration unless visual examination would affect the integrity of the reserve sample. Any...

78 FR 57641 - Proposed Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-19

..., designed to improve the well-being of children affected by parental substance abuse. On September 28, 2012... the programs and activities conducted through the RPG Grant Program. Title: RPG National Cross-Site... integration of programs, activities, and services designed to increase well-being, improve permanency, and...

An Introduction for Distance Educators [and] Five Essential Factors Every Administrator Needs To Know about Integrated Telecommunications Infrastructures.

ERIC Educational Resources Information Center

Saba, Farhad; Mahon, J. Michael

1999-01-01

Discusses telecommunications developments that are affecting distance educators. Topics include bandwidth; educational radio and television; instructional television-fixed services (ITFS); cable television; communication satellites; computers; digital telecommunications; the Internet; other protocols; future systems; telephone switches and…

20 CFR 216.23 - Work which does not affect eligibility.

Code of Federal Regulations, 2011 CFR

2011-04-01

... business, trade or profession as an independent contractor, rather than as an employee. An individual is not self-employed if the business is incorporated. The designation or description of the relationship... business. Integration of an individual's services into the business operations of an employer generally...

20 CFR 216.23 - Work which does not affect eligibility.

Code of Federal Regulations, 2010 CFR

2010-04-01

... business, trade or profession as an independent contractor, rather than as an employee. An individual is not self-employed if the business is incorporated. The designation or description of the relationship... business. Integration of an individual's services into the business operations of an employer generally...

Laboratory medicine: challenges and opportunities.

PubMed

Bossuyt, Xavier; Verweire, Kurt; Blanckaert, Norbert

2007-10-01

Technologic innovations have substantially improved the productivity of clinical laboratories, but the services provided by clinical laboratories are increasingly becoming commoditized. We reflect on how current developments may affect the future of laboratory medicine and how to deal with these changes. We argue that to be prepared for the future, clinical laboratories should enhance efficiency and reduce costs by forming alliances and networks; consolidating, integrating, or outsourcing; and more importantly, create additional value by providing knowledge services related to in vitro diagnostics.

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.

MOWServ: a web client for integration of bioinformatic resources

PubMed Central

Ramírez, Sergio; Muñoz-Mérida, Antonio; Karlsson, Johan; García, Maximiliano; Pérez-Pulido, Antonio J.; Claros, M. Gonzalo; Trelles, Oswaldo

2010-01-01

The productivity of any scientist is affected by cumbersome, tedious and time-consuming tasks that try to make the heterogeneous web services compatible so that they can be useful in their research. MOWServ, the bioinformatic platform offered by the Spanish National Institute of Bioinformatics, was released to provide integrated access to databases and analytical tools. Since its release, the number of available services has grown dramatically, and it has become one of the main contributors of registered services in the EMBRACE Biocatalogue. The ontology that enables most of the web-service compatibility has been curated, improved and extended. The service discovery has been greatly enhanced by Magallanes software and biodataSF. User data are securely stored on the main server by an authentication protocol that enables the monitoring of current or already-finished user’s tasks, as well as the pipelining of successive data processing services. The BioMoby standard has been greatly extended with the new features included in the MOWServ, such as management of additional information (metadata such as extended descriptions, keywords and datafile examples), a qualified registry, error handling, asynchronous services and service replication. All of them have increased the MOWServ service quality, usability and robustness. MOWServ is available at http://www.inab.org/MOWServ/ and has a mirror at http://www.bitlab-es.com/MOWServ/. PMID:20525794

Quasi-experimental Study of Systematic Screening for Family Planning Services among Postpartum Women Attending Village Health and Nutrition Days in Jharkhand, India.

PubMed

Balasubramaniam, Sudharsanam; Kumar, Somesh; Sethi, Reena; Charurat, Elaine; Lalchandani, Kamlesh; Schuster, Anne; Sood, Bulbul

2018-01-25

Systematic screening helps increase family planning uptake through integration with other services, including immunization. Though successfully demonstrated at health facilities, this strategy has not been demonstrated in communities. This study assessed the effectiveness of systematic screening to increase postpartum family planning use during community health days in India without adversely affecting immunization services. The study was conducted during 180 individual Village Health and Nutrition Days in Jharkhand, India. All health workers were trained in postpartum family planning counseling. Intervention providers were also trained in systematic screening. 217 postpartum women aged 15-49 years participated in baseline and endline exit interviews and routine service statistics were analyzed from 2,485 facility visits at affiliated health centers. No difference in family planning service use was found in the intervention group, but significantly fewer interviewed women reported receiving family planning services at endline in the comparison group (p = 0.014). Family planning acceptance at affiliated health centers increased significantly in intervention areas (p < 0.001) but not in comparison areas, while immunization service use increased in both groups (p = 0.002 intervention, p < 0.001 comparison). The use of the postpartum systematic screening tool appears to increase acceptance of family planning services when integrated with community-based services in Jharkhand.

MOWServ: a web client for integration of bioinformatic resources.

PubMed

Ramírez, Sergio; Muñoz-Mérida, Antonio; Karlsson, Johan; García, Maximiliano; Pérez-Pulido, Antonio J; Claros, M Gonzalo; Trelles, Oswaldo

2010-07-01

The productivity of any scientist is affected by cumbersome, tedious and time-consuming tasks that try to make the heterogeneous web services compatible so that they can be useful in their research. MOWServ, the bioinformatic platform offered by the Spanish National Institute of Bioinformatics, was released to provide integrated access to databases and analytical tools. Since its release, the number of available services has grown dramatically, and it has become one of the main contributors of registered services in the EMBRACE Biocatalogue. The ontology that enables most of the web-service compatibility has been curated, improved and extended. The service discovery has been greatly enhanced by Magallanes software and biodataSF. User data are securely stored on the main server by an authentication protocol that enables the monitoring of current or already-finished user's tasks, as well as the pipelining of successive data processing services. The BioMoby standard has been greatly extended with the new features included in the MOWServ, such as management of additional information (metadata such as extended descriptions, keywords and datafile examples), a qualified registry, error handling, asynchronous services and service replication. All of them have increased the MOWServ service quality, usability and robustness. MOWServ is available at http://www.inab.org/MOWServ/ and has a mirror at http://www.bitlab-es.com/MOWServ/.

Impacts of land use/cover change on ecosystem services for Xiamen

NASA Astrophysics Data System (ADS)

Shi, L.; Cui, S.

2009-12-01

Based on remote sensing images of Xiamen in 1987, 1997 and 2007, the process of ecosystem service alteration resulting from land use/cover change was quantitatively analyzed through RS and GIS techniques. Consulting relative researches, an integrated assessment model was built to evaluating regional ecosystem services of Xiamen. The results showed that the total ecosystem service value of Xiamen was increased by 14.67%, from 3271.5 million to 3751.39 RMB. The relative change rate of supplying service, regulation service, cultural service and supporting service were 97.8%, -25.1%, 165.0% and -44.7% respectively, which indicated that land use/ cover change had positive effects on supplying and cultural service, whereas it had negatively affected both regulation service and supporting service. Land use/cover types of Xiamen in 1987, 1997 and 2007 Ecosystem values of Xiamen in 1987, 1997 and 2007 10 thousand RMB

Toward an Information Integration Approach to Issue Advertising.

ERIC Educational Resources Information Center

Douglas, William; And Others

Issue advertising is intended to inform an audience--most commonly with the intent of changing unfavorable opinions or reinforcing favorable ones--to affect cognition (in contrast to the behavioral emphasis of product and service advertising, intended to stimulate trail and adoption). To explore public reactions to printed and televised issues…

78 FR 44469 - Airworthiness Directives; BAE Systems (Operations) Limited Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-24

... June 15, 2009. (5) This paragraph restates the provisions of Note 5 of AD 2011- 24-06, Amendment 39... fatigue cracking of certain structural elements, which could adversely affect the structural integrity of....m. and 5 p.m., Monday through Friday, except Federal holidays. For BAE Systems service information...

Trends in domestic violence service and leadership: implications for an integrated shelter model.

PubMed

Panzer, P G; Philip, M B; Hayward, R A

2000-05-01

Domestic violence is a dangerous and prevalent social problem affecting up to 4 million women and countless children annually. Shelters offer safety and an opportunity for change during the crisis of family violence. These individuals also have the potential for retraumatization if leadership within the program recapitulates the abuse and coercion felt at home. This article reviews three related trends through the lens of power and control--domestic violence policy and service, models of leadership, and the study of traumatic stress disorders and recovery--and describes their implications for modern shelter service delivery.

"Do positive affectivity and boundary preferences matter for work-family enrichment? A study of human service workers": Correction to McNall, Scott, and Nicklin (2015).

PubMed

2016-07-01

Reports an error in "Do positive affectivity and boundary preferences matter for work-family enrichment? A study of human service workers" by Laurel A. McNall, Lindsay D. Scott and Jessica M. Nicklin (Journal of Occupational Health Psychology, 2015[Jan], Vol 20[1], 93-104). In the article there was an error in Figure 1. The lower left bubble should read "Boundary Preference Toward Segmentation" instead of "Boundary Preference Toward Integration." (The following abstract of the original article appeared in record 2014-44477-001.) More individuals than ever are managing work and family roles, but relatively little research has been done exploring whether boundary preferences help individuals benefit from multiple role memberships. Drawing on Greenhaus and Powell's (2006) work-family enrichment theory, along with Boundary Theory (Ashforth, Kreiner, & Fugate, 2000) and Conservation of Resources Theory (Hobfoll, 2002), we explore the impact of personal characteristics as enablers of work-family enrichment, and in turn, work outcomes relevant to human service workers: turnover intentions and emotional exhaustion. In a 2-wave study of 161 human service employees, we found that individuals high in positive affectivity were more likely to experience both work-to-family and family to-work enrichment, whereas those with preferences toward integration were more likely to experience work-to-family enrichment (but not family to-work enrichment). In turn, work-to-family enrichment (but not family to-work enrichment) was related to lower turnover intentions and emotional exhaustion. Enrichment served as a mediating mechanism for only some of the hypothesized relationships. Implications for theory and practice are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Barriers to Integrating Mental Health Services in Community-Based Primary Care Settings in Mexico City: A Qualitative Analysis.

PubMed

Martinez, William; Galván, Jorge; Saavedra, Nayelhi; Berenzon, Shoshana

2017-05-01

Despite the high prevalence of mental disorders in Mexico, minimal mental health services are available and there are large gaps in mental health treatment. Community-based primary care settings are often the first contact between patients and the health system and thus could serve as important settings for assessing and treating mental disorders. However, no formal assessment has been undertaken regarding the feasibility of implementing these services in Mexico. Before tools are developed to undertake such an assessment, a more nuanced understanding of the microprocesses affecting mental health service delivery must be acquired. A qualitative study used semistructured interviews to gather information from 25 staff in 19 community-based primary care clinics in Mexico City. Semistructured interviews were analyzed by using the meaning categorization method. In a second phase of coding, emerging themes were compared with an established typology of barriers to health care access. Primary care staff reported a number of significant barriers to implementing mental health services in primary care clinics, an already fragile and underfunded system. Barriers included the following broad thematic categories: service issues, language and cultural issues, care recipient characteristics, and issues with lack of knowledge. Results indicate that the implementation of mental health services in primary care clinics in Mexico will be difficult. However, the information in this study can help inform the integration of mental health into community-based primary care in Mexico through the development of adequate evaluative tools to assess the feasibility and progress of integrating these services.

An approach to plan and evaluate the location of radiotherapy services and its application in the New South Wales, Australia.

PubMed

Shukla, Nagesh; Wickramasuriya, Rohan; Miller, Andrew; Perez, Pascal

2015-11-01

This paper proposes an integrated modelling approach for location planning of radiotherapy treatment services based on cancer incidence and road network-based accessibility. Previous research efforts have established travel distance/time barriers as a key factor affecting access to cancer treatment services, as well as epidemiological studies have shown that cancer incidence rates vary with population demography. Our study is built on the evidence that the travel distances to treatment centres and demographic profiles of the accessible regions greatly influence the uptake of cancer radiotherapy (RT) services. An integrated service planning approach that combines spatially-explicit cancer incidence projections, and the placement of new RT services based on road network based accessibility measures have never been attempted. This research presents a novel approach for the location planning of RT services, and demonstrates its viability by modelling cancer incidence rates for different age-sex groups in New South Wales, Australia based on observed cancer incidence trends; and estimations of the road network-based access to current NSW treatment centres. Using three indices (General Efficiency, Service Availability and Equity), we show how the best location for a new RT centre may be chosen when there are multiple competing locations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Integrating post-manufacturing issues into design and manufacturing decisions

NASA Technical Reports Server (NTRS)

Eubanks, Charles F.

1996-01-01

An investigation is conducted on research into some of the fundamental issues underlying the design for manufacturing, service and recycling that affect engineering decisions early in the conceptual design phase of mechanical systems. The investigation focuses on a system-based approach to material selection, manufacturing methods and assembly processes related to overall product requirements, performance and life-cycle costs. Particular emphasis is placed on concurrent engineering decision support for post-manufacturing issues such as serviceability, recyclability, and product retirement.

How vertical integration affects the quantity and cost of care for Medicare beneficiaries.

PubMed

Koch, Thomas G; Wendling, Brett W; Wilson, Nathan E

2017-03-01

Health systems are employing physicians in growing numbers. The implications of this trend are poorly understood and controversial. We use rich data from the Centers for Medicare and Medicaid Services to examine the effects of a set of physician acquisitions by hospital systems on outpatient utilization and spending. We find that financial integration systematically produces economically large changes in the acquired physicians' behavior, but has less consistent effects at the acquiring system level. Published by Elsevier B.V.

In-home behavioral health case management: an integrated model for high-risk populations.

PubMed

Theis, Gerald A; Kozlowski, Deirdre; Behrens, Jenna

2006-01-01

The escalating health care costs attributed to high-risk populations have fueled a need for a proactive approach to deal with people affected by complex mental health issues that often coexist with chronic medical conditions. Through an in-home behavioral health case management (CM) program, patients with mental illnesses (some with coexisting medical conditions) receive integrated medical and mental health services through a disease-management approach that has proven effective in treating high-risk patients.

An integrative fuzzy Kansei engineering and Kano model for logistics services

NASA Astrophysics Data System (ADS)

Hartono, M.; Chuan, T. K.; Prayogo, D. N.; Santoso, A.

2017-11-01

Nowadays, customer emotional needs (known as Kansei) in product and especially in services become a major concern. One of the emerging services is the logistics services. In obtaining a global competitive advantage, logistics services should understand and satisfy their customer affective impressions (Kansei). How to capture, model and analyze the customer emotions has been well structured by Kansei Engineering, equipped with Kano model to strengthen its methodology. However, its methodology lacks of the dynamics of customer perception. More specifically, there is a criticism of perceived scores on user preferences, in both perceived service quality and Kansei response, whether they represent an exact numerical value. Thus, this paper is proposed to discuss an approach of fuzzy Kansei in logistics service experiences. A case study in IT-based logistics services involving 100 subjects has been conducted. Its findings including the service gaps accompanied with prioritized improvement initiatives are discussed.

Regional Approach for Managing for Resilience Linking Ecosystem Services and Livelihood Strategies for Agro-Pastoral Communities in the Mongolian Steppe Ecosystem

NASA Astrophysics Data System (ADS)

Ojima, D. S.; Togtohyn, C.; Qi, J.; Galvin, K.

2011-12-01

Dramatic changes due to climate and land use dynamics in the Mongolian Plateau are affecting ecosystem services and agro-pastoral livelihoods in Mongolia and China. Recently, evaluation of pastoral systems, where humans depend on livestock and grassland ecosystem services, have demonstrated the vulnerability of the social-ecological system to climate change. Current social-ecological changes in ecosystem services are affecting land productivity and carrying capacity, land-atmosphere interactions, water resources, and livelihood strategies. Regional dust events, changes in hydrological cycle, and land use changes contribute to changing interactions between ecosystem and landscape processes which then affect social-ecological systems. The general trend involves greater intensification of resource exploitation at the expense of traditional patterns of extensive range utilization. Thus we expect climate-land use-land cover relationships to be crucially modified by the socio-economic forces. The analysis incorporates information of the socio-economic transitions taking place in the region which affect land-use, food security, and ecosystem dynamics. The region of study extends from the Mongolian plateau in Mongolia and China to the fertile northeast China plain. Sustainability of agro-pastoral systems in the region needs to integrate the impact of climate change on ecosystem services with socio-economic changes shaping the livelihood strategies of pastoral systems in the region. Adaptation strategies which incorporate landscape management provides a potential framework to link ecosystem services across space and time more effectively to meet the needs of agro-pastoral land use, herd quality, and herder's living standards. Under appropriate adaptation strategies agro-pastoralists will have the opportunity to utilize seasonal resources and enhance their ability to process and manufacture products from the available ecosystem services in these dynamic social-ecological systems.

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

PubMed

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

2015-10-05

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

Eating Disorder Public Service Announcements: Analyzing Effects from an Intergroup Affect and Stereotype Perspective

ERIC Educational Resources Information Center

Iles, Irina A.; Seate, Anita Atwell; Waks, Leah

2016-01-01

Purpose: Previous studies have documented that exposure to stereotypical information about certain social groups leads to unfavorable perceptions and feelings toward that group. Integrating insights from the mental illness stigma and the social identity perspective literatures, the purpose of this paper is to explore the effects of eating disorder…

EPA Facility Registry Service (FRS): PCS_NPDES

EPA Pesticide Factsheets

This web feature service contains location and facility identification information from EPA's Facility Registry Service (FRS) for the subset of facilities that link to the Permit Compliance System (PCS) or the National Pollutant Discharge Elimination System (NPDES) module of the Integrated Compliance Information System (ICIS). PCS tracks NPDES surface water permits issued under the Clean Water Act. This system is being incrementally replaced by the NPDES module of ICIS. Under NPDES, all facilities that discharge pollutants from any point source into waters of the United States are required to obtain a permit. The permit will likely contain limits on what can be discharged, impose monitoring and reporting requirements, and include other provisions to ensure that the discharge does not adversely affect water quality. FRS identifies and geospatially locates facilities, sites or places subject to environmental regulations or of environmental interest. Using vigorous verification and data management procedures, FRS integrates facility data from EPA's national program systems, other federal agencies, and State and tribal master facility records and provides EPA with a centrally managed, single source of comprehensive and authoritative information on facilities. This data set contains the subset of FRS integrated facilities that link to NPDES facilities once the PCS or ICIS-NPDES data has been integrated into the FRS database. Additional information on FRS is available

Towards Enhanced Affective Design: Rethinking the Notion of Design

NASA Astrophysics Data System (ADS)

Kim, SuKyoung; Cho, Youngil

2017-09-01

Design disciplines have been contributing to shaping the life of human beings, as well as fostering culture and heritage. Design disciplines and research have been rapidly transforming, and not only objects but also services are target of design. This paper reviews design disciplines towards enhanced affective design, which attributes to intuitive knowledge. It aims at rethinking the notion of design to propose a conceptual framework for integrating user experience into objects that strengthen the form and function based design with pleasing.

The effect of integration of HIV care and treatment into antenatal care clinics on mother-to-child HIV transmission and maternal outcomes in Nyanza, Kenya: results from the SHAIP cluster randomized controlled trial

PubMed Central

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

2015-01-01

Background Many HIV-infected pregnant women identified during antenatal care do not enroll in long-term HIV care, resulting in deterioration of maternal health and continued risk of HIV transmission to infants. Methods We performed a cluster-randomized trial to evaluate the effect of integrating HIV care into ANC clinics in rural Kenya. Twelve facilities were randomized to provide either integrated services (ANC, PMTCT, and HIV care delivered in the ANC clinic; n=6 intervention facilities), or standard ANC services (including PMTCT and referral to a separate clinic for HIV care; n=6 control facilities). Results There were high patient attrition rates over the course of this study. Among study participants who enrolled in HIV care, there was twelve month follow up data for 256/611 (41.8%) women, and postpartum data for only 325/1172 (28%) women. By 9 months of age, 382/568 (67.3%) infants at intervention sites and 338/594 (57.0%) at control sites had tested for HIV (OR 1.45, 95% CI 0.71-2.82); 7.3% of infants tested HIV-positive at intervention sites compared to 8.0% of infants at control sites (OR 0.89, 95% CI 0.56-1.43). The composite clinical/immunologic progression into AIDS was similar in both arms (4.9% vs. 5.1 %, OR 0.83, 95% CI 0.41 - 1.68). Conclusions Despite the provision of integrated services, patient attrition was substantial in both arms, suggesting barriers beyond lack of service integration. Integration of HIV services into the ANC clinic was not associated with a reduced risk HIV transmission to infants and did not appear to affect short-term maternal health outcomes. PMID:25886930

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

PubMed

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

2003-06-01

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

Low earth orbit satellite/terrestrial mobile service compatibility

NASA Technical Reports Server (NTRS)

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

1993-01-01

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

Ecosystem Services Connect Environmental Change to Human Health Outcomes

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

Bayles, Brett R.; Brauman, Kate A.; Adkins, Joshua N.

Global environmental change, driven in large part by human activities, profoundly impacts the structure and functioning of Earth’s ecosystems (Millennium Ecosystem Assessment 2005). We are beginning to push beyond planetary boundaries (Steffan et al. 2015), and the consequences for human health remain largely unknown (Myers et al. 2013). Growing evidence suggests that ecological transformations can dramatically affect human health in ways that are both obvious and obscure (Myers and Patz 2009; Myers et al. 2013). The framework of ecosystem services, designed to evaluate the benefits that people derive from ecosystem products and processes, provides a compelling framework for integrating themore » many factors that influence the human health response to global change, as well as for integrating health impacts into broader analyses of the impacts of this change« less

General Practitioners' Attitudes Toward a Web-Based Mental Health Service for Adolescents: Implications for Service Design and Delivery.

PubMed

Subotic-Kerry, Mirjana; King, Catherine; O'Moore, Kathleen; Achilles, Melinda; O'Dea, Bridianne

2018-03-23

Anxiety disorders and depression are prevalent among youth. General practitioners (GPs) are often the first point of professional contact for treating health problems in young people. A Web-based mental health service delivered in partnership with schools may facilitate increased access to psychological care among adolescents. However, for such a model to be implemented successfully, GPs' views need to be measured. This study aimed to examine the needs and attitudes of GPs toward a Web-based mental health service for adolescents, and to identify the factors that may affect the provision of this type of service and likelihood of integration. Findings will inform the content and overall service design. GPs were interviewed individually about the proposed Web-based service. Qualitative analysis of transcripts was performed using thematic coding. A short follow-up questionnaire was delivered to assess background characteristics, level of acceptability, and likelihood of integration of the Web-based mental health service. A total of 13 GPs participated in the interview and 11 completed a follow-up online questionnaire. Findings suggest strong support for the proposed Web-based mental health service. A wide range of factors were found to influence the likelihood of GPs integrating a Web-based service into their clinical practice. Coordinated collaboration with parents, students, school counselors, and other mental health care professionals were considered important by nearly all GPs. Confidence in Web-based care, noncompliance of adolescents and GPs, accessibility, privacy, and confidentiality were identified as potential barriers to adopting the proposed Web-based service. GPs were open to a proposed Web-based service for the monitoring and management of anxiety and depression in adolescents, provided that a collaborative approach to care is used, the feedback regarding the client is clear, and privacy and security provisions are assured. ©Mirjana Subotic-Kerry, Catherine King, Kathleen O'Moore, Melinda Achilles, Bridianne O'Dea. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 23.03.2018.

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

PubMed

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

2016-01-01

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

"Integrating Kuwait's mental health system to end stigma: a call to action".

PubMed

Almazeedi, Hind; Alsuwaidan, Mohammad T

2014-02-01

Despite the global prevalence of mental illness and its negative effects on the economy in terms of healthcare spending, many affected individuals do not receive timely or adequate treatment due to stigmatization of such disorders in their communities. Being labeled as mentally ill can have detrimental consequences in several cultures. In Kuwait, the stigma associated with visiting the country's main provider of mental health services, the Psychological Medicine Hospital, is an obstacle for many seeking professional help for mental health. Cultural acceptance of visiting the local primary care clinic, however, allows frequent contact with primary care physicians who often find themselves frustrated at their inability to provide psychiatric services because it is not part of their training. The refusal of the patient to be referred to a stigmatized institution further increases the challenges of treating such patients for these physicians. The integration of mental health care into general health services is a concept encouraged by the World Health Organization's 2001 World Health Report and should be considered in order to overcome this dilemma. Such integrated care would serve as a cost-effective solution to facilitating the treatment of these individuals and reducing the stigma associated with mental disorders through education.

Biological invasions in forest ecosystems: a global problem requiring international and multidisciplinary integration

Treesearch

Andrew M. Liebhold; Eckehard G. Brockerhoff; Martin A. Nuñez

2017-01-01

The world's forests are crucial biological resources that provide a variety of ecosystem services such as nutrient cycling and provisioning of resources to society. But forests are particularly affected by biological invasions, with regions around the world experiencing invasions by species from virtually every kingdom. Many of these species have severely...

Forest inventory, catastrophic events and historic geospatial assessments in the south

Treesearch

Dennis M. Jacobs

2007-01-01

Catastrophic events are a regular occurrence of disturbance to forestland in the Southern United States. Each major event affects the integrity of the forest inventory database developed and maintained by the Forest Inventory & Analysis Research Work Unit of the U.S. Department of Agriculture, Forest Service. Some of these major disturbances through the years have...

"All Stories Bring Hope Because Stories Bring Awareness": Students' Perceptions of Digital Storytelling for Social Justice Education

ERIC Educational Resources Information Center

Gachago, Daniela; Condy, Janet; Ivala, Eunice; Chigona, Agnes

2014-01-01

Although becoming a more racially-integrated society, the legacy of Apartheid still affects learners' social engagements in and outside their classrooms. Adopting Nussbaum's (2010) capabilities framework for a socially just democracy, this paper examines 27 pre-service teacher education students' perceptions of a digital storytelling project and…

Throw Me the Online Life Vest: Advising Support as Perceived by Online Students and Advisors

ERIC Educational Resources Information Center

Phillips, Cassetta L.

2016-01-01

This qualitative case study examined the perceptions of advisors and students enrolled in online courses regarding the effectiveness of academic advising services as they affect student success and persistence. This study applied Tinto's model of student integration to understand the interaction between online students and advisors. The data was…

Children and Society Policy Review: Health Policy Affecting Children and Young People

ERIC Educational Resources Information Center

Simkiss, Doug

2013-01-01

The Health and Social Care Act comes into force in April 2013. It changes the organisation of the health service and accelerates the integration of health and social care. New relationships between primary and secondary healthcare will develop and the culture of clinical and cost effectiveness will expand into social care; work on children in…

An Integrated, Multidimensional Treatment Model for Individuals Living with HIV, Mental Illness, and Substance Abuse

ERIC Educational Resources Information Center

Bouis, Stephanie; Reif, Susan; Whetten, Kathryn; Scovil, Janet; Murray, Andrea; Swartz, Marvin

2007-01-01

The challenge of providing effective treatment services for the growing population of HIV-positive individuals who are also dually diagnosed with substance use and mental disorders has only recently been recognized as an important public health concern affecting both HIV treatment and prevention. This article describes a treatment model that was…

Pacific Hake Characteristics Affecting the Conduct of an Acoustic Clutter Experiment off the West Coast of the United States

DTIC Science & Technology

2012-07-04

Blois , L. C. Hufnagle, A. R. Kronlund, J. A. Holmes, and C. D. Wilson, "The 2003 Integrated Acoustic and Trawl Survey of Pacific Hake, Merluccius...Center, Seattle, WA, 2005. 17. Fleischer, G. W., K. D. Cooke, P. H. Ressler, R. E. Thomas, S. K. de Blois , and L. C. Hufnagle, "The 2005 Integrated...Marine Fisheries Service, Northwest Fisheries Science Center, Seattle, WA, 2008. 18. de Blois , S. K., D. Chu, and K. D. Cooke, "Results of the 2007

Developing Dental Students' Awareness of Health Care Disparities and Desire to Serve Vulnerable Populations Through Service-Learning.

PubMed

Behar-Horenstein, Linda S; Feng, Xiaoying; Roberts, Kellie W; Gibbs, Micaela; Catalanotto, Frank A; Hudson-Vassell, Charisse M

2015-10-01

Service-learning in dental education helps students integrate knowledge with practice in an underserved community setting. The aim of this study was to explore how a service-learning experience affected a small group of dental students' beliefs about cultural competence, professionalism, career development, desire to practice in a community service setting, and perceptions about access and disparities issues. Prior to beginning their first year of dental school, five first-year dental students at one U.S. dental school participated in a six-week service-learning program in which they interned at one of three at-risk settings in order to experience health care delivery there. After the program, 60 reflective writing assignments completed by the participants were analyzed using grounded theory methods; interviews with the students were used to corroborate the findings from that analysis. Seven themes identified in the journal reflections and interview findings showed enhanced awareness of social health care issues and patient differences, as well as a social justice orientation and desire to address disparities. Building on this study, future research should explore the curricular components of service-learning programs to ensure students receive ample opportunity to reflect upon their experiences in order to integrate previously held assumptions with their newfound knowledge.

Management support and perceived consumer satisfaction in skilled nursing facilities.

PubMed

Metlen, Scott; Eveleth, Daniel; Bailey, Jeffrey J

2005-08-01

How managers 'manage' employees influences important firm outcomes. Heskett, Sasser, and Schlesinger contend that the level of internal support for service workers will influence consumer satisfaction. This study empirically explores how skilled nursing facility (SNF) managers affect consumer satisfaction by encouraging employee effectiveness and listening to employees to determine how to improve employee effectiveness. We extend previous research by proposing management as a form of internal support and demonstrating its relationship to service process integration, as a distinct form of internal support. The results of our individual-level investigation of 630 nursing assistants from 45 SNFs provide support for our two-part hypothesis. First, active management support and process integration, as elements of internal support, do lead to increased employee satisfaction and employee effectiveness. Second, the increased employee satisfaction and effectiveness was positively related to consumer satisfaction, as evaluated by the service workers. Thus, there is a positive influence of management's internal support of nursing assistants on perceived consumer satisfaction.

Review on Malaysian Rail Transit Operation and Management System: Issues and Solution in Integration

NASA Astrophysics Data System (ADS)

Masirin, Mohd Idrus Mohd; Salin, Aminah Mohd; Zainorabidin, Adnan; Martin, David; Samsuddin, Norshakina

2017-08-01

In any context, operation and management of transportation systems are key issues which may affect both life quality and economic development. In large urban agglomerations, an efficient public transportation system may help abate the negative externalities of private car use such as congestion, air and noise pollution, accident and fuel consumption, without excessively penalizing user travel times or zone accessibility. Thus, this study is conducted to appraise the Malaysian rural rail transit operation and management system, which are considered important as there are many issues and solution in integration of the services that need to be tackled more conscientiously. The purpose of this paper is to describe some of the most important issues on integration of services and rail transit system in Malaysian and how to solve or reduce these problems and conflicts. In this paper, it consists of the historical development of rail transit construction in Malaysia. This paper also attempts to identify the important issues related to rail transit services and integration in Malaysian rural rail operation and management system. Comparison is also conducted with other countries such as UK, France, and Japan. Finally, a critical analysis is presented in this paper by looking at the possible application for future Malaysian rail transit operation system and management, especially focusing on enhancing the quality of Malaysian rural rail transit. In conclusion, this paper is expected to successfully review and appraise the existing Malaysian rural rail transit operation and management system pertaining to issues & solution in integration. It is also hoped that reformation or transformation of present service delivery quality of the rail transit operation and management will enable Malaysia to succeed in transforming Malaysian transportation system to greater heights.

CopperCore Service Integration

ERIC Educational Resources Information Center

Vogten, Hubert; Martens, Harrie; Nadolski, Rob; Tattersall, Colin; van Rosmalen, Peter; Koper, Rob

2007-01-01

In an e-learning environment there is a need to integrate various e-learning services like assessment services, collaboration services, learning design services and communication services. In this article we present the design and implementation of a generic integrative service framework, called CopperCore Service Integration (CCSI). We will…

Factors affecting costs in Medicaid populations with behavioral health disorders.

PubMed

Freeman, Elsie; McGuire, Catherine A; Thomas, John W; Thayer, Deborah A

2014-03-01

Persons with behavioral disorders incur higher healthcare costs. Although they utilize behavioral health (BH) services others do not, they also have higher utilization of medical services : To determine the degree to which higher costs for persons with BH disorders are attributable to utilization of BH services, multiple chronic medical conditions (CMCs) or other issues specific to populations with BH disorders. Data base consisted of claims for 63,141 Medicaid beneficiaries, 49% of whom had one of 5 categories of BH disorder. Generalized linear models were used to identify relative impact of demographics, BH status, multiple CMCs and primary care access on total, behavioral, nonbehavioral, and medical/surgical costs. Number of CMCs was associated with significant increases in all cost categories, including behavioral costs. Presence of any BH disorder significantly influenced these same costs, including those not associated with BH care. Effect size in each cost category varied by BH group. BH status has a large impact on all healthcare costs, including costs of medical and other non-BH services. The number of CMCs affects BH costs independent of BH disorder. Results suggest that costs might be reduced through better integration of behavioral and medical health services.

Satisfaction and adherence of patients with amputations to physiotherapy service at public hospitals in KwaZulu-Natal, South Africa.

PubMed

Verusia, Chetty; Tanuja, Dunpath; Simira, Meghnath; Sarisha, Mothalal; Varuna, Sewmungal; Ursula, Kunene; Thalente, Ntshakala

2015-06-01

Individuals who have undergone a lower limb amputation require comprehensive rehabilitation from the multidisciplinary team to ensure optimal treatment outcomes and social integration. Physiotherapists play a pivotal role within the multidisciplinary team and offer patients physical and psychosocial rehabilitative care. Determining patients' satisfaction levels and exploring factors affecting adherence to physiotherapy interventions can inform practice and improve service delivery of rehabilitation within resource poor settings such as South Africa. To determine the level of satisfaction with physiotherapy services rendered to acute and sub-acute in-patients with lower limb amputations and to explore factors affecting adherence to physiotherapy intervention. A prospective survey of 35 patients with lower limb amputations from four public hospitals in South Africa was undertaken. A modified version of the Hampstead rehabilitation centre patient satisfaction questionnaire was utilised. Majority of participants were satisfied with the physiotherapy services whilst a few reported dissatisfaction. Three themes emerged whilst exploring the patients' experience relating to adherence to physiotherapy programmes. Themes included service delivery, patient-therapist interaction and participation barriers and facilitators. Recommendations aimed to improve quality of care and healthcare outcomes thereby enhancing the participants' adherence to the physiotherapy programme.

Risk management for optimal land use planning integrating ecosystem services values: A case study in Changsha, Middle China.

PubMed

Liang, Jie; Zhong, Minzhou; Zeng, Guangming; Chen, Gaojie; Hua, Shanshan; Li, Xiaodong; Yuan, Yujie; Wu, Haipeng; Gao, Xiang

2017-02-01

Land-use change has direct impact on ecosystem services and alters ecosystem services values (ESVs). Ecosystem services analysis is beneficial for land management and decisions. However, the application of ESVs for decision-making in land use decisions is scarce. In this paper, a method, integrating ESVs to balance future ecosystem-service benefit and risk, is developed to optimize investment in land for ecological conservation in land use planning. Using ecological conservation in land use planning in Changsha as an example, ESVs is regarded as the expected ecosystem-service benefit. And uncertainty of land use change is regarded as risk. This method can optimize allocation of investment in land to improve ecological benefit. The result shows that investment should be partial to Liuyang City to get higher benefit. The investment should also be shifted from Liuyang City to other regions to reduce risk. In practice, lower limit and upper limit for weight distribution, which affects optimal outcome and selection of investment allocation, should be set in investment. This method can reveal the optimal spatial allocation of investment to maximize the expected ecosystem-service benefit at a given level of risk or minimize risk at a given level of expected ecosystem-service benefit. Our results of optimal analyses highlight tradeoffs between future ecosystem-service benefit and uncertainty of land use change in land use decisions. Copyright © 2016 Elsevier B.V. All rights reserved.

Service distribution and models of rural outreach by specialist doctors in Australia: a national cross-sectional study.

PubMed

O'Sullivan, Belinda G; McGrail, Matthew R; Joyce, Catherine M; Stoelwinder, Johannes

2016-06-01

Objective This paper describes the service distribution and models of rural outreach by specialist doctors living in metropolitan or rural locations. Methods The present study was a national cross-sectional study of 902 specialist doctors providing 1401 rural outreach services in the Medicine in Australia: Balancing Employment and Life study, 2008. Five mutually exclusive models of rural outreach were studied. Results Nearly half of the outreach services (585/1401; 42%) were provided to outer regional or remote locations, most (58%) by metropolitan specialists. The most common model of outreach was drive-in, drive-out (379/902; 42%). In comparison, metropolitan-based specialists were less likely to provide hub-and-spoke models of service (odd ratio (OR) 0.31; 95% confidence interval (CI) 0.21-0.46) and more likely to provide fly-in, fly-out models of service (OR 4.15; 95% CI 2.32-7.42). The distance travelled by metropolitan specialists was not affected by working in the public or private sector. However, rural-based specialists were more likely to provide services to nearby towns if they worked privately. Conclusions Service distribution and models of outreach vary according to where specialists live as well as the practice sector of rural specialists. Multilevel policy and planning is needed to manage the risks and benefits of different service patterns by metropolitan and rural specialists so as to promote integrated and accessible services. What is known about this topic? There are numerous case studies describing outreach by specialist doctors. However, there is no systematic evidence describing the distribution of rural outreach services and models of outreach by specialists living in different locations and the broad-level factors that affect this. What does this paper add? The present study provides the first description of outreach service distribution and models of rural outreach by specialist doctors living in rural versus metropolitan areas. It shows that metropolitan and rural-based specialists have different levels of service reach and provide outreach through different models. Further, the paper highlights that practice sector has no effect on metropolitan specialists, but private rural specialists limit their travel distance. What are the implications for practitioners? The complexity of these patterns highlights the need for multilevel policy and planning approaches to promote integrated and accessible outreach in rural and remote Australia.

[Health policy in the European Union: impact on the Spanish health system].

PubMed

Guimarães, Luisa; Freire, José-Manuel

2007-01-01

This text reviews the impact of European integration on the health sector (public health and health services) by studying European Union (EU) institutions, functioning, and responsibilities through the literature, documents, and authors' observations. The EU does not have direct health responsibilities, but Community legislation has important repercussions on all member states' health policies. This influence affects health protection issues, consumer safety, regulation of medicines and medical devices, mutual recognition of professional qualifications, freedom of movement for health professionals and patients, public contracts and bidding, research, etc. The evolution of EU health policy shows a progressive reinforcement of responsibilities consistent with the objective of reaching a high level of health protection, which in turn affects other European policies. The impact of European integration on the Spanish health system is analyzed as a case study, and key aspects and present and future challenges are highlighted. Lessons are also drawn for regional integration processes to foster equity and efficiency in health.

Administrative Challenges to the Integration of Oral Health With Primary Care

PubMed Central

Maxey, Hannah L.; Randolph, Courtney; Gano, Laura; Kochhar, Komal

2017-01-01

Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce. PMID:27218701

Locally Generated Information and Referral Services in Indian Libraries. Guide 8: Generating Information in Indian Libraries.

ERIC Educational Resources Information Center

Townley, Charles T.

Libraries and information centers are rapidly becoming an integral part of American Indian live. A primary concern of Indian people is the availability of dependable information on those issues and programs which directly affect their day to day lives. As the community information agency, the library plays a key role in improving access to local…

The Integrated Landscape Modeling partnership - Current status and future directions

USGS Publications Warehouse

Mushet, David M.; Scherff, Eric J.

2016-01-28

The Integrated Landscape Modeling (ILM) partnership is an effort by the U.S. Geological Survey (USGS) and U.S. Department of Agriculture (USDA) to identify, evaluate, and develop models to quantify services derived from ecosystems, with a focus on wetland ecosystems and conservation effects. The ILM partnership uses the Integrated Valuation of Ecosystem Services and Tradeoffs (InVEST) modeling platform to facilitate regional quantifications of ecosystem services under various scenarios of land-cover change that are representative of differing conservation program and practice implementation scenarios. To date, the ILM InVEST partnership has resulted in capabilities to quantify carbon stores, amphibian habitat, plant-community diversity, and pollination services. Work to include waterfowl and grassland bird habitat quality is in progress. Initial InVEST modeling has been focused on the Prairie Pothole Region (PPR) of the United States; future efforts might encompass other regions as data availability and knowledge increase as to how functions affecting ecosystem services differ among regions.The ILM partnership is also developing the capability for field-scale process-based modeling of depressional wetland ecosystems using the Agricultural Policy/Environmental Extender (APEX) model. Progress was made towards the development of techniques to use the APEX model for closed-basin depressional wetlands of the PPR, in addition to the open systems that the model was originally designed to simulate. The ILM partnership has matured to the stage where effects of conservation programs and practices on multiple ecosystem services can now be simulated in selected areas. Future work might include the continued development of modeling capabilities, as well as development and evaluation of differing conservation program and practice scenarios of interest to partner agencies including the USDA’s Farm Service Agency (FSA) and Natural Resources Conservation Service (NRCS). When combined, the ecosystem services modeling capabilities of InVEST and the process-based abilities of the APEX model should provide complementary information needed to meet USDA and the Department of the Interior information needs.

The impact of programs for prevention of mother-to-child transmission of HIV on health care services and systems in sub-Saharan Africa - A review.

PubMed

Mutabazi, Jean Claude; Zarowsky, Christina; Trottier, Helen

2017-01-01

The global scale-up of Prevention of mother-to-child transmission (PMTCT) services is credited for a 52% worldwide decline in new HIV infections among children between 2001 and 2012. However, the epidemic continues to challenge maternal and paediatric HIV control efforts in Sub Saharan Africa (SSA), with repercussions on other health services beyond those directly addressing HIV and AIDS. This systematised narrative review describes the effects of PMTCT programs on other health care services and the implications for improving health systems in SSA as reported in the existing articles and scientific literature. The following objectives framed our review:To describe the effects of PMTCT on health care services and systems in SSA and assess whether the PMTCT has strengthened or weakened health systems in SSATo describe the integration of PMTCT and its extent within broader programs and health systems. Articles published in English and French over the period 1st January 2007 (the year of publication of WHO/UNICEF guidelines on global scale-up of the PMTCT) to 31 November 2016 on PMTCT programs in SSA were sought through searches of electronic databases (Medline and Google Scholar). Articles describing the impact (positive and negative effects) of PMTCT on other health care services and those describing its integration in health systems in SSA were eligible for inclusion. We assessed 6223 potential papers, reviewed 225, and included 57. The majority of selected articles offered arguments for increased health services utilisation, notably of ante-natal care, and some evidence of beneficial synergies between PMTCT programs and other health services especially maternal health care, STI prevention and early childhood immunisation. Positive and negative impact of PMTCT on other health care services and health systems are suggested in thirty-two studies while twenty-five papers recommend more integration and synergies. However, the empirical evidence of impact of PMTCT integration on broader health systems is scarce. Underlying health system challenges such as weak physical and human resource infrastructure and poor working conditions, as well as social and economic barriers to accessing health services, affect both PMTCT and the health services with which PMTCT interacts. PMTCT services increase to some extent the availability, accessibility and utilisation of antenatal care and services beyond HIV care. Vertical PMTCT programs work, when well-funded and well-managed, despite poorly functioning health systems. The beneficial synergies between PMTCT and other services are widely suggested, but there is a lack of large-scale evidence of this.

A National Approach to Quantify and Map Biodiversity ...

EPA Pesticide Factsheets

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 strategic national interests for integrating ecology with economics to help understand the effects of human policies and actions and their subsequent impacts on both ecosystem function and human welfare. The degradation of natural ecosystems and climate variation impact the environment and society by affecting ecological integrity and ecosystems’ capacity to provide critical services (i.e., the contributions of ecosystems to human well-being). These challenges will require complex management decisions that can often involve significant trade-offs between societal desires and environmental needs. Evaluating trade-offs in terms of ecosystem services and human well-being provides an intuitive and comprehensive way to assess the broad implications of our decisions and to help shape policies that enhance environmental and social sustainability. In answer to this challenge, the U.S. government has created a partnership among the U.S. Environmental Protection Agency, other Federal agencies, academic institutions, and, Non-Governmental Organizations to develop the EnviroAtlas, an online Decision Support Tool that allows users (e.g., planners, policy-makers, resource managers, NGOs, private indu

Revisiting Health Regionalization in Canada.

PubMed

Barker, Paul; Church, John

2017-04-01

Twenty years ago, many of Canada's provinces began to introduce regional health authorities to address problems with their health care systems. With this action, the provinces sought to achieve advances in community decision-making, the integration of health services, and the provision of care in the home and community. The authorities were also to help restrict health care costs. An assessment of the authorities indicates, however, that over the past two decades they have been unable to meet their objectives. Community representatives continue to play little role in determining the appropriate health services for their regions. Gains have been made towards integrating health services, but the plan for a near seamless set of health services has not been realized. Funding for health services remains focused on hospital and physician care, and health care expenditures have until very recently been little affected by regional authorities. This disappointing performance has caused some provinces to abandon their regional authorities, but this article argues that the provision of greater autonomy and a better public appreciation of their role and potential may lead to more successful regional authorities. Accordingly, the objective of this article is to reveal the shortcomings of regional health authorities in Canada while at the same time arguing that changes can be made to increase the chances of more workable authorities.

Infusing Neuroscience into Teacher Professional Development

PubMed Central

Dubinsky, Janet M; Roehrig, Gillian; Varma, Sashank

2015-01-01

Bruer (1997) advocated connecting neuroscience and education indirectly through the intermediate discipline of psychology. We argue for a parallel route: the neurobiology of learning, and in particular the core concept of plasticity, have the potential to directly transform teacher preparation and professional development, and ultimately to affect how students think about their own learning. We present a case study of how the core concepts of neuroscience can be brought to in-service teachers – the BrainU workshops. We then discuss how neuroscience can be meaningfully integrated into pre-service teacher preparation, focusing on institutional and cultural barriers. PMID:26139861

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

PubMed

Ryu, Jeong-Im; Kim, Kisook

2018-06-20

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

Rheumatic heart disease: infectious disease origin, chronic care approach.

PubMed

Katzenellenbogen, Judith M; Ralph, Anna P; Wyber, Rosemary; Carapetis, Jonathan R

2017-11-29

Rheumatic heart disease (RHD) is a chronic cardiac condition with an infectious aetiology, causing high disease burden in low-income settings. Affected individuals are young and associated morbidity is high. However, RHD is relatively neglected due to the populations involved and its lower incidence relative to other heart diseases. In this narrative review, we describe how RHD care can be informed by and integrated with models of care developed for priority non-communicable diseases (coronary heart disease), and high-burden communicable diseases (tuberculosis). Examining the four-level prevention model (primordial through tertiary prevention) suggests primordial and primary prevention of RHD can leverage off existing tuberculosis control efforts, given shared risk factors. Successes in coronary heart disease control provide inspiration for similarly bold initiatives for RHD. Further, we illustrate how the Chronic Care Model (CCM), developed for use in non-communicable diseases, offers a relevant framework to approach RHD care. Systems strengthening through greater integration of services can improve RHD programs. Strengthening of systems through integration/linkages with other well-performing and resourced services in conjunction with policies to adopt the CCM framework for the secondary and tertiary prevention of RHD in settings with limited resources, has the potential to significantly reduce the burden of RHD globally. More research is required to provide evidence-based recommendations for policy and service design.

Stormwater management and ecosystem services: a review

NASA Astrophysics Data System (ADS)

Prudencio, Liana; Null, Sarah E.

2018-03-01

Researchers and water managers have turned to green stormwater infrastructure, such as bioswales, retention basins, wetlands, rain gardens, and urban green spaces to reduce flooding, augment surface water supplies, recharge groundwater, and improve water quality. It is increasingly clear that green stormwater infrastructure not only controls stormwater volume and timing, but also promotes ecosystem services, which are the benefits that ecosystems provide to humans. Yet there has been little synthesis focused on understanding how green stormwater management affects ecosystem services. The objectives of this paper are to review and synthesize published literature on ecosystem services and green stormwater infrastructure and identify gaps in research and understanding, establishing a foundation for research at the intersection of ecosystems services and green stormwater management. We reviewed 170 publications on stormwater management and ecosystem services, and summarized the state-of-the-science categorized by the four types of ecosystem services. Major findings show that: (1) most research was conducted at the parcel-scale and should expand to larger scales to more closely understand green stormwater infrastructure impacts, (2) nearly a third of papers developed frameworks for implementing green stormwater infrastructure and highlighted barriers, (3) papers discussed ecosystem services, but less than 40% quantified ecosystem services, (4) no geographic trends emerged, indicating interest in applying green stormwater infrastructure across different contexts, (5) studies increasingly integrate engineering, physical science, and social science approaches for holistic understanding, and (6) standardizing green stormwater infrastructure terminology would provide a more cohesive field of study than the diverse and often redundant terminology currently in use. We recommend that future research provide metrics and quantify ecosystem services, integrate disciplines to measure ecosystem services from green stormwater infrastructure, and better incorporate stormwater management into environmental policy. Our conclusions outline promising future research directions at the intersection of stormwater management and ecosystem services.

Urban forests and pollution mitigation: analyzing ecosystem services and disservices.

PubMed

Escobedo, Francisco J; Kroeger, Timm; Wagner, John E

2011-01-01

The purpose of this paper is to integrate the concepts of ecosystem services and disservices when assessing the efficacy of using urban forests for mitigating pollution. A brief review of the literature identifies some pollution mitigation ecosystem services provided by urban forests. Existing ecosystem services definitions and typologies from the economics and ecological literature are adapted and applied to urban forest management and the concepts of ecosystem disservices from natural and semi-natural systems are discussed. Examples of the urban forest ecosystem services of air quality and carbon dioxide sequestration are used to illustrate issues associated with assessing their efficacy in mitigating urban pollution. Development of urban forest management alternatives that mitigate pollution should consider scale, contexts, heterogeneity, management intensities and other social and economic co-benefits, tradeoffs, and costs affecting stakeholders and urban sustainability goals. Copyright © 2011 Elsevier Ltd. All rights reserved.

Variables affecting the academic and social integration of nursing students.

PubMed

Zeitlin-Ophir, Iris; Melitz, Osnat; Miller, Rina; Podoshin, Pia; Mesh, Gustavo

2004-07-01

This study attempted to analyze the variables that influence the academic integration of nursing students. The theoretical model presented by Leigler was adapted to the existing conditions in a school of nursing in northern Israel. The independent variables included the student's background; amount of support received in the course of studies; extent of outside family and social commitments; satisfaction with the school's facilities and services; and level of social integration. The dependent variable was the student's level of academic integration. The findings substantiated four central hypotheses, with the study model explaining approximately 45% of the variance in the dependent variable. Academic integration is influenced by a number of variables, the most prominent of which is the social integration of the student with colleagues and educational staff. Among the background variables, country of origin was found to be significant to both social and academic integration for two main groups in the sample: Israeli-born students (both Jewish and Arab) and immigrant students.

A Physician's Perspective On Vertical Integration.

PubMed

Berenson, Robert A

2017-09-01

Vertical integration has been a central feature of health care delivery system change for more than two decades. Recent studies have demonstrated that vertically integrated health care systems raise prices and costs without observable improvements in quality, despite many theoretical reasons why cost control and improved quality might occur. Less well studied is how physicians view their newfound partnerships with hospitals. In this article I review literature findings and other observations on five aspects of vertical integration that affect physicians in their professional and personal lives: patients' access to physicians, physician compensation, autonomy versus system support, medical professionalism and culture, and lifestyle. I conclude that the movement toward physicians' alignment with and employment in vertically integrated systems seems inexorable but that policy should not promote such integration either intentionally or inadvertently. Instead, policy should address the flaws in current payment approaches that reward high prices and excessive service use-outcomes that vertical integration currently produces. Project HOPE—The People-to-People Health Foundation, Inc.

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

Early abortion services in the United States: a provider survey.

PubMed

Benson, Janie; Clark, Kathryn Andersen; Gerhardt, Ann; Randall, Lynne; Dudley, Susan

2003-04-01

The objective of this study was to describe the availability of early surgical and medical abortion among members of the National Abortion Federation (NAF) and to identify factors affecting the integration of early abortion services into current services. Telephone interviews were conducted with staff at 113 Planned Parenthood affiliates and independent abortion providers between February and April 2000, prior to FDA approval of mifepristone. Early abortion services were available at 59% of sites, and establishing services was less difficult than or about what was anticipated. Sites generally found it easier to begin offering early surgical abortion than early medical abortion. Physician participation was found to be critical to implementing early services. At sites where some but not all providers offered early abortion, variations in service availability resulted. Given the option of reconsidering early services, virtually all sites would make the same decision again. These data suggest that developing mentoring relationships between experienced early abortion providers/sites and those not offering early services, and training physicians and other staff, are likely to be effective approaches to expanding service availability.

Methods to Improve Survival and Growth of Planted Alternative Species Seedlings in Black Ash Ecosystems Threatened by Emerald Ash Borer

Treesearch

Nicholas Bolton; Joseph Shannon; Joshua Davis; Matthew Grinsven; Nam Noh; Shon Schooler; Randall Kolka; Thomas Pypker; Joseph Wagenbrenner

2018-01-01

Emerald ash borer (EAB) continues to spread across North America, infesting native ash trees and changing the forested landscape. Black ash wetland forests are severely affected by EAB. As black ash wetland forests provide integral ecosystem services, alternative approaches to maintain forest cover on the landscape are needed. We implemented simulated EAB infestations...

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

PubMed

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

2017-11-01

The lack of human resources is a key challenge in scaling up of HIV services in Africa's health care system. Integrating HIV services could potentially increase their effectiveness and optimize the use of limited resources and clinical staff time. We examined the impact of integration of provider initiated HIV counselling and testing (PITC) and family planning (FP counselling and FP provision) services on duration of consultation to assess the impact of PITC and FP integration on staff workload. This study was conducted in 24 health facilities in Kenya under the Integra Initiative, a non-randomized, pre/post intervention trial to evaluate the impact of integrated HIV and sexual and reproductive health services on health and service outcomes. We compared the time spent providing PITC-only services, FP-only services and integrated PITC/FP services. We used log-linear regression to assess the impact of plausible determinants on the duration of clients' consultation times. Median consultation duration times were highest for PITC-only services (30 min), followed by integrated services (10 min) and FP-only services (8 min). Times for PITC-only and FP-only services were 69.7% higher (95% Confidence Intervals (CIs) 35.8-112.0) and 43.9% lower (95% CIs -55.4 to - 29.6) than times spent on these services when delivered as an integrated service, respectively. The reduction in consultation times with integration suggests a potential reduction in workload. The higher consultation time for PITC-only could be because more pre- and post-counselling is provided at these stand-alone services. In integrated PITC/FP services, the duration of the visit fell below that required by HIV testing guidelines, and service mix between counselling and testing substantially changed. Integration of HIV with FP services may compromise the quality of services delivered and care must be taken to clearly specify and monitor appropriate consultation duration times and procedures during the process of integrating HIV and FP services. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

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

PubMed Central

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

2017-01-01

Abstract The lack of human resources is a key challenge in scaling up of HIV services in Africa’s health care system. Integrating HIV services could potentially increase their effectiveness and optimize the use of limited resources and clinical staff time. We examined the impact of integration of provider initiated HIV counselling and testing (PITC) and family planning (FP counselling and FP provision) services on duration of consultation to assess the impact of PITC and FP integration on staff workload. This study was conducted in 24 health facilities in Kenya under the Integra Initiative, a non-randomized, pre/post intervention trial to evaluate the impact of integrated HIV and sexual and reproductive health services on health and service outcomes. We compared the time spent providing PITC-only services, FP-only services and integrated PITC/FP services. We used log-linear regression to assess the impact of plausible determinants on the duration of clients’ consultation times. Median consultation duration times were highest for PITC-only services (30 min), followed by integrated services (10 min) and FP-only services (8 min). Times for PITC-only and FP-only services were 69.7% higher (95% Confidence Intervals (CIs) 35.8–112.0) and 43.9% lower (95% CIs −55.4 to − 29.6) than times spent on these services when delivered as an integrated service, respectively. The reduction in consultation times with integration suggests a potential reduction in workload. The higher consultation time for PITC-only could be because more pre- and post-counselling is provided at these stand-alone services. In integrated PITC/FP services, the duration of the visit fell below that required by HIV testing guidelines, and service mix between counselling and testing substantially changed. Integration of HIV with FP services may compromise the quality of services delivered and care must be taken to clearly specify and monitor appropriate consultation duration times and procedures during the process of integrating HIV and FP services. PMID:29194545

Administrative Challenges to the Integration of Oral Health With Primary Care: A SWOT Analysis of Health Care Executives at Federally Qualified Health Centers.

PubMed

Norwood, Connor W; Maxey, Hannah L; Randolph, Courtney; Gano, Laura; Kochhar, Komal

Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.

Proposal of a Methodology for Implementing a Service-Oriented Architecture in Distributed Manufacturing Systems

NASA Astrophysics Data System (ADS)

Medina, I.; Garcia-Dominguez, A.; Aguayo, F.; Sevilla, L.; Marcos, M.

2009-11-01

As envisioned by Intelligent Manufacturing Systems (IMS), Next Generation Manufacturing Systems (NGMS) will satisfy the needs of an increasingly fast-paced and demanding market by dynamically integrating systems from inside and outside the manufacturing firm itself into a so-called extended enterprise. However, organizing these systems to ensure the maximum flexibility and interoperability with those from other organizations is difficult. Additionally, a defect in the system would have a great impact: it would affect not only its owner, but also its partners. For these reasons, we argue that a service-oriented architecture (SOA) would be a good candidate. It should be designed following a methodology where services play a central role, instead of being an implementation detail. In order for the architecture to be reliable enough as a whole, the methodology will need to help find errors before they arise in a production environment. In this paper we propose using SOA-specific testing techniques, compare some of the existing methodologies and outline several extensions upon one of them to integrate testing techniques.

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

PubMed

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

2016-01-01

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

U.S. Geological Survey Community for Data Integration-NWIS Web Services Snapshot Tool for ArcGIS

USGS Publications Warehouse

Holl, Sally

2011-01-01

U.S. Geological Survey (USGS) data resources are so vast that many scientists are unaware of data holdings that may be directly relevant to their research. Data are also difficult to access and large corporate databases, such as the National Water Information System (NWIS) that houses hydrologic data for the Nation, are challenging to use without considerable expertise and investment of time. The USGS Community for Data Integration (CDI) was established in 2009 to address data and information management issues affecting the proficiency of earth science research. A CDI workshop convened in 2009 identified common data integration needs of USGS scientists and targeted high value opportunities that might address these needs by leveraging existing projects in USGS science centers, in-kind contributions, and supplemental funding. To implement this strategy, CDI sponsored a software development project in 2010 to facilitate access and use of NWIS data with ArcGIS, a widely used Geographic Information System. The resulting software product, the NWIS Web Services Snapshot Tool for ArcGIS, is presented here.

Economic evidence on integrated care for stroke patients; a systematic review

PubMed Central

Tummers, Johanneke F.M.M; Schrijvers, Augustinus J.P; Visser-Meily, Johanna M.A

2012-01-01

Introduction Given the high incidence of stroke worldwide and the large costs associated with the use of health care resources, it is important to define cost-effective and evidence-based services for stroke rehabilitation. The objective of this review was to assess the evidence on the relative cost or cost-effectiveness of all integrated care arrangements for stroke patients compared to usual care. Integrated care was defined as a multidisciplinary tool to improve the quality and efficiency of evidence-based care and is used as a communication tool between professionals to manage and standardize the outcome-orientated care. Methods A systematic literature review of cost analyses and economic evaluations was performed. Study characteristics, study quality and results were summarized. Results Fifteen studies met the inclusion criteria; six on early-supported discharge services, four on home-based rehabilitation, two on stroke units and three on stroke services. The follow-up per patient was generally short; one year or less. The comparators and the scope of included costs varied between studies. Conclusions Six out of six studies provided evidence that the costs of early-supported discharge are less than for conventional care, at similar health outcomes. Home-based rehabilitation is unlikely to lead to cost-savings, but achieves better health outcomes. Care in stroke units is more expensive than conventional care, but leads to improved health outcomes. The cost-effectiveness studies on integrated stroke services suggest that they can reduce costs. For future research we recommend to focus on the moderate and severely affected patients, include stroke severity as variable, adopt a societal costing perspective and include long-term costs and effects. PMID:23593053

An ecological economic assessment of flow regimes in a hydropower dominated river basin: the case of the lower Zambezi River, Mozambique.

PubMed

Fanaian, Safa; Graas, Susan; Jiang, Yong; van der Zaag, Pieter

2015-02-01

The flow regime of rivers, being an integral part of aquatic ecosystems, provides many important services benefiting humans in catchments. Past water resource developments characterized by river embankments and dams, however, were often dominated by one (or few) economic use(s) of water. This results in a dramatically changed flow regime negatively affecting the provision of other ecosystem services sustained by the river flow. This study is intended to demonstrate the value of alternative flow regimes in a river that is highly modified by the presence of large hydropower dams and reservoirs, explicitly accounting for a broad range of flow-dependent ecosystem services. In this study, we propose a holistic approach for conducting an ecological economic assessment of a river's flow regime. This integrates recent advances in the conceptualization and classification of ecosystem services (UK NEA, 2011) with the flow regime evaluation technique developed by Korsgaard (2006). This integrated approach allows for a systematic comparison of the economic values of alternative flow regimes, including those that are considered beneficial for aquatic ecosystems. As an illustration, we applied this combined approach to the Lower Zambezi Basin, Mozambique. Empirical analysis shows that even though re-operating dams to create environmentally friendly flow regimes reduces hydropower benefits, the gains to goods derived from the aquatic ecosystem may offset the forgone hydropower benefits, thereby increasing the total economic value of river flow to society. The proposed integrated flow assessment approach can be a useful tool for welfare-improving decision-making in managing river basins. Copyright © 2014 Elsevier B.V. All rights reserved.

Directions in healthcare research: pointers from retailing and services marketing.

PubMed

Van Rompay, Thomas L J; Tanja-Dijkstra, Karin

2010-01-01

Although the importance of the environment in relation to healing processes has been well established, empirical evidence for environmental effects on patient well-being and behavior is sparse. In addition, few attempts have been made to integrate insights from related fields of research such as retailing and services marketing with findings from healthcare studies. In this paper, relevant findings and insights from these domains are discussed. What insights and findings from retailing and services marketing are (potentially) of interest to the healthcare context, and how should one interpret and follow up on these results in healthcare environments? Research in retailing and services marketing indicates that physical environmental factors (i.e., music and scent) and social environmental factors (i.e., crowded conditions) may affect consumer satisfaction and well-being. In addition, environmental effects have been shown to vary with contextual factors (e.g., the type of environment) and consumer needs (e.g., the extent to which consumers value social contact or stimulation in a specific setting). Although the evidence base for environmental factors in health environments is steadily growing, few attempts have been made to integrate findings from both domains. The findings presented indicate that environmental variables such as music and scent can contribute to patient well-being and overall satisfaction. In addition, findings suggest that these variables may be used to counteract the negative effects resulting from crowded conditions in different healthcare units. Taking into account recent developments in the healthcare industry, the importance of creating memorable and pleasant patient experiences is likely to grow in the years to come. Hence, the finding that subtle and relatively inexpensive manipulations may affect patient well-being in profound ways should inspire follow-up research aimed at unraveling the specifics of environmental influences in health environments.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-01-01

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

The ethics of donor human milk banking.

PubMed

Arnold, Lois D W

2006-01-01

This case study of donor human milk banking and the ethics that govern interested parties is the first time the ethics of donor milk banking has been explored. Two different models of ethics and their direct impact on donor milk banking are examined: biomedical ethics and public health ethics. How these models and principles affect different aspects of donor human milk banking and the parties involved in the delivery of this service are elucidated. Interactions of parties with each other and how the quality and type of interaction affects the ethical delivery of donor milk banking services are described. Crystallization is at the heart of the qualitative methodology used. Writing as a method of inquiry, an integrative research review, and personal experience are the three methods involved in the crystallization process. Suggestions are made for improving access and knowledge of banked donor human milk, a valuable public health resource.

Gender, sexual health and reproductive health promotion.

PubMed

Moeti, M R

1995-01-01

The underlying factors of poverty, migration, marginalization, lack of information and skills, disempowerment, and poor access to services which affect HIV/STD risk are also closely related to those which affect sexual and reproductive health. Reproductive health problems include unplanned and unwanted pregnancies, unsafe abortions, pregnancy-related illness and death, and STDs including HIV/AIDS. This interrelationship between factors is leading increasingly to the integration of HIV/STD education and prevention within the broader framework of sexual and reproductive health promotion. Such intervention allows the possible reinforcement of the impact of interventions upon important underlying factors and behaviors linked to individual, family, and community vulnerability to HIV/STDs as well as other reproductive health problems. Integration will also optimize the use of increasingly scarce resources and increase the likelihood of responses, interventions, and programs being sustainable. Sexual and reproductive health, placing HIV/STD prevention into context, and focus upon men are discussed.

Impacts of climate change on biodiversity, ecosystems, and ecosystem services: technical input to the 2013 National Climate Assessment

USGS Publications Warehouse

Staudinger, Michelle D.; Grimm, Nancy B.; Staudt, Amanda; Carter, Shawn L.; Stuart, F. Stuart; Kareiva, Peter; Ruckelshaus, Mary; Stein, Bruce A.

2012-01-01

Ecosystems, and the biodiversity and services they support, are intrinsically dependent on climate. During the twentieth century, climate change has had documented impacts on ecological systems, and impacts are expected to increase as climate change continues and perhaps even accelerates. This technical input to the National Climate Assessment synthesizes our scientific understanding of the way climate change is affecting biodiversity, ecosystems, ecosystem services, and what strategies might be employed to decrease current and future risks. Building on past assessments of how climate change and other stressors are affecting ecosystems in the United States and around the world, we approach the subject from several different perspectives. First, we review the observed and projected impacts on biodiversity, with a focus on genes, species, and assemblages of species. Next, we examine how climate change is affecting ecosystem structural elements—such as biomass, architecture, and heterogeneity—and functions—specifically, as related to the fluxes of energy and matter. People experience climate change impacts on biodiversity and ecosystems as changes in ecosystem services; people depend on ecosystems for resources that are harvested, their role in regulating the movement of materials and disturbances, and their recreational, cultural, and aesthetic value. Thus, we review newly emerging research to determine how human activities and a changing climate are likely to alter the delivery of these ecosystem services. This technical input also examines two cross-cutting topics. First, we recognize that climate change is happening against the backdrop of a wide range of other environmental and anthropogenic stressors, many of which have caused dramatic ecosystem degradation already. This broader range of stressors interacts with climate change, and complicates our abilities to predict and manage the impacts on biodiversity, ecosystems, and the services they support. The second cross-cutting topic is the rapidly advancing field of climate adaptation, where there has been significant progress in developing the conceptual framework, planning approaches, and strategies for safeguarding biodiversity and other ecological resources. At the same time, ecosystem-based adaptation is becoming more prominent as a way to utilize ecosystem services to help human systems adapt to climate change. In this summary, we present key findings of the technical input, focusing on themes that can be found throughout the report. Thus, this summary takes a more integrated look at the question of how climate change is affecting our ecological resources, the implications for humans, and possible response strategies. This integrated approach better reflects the impacts of climate in the real world, where changes in ecosystem structure or function will alter the viability of different species and the efficacy of ecosystem services. Likewise, adaptation to climate change will simultaneously address a range of conservation goals. Case studies are used to illustrate this complete picture throughout the report; a snapshot of one case study, 2011 Las Conchas, New Mexico Fire, is included in this summary.

A review of factors affecting patient satisfaction with nurse led triage in emergency departments.

PubMed

Rehman, Salma Abdul; Ali, Parveen Azam

2016-11-01

To determine the factors that affect patient satisfaction with nurse-led-triage in EDs using a systematic review. Nurses' involvement in the triage services provided in the Emergency Department has been an integral part of practice for several decades in some countries. Although studies exploring patient satisfaction with nurse-led ED triage exist, no systematic review of this evidence is available. MEDLINE, CINAHL, PsycInfo, EMBASE, the Cochrane Library, Joanna Briggs Library and Google Scholar were searched (January 1980-June 2013). Eighteen studies that met the inclusion criteria were reviewed. Factors that affect patient satisfaction with nurse-led-triage include nurses' abilities to provide patient centred care, communication skills, nurses' caring abilities, concern for the patient and competence in diagnosing and treating the health problem. Other factors include availability and visibility of nurses, provision of appropriate health related information in a jargon-free language, nurses' ability to answer questions, and an ability to provide patients with an opportunity to ask questions. There is continued scope for nurse-led-triage services in the ED. Patients are generally satisfied with the service provided by nurses in EDs and report a willingness to see the same professional again in the future if needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Consensus statement: Supporting Safer Conception and Pregnancy For Men And Women Living with and Affected by HIV.

PubMed

Matthews, Lynn T; Beyeza-Kashesya, Jolly; Cooke, Ian; Davies, Natasha; Heffron, Renee; Kaida, Angela; Kinuthia, John; Mmeje, Okeoma; Semprini, Augusto E; Weber, Shannon

2018-06-01

Safer conception interventions reduce HIV incidence while supporting the reproductive goals of people living with or affected by HIV. We developed a consensus statement to address demand, summarize science, identify information gaps, outline research and policy priorities, and advocate for safer conception services. This statement emerged from a process incorporating consultation from meetings, literature, and key stakeholders. Three co-authors developed an outline which was discussed and modified with co-authors, working group members, and additional clinical, policy, and community experts in safer conception, HIV, and fertility. Co-authors and working group members developed and approved the final manuscript. Consensus across themes of demand, safer conception strategies, and implementation were identified. There is demand for safer conception services. Access is limited by stigma towards PLWH having children and limits to provider knowledge. Efficacy, effectiveness, safety, and acceptability data support a range of safer conception strategies including ART, PrEP, limiting condomless sex to peak fertility, home insemination, male circumcision, STI treatment, couples-based HIV testing, semen processing, and fertility care. Lack of guidelines and training limit implementation. Key outstanding questions within each theme are identified. Consumer demand, scientific data, and global goals to reduce HIV incidence support safer conception service implementation. We recommend that providers offer services to HIV-affected men and women, and program administrators integrate safer conception care into HIV and reproductive health programs. Answers to outstanding questions will refine services but should not hinder steps to empower people to adopt safer conception strategies to meet reproductive goals.

Antiservice Within the Medical Service Encounter: Lessons for Radiologists Beyond Service Recovery.

PubMed

Hill, Paul Armstrong; Hill, Ronald Paul

2015-12-01

Recent modifications in the metrics for reimbursement have reinforced the importance of radiology service-delivery experiences of patients. Evaluating current radiology practices calls for reflection on the various touch points with patients, as well as their overall satisfaction. If problems occur during encounters, service failure, or lack of satisfactory medical experiences can be transformed through service recovery, whereby patients-as-customers are given chances to voice their concerns, and health care providers across the spectrum can work together to resolve problematic issues. This paper takes a systemic view of the patient experience as embedded in the care continuum, recognizing that different beliefs, attitudes, and behaviors of members of the health care team can negatively affect or sabotage patient satisfaction. Although radiologists are only one of many roles in the care continuum, recommendations are discussed for how they can integrate service satisfaction as a pervasive communal goal among all health care team members. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

[The family planning program in Rwanda: assessment of ten years (1981-1991) and prospects].

PubMed

Munyakazi, A

1990-12-01

Rwanda's official family planning policy dates back to 1981 and creation of the National Office of Population (ONAPO). Among its other function, ONAPO monitors proper use of family planning methods and studies the integration of family planning services into public health. Pilot family planning programs began in the prefectures of Butare, Kigali, and Ruhengeri and were extended to the other 7 around 1985. The development of family planning services in Rwanda is based on their integration into existing services, especially those devoted to maternal-child health. In 1989, 277 of the 350 health centers of all kinds in Rwanda and 12 secondary posts offered family planning services. The rate of integration was 79.4%. 185 of the 277 health services with family planning services were in the public sector. As of December 1989, the rate of integration in different prefectures varied from a high of 95.5% in Kibungo to a low of 64.9% in Gisenyi. Integration is particularly weak in health facilities administered by the Catholic Church. The 2 strategies to confront this situation are continuing dialogue with Catholic Church officials and creation of secondary family planning posts to improve accessibility to family planning for populations served by Church health services. The number of new and continuing family planning users increased from 1178 and 1368 respectively in 1982 to 66,950 and 104,604 through September 1990. There is wide variation from 1 prefecture to another in recruitment of new acceptors and in the number of acceptors per health facility. Recruitment of new acceptors is greatest in Ruhengeri, followed by Kigali and Byumba. As of September 1990, 28,943 women used pills, 2037 used IUDs, 66,515 used injectables, 3051 used barrier methods, 2888 used auto-observation methods, 343 used implants, and 588 were sterilized. The overall rate of contraceptive prevalence increased from .9% in 1983 to 6.2% in 1989 and 10% in 1990. The strategy for promoting family planning has included training of personnel, improvement of supervision, regular supply of contraceptive equipment and supplies to health supervision, regular supply of contraceptive equipment and supplies to health centers, diversification of available methods, and addition of secondary family planning posts to improve accessibility. Obstacles still affecting Rwanda's family planning program include the pronatalist cultural orientation, which is being confronted by a vigorous IEC program. The reluctance of Catholic-affiliated health services to offer modern family planning methods, the shortage of trained family planning workers, contraceptive supply problems, and geographic inaccessibility of family planning services are other serious problems. To confront these problems, ONAPO plans to begin social marketing program, create more secondary health planning posts, promote integration of family planning services into the vaccination program, strengthen efforts to motivate postpartum women, and undertake a community distribution program for condoms and spermicides.

The medical home and integrated behavioral health: advancing the policy agenda.

PubMed

Ader, Jeremy; Stille, Christopher J; Keller, David; Miller, Benjamin F; Barr, Michael S; Perrin, James M

2015-05-01

There has been a considerable expansion of the patient-centered medical home model of primary care delivery, in an effort to reduce health care costs and to improve patient experience and population health. To attain these goals, it is essential to integrate behavioral health services into the patient-centered medical home, because behavioral health problems often first present in the primary care setting, and they significantly affect physical health. At the 2013 Patient-Centered Medical Home Research Conference, an expert workgroup convened to determine policy recommendations to promote the integration of primary care and behavioral health. In this article we present these recommendations: Build demonstration projects to test existing approaches of integration, develop interdisciplinary training programs to support members of the integrated care team, implement population-based strategies to improve behavioral health, eliminate behavioral health carve-outs and test innovative payment models, and develop population-based measures to evaluate integration. Copyright © 2015 by the American Academy of Pediatrics.

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

PubMed

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

2014-01-01

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

A new road map for healthcare business success.

PubMed

Williams, Jeni

2011-05-01

Action steps hospitals should take to prepare their organizations for a changing business development environment include: Developing a comprehensive forecast of the ways in which reform and market forces will affect patient volumes and service line demand. Aligning with physicians and other care entities in a tightly integrated way. Heightening transparency related to quality and cost. Investing in marketing and social media to strengthen the organization's market position.

Preoperative planning and perioperative management for minimally invasive total knee arthroplasty.

PubMed

Scuderi, Giles R

2006-07-01

The introduction of minimally invasive surgery (MIS) has led to new clinical pathways for total knee arthroplasty (TKA). MIS TKA outcomes are affected by multiple factors--the surgery itself; preoperative planning and medical management; preoperative patient education; preemptive perioperative and postoperative analgesia; mode of anesthesia; optimal rehabilitation; and enlightened home care and social services-and therefore an integrated team approach to patient and surgery is required.

A proposal for health care management and leadership education within the UK undergraduate medical curriculum.

PubMed

Mafe, Cecilia; Menyah, Effie; Nkere, Munachi

2016-01-01

Health care management and leadership education is an important gap in the undergraduate medical curriculum. Lack of training promotes poor decision making and may lead to inadequate health services, adversely affecting patients. We propose an integrated approach to health care management and leadership education at undergraduate level, to enable doctors to be effective leaders and manage resources appropriately and to ultimately improve patient care.

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

PubMed Central

Kendall, Tamil; Langer, Ana; Bärnighausen, Till

2014-01-01

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

Same day HIV diagnosis and antiretroviral therapy initiation affects retention in Option B+ prevention of mother-to-child transmission services at antenatal care in Zomba District, Malawi.

PubMed

Chan, Adrienne K; Kanike, Emmanuel; Bedell, Richard; Mayuni, Isabel; Manyera, Ruth; Mlotha, William; Harries, Anthony D; van Oosterhout, Joep J; van Lettow, Monique

2016-01-01

Data from the Option B+ prevention of mother-to-child transmission (PMTCT) program in Malawi show considerable variation between health facilities in retention on antiretroviral therapy (ART). In a programmatic setting, we studied whether the "model of care," based on the degree of integration of antenatal care (ANC), HIV testing and counselling (HTC) and ART service provision-influenced uptake of and retention on ART. We conducted a retrospective cohort study of pregnant women seeking ANC at rural primary health facilities in Zomba District, Malawi. Data were extracted from standardized national ANC registers, ART registers and ART master cards. The "model of care" of Option B+ service delivery was determined at each health facility, based on the degree of integration of ANC, HTC and ART. Full integration (Model 1) of HTC and ART initiation at ANC was compared with integration of HTC only into ANC services (Model 2) with subsequent referral to an existing ART clinic for treatment initiation. A total of 10,528 women were newly registered at ANC between October 2011 and March 2012 in 23 rural health facilities (12 were Model 1 and 11 Model 2). HIV status was ascertained in 8,572 (81%) women. Among 914/8,572 (9%) HIV-positive women enrolling at ANC, 101/914 (11%) were already on ART; of those not on treatment, 456/813 (56%) were started on ART. There was significantly higher ART uptake in Model 1 compared with Model 2 sites (63% vs. 51%; p=0.001), but significantly lower ART retention in Model 1 compared with Model 2 sites (79% vs. 87%; p=0.02). Multivariable analysis showed that initiation of ART on the same day as HIV diagnosis, but not model of care, was independently associated with reduced retention in the first six months (adjusted odds ratio 2.27; 95% CI: 1.34-3.85; p=0.002). HIV diagnosis and treatment on the same day was associated with reduced retention on ART, independent of the level of PMTCT service integration at ANC.

"If I speak English, what am I? I am full man, me": Emotional impact and barriers for refugees and asylum seekers learning English.

PubMed

Salvo, Tania; de C Williams, Amanda C

2017-01-01

Lack of proficiency in the language of the host country predicts distress among refugees, but many refugees and asylum seekers in the United Kingdom have less than functional English. This study examined how learning English affected refugees' and asylum seekers' lives, particularly their emotional wellbeing, to explore what factors, particularly psychological ones, facilitated or impeded their learning English. We recruited 16 refugees and asylum seekers from an inner-city National Health Service trauma service and from a charity providing one-to-one English classes. All participants were interviewed in English. Interview data were analysed using thematic analysis from a critical realist perspective. Interviewees provided consistent accounts of their efforts to learn English, integrated into often unsettled and difficult lives. The analysis generated six themes in two domains. The impact of learning English was mainly positive, associated with autonomy, sense of achievement, and aspirations. Barriers to learning English consisted of other problems affecting refugees' capacity to learn, limited opportunities to speak English, and a sense of shame associated with perceived lack of English language competence. Findings highlight the need to provide adequate psychological support for refugees and asylum seekers learning English, recognising its importance in promoting both their integration in the UK and their individual psychological well-being.

Geospatial information technology: an adjunct to service-based outreach and education.

PubMed

Faruque, Fazlay; Hewlett, Peggy O; Wyatt, Sharon; Wilson, Kaye; Lofton, Susan; Frate, Dennis; Gunn, Jennie

2004-02-01

This exemplar highlights how geospatial information technology was effective in supporting academic practice, faculty outreach, and education initiatives at the University of Mississippi School of Nursing. Using this cutting-edge technology created a community-based prototype for fully integrating point-of-service research, practice, and academics into a cohesive strategy to influence change within the health care delivery system. This exemplar discusses ways this knowledge benefits practice and curriculum development; informs critical decision making affecting the people we serve; underscores the vital role nurses play in linking this technology to practice; and develops community residents as partners in their own health and that of the community.

A Coupled SD and CLUE-S Model for Exploring the Impact of Land Use Change on Ecosystem Service Value: A Case Study in Baoshan District, Shanghai, China

NASA Astrophysics Data System (ADS)

Wu, Meng; Ren, Xiangyu; Che, Yue; Yang, Kai

2015-08-01

Most of the cities in developing countries are experiencing rapid urbanization. Land use change driven by urban sprawl, population growth, and intensified socio-economic activities have led to a steep decline of ecosystem service value (ESV) in rapid urbanization areas, and decision-makers often ignore some valuable ecosystem service functions and values in land use planning. In this paper, we attempt to build a modeling framework which integrated System Dynamics model with Conversion of Land Use and its Effects at Small Extent model to simulate the dynamics of ESV of landscape and explore the potential impacts of land use change on ESV. We take Baoshan district of Shanghai as an example which is a fast urbanization area of metropolitan in China. The results of the study indicate that: (1) The integrated methodology can improve the characterization and presentation of the dynamics of ESV, which may give insight into understanding the possible impacts of land use change on ESV and provide information for land use planning. (2) Land use polices can affect the magnitude and location of ESV both directly and indirectly. Land use changes tend to weaken and simplify ecosystem service functions and values of landscape at urban rural fringe where land use change is more intensive. (3) The application of the methodology has proved that the integration of currently existing models within a single modeling framework could be a beneficial exploration, and should be encouraged and enhanced in the future research on the changing dynamics of ESV due to the complexity of ecosystem services and land use system.

A Coupled SD and CLUE-S Model for Exploring the Impact of Land Use Change on Ecosystem Service Value: A Case Study in Baoshan District, Shanghai, China.

PubMed

Wu, Meng; Ren, Xiangyu; Che, Yue; Yang, Kai

2015-08-01

Most of the cities in developing countries are experiencing rapid urbanization. Land use change driven by urban sprawl, population growth, and intensified socio-economic activities have led to a steep decline of ecosystem service value (ESV) in rapid urbanization areas, and decision-makers often ignore some valuable ecosystem service functions and values in land use planning. In this paper, we attempt to build a modeling framework which integrated System Dynamics model with Conversion of Land Use and its Effects at Small Extent model to simulate the dynamics of ESV of landscape and explore the potential impacts of land use change on ESV. We take Baoshan district of Shanghai as an example which is a fast urbanization area of metropolitan in China. The results of the study indicate that: (1) The integrated methodology can improve the characterization and presentation of the dynamics of ESV, which may give insight into understanding the possible impacts of land use change on ESV and provide information for land use planning. (2) Land use polices can affect the magnitude and location of ESV both directly and indirectly. Land use changes tend to weaken and simplify ecosystem service functions and values of landscape at urban rural fringe where land use change is more intensive. (3) The application of the methodology has proved that the integration of currently existing models within a single modeling framework could be a beneficial exploration, and should be encouraged and enhanced in the future research on the changing dynamics of ESV due to the complexity of ecosystem services and land use system.

Health justice partnerships: initial insights into the delivery of an integrated health and legal service for youth in regional Victoria.

PubMed

Ollerenshaw, Alison; Camilleri, Margaret

2017-01-01

This article presents interim findings from research examining the implementation of a health justice partnership (HJP) focusing on the legal and health needs of regional young people. HJPs provide an innovative service model offering an integrated health and legal service for the community. HJPs are a relatively new service model for Australia, yet the program is well suited to meet the needs of particular population cohorts, including young people and those in regional locations experiencing complex legal issues. Funded by the Victorian Legal Services Board and Commissioner, an HJP in partnership with three organisations was established in a large regional area in Victoria, Australia. Research is being conducted alongside the program to examine its impact on young people, and the implications on practice for staff in the partner organisations. Findings provide preliminary support for the HJP model with a number of young people - from predominantly disadvantaged backgrounds and with varying legal issues - having been referred to the program in the first 6 months. Referrals were received from both partner agencies and external agencies. Initial client and staff survey responses indicate that the legal problem of the young people was affecting how they feel. While these findings provide preliminary support for the HJP further research will offer longer term insights about HJPs within the Australian context, particularly rural and regional settings.

Illustrating Services Integration from Categorical Bases. Human Services Monograph Series No. 3.

ERIC Educational Resources Information Center

Horton, Gerald T.; And Others

This report focuses on one method of human services integration--starting with a categorical funding and program base which is expanded to integrate complementary services and resources into a comprehensive service package. The four projects examined illustrate the following initial categorical bases: Community mental health services, primarily…

Knowledge exchange and integrated services: experiences from an integrated community intellectual (learning) disability service for adults.

PubMed

Farrington, C; Clare, I C H; Holland, A J; Barrett, M; Oborn, E

2015-03-01

This paper examines knowledge exchange dynamics in a specialist integrated intellectual (learning) disability service, comprising specialist healthcare provision with social care commissioning and management, and considers their significance in terms of integrated service delivery. A qualitative study focusing on knowledge exchange and integrated services. Semi-structured interviews (n = 25) were conducted with members of an integrated intellectual disability service in England regarding their perceptions of knowledge exchange within the service and the way in which knowledge exchange impinges on the operation of the integrated service. Exchange of 'explicit' (codifiable) knowledge between health and care management components of the service is problematic because of a lack of integrated clinical governance and related factors such as IT and care record systems and office arrangements. Team meetings and workplace interactions allowed for informal exchange of explicit and 'tacit' (non-codifiable) knowledge, but presented challenges in terms of knowledge exchange completeness and sustainability. Knowledge exchange processes play an important role in the functioning of integrated services incorporating health and care management components. Managers need to ensure that knowledge exchange processes facilitate both explicit and tacit knowledge exchange and do not rely excessively on informal, 'ad hoc' interactions. Research on integrated services should take account of micro-scale knowledge exchange dynamics and relationships between social dynamics and physical factors. © 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Unmet home healthcare needs and quality of life in cancer patients: a hospital-based Turkish sample.

PubMed

Ataman, Gülsen; Erbaydar, Tugrul

2017-07-01

Home healthcare services in Turkey are provided primarily to patients that are bedridden or seriously disabled. There are no such services integrated with hospital services that are specifically designed for cancer patients. The present study aimed to explore the home healthcare needs of cancer patients and their experiences related to unmet home healthcare needs. The study included 394 adult cancer patients who were followed up at the surgical oncology department of a university hospital. A 37-item, study-specific questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for cancer patients (EORTC-QLQ-C30) were administered, and patient clinical records were evaluated. Home healthcare was provided primarily by the patients' immediate family members; the professional home healthcare usage rate was only 2.8%. Patient quality of life (QoL) was negatively affected by cancer, especially those with stage three and four disease. The frequency of the need for home healthcare services due to disease-related health problems during the 30 days prior to administration of the questionnaires was as follows: pain (62.9%), surgical wound care (44.9%), injection of therapeutics (52.3%), gastrointestinal complaints (51.8%), anxiety (87.1%), psychosocial assistance (77.2%) and information about cancer (94.4%). In the absence of home healthcare services, the patients primarily used institutional healthcare services to meet their needs; otherwise, their needs were not met. The physical and psychosocial problems that cancer patients experience could be solved in most cases by professional home healthcare services. Hospital-integrated home healthcare services might not only improve cancer patient QoL but might also increase the effectiveness of hospital-based healthcare services. © 2017 John Wiley & Sons Ltd.

Technology management: case study of an integrated health system.

PubMed

Dahl, D H; McFarlan, T K

1994-12-01

Technology management has assumed a role of vital importance in today's health care environment. Capital reserves and operating income have been stretched by pervasive and expensive technologies, while overall reimbursement has been reduced. It is imperative for hospitals to develop and consistently use technology management processes that begin prior to a technology's introduction in the hospital and continue throughout its life cycle. At Samaritan Health System (SHS), an integrated health care delivery system based in Phoenix, technology management provides tools to improve decision making and assist in the system's integration strategy as well as control expenses. SHS uses a systemwide technology-specific plan to guide acquisition and/or funding decisions. This plan describes how particular technologies can help achieve SHS' organizational goals such as promoting system integration and/or improving patient outcomes while providing good economic value. After technologies are targeted in this systemwide plan they are prioritized using a two-stage capital prioritization process. The first stage of the capital prioritization process considers the quantitative and qualitative factors critical for equitable capital distribution across the system. The second stage develops a sense of ownership among the parties that affect and are affected by the allocation at a facility level. This process promotes an efficient, effective, equitable, and defensible approach to resource allocation and technology decision making. Minimizing equipment maintenance expenditures is also an integral part of technology management at SHS. The keys to reducing maintenance expenditures are having a process in place that supports a routine fiscal evaluation of maintenance coverage options and ensuring that manufacturers are obligated to provide critical maintenance resources at the time of equipment purchase. Maintenance service options under consideration in this report include full-service contracts with the manufacturer, insurance coverage, time and materials, and independent service vendors/in-house support. Careful consideration of all the ramifications of each option is warranted because there are substantial cost differences among these methods. At SHS, technology management efforts resulted in equipment purchases and maintenance negotiations representing savings of more than $1.5 million in a single year. SHS undertakes an intensive review of purchases and maintenance expenditures, using the techniques described in this report, with the objective of reducing expenses by 10% per year. This report describes the technology management methods that SHS uses to achieve these results.

Elements affecting food waste in the food service sector.

PubMed

Heikkilä, Lotta; Reinikainen, Anu; Katajajuuri, Juha-Matti; Silvennoinen, Kirsi; Hartikainen, Hanna

2016-10-01

Avoidable food waste is produced in the food service sector, with significant ecological and economical impacts. In order to understand and explain better the complex issue of food waste a qualitative study was conducted on the reasons for its generation in restaurants and catering businesses. Research data were collected during three participatory workshops for personnel from three different catering sector companies in Finland. Based on synthesized qualitative content analysis, eight elements influencing production and reduction of food waste were identified. Results revealed the diversity of managing food waste in the food service sector and how a holistic approach is required to prevent and reduce it. It is crucial to understand that food waste is manageable and should be an integral component of the management system. The model of eight factors provides a framework for recognition and management of food waste in the food service sector. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed

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

2007-01-01

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

Study on Network Error Analysis and Locating based on Integrated Information Decision System

NASA Astrophysics Data System (ADS)

Yang, F.; Dong, Z. H.

2017-10-01

Integrated information decision system (IIDS) integrates multiple sub-system developed by many facilities, including almost hundred kinds of software, which provides with various services, such as email, short messages, drawing and sharing. Because the under-layer protocols are different, user standards are not unified, many errors are occurred during the stages of setup, configuration, and operation, which seriously affect the usage. Because the errors are various, which may be happened in different operation phases, stages, TCP/IP communication protocol layers, sub-system software, it is necessary to design a network error analysis and locating tool for IIDS to solve the above problems. This paper studies on network error analysis and locating based on IIDS, which provides strong theory and technology supports for the running and communicating of IIDS.

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

PubMed Central

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

2017-01-01

Introduction: During the past two decades, HIV and Sexual and Reproductive Health services in Namibia have been provided in silos, with high fragmentation. As a consequence of this, quality and efficiency of services in Primary Health Care has been compromised. Methods: We conducted an operational research (observational pre-post study) in a public health facility in Namibia. A health facility assessment was conducted before and after the integration of health services. A person-centred integrated model was implemented to integrate all health services provided at the health facility in addition to HIV and Sexual and Reproductive Health services. Comprehensive services are provided by each health worker to the same patients over time (longitudinality), on a daily basis (accessibility) and with a good external referral system (coordination). Prevalence rates of time flows and productivity were done. Results: Integrated services improved accessibility, stigma and quality of antenatal care services by improving the provider-patient communication, reducing the time that patients stay in the clinic in 16% and reducing the waiting times in 14%. In addition, nurse productivity improved 85% and the expected time in the health facility was reduced 24% without compromising the uptake of TB, HIV, outpatient, antenatal care or first visit family planning services. Given the success on many indicators resulting from integration of services, the goal of this paper was to describe “how” health services have been integrated, the “process” followed and presenting some “results” from the integrated clinic. Conclusions: Our study shows that HIV and SRH services can be effectively integrated by following the person-centred integrated model. Based on the Namibian experience on “how” to integrate health services and the “process” to achieve it, other African countries can replicate the model to move away from the silo approach and contribute to the achievement of Universal Health Coverage. PMID:28970759

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

PubMed

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

2018-04-03

Maternal, newborn and child health (MNCH) services represent opportunities to integrate postpartum family planning (PPFP). Objectives were to determine levels of MNCH-family planning (FP) integration and associations between integration, client characteristics and service delivery factors in facilities that received programmatic PPFP support. Cross-sectional client flow assessment conducted during May-July 2014, over 5 days at 10 purposively selected public sector facilities in India (4 hospitals) and Kenya (2 hospitals and 4 health centres). 2158 client visits tracked (1294 India; 864 Kenya). Women aged 18 or older accessing services while pregnant and/or with a child under 2 years. PPFP/postpartum intrauterine device-Bihar, India (2012-2013); Jharkhand, India (2009-2014); Embu, Kenya (2006-2010). Maternal, infant and young child nutrition/FP integration-Bondo, Kenya (2011-2014). Proportion of visits where clients received integrated MNCH-FP services, client characteristics as predictors of MNCH-FP integration and MNCH-FP integration as predictor of length of time spent at facility. Levels of MNCH-FP integration varied widely across facilities (5.3% to 63.0%), as did proportion of clients receiving MNCH-FP integrated services by service area. Clients travelling 30-59 min were half as likely to receive integrated services versus those travelling under 30 min (OR 0.5, 95% CI 0.4 to 0.7, P<0.001). Clients receiving MNCH-FP services (vs MNCH services only) spent an average of 10.5 min longer at the facility (95% CI -0.1 to 21.9, not statistically significant). Findings suggest importance of focused programmatic support for integration by MNCH service area. FP integration was highest in areas receiving specific support. Integration does not seem to impose an undue burden on clients in terms of time spent at the facility. Clients living furthest from facilities are least likely to receive integrated services. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

How the Kano model contributes to Kansei engineering in services.

PubMed

Hartono, Markus; Chuan, Tan Kay

2011-11-01

Recent studies show that products and services hold great appeal if they are attractively designed to elicit emotional feelings from customers. Kansei engineering (KE) has good potential to provide a competitive advantage to those able to read and translate customer affect and emotion in actual product and services. This study introduces an integrative framework of the Kano model and KE, applied to services. The Kano model was used and inserted into KE to exhibit the relationship between service attribute performance and customer emotional response. Essentially, the Kano model categorises service attribute quality into three major groups (must-be [M], one-dimensional [O] and attractive [A]). The findings of a case study that involved 100 tourists who stayed in luxury 4- and 5-star hotels are presented. As a practical matter, this research provides insight on which service attributes deserve more attention with regard to their significant impact on customer emotional needs. STATEMENT OF RELEVANCE: Apart from cognitive evaluation, emotions and hedonism play a big role in service encounters. Through a focus on delighting qualities of service attributes, this research enables service providers and managers to establish the extent to which they prioritise their improvement efforts and to always satisfy their customer emotions beyond expectation.

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

PubMed

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

2004-01-01

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

76 FR 28767 - Desert Southwest Customer Service Region-Rate Order No. WAPA-152

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-18

... Temporarily Extending Network Integration Transmission Service (NITS). SUMMARY: This action is to temporarily... Administration, Rate Extension for Desert Southwest Region Network Integration Transmission Service and WALC... Integration Transmission Service and Ancillary Services Formula Rates Section 302 of the Department of Energy...

Disparities in Water and Sewer Services in North Carolina: An Analysis of the Decision-Making Process

PubMed Central

Gibson, Jacqueline MacDonald

2015-01-01

Objectives. We examined the factors that affect access to municipal water and sewer service for unincorporated communities relying on wells and septic tanks. Methods. Using a multisite case study design, we conducted in-depth, semistructured interviews with 25 key informants from 3 unincorporated communities in Hoke, New Hanover, and Transylvania counties, North Carolina, July through September 2013. Interviewees included elected officials, health officials, utility providers, and community members. We coded the interviews in ATLAS.ti to identify common themes. Results. Financing for water and sewer service emerged as the predominant factor that influenced decisions to extend these services. Improved health emerged as a minor factor, suggesting that local officials may not place a high emphasis on the health benefits of extending public water and sewer services. Awareness of failed septic systems in communities can prompt city officials to extend sewer service to these areas; however, failed systems are often underreported. Conclusions. Understanding the health costs and benefits of water and sewer extension and integrating these findings into the local decision-making process may help address disparities in access to municipal services. PMID:26270307

Visual impairment, coping strategies and impact on daily life: a qualitative study among working-age UK ex-service personnel.

PubMed

Stevelink, Sharon A M; Malcolm, Estelle M; Fear, Nicola T

2015-11-12

Sustaining a visual impairment may have a substantial impact on various life domains such as work, interpersonal relations, mobility and social and mental well-being. How to adjust to the loss of vision and its consequences might be a challenge for the visually impaired person. The purpose of the current study was to explore how younger male ex-Service personnel cope with becoming visually impaired and how this affects their daily life. Semi-structured interviews with 30 visually impaired male ex-Service personnel, all under the age of 55, were conducted. All participants are members of the charity organisation Blind Veterans UK. Interviews were analysed thematically. Younger ex-Service personnel applied a number of different strategies to overcome their loss of vision and its associated consequences. Coping strategies varied from learning new skills, goal setting, integrating the use of low vision aids in their daily routine, to social withdrawal and substance misuse. Vision loss affected on all aspects of daily life and ex-Service personnel experienced an on-going struggle to accept and adjust to becoming visually impaired. Health care professionals, family and friends of the person with the visual impairment need to be aware that coping with a visual impairment is a continuous struggle; even after a considerable amount of time has passed, needs for emotional, social, practical and physical support may still be present.

An intervention to improve mental health care for conflict-affected forced migrants in low-resource primary care settings: a WHO MhGAP-based pilot study in Sri Lanka (COM-GAP study)

PubMed Central

2013-01-01

Background Inadequacy in mental health care in low and middle income countries has been an important contributor to the rising global burden of disease. The treatment gap is salient in resource-poor settings, especially when providing care for conflict-affected forced migrant populations. Primary care is often the only available service option for the majority of forced migrants, and integration of mental health into primary care is a difficult task. The proposed pilot study aims to explore the feasibility of integrating mental health care into primary care by providing training to primary care practitioners serving displaced populations, in order to improve identification, treatment, and referral of patients with common mental disorders via the World Health Organization Mental Health Gap Action Programme (mhGAP). Methods/Design This pilot randomized controlled trial will recruit 86 primary care practitioners (PCP) serving in the Puttalam and Mannar districts of Sri Lanka (with displaced and returning conflict-affected populations). The intervention arm will receive a structured training program based on the mhGAP intervention guide. Primary outcomes will be rates of correct identification, adequate management based on set criteria, and correct referrals of common mental disorders. A qualitative study exploring the attitudes, views, and perspectives of PCP on integrating mental health and primary care will be nested within the pilot study. An economic evaluation will be carried out by gathering service utilization information. Discussion In post-conflict Sri Lanka, an important need exists to provide adequate mental health care to conflict-affected internally displaced persons who are returning to their areas of origin after prolonged displacement. The proposed study will act as a local demonstration project, exploring the feasibility of formulating a larger-scale intervention study in the future, and is envisaged to provide information on engaging PCP, and data on training and evaluation including economic costs, patient recruitment, and acceptance and follow-up rates. The study should provide important information on the WHO mhGAP intervention guide to add to the growing evidence base of its implementation. Trial registration SLCTR/2013/025. PMID:24321171

An intervention to improve mental health care for conflict-affected forced migrants in low-resource primary care settings: a WHO MhGAP-based pilot study in Sri Lanka (COM-GAP study).

PubMed

Siriwardhana, Chesmal; Adikari, Anushka; Van Bortel, Tine; McCrone, Paul; Sumathipala, Athula

2013-12-09

Inadequacy in mental health care in low and middle income countries has been an important contributor to the rising global burden of disease. The treatment gap is salient in resource-poor settings, especially when providing care for conflict-affected forced migrant populations. Primary care is often the only available service option for the majority of forced migrants, and integration of mental health into primary care is a difficult task. The proposed pilot study aims to explore the feasibility of integrating mental health care into primary care by providing training to primary care practitioners serving displaced populations, in order to improve identification, treatment, and referral of patients with common mental disorders via the World Health Organization Mental Health Gap Action Programme (mhGAP). This pilot randomized controlled trial will recruit 86 primary care practitioners (PCP) serving in the Puttalam and Mannar districts of Sri Lanka (with displaced and returning conflict-affected populations). The intervention arm will receive a structured training program based on the mhGAP intervention guide. Primary outcomes will be rates of correct identification, adequate management based on set criteria, and correct referrals of common mental disorders. A qualitative study exploring the attitudes, views, and perspectives of PCP on integrating mental health and primary care will be nested within the pilot study. An economic evaluation will be carried out by gathering service utilization information. In post-conflict Sri Lanka, an important need exists to provide adequate mental health care to conflict-affected internally displaced persons who are returning to their areas of origin after prolonged displacement. The proposed study will act as a local demonstration project, exploring the feasibility of formulating a larger-scale intervention study in the future, and is envisaged to provide information on engaging PCP, and data on training and evaluation including economic costs, patient recruitment, and acceptance and follow-up rates. The study should provide important information on the WHO mhGAP intervention guide to add to the growing evidence base of its implementation. SLCTR/2013/025.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-19

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

Semi-automated software service integration in virtual organisations

NASA Astrophysics Data System (ADS)

Afsarmanesh, Hamideh; Sargolzaei, Mahdi; Shadi, Mahdieh

2015-08-01

To enhance their business opportunities, organisations involved in many service industries are increasingly active in pursuit of both online provision of their business services (BSs) and collaborating with others. Collaborative Networks (CNs) in service industry sector, however, face many challenges related to sharing and integration of their collection of provided BSs and their corresponding software services. Therefore, the topic of service interoperability for which this article introduces a framework is gaining momentum in research for supporting CNs. It contributes to generation of formal machine readable specification for business processes, aimed at providing their unambiguous definitions, as needed for developing their equivalent software services. The framework provides a model and implementation architecture for discovery and composition of shared services, to support the semi-automated development of integrated value-added services. In support of service discovery, a main contribution of this research is the formal representation of services' behaviour and applying desired service behaviour specified by users for automated matchmaking with other existing services. Furthermore, to support service integration, mechanisms are developed for automated selection of the most suitable service(s) according to a number of service quality aspects. Two scenario cases are presented, which exemplify several specific features related to service discovery and service integration aspects.

Using mobile clinics to deliver HIV testing and other basic health services in rural Malawi.

PubMed

Lindgren, T G; Deutsch, K; Schell, E; Bvumbwe, A; Hart, K B; Laviwa, J; Rankin, S H

2011-01-01

The majority of Malawians are impoverished and primarily dependant on subsistence farming, with 85% of the population living in a rural area. The country is highly affected by HIV and under-resourced rural health centers struggle to meet the government's goal of expanding HIV testing, antiretroviral treatment, and other basic services. This report describes the work of two four-wheel drive mobile clinics launched in 2008 to fill an identified service gap in the remote areas of Mulanje District, Malawi. The program was developed by an international non-governmental organization, Global AIDS Interfaith Alliance (GAIA), and the Mulanje District Health Office, with funding from the Elizabeth Taylor HIV/AIDS Foundation. The clinics provide: (1) rapid HIV testing and treatment referral; (2) diagnosis and treatment of malaria; (3) sputum collection for TB screening; (4) diagnosis and treatment of sexually transmitted and opportunistic infections; and (5) pre-natal care. The clinic vehicles provide medical supplies and personnel (a clinical officer, nurse, and nurse aide) to set up clinics in community buildings such as churches or schools. In such a project, the implementation process and schedule can be affected by medication, supply chain and infrastructural issues, as well as governmental and non-governmental requirements. Timelines should be sufficiently flexible to accommodate unexpected delays. Once established, service scheduling should be flexible and responsive; for instance, malaria treatment rather than HIV testing was most urgently needed in the season when these services were launched. Assessing the impact of healthcare delivery in Malawi is challenging. Although mobile clinic and the government Health Management Information System (HMIS) data were matched, inconsistent variables and gaps in data made direct comparisons difficult. Data collection was compromised by the competing demand of high patient volume; however, rather than reducing the burden on existing health centers, the data suggest that the mobile clinics provided services for people who otherwise may not have attended a health center. The GAIA mobile clinics were integrated into a catchment area through a community participation model, allowing point-of-care primary health services to be provided to thousands of people in remote rural villagers. Strong relationships have been forged with local community leaders and with Malawi Ministry of Health officers as the foundation for long-term sustainable engagement and eventual integration of services into Health Ministry programs.

Web Based Rapid Mapping of Disaster Areas using Satellite Images, Web Processing Service, Web Mapping Service, Frequency Based Change Detection Algorithm and J-iView

NASA Astrophysics Data System (ADS)

Bandibas, J. C.; Takarada, S.

2013-12-01

Timely identification of areas affected by natural disasters is very important for a successful rescue and effective emergency relief efforts. This research focuses on the development of a cost effective and efficient system of identifying areas affected by natural disasters, and the efficient distribution of the information. The developed system is composed of 3 modules which are the Web Processing Service (WPS), Web Map Service (WMS) and the user interface provided by J-iView (fig. 1). WPS is an online system that provides computation, storage and data access services. In this study, the WPS module provides online access of the software implementing the developed frequency based change detection algorithm for the identification of areas affected by natural disasters. It also sends requests to WMS servers to get the remotely sensed data to be used in the computation. WMS is a standard protocol that provides a simple HTTP interface for requesting geo-registered map images from one or more geospatial databases. In this research, the WMS component provides remote access of the satellite images which are used as inputs for land cover change detection. The user interface in this system is provided by J-iView, which is an online mapping system developed at the Geological Survey of Japan (GSJ). The 3 modules are seamlessly integrated into a single package using J-iView, which could rapidly generate a map of disaster areas that is instantaneously viewable online. The developed system was tested using ASTER images covering the areas damaged by the March 11, 2011 tsunami in northeastern Japan. The developed system efficiently generated a map showing areas devastated by the tsunami. Based on the initial results of the study, the developed system proved to be a useful tool for emergency workers to quickly identify areas affected by natural disasters.

Towards Integration of Ecosystem and Human Health: A Novel Conceptual Framework to Operationalise Ecological Public Health and to Incorporate Distal and Proximal Effects of Climate Change

NASA Astrophysics Data System (ADS)

Reis, S.; Fleming, L. E.; Beck, S.; Austen, M.; Morris, G.; White, M.; Taylor, T. J.; Orr, N.; Osborne, N. J.; Depledge, M.

2014-12-01

Conceptual models for problem framing in environmental (EIA) and health impact assessment (HIA) share similar concepts, but differ in their scientific or policy focus, methodologies and underlying causal chains, and the degree of complexity and scope. The Driver-Pressure-State-Impact-Response (DPSIR) framework used by the European Environment Agency, the OECD and others and the Integrated Science for Society and the Environment (ISSE) frameworks are widely applied in policy appraisal and impact assessments. While DPSIR is applied across different policy domains, the ISSE framework is used in Ecosystem Services assessments. The modified Driver-Pressure-State-Exposure-Effect-Action (DPSEEA) model extends DPSIR by separating exposure from effect, adding context as a modifier of effect, and susceptibility to exposures due to socio-economic, demographic or other determinants. While continuously evolving, the application of conceptual frameworks in policy appraisals mainly occurs within established discipline boundaries. However, drivers and environmental states, as well as policy measures and actions, affect both human and ecosystem receptors. Furthermore, unintended consequences of policy actions are seldom constrained within discipline or policy silos. Thus, an integrated conceptual model is needed, accounting for the full causal chain affecting human and ecosystem health in any assessment. We propose a novel model integrating HIA methods and ecosystem services in an attempt to operationalise the emerging concept of "Ecological Public Health." The conceptual approach of the ecosystem-enriched DPSEEA model ("eDPSEEA") has stimulated wide-spread debates and feedback. We will present eDPSEEA as a stakeholder engagement process and a conceptual model, using illustrative case studies of climate change as a starting point, not a complete solution, for the integration of human and ecosystem health impact assessment as a key challenge in a rapidly changing world. Rayner G and Lang T Ecological Public Health: Reshaping the Conditions for Good Health. Routledge Publishers; 2012.Reis S, Morris G, Fleming LE, Beck S, Taylor T, White M, Depledge MH, Steinle S, Sabel CE, Cowie H, Hurley F, Dick JMcP, Smith RI, Austen M (2013) Integrating Health & Environmental Impact Analysis. Public Health.

Organisational strategies and midwives' readiness to provide care for out of hospital births: an analysis from the birthplace organisational case studies.

PubMed

McCourt, Christine; Rayment, Juliet; Rance, Susanna; Sandall, Jane

2012-10-01

the objective of the Birthplace in England Case Studies was to explore the organisational and professional issues that may impact on the quality and safety of labour and birth care in different birth settings: Home, Freestanding Midwifery Unit, Alongside Midwifery Unit or Obstetric Unit. This analysis examines the factors affecting the readiness of community midwives to provide women with choice of out of hospital birth, using the findings from the Birthplace in England Case Studies. organisational ethnographic case studies, including interviews with professionals, key stakeholders, women and partners, observations of service processes and document review. a maximum variation sample of four maternity services in terms of configuration, region and population characteristics. All were selected from the Birthplace cohort study sample as services scoring 'best' or 'better' performing in the Health Care Commission survey of maternity services (HCC 2008). professionals and stakeholders (n=86), women (64), partners (6), plus 50 observations and 200 service documents. each service experienced challenges in providing an integrated service to support choice of place of birth. Deployment of community midwives was a particular concern. Community midwives and managers expressed lack of confidence in availability to cover home birth care in particular, with the exception of caseload midwifery and a 'hub and spoke' model of care. Community midwives and women's interviews indicated that many lacked home birth experience and confidence. Those in midwifery units expressed higher levels of support and confidence. maternity services need to consider and develop models for provision of a more integrated model of staffing across hospital and community boundaries. Copyright © 2012 Elsevier Ltd. All rights reserved.

A pragmatic observational feasibility study on integrated treatment for musculoskeletal disorders: Design and protocol.

PubMed

Hu, Xiao-yang; Hughes, John; Fisher, Peter; Lorenc, Ava; Purtell, Rachel; Park, A-La; Robinson, Nicola

2016-02-01

Musculoskeletal disorders (MSD) comprise a wide range of conditions, associated with an enormous pain and impaired mobility, and are affecting people's lives and work. Management of musculoskeletal disorders typically involves a multidisciplinary team approach. Positive findings have been found in previous studies evaluating the effectiveness of complementary therapies, though little attention has been paid to evaluating of the effectiveness of integrated packages of care combining conventional and complementary approaches for musculoskeletal conditions in a National Health Service (NHS) setting. To determine the feasibility of all aspects of a pragmatic observational study designed: (1) to evaluate the effectiveness and cost effectiveness of integrated treatments for MSDs in an integrated NHS hospital in the UK; (2) to determine the acceptability of the study design and research process to patients; (3) to explore patients' expectation and experience of receiving integrated treatments. This is an observational feasibility study, with 1-year recruitment and 1-year follow-up, conducted in Royal London Hospital for Integrated Medicine, University College London Hospital Trust, UK. All eligible patients with MSDs newly referred to the hospital were included in the study. Interventions are integrated packages of care (conventional and complementary) as currently provided in the hospital. SF-36™ Health Survey, short form Brief Pain Inventory, Visual Analogue Scale, and modified Client Service Receipt Inventory will be assessed at 4/5 time points. Semi-structured interview/focus group will be carried out before treatment, and 1 year after commence of treatment. We intend to conduct a pragmatic observational study of integrated medical treatment of MSDs at a public sector hospital. It will inform the design of a future trial including recruitment, retention, suitability of the outcome measures and patients experiences.

Factors affecting success of an integrated community-based telehealth system.

PubMed

Hsieh, Hui-Lung; Tsai, Chung-Hung; Chih, Wen-Hai; Lin, Huei-Hsieh

2015-01-01

The rise of chronic and degenerative diseases in developed countries has become one critical epidemiologic issue. Telehealth can provide one viable way to enhance health care, public health, and health education delivery and support. The study aims to empirically examine and evaluate the success factors of community-based telehealth system adoption. The valid 336 respondents are the residents of a rural community in Taiwan. The structural equation modeling (SEM) was used to assess the proposed model applied to telehealth. The findings showed the research model had good explanatory power and fitness. Also, the findings indicated that system quality exerted the strongest overall effect on intention to use. Furthermore, service quality exerted the strongest overall effect on user satisfaction. The findings also illustrated that the joint effects of three intrinsic qualities (system quality, information quality, and service quality) on use were mediated by user satisfaction and intention to use. The study implies that community-based telehealth service providers should improve three intrinsic qualities to enhance user satisfaction and intention to use, which in turn can lead to increase the usage of the telehealth equipment. The integrated community-based telehealth system may become an innovative and suitable way to deliver better care to the residents of communities.

Integrated Distributed Directory Service for KSC

NASA Technical Reports Server (NTRS)

Ghansah, Isaac

1997-01-01

This paper describes an integrated distributed directory services (DDS) architecture as a fundamental component of KSC distributed computing systems. Specifically, an architecture for an integrated directory service based on DNS and X.500/LDAP has been suggested. The architecture supports using DNS in its traditional role as a name service and X.500 for other services. Specific designs were made in the integration of X.500 DDS for Public Key Certificates, Kerberos Security Services, Network-wide Login, Electronic Mail, WWW URLS, Servers, and other diverse network objects. Issues involved in incorporating the emerging Microsoft Active Directory Service MADS in KSC's X.500 were discussed.

Design of the Indian NCA study (Indian national collaboration on AIDS): a cluster randomized trial to evaluate the effectiveness of integrated care centers to improve HIV outcomes among men who have sex with men and persons who inject drugs in India.

PubMed

Solomon, Sunil S; Lucas, Gregory M; Celentano, David D; McFall, Allison M; Ogburn, Elizabeth; Moulton, Lawrence H; Srikrishnan, Aylur K; Kumar, M Suresh; Anand, Santhanam; Solomon, Suniti; Mehta, Shruti H

2016-11-14

Globally, men who have sex with men and people who inject drugs remain disproportionately affected by HIV, but they have not been the focus of prevention and treatment interventions in many resource-limited settings. This cluster-randomized trial (conducted from June 2012 to June 2017), evaluates whether single-venue, integrated delivery of core HIV services to vulnerable high-risk populations improves service utilization and consequently, HIV testing and other outcomes along the HIV care continuum. Core services include: HIV counseling and testing, information, education and communication, condom distribution, needle and syringe exchange programs, opioid agonist therapy, management of sexually transmitted infections, tuberculosis screening, diagnosis, and treatment, and antiretroviral therapy. Stratified restricted randomization was used to allocate 22 Indian cities (10 men who have sex with men and 12 people who inject drugs sites) at a 1:1 ratio to either the intervention or control condition. Integrated care centers were scaled-up and implemented in the 11 intervention cities and outcomes will be assessed by pre- and post-intervention surveys at intervention and control sites. As men who have sex with men and people who inject drugs are hidden populations, with no sampling frame, respondent-driven sampling will be used to accrue samples for the two independent cross-sectional surveys. For an AIDS-free generation to be realized, prevention, care and treatment services need to reach all populations at risk for HIV infection. There is a clear gap in access to services among men who have sex with men and people who inject drugs. Trials need to be designed to optimize utilization of services in these populations. ClinicalTrials.gov Identifier: NCT01686750 Date of Registration: September 13, 2012.

Innovation in health service delivery: integrating community health assistants into the health system at district level in Zambia.

PubMed

Zulu, Joseph Mumba; Hurtig, Anna-Karin; Kinsman, John; Michelo, Charles

2015-01-28

To address the huge human resources for health gap in Zambia, the Ministry of Health launched the National Community Health Assistant Strategy in 2010. The strategy aims to integrate community-based health workers into the health system by creating a new group of workers, called community health assistants (CHAs). However, literature suggests that the integration process of national community-based health worker programmes into health systems has not been optimal. Conceptually informed by the diffusion of innovations theory, this paper qualitatively aimed to explore the factors that shaped the acceptability and adoption of CHAs into the health system at district level in Zambia during the pilot phase. Data gathered through review of documents, 6 focus group discussions with community leaders, and 12 key informant interviews with CHA trainers, supervisors and members of the District Health Management Team were analysed using thematic analysis. The perceived relative advantage of CHAs over existing community-based health workers in terms of their quality of training and scope of responsibilities, and the perceived compatibility of CHAs with existing groups of health workers and community healthcare expectations positively facilitated the integration process. However, limited integration of CHAs in the district health governance system hindered effective programme trialability, simplicity and observability at district level. Specific challenges at this level included a limited information flow and sense of programme ownership, and insufficient documentation of outcomes. The district also had difficulties in responding to emergent challenges such as delayed or non-payment of CHA incentives, as well as inadequate supervision and involvement of CHAs in the health posts where they are supposed to be working. Furthermore, failure of the health system to secure regular drug supplies affected health service delivery and acceptability of CHA services at community level. The study has demonstrated that implementation of policy guidelines for integrating community-based health workers in the health system may not automatically guarantee successful integration at the local or district level, at least at the start of the process. The study reiterates the need for fully integrating such innovations into the district health governance system if they are to be effective.

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

PubMed

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

2016-06-01

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

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

ERIC Educational Resources Information Center

Redcay, Shirley

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

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

PubMed Central

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

2012-01-01

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

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

PubMed Central

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

2013-01-01

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

Selecting process quality indicators for the integrated care of vulnerable older adults affected by cognitive impairment or dementia.

PubMed

Kröger, Edeltraut; Tourigny, André; Morin, Diane; Côté, Lise; Kergoat, Marie-Jeanne; Lebel, Paule; Robichaud, Line; Imbeault, Shirley; Proulx, Solange; Benounissa, Zohra

2007-11-29

This study aimed at evaluating face and content validity, feasibility and reliability of process quality indicators developed previously in the United States or other countries. The indicators can be used to evaluate care and services for vulnerable older adults affected by cognitive impairment or dementia within an integrated service system in Quebec, Canada. A total of 33 clinical experts from three major urban centres in Quebec formed a panel representing two medical specialties (family medicine, geriatrics) and seven health or social services specialties (nursing, occupational therapy, psychology, neuropsychology, pharmacy, nutrition, social work), from primary or secondary levels of care, including long-term care. A modified version of the RAND(R)/University of California at Los Angeles (UCLA) appropriateness method, a two-round Delphi panel, was used to assess face and content validity of process quality indicators. The appropriateness of indicators was evaluated according to a) agreement of the panel with three criteria, defined as a median rating of 7-9 on a nine-point rating scale, and b) agreement among panellists, judged by the statistical measure of the interpercentile range adjusted for symmetry. Feasibility of quality assessment and reliability of appropriate indicators were then evaluated within a pilot study on 29 patients affected by cognitive impairment or dementia. For measurable indicators the inter-observer reliability was calculated with the Kappa statistic. Initially, 82 indicators for care of vulnerable older adults with cognitive impairment or dementia were submitted to the panellists. Of those, 72 (88%) were accepted after two rounds. Among 29 patients for whom medical files of the preceding two years were evaluated, 63 (88%) of these indicators were considered applicable at least once, for at least one patient. Only 22 indicators were considered applicable at least once for ten or more out of 29 patients. Four indicators could be measured with the help of a validated questionnaire on patient satisfaction. Inter-observer reliability was moderate (Kappa = 0.57). A multidisciplinary panel of experts judged a large majority of the initial indicators valid for use in integrated care systems for vulnerable older adults in Quebec, Canada. Most of these indicators can be measured using patient files or patient or caregiver interviews and reliability of assessment from patient-files is moderate.

Selecting process quality indicators for the integrated care of vulnerable older adults affected by cognitive impairment or dementia

PubMed Central

Kröger, Edeltraut; Tourigny, André; Morin, Diane; Côté, Lise; Kergoat, Marie-Jeanne; Lebel, Paule; Robichaud, Line; Imbeault, Shirley; Proulx, Solange; Benounissa, Zohra

2007-01-01

Background This study aimed at evaluating face and content validity, feasibility and reliability of process quality indicators developed previously in the United States or other countries. The indicators can be used to evaluate care and services for vulnerable older adults affected by cognitive impairment or dementia within an integrated service system in Quebec, Canada. Methods A total of 33 clinical experts from three major urban centres in Quebec formed a panel representing two medical specialties (family medicine, geriatrics) and seven health or social services specialties (nursing, occupational therapy, psychology, neuropsychology, pharmacy, nutrition, social work), from primary or secondary levels of care, including long-term care. A modified version of the RAND®/University of California at Los Angeles (UCLA) appropriateness method, a two-round Delphi panel, was used to assess face and content validity of process quality indicators. The appropriateness of indicators was evaluated according to a) agreement of the panel with three criteria, defined as a median rating of 7–9 on a nine-point rating scale, and b) agreement among panellists, judged by the statistical measure of the interpercentile range adjusted for symmetry. Feasibility of quality assessment and reliability of appropriate indicators were then evaluated within a pilot study on 29 patients affected by cognitive impairment or dementia. For measurable indicators the inter-observer reliability was calculated with the Kappa statistic. Results Initially, 82 indicators for care of vulnerable older adults with cognitive impairment or dementia were submitted to the panellists. Of those, 72 (88%) were accepted after two rounds. Among 29 patients for whom medical files of the preceding two years were evaluated, 63 (88%) of these indicators were considered applicable at least once, for at least one patient. Only 22 indicators were considered applicable at least once for ten or more out of 29 patients. Four indicators could be measured with the help of a validated questionnaire on patient satisfaction. Inter-observer reliability was moderate (Kappa = 0.57). Conclusion A multidisciplinary panel of experts judged a large majority of the initial indicators valid for use in integrated care systems for vulnerable older adults in Quebec, Canada. Most of these indicators can be measured using patient files or patient or caregiver interviews and reliability of assessment from patient-files is moderate. PMID:18047668

[Efficiency indicators to contribute to sustainability of health services in Spain].

PubMed

García, E I; Mira Solves, J J; Guilabert Mora, M

2014-01-01

Identifying a minimum set of efficiency indicators calculated from current information sources. Interventions adopted from the analysis of these indicators could contribute to health services sustainability. We applied the discussion group technique. A total of 23 quality coordinators from around the country and the representatives of the regional quality societies in SECA (Spanish Society for Quality in Healthcare) participated. Ten efficiency indicators useful for integrated management areas were identified and accepted, 5 in the area of primary care and 5 for hospital management. The efficiency indicators agreed upon could contribute to the sustainability of the health system without this affecting the quality of care. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

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

Nurse managed occupational health services: a primary care model in practice.

PubMed

Childre, F

1997-10-01

1. Managed care focus on delivering health care which values prevention, early intervention, continuity of care, commitment to quality care, and outcomes, as well as client satisfaction. Occupational health nurses routinely integrate these values into their practice. 2. An on-site model of primary health care delivery, incorporating the fundamentals of occupational health nursing, can bring significant savings to the organization in health related costs. 3. Case management may provide the greatest potential for growth in occupational health nursing. It is a method that can be used together with managed care to maximize quality health care services. 4. Viewing health related costs as an investment as opposed to part of a benefit plan, influences employees to make positive choices. It also impacts the delivery of health care services on a systematic, global level, which affects total health care costs.

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

PubMed Central

2014-01-01

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

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

PubMed

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

2014-08-07

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

Evaluating the Economic Impact of Smart Care Platforms: Qualitative and Quantitative Results of a Case Study

PubMed Central

Van der Auwermeulen, Thomas; Van Ooteghem, Jan; Jacobs, An; Verbrugge, Sofie; Colle, Didier

2016-01-01

Background In response to the increasing pressure of the societal challenge because of a graying society, a gulf of new Information and Communication Technology (ICT) supported care services (eCare) can now be noticed. Their common goal is to increase the quality of care while decreasing its costs. Smart Care Platforms (SCPs), installed in the homes of care-dependent people, foster the interoperability of these services and offer a set of eCare services that are complementary on one platform. These eCare services could not only result in more quality care for care receivers, but they also offer opportunities to care providers to optimize their processes. Objective The objective of the study was to identify and describe the expected added values and impacts of integrating SCPs in current home care delivery processes for all actors. In addition, the potential economic impact of SCP deployment is quantified from the perspective of home care organizations. Methods Semistructured and informal interviews and focus groups and cocreation workshops with service providers, managers of home care organizations, and formal and informal care providers led to the identification of added values of SCP integration. In a second step, process breakdown analyses of home care provisioning allowed defining the operational impact for home care organization. Impacts on 2 different process steps of providing home care were quantified. After modeling the investment, an economic evaluation compared the business as usual (BAU) scenario versus the integrated SCP scenario. Results The added value of SCP integration for all actors involved in home care was identified. Most impacts were qualitative such as increase in peace of mind, better quality of care, strengthened involvement in care provisioning, and more transparent care communication. For home care organizations, integrating SCPs could lead to a decrease of 38% of the current annual expenses for two administrative process steps namely, care rescheduling and the billing for care provisioning. Conclusions Although integrating SCP in home care processes could affect both the quality of life of the care receiver and informal care giver, only scarce and weak evidence was found that supports this assumption. In contrast, there exists evidence that indicates the lack of the impact on quality of life of the care receiver while it increases the cost of care provisioning. However, our cost-benefit quantification model shows that integrating SCPs in home care provisioning could lead to a considerable decrease of costs for care administrative tasks. Because of this cost decreasing impact, we believe that the integration of SCPs will be driven by home care organizations instead of the care receivers themselves. PMID:27799137

Evaluating the Economic Impact of Smart Care Platforms: Qualitative and Quantitative Results of a Case Study.

PubMed

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

2016-10-31

In response to the increasing pressure of the societal challenge because of a graying society, a gulf of new Information and Communication Technology (ICT) supported care services (eCare) can now be noticed. Their common goal is to increase the quality of care while decreasing its costs. Smart Care Platforms (SCPs), installed in the homes of care-dependent people, foster the interoperability of these services and offer a set of eCare services that are complementary on one platform. These eCare services could not only result in more quality care for care receivers, but they also offer opportunities to care providers to optimize their processes. The objective of the study was to identify and describe the expected added values and impacts of integrating SCPs in current home care delivery processes for all actors. In addition, the potential economic impact of SCP deployment is quantified from the perspective of home care organizations. Semistructured and informal interviews and focus groups and cocreation workshops with service providers, managers of home care organizations, and formal and informal care providers led to the identification of added values of SCP integration. In a second step, process breakdown analyses of home care provisioning allowed defining the operational impact for home care organization. Impacts on 2 different process steps of providing home care were quantified. After modeling the investment, an economic evaluation compared the business as usual (BAU) scenario versus the integrated SCP scenario. The added value of SCP integration for all actors involved in home care was identified. Most impacts were qualitative such as increase in peace of mind, better quality of care, strengthened involvement in care provisioning, and more transparent care communication. For home care organizations, integrating SCPs could lead to a decrease of 38% of the current annual expenses for two administrative process steps namely, care rescheduling and the billing for care provisioning. Although integrating SCP in home care processes could affect both the quality of life of the care receiver and informal care giver, only scarce and weak evidence was found that supports this assumption. In contrast, there exists evidence that indicates the lack of the impact on quality of life of the care receiver while it increases the cost of care provisioning. However, our cost-benefit quantification model shows that integrating SCPs in home care provisioning could lead to a considerable decrease of costs for care administrative tasks. Because of this cost decreasing impact, we believe that the integration of SCPs will be driven by home care organizations instead of the care receivers themselves. ©Frederic Vannieuwenborg, Thomas Van der Auwermeulen, Jan Van Ooteghem, An Jacobs, Sofie Verbrugge, Didier Colle. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 31.10.2016.

The Department of Defense Critical Technologies Plan for the Committees on Armed Services United States Congress

DTIC Science & Technology

1991-05-01

health monitoring , and detection avoidance. Similar to the im!proved ca abi!ities of electr,-.ics with the introduction of the integrated circuit...Sensors not needing to emit signals to detect targets, monitor the environment, or determine 1he status or condition of equipment. 9 Signal & Image... monitoring , and detection avoidance. Photonics R &D will significantly affect the high-speed computing defense iadustrial base through the development of

The Early Impact Of The ‘Alternative Quality Contract’ On Mental Health Service Use And Spending In Massachusetts

PubMed Central

Barry, Colleen L.; Stuart, Elizabeth A.; Donohue, Julie M.; Greenfield, Shelly F.; Kouri, Elena; Duckworth, Kenneth; Song, Zirui; Mechanic, Robert E.; Chernew, Michael E.; Huskamp, Haiden A.

2016-01-01

Accountable care using global payment with performance bonuses has shown promise in controlling spending growth and improving care. This study examined how an early model, the Alternative Quality Contract (AQC) established in 2009 by Blue Cross Blue Shield of Massachusetts (BCBSMA), has affected care for mental illness. We compared spending and use for enrollees in AQC organizations that did and did not accept financial risk for mental health with enrollees not participating in the contract. Compared with BCBSMA enrollees in organizations not participating in the AQC, we found that enrollees in organizations participating in the AQC were slightly less likely to use mental health services and had small declines in total health care spending, but no change was found in mental health spending among all users. The declines in probability of use of mental health services and in total health spending attributable to the AQC were concentrated among enrollees in AQC organizations that accepted financial risk for behavioral health. Interviews with AQC organization leaders suggested that the contractual arrangements did not meaningfully affect mental health care delivery in the program’s initial years, but organizations are now at varying stages of efforts to improve integration. PMID:26643628

Study of the impacts of regulations affecting the acceptance of Integrated Community Energy Systems: public utility, energy facility siting and municipal franchising regulatory programs in Arizona. Preliminary background report

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

Feurer, D.A.; Weaver, C.L.; Gallagher, K.C.

1980-01-01

This report is one of a series of preliminary reports describing the laws and regulatory programs of the United States and each of the 50 states affecting the siting and operation of energy generating facilities likely to be used in Integrated Community Energy Systems (ICES). Public utility regulatory statutes, energy facility siting programs, and municipal franchising authority are examined to identify how they may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES. This report describes laws and regulatory programs in Arizona. The Arizona state constitution establishes themore » Arizona Corporation Commission to regulate public service corporations. Within the area of its jurisdiction, the Commission has exclusive power and may not be interfered with by the legislature except in one narrow instance as described in the case Corporation Commission v. Pacific Greyhound Lines.« less

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

ERIC Educational Resources Information Center

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

2013-01-01

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

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

ERIC Educational Resources Information Center

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

2015-01-01

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

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

PubMed

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

2017-08-01

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

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

PubMed

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

2013-11-01

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

Integrating HIV and substance use services: a systematic review

PubMed Central

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

2017-01-01

Abstract Introduction: Substance use is an important risk factor for HIV, with both concentrated in certain vulnerable and marginalized populations. Although their management differs, there may be opportunities to integrate services for substance use and HIV. In this paper we systematically review evidence from studies that sought to integrate care for people living with HIV and substance use problems. Methods: Studies were included if they evaluated service integration for substance use and HIV. We searched multiple databases from inception until October 2015. Articles were screened independently by two reviewers and assessed for risk of bias. Results and discussion: 11,057 records were identified, with 7616 after removal of duplicates. After screening titles and abstracts, 51 met the inclusion criteria. Integration models were categorized by location (HIV, substance use and other facilities), level of integration from mirco (integrated care delivered to individuals) to macro (system level integrations) and degree of integration from least (screening and counselling only) to most (care for HIV, substance use and/or other illnesses at the same facility). Most reported descriptive or cohort studies; in four randomized control trials integrated activities improved patient outcomes. There is potential for integrating services at all facility types, including mobile health services. While services offering screening only can achieve synergies, there are benefits from delivering integrated treatment for HIV and substance use, including ease of referral to other mental health and social services. Conclusions: Our review used a wide range of databases and conference archives to increase representation of papers from low- and middle-income countries. Limitations include the overrepresentation of studies from the United States, and the descriptive nature of the majority of papers. The evidence reviewed shows that greater integration offers important benefits in both patient and service outcomes but further research and outcome reporting is needed to better understand innovative and holistic care models at the complex intersection of substance use and HIV services. PMID:28692211

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

PubMed

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

2018-06-01

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

Integrating cervical cancer with HIV healthcare services: A systematic review

PubMed Central

Sigfrid, Louise; Murphy, Georgina; Haldane, Victoria; Chuah, Fiona Leh Hoon; Ong, Suan Ee; Cervero-Liceras, Francisco; Watt, Nicola; Alvaro, Alconada; Otero-Garcia, Laura; Balabanova, Dina; Hogarth, Sue; Maimaris, Will; Buse, Kent; Mckee, Martin; Piot, Peter; Perel, Pablo

2017-01-01

Background Cervical cancer is a major public health problem. Even though readily preventable, it is the fourth leading cause of death in women globally. Women living with HIV are at increased risk of invasive cervical cancer, highlighting the need for access to screening and treatment for this population. Integration of services has been proposed as an effective way of improving access to cervical cancer screening especially in areas of high HIV prevalence as well as lower resourced settings. This paper presents the results of a systematic review of programs integrating cervical cancer and HIV services globally, including feasibility, acceptability, clinical outcomes and facilitators for service delivery. Methods This is part of a larger systematic review on integration of services for HIV and non-communicable diseases. To be considered for inclusion studies had to report on programs to integrate cervical cancer and HIV services at the level of service delivery. We searched multiple databases including Global Health, Medline and Embase from inception until December 2015. Articles were screened independently by two reviewers for inclusion and data were extracted and assessed for risk of bias. Main results 11,057 records were identified initially. 7,616 articles were screened by title and abstract for inclusion. A total of 21 papers reporting interventions integrating cervical cancer care and HIV services met the criteria for inclusion. All but one study described integration of cervical cancer screening services into existing HIV services. Most programs also offered treatment of minor lesions, a ‘screen-and-treat’ approach, with some also offering treatment of larger lesions within the same visit. Three distinct models of integration were identified. One model described integration within the same clinic through training of existing staff. Another model described integration through co-location of services, with the third model describing programs of integration through complex coordination across the care pathway. The studies suggested that integration of cervical cancer services with HIV services using all models was feasible and acceptable to patients. However, several barriers were reported, including high loss to follow up for further treatment, limited human-resources, and logistical and chain management support. Using visual screening methods can facilitate screening and treatment of minor to larger lesions in a single ‘screen-and-treat’ visit. Complex integration in a single-visit was shown to reduce loss to follow up. The use of existing health infrastructure and funding together with comprehensive staff training and supervision, community engagement and digital technology were some of the many other facilitators for integration reported across models. Conclusions This review shows that integration of cervical cancer screening and treatment with HIV services using different models of service delivery is feasible as well as acceptable to women living with HIV. However, the descriptive nature of most papers and lack of data on the effect on long-term outcomes for HIV or cervical cancer limits the inference on the effectiveness of the integrated programs. There is a need for strengthening of health systems across the care continuum and for high quality studies evaluating the effect of integration on HIV as well as on cervical cancer outcomes. PMID:28732037

Ecosystem services and livelihoods in deltaic environments

NASA Astrophysics Data System (ADS)

Nicholls, R. J.; Rahman, M. M.; Salehin, M.; Hutton, C.

2015-12-01

While overall, deltas account for only 1% of global land area, they are home to more than a half billion people or ca. 7% of the world's population. In many deltas, livelihoods and food security are strongly dependent on ecosystem services, which in turn are affected by various environmental change factors, including climate variability and change, modifications to upstream river, sediment and nutrient fluxes, evolving nearshore ecosystems, and delta-level change factors such as subsidence, changing land use and management interventions such as polders. Key limits include scarcity of fresh water, saline water intrusion and the impacts of extreme events (e.g. river floods, cyclones and storm surges), which constrain land use choices and livelihood opportunities for the deltaic populations. The ESPA Deltas project takes a systemic perspective of the interaction between the coupled bio-physical environment and the livelihoods of rural delta residents. The methods emphasise poverty reduction and use coastal Bangladesh as an example. This includes a set of consistent biophysical analyses of the delta and the upstream catchments and the downstream Bay of Bengal, as well as governance and policy analysis and socio-demographic analysis, including an innovative household survey on ecosystem utilization. These results are encapsulated in an integrated model that analyses ecosystem services and livelihood implications. This integrated approach is designed to support delta-level policy formulation. It allows the exploration of contrasting development trajectories, including issues such as robustness of different governance options on ecosystem services and livelihoods. The method is strongly participatory including an ongoing series of stakeholder workshops addressing issue identification, scenario development and consideration of policy responses. The methods presented are generic and transferable to other deltas. The paper will consider the overall ESPA Deltas project and its wider lessons for integrated assessment of deltaic environments.

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

NASA Astrophysics Data System (ADS)

Xia, Weiwei; Shen, Lianfeng

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

Collaboration between family physicians and psychologists

PubMed Central

Grenier, Jean; Chomienne, Marie-Hélène; Gaboury, Isabelle; Ritchie, Pierre; Hogg, William

2008-01-01

OBJECTIVE To explore factors affecting collaboration between family physicians and psychologists. DESIGN Mailed French-language survey. SETTING Eastern Ontario. PARTICIPANTS Family physicians practising in the area of the Réseau des services de santé en français de l’Est de l’Ontario. MAIN OUTCOME MEASURES Physicians’ knowledge and understanding of the qualifications of psychologists and the regulations governing their profession; beliefs regarding the effectiveness of psychological treatments; views on the integration of psychologists into primary care; and factors affecting referrals to psychologists. RESULTS Of 457 surveys sent, 118 were returned and analyzed (27% of surveys delivered). Most family physicians were well aware that there were evidence-based psychological interventions for mental health and personal difficulties, and some knew that psychological interventions could help with physical conditions. Physicians had some knowledge about the qualifications and training of psychologists. Many physicians reported being uncomfortable providing counseling themselves owing to time constraints, the perception that they were inadequately trained for such work, and personal preferences. The largest barrier to referring patients to psychologists was cost, since services were not covered by public health insurance. Some physicians were deterred from referring by previous experience of not receiving feedback on patients from psychologists. Increased access to clinical psychologists through collaborative care was considered a desirable goal for primary health care. CONCLUSIONS Family physicians know that there are evidence-based psychological interventions for mental health issues. Psychologists need to communicate better about their credentials and what they can offer, and share their professional opinions and recommendations on referred patients. Physicians would welcome practice-based psychological services and integrated interdisciplinary collaboration as recommended by the Kirby and Romanow commissions, but such collaboration is hampered by the lack of public health insurance coverage. PMID:18272640

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

PubMed

Danzer, Graham

2012-01-01

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

Covert brand recognition engages emotion-specific brain networks.

PubMed

Casarotto, Silvia; Ricciardi, Emiliano; Romani, Simona; Dalli, Daniele; Pietrini, Pietro

2012-12-01

Consumer goods' brands have become a major driver of consumers' choice: they have got symbolic, relational and even social properties that add substantial cultural and affective value to goods and services. Therefore, measuring the role of brands in consumers' cognitive and affective processes would be very helpful to better understand economic decision making. This work aimed at finding the neural correlates of automatic, spontaneous emotional response to brands, showing how deeply integrated are consumption symbols within the cognitive and affective processes of individuals. Functional magnetic resonance imaging (fMRI) was measured during a visual oddball paradigm consisting in the presentation of scrambled pictures as frequent stimuli, colored squares as targets, and brands and emotional pictures (selected from the International Affective Picture System [IAPS]) as emotionally-salient distractors. Affective rating of brands was assessed individually after scanning by a validated questionnaire. Results showed that, similarly to IAPS pictures, brands activated a well-defined emotional network, including amygdala and dorsolateral prefrontal cortex, highly specific of affective valence. In conclusion, this work identified the neural correlates of brands within cognitive and affective processes of consumers.

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

ERIC Educational Resources Information Center

Polly, Drew

2015-01-01

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

Urology Group Compensation and Ancillary Service Models in an Era of Value-based Care.

PubMed

Shore, Neal D; Jacoby, Dana

2016-01-01

Changes involving the health care economic landscape have affected physicians' workflow, productivity, compensation structures, and culture. Ongoing Federal legislation regarding regulatory documentation and imminent payment-changing methodologies have encouraged physician consolidation into larger practices, creating affiliations with hospitals, multidisciplinary medical specialties, and integrated delivery networks. As subspecialization and evolution of care models have accelerated, independent medical groups have broadened ancillary service lines by investing in enterprises that compete with hospital-based (academic and nonacademic) entities, as well as non-physician- owned multispecialty enterprises, for both outpatient and inpatient services. The looming and dramatic shift from volume- to value-based health care compensation will assuredly affect urology group compensation arrangements and productivity formulae. For groups that can implement change rapidly, efficiently, and harmoniously, there will be opportunities to achieve the Triple Aim goals of the Patient Protection and Affordable Care Act, while maintaining a successful medical-financial practice. In summary, implementing new payment algorithms alongside comprehensive care coordination will assist urology groups in addressing the health economic cost and quality challenges that have been historically encountered with fee-for-service systems. Urology group leadership and stakeholders will need to adjust internal processes, methods of care coordination, cultural dependency, and organizational structures in order to create better systems of care and management. In response, ancillary services and patient throughput will need to evolve in order to adequately align quality measurement and reporting systems across provider footprints and patient populations.

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

PubMed

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

2006-06-01

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

Integrated care

PubMed Central

Gröne, Oliver; Garcia-Barbero, Mila

2001-01-01

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

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

PubMed

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

2018-03-01

Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle-income countries (LMICs). We adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for and capacity to implement integrated services. We searched Medline via Ovid, Web of Science and the Cochrane library using terms adapted from Dudley and Garner's systematic review on integration in LMICs. From an initial list of 10 550 articles, 206 were selected for full-text review by two reviewers who independently reviewed articles and inductively extracted and synthesized themes related to health system preparedness. We identified five 'context' related categories and four health system 'capability' themes. The contextual enabling and constraining factors for frontline service integration were: (1) the organizational framework of frontline services, (2) health care worker preparedness, (3) community and client preparedness, (4) upstream logistics and (5) policy and governance issues. The intersecting health system capabilities identified were the need for: (1) sufficiently functional frontline health services, (2) sufficiently trained and motivated health care workers, (3) availability of technical tools and equipment suitable to facilitate integrated frontline services and (4) appropriately devolved authority and decision-making processes to enable frontline managers and staff to adapt integration to local circumstances. Moving beyond claims that integration is defined differently by different programs and thus unsuitable for comparison, this review demonstrates that synthesis is possible. It presents a common set of contextual factors and health system capabilities necessary for successful service integration which may be considered indicators of preparedness and could form the basis for an 'integration preparedness tool'. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

How Environmental Uncertainty Moderates the Effect of Relative Advantage and Perceived Credibility on the Adoption of Mobile Health Services by Chinese Organizations in the Big Data Era.

PubMed

Chen, Xing; Zhang, Xing

2016-01-01

Despite the importance of adoption of mobile health services by an organization on the diffusion of mobile technology in the big data era, it has received minimal attention in literature. This study investigates how relative advantage and perceived credibility affect an organization's adoption of mobile health services, as well as how environmental uncertainty changes the relationship of relative advantage and perceived credibility with adoption. A research model that integrates relative advantage, perceived credibility, environmental uncertainty, and an organization's intention to use mobile health service is developed. Quantitative data are collected from senior managers and information systems managers in 320 Chinese healthcare organizations. The empirical findings show that while relative advantage and perceived credibility both have positive effects on an organization's intention to use mobile health services, relative advantage plays a more important role than perceived credibility. Moreover, environmental uncertainty positively moderates the effect of relative advantage on an organization's adoption of mobile health services. Thus, mobile health services in environments characterized with high levels of uncertainty are more likely to be adopted because of relative advantage than in environments with low levels of uncertainty.

How Environmental Uncertainty Moderates the Effect of Relative Advantage and Perceived Credibility on the Adoption of Mobile Health Services by Chinese Organizations in the Big Data Era

PubMed Central

2016-01-01

Despite the importance of adoption of mobile health services by an organization on the diffusion of mobile technology in the big data era, it has received minimal attention in literature. This study investigates how relative advantage and perceived credibility affect an organization's adoption of mobile health services, as well as how environmental uncertainty changes the relationship of relative advantage and perceived credibility with adoption. A research model that integrates relative advantage, perceived credibility, environmental uncertainty, and an organization's intention to use mobile health service is developed. Quantitative data are collected from senior managers and information systems managers in 320 Chinese healthcare organizations. The empirical findings show that while relative advantage and perceived credibility both have positive effects on an organization's intention to use mobile health services, relative advantage plays a more important role than perceived credibility. Moreover, environmental uncertainty positively moderates the effect of relative advantage on an organization's adoption of mobile health services. Thus, mobile health services in environments characterized with high levels of uncertainty are more likely to be adopted because of relative advantage than in environments with low levels of uncertainty. PMID:28115932

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

NASA Astrophysics Data System (ADS)

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

2005-12-01

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

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

NASA Astrophysics Data System (ADS)

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

2009-12-01

The Tsunami Service Bus (TSB) is the sensor integration platform of the German Indonesian Tsunami Early Warning System (GITEWS) [1]. The primary goal of GITEWS is to deliver reliable tsunami warnings as fast as possible. This is achieved on basis of various sensor systems like seismometers, ocean instrumentation, and GPS stations, all providing fundamental data to support prediction of tsunami wave propagation by the GITEWS warning center. However, all these sensors come with their own proprietary data formats and specific behavior. Also new sensor types might be added, old sensors will be replaced. To keep GITEWS flexible the TSB was developed in order to access and control sensors in a uniform way. To meet these requirements the TSB follows the architectural blueprint of a Service Oriented Architecture (SOA). The integration platform implements dedicated services communicating via a service infrastructure. The functionality required for early warnings is provided by loosely coupled services replacing the "hard-wired" coupling at data level. Changes in the sensor specification are confined to the data level without affecting the warning center. Great emphasis was laid on following the Sensor Web Enablement (SWE) standard [2], specified by the Open Geospatial Consortium (OGC) [3]. As a result the full functionality needed in GITEWS could be achieved by implementing the four SWE services: The Sensor Observation Service for retrieving sensor measurements, the Sensor Alert Service in order to deliver sensor alerts, the Sensor Planning Service for tasking sensors, and the Web Notification Service for conduction messages to various media channels. Beyond these services the TSB also follows SWE Observation & Measurements specifications (O&M) for data encoding and Sensor Model Language (SensorML) for meta information. Moreover, accessing sensors via the TSB is not restricted to GITEWS. Multiple instances of the TSB can be composed to realize federate warning system. Beside the already operating TSB at the BMKG warning center [4], two other organizations in Indonesia ([5], [6]) consider using the TSB, making their data centers available to GITEWS. The presentation takes a look at the concepts and implementation and reflects the usefulness of the mentioned standards. REFERENCES [1] GITEWS is a project of the German Federal Government to aid the recon¬struction of the tsunami-prone region of the Indian Ocean, http://www.gitews.org/ [2] SWE, www.opengeospatial.org/projects/groups/sensorweb [3] OGC, www.opengeospatial.org [4] Meteorological and Geophysical Agency of Indonesia (BMKG), www.bmg.go.id [5] National Coordinating Agency for Surveys and Mapping (BAKOSURTANAL), www.bakosurtanal.go.id [6] Agency for the Assessment & Application of Technology (BPPT), www.bppt.go.id

Managing physical and mental health conditions: Consumer perspectives on integrated care.

PubMed

Rollins, Angela L; Wright-Berryman, Jennifer; Henry, Nancy H; Quash, Alicia M; Benbow, Kyle; Bonfils, Kelsey A; Hedrick, Heidi; Miller, Alex P; Firmin, Ruthie; Salyers, Michelle P

2017-01-01

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.

An empirical typology of private child and family serving agencies.

PubMed

Chuang, Emmeline; Collins-Camargo, Crystal; McBeath, Bowen; Wells, Rebecca; Bunger, Alicia

2014-03-01

Differences in how services are organized and delivered can contribute significantly to variation in outcomes experienced by children and families. However, few comparative studies identify the strengths and limitations of alternative delivery system configurations. The current study provides the first empirical typology of private agencies involved with the formal child welfare system. Data collected in 2011 from a national sample of private agencies were used to classify agencies into five distinct groups based on internal management capacity, service diversification, integration, and policy advocacy. Findings reveal considerable heterogeneity in the population of private child and family serving agencies. Cross-group comparisons suggest that differences in agencies' strategic and structural characteristics correlated with agency directors' perceptions of different pressures in their external environment. Future research can use this typology to better understand local service systems and the extent to which different agency strategies affect performance and other outcomes. Such information has implications for public agency contracting decisions and could inform system-level assessment and planning of services for children and families.

Sentinels of safety: service dogs ensure safety and enhance freedom and well-being for families with autistic children.

PubMed

Burrows, Kristen E; Adams, Cindy L; Spiers, Jude

2008-12-01

Children with autism might display unpredictable and volatile behavior that places them in considerable physical danger and creates stress for the family. Families of autistic children often have limited freedom and experience difficulty with everyday activities. In this qualitative ethology study, we examined the effect of integrating service dogs into ten families with an autistic child. Data included participant observation, video recordings of family-parent-dog interaction, and semistructured interviews with the parents. The themes were (a) the dog as a sentinel of safety, (b) gaining freedom through enhanced safety, facilitating public outings and family activities, and (c) improving social recognition and status, in which the presence of the dog promoted awareness of autism and affected social interaction. The triadic relationship between parent, autistic child, and service dog constantly evolves. This research provides valuable information for parents interested in having a service dog for their autistic child, and has implications for long-term human-animal companionship for children with special needs and their caregivers.

Development of Web Mapping Service Capabilities to Support NASA Disasters Applications/App Development

NASA Technical Reports Server (NTRS)

Burks, Jason E.; Molthan, Andrew L.; McGrath, Kevin M.

2014-01-01

During the last year several significant disasters have occurred such as Superstorm Sandy on the East coast of the United States, and Typhoon Bopha in the Phillipines, along with several others. In support of these disasters NASA's Short-term Prediction Research and Transition (SPoRT) Center delivered various products derived from satellite imagery to help in the assessment of damage and recovery of the affected areas. To better support the decision makers responding to the disasters SPoRT quickly developed several solutions to provide the data using open Geographical Information Service (GIS) formats. Providing the data in open GIS standard formats allowed the end user to easily integrate the data into existing Decision Support Systems (DSS). Both Tile Mapping Service (TMS) and Web Mapping Service (WMS) were leveraged to quickly provide the data to the end-user. Development of the deliver methodology allowed quick response to rapidly developing disasters and enabled NASA SPoRT to bring science data to decision makers in a successful research to operations transition.

Development of Web Mapping Service Capabilities to Support NASA Disasters Applications / App Development

NASA Technical Reports Server (NTRS)

Burks, Jason E.; Molthan, Andrew L.; McGrath, Kevin M.

2014-01-01

During the last year several significant disasters have occurred such as Superstorm Sandy on the East coast of the United States, and Typhoon Bopha in the Phillipines, along with several others. In support of these disasters NASA's Short-term Prediction Research and Transition (SPoRT) Center delivered various products derived from satellite imagery to help in the assessment of damage and recovery of the affected areas. To better support the decision makers responding to the disasters SPoRT quickly developed several solutions to provide the data using open Geographical Information Service (GIS) formats. Providing the data in open GIS standard formats allowed the end user to easily integrate the data into existing Decision Support Systems (DSS). Both Tile Mapping Service (TMS) and Web Mapping Service (WMS) were leveraged to quickly provide the data to the end-user. Development of the deliver methodology allowed quick response to rapidly developing disasters and enabled NASA SPoRT to bring science data to decision makers in a successful research to operations transition.

An empirical typology of private child and family serving agencies

PubMed Central

Collins-Camargo, Crystal; McBeath, Bowen; Wells, Rebecca; Bunger, Alicia

2014-01-01

Differences in how services are organized and delivered can contribute significantly to variation in outcomes experienced by children and families. However, few comparative studies identify the strengths and limitations of alternative delivery system configurations. The current study provides the first empirical typology of private agencies involved with the formal child welfare system. Data collected in 2011 from a national sample of private agencies were used to classify agencies into five distinct groups based on internal management capacity, service diversification, integration, and policy advocacy. Findings reveal considerable heterogeneity in the population of private child and family serving agencies. Cross-group comparisons suggest that differences in agencies’ strategic and structural characteristics correlated with agency directors’ perceptions of different pressures in their external environment. Future research can use this typology to better understand local service systems and the extent to which different agency strategies affect performance and other outcomes. Such information has implications for public agency contracting decisions and could inform system-level assessment and planning of services for children and families. PMID:24648603

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

PubMed

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

2018-07-01

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

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

PubMed

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

2017-03-10

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

Situational Effects on the Usage Intention of Mobile Games

NASA Astrophysics Data System (ADS)

Liang, Ting-Peng; Yeh, Yi-Hsuan

As value-added services on mobile devices are developing rapidly, text messaging, multi-media messaging, music, video, games, GPS navigation, RFID, and mobile TV are all accessible from a single device. Mobile games that combine mobile communication with computer games are an emerging industry. The purpose of this research is to explore what situation factors may affect the intention to play mobile game. We propose a research model to fit the nature of mobile games and conducted an online survey to examine the effect of situational factors. The model integrates constructs in TAM and TRA. The findings are as follows. First, Subjective norm affects a user’s intention in using mobile games when a user has no other task. Second, perceived playfulness affects a user’s intention to use mobile games when the user has another task.

Management of health care services for flood victims: the case of the shelter at Nakhon Pathom Rajabhat University Central Thailand.

PubMed

Buajaroen, Hathaichanok

2013-08-01

In Central Thailand basic health care services were affected by a natural disaster in the form of a flood situation. Flood Relief Operations Centers were established from the crisis. Nakhon Pathom Rajabhat University and including the faculty of nursing volunteered to care for those affected and assist in re-establishing a functioning health care system. The aim of this study was to make explicit knowledge of concept, lesson learned, and the process of management for re-establishing a health care service system at a flood victims at Relief Operations Center, Nakhon Pathom Rajabhat University. We used a qualitative design with mixed methods. This involved in-depth interviews, focus group, observational participation and non-observational participation. Key informants included university administrators, instructors, leaders of flood victims and the flood victims. Data was collected during October-December, 2010. Data were analysed using content analysis and compared matrix. We found that the concept and principle of health care services management were community based and involved home care and field hospital services. We had prepared a management system that placed emphasise on a community based approach and holistic caring such as 24h Nursing Clinic Home, visits with family, a referral system, field hospital. The core of management was to achieve integrated instruction started from nursing students were practiced skills as Health promotion and nursing techniques practicum. Rules were established regarding the health care service system. The outcomes of Health Care Service at the Flood Relief Operations Center were direct and sincere help without conditions, administrations concerned and volunteer nursing students instructors, University Officer have sympathetic and charitable with flood victims and environment. Copyright © 2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

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

ERIC Educational Resources Information Center

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

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

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

ERIC Educational Resources Information Center

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

2008-01-01

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

Jungle pipeline inspected for corrosion by camera pig

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

Not Available

1984-03-01

Acting on a suspicion that internal corrosion could be affection the integrity of the Cambai-to-Simpans Y line - a 14-in. OD, 36-mile natural gas pipeline in Indonesia's South Sumatra region - Pertamina elected to use GEO Pipeline Services's camera pig to photographically inspect the inner pipe wall's condition. As a result of this inspection, the Indonesian company was able to obtain more than 400 high-resolution photographs surveying the interior of the line, in addition to precise measurements of the corrosion in these areas.

Critical factors for the return-to-work process among people with affective disorders: Voices from two vocational approaches.

PubMed

Porter, Susann; Lexén, Annika; Johansson, Suzanne; Bejerholm, Ulrika

2018-05-22

Depression is among the major causes of disability with a negative impact on both daily life and work performance. Whilst depression is the primary cause of sick-leave and unemployment in today's workplace there is a lack of knowledge of the needs of individuals with depression regarding their return-to-work (RTW) process. To explore which factors are of critical importance for people suffering from depression and who also are unemployed in their RTW-process and to explore the impact of two vocational approaches on the service users' experiences. The study included participants in two vocational rehabilitation approaches; Individual Enabling and Support (IES) and Traditional Vocational Rehabilitation (TVR). Qualitative methods were applied to explore critical factors in the RTW-process. Individuals with affective disorders including depression and bipolar disorder were included.RESULTSThree themes emerged as critical factors; Experiencing hope and power, Professionals' positive attitudes, beliefs and behaviours, and Employing a holistic perspective and integrating health and vocational service.CONCLUSIONThis study has demonstrated critical factors for the return-to-work process as experienced by persons with depression. To experience hope and power, to meet professionals that believe "you can work", who use a person-centred and holistic service approach, are such factors necessary for gaining a real job. In particular, professionals in TVR need to embrace this understanding since their services were not experienced as including these elements.

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

NASA Astrophysics Data System (ADS)

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

2018-01-01

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

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2017-03-14

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

Quebec mental health services networks: models and implementation

PubMed Central

Fleury, Marie-Josée

2005-01-01

Abstract Purpose In the transformation of health care systems, the introduction of integrated service networks is considered to be one of the main solutions for enhancing efficiency. In the last few years, a wealth of literature has emerged on the topic of services integration. However, the question of how integrated service networks should be modelled to suit different implementation contexts has barely been touched. To fill that gap, this article presents four models for the organization of mental health integrated networks. Data sources The proposed models are drawn from three recently published studies on mental health integrated services in the province of Quebec (Canada) with the author as principal investigator. Description Following an explanation of the concept of integrated service network and a description of the Quebec context for mental health networks, the models, applicable in all settings: rural, urban or semi-urban, and metropolitan, and summarized in four figures, are presented. Discussion and conclusion To apply the models successfully, the necessity of rallying all the actors of a system, from the strategic, tactical and operational levels, according to the type of integration involved: functional/administrative, clinical and physician-system is highlighted. The importance of formalizing activities among organizations and actors in a network and reinforcing the governing mechanisms at the local level is also underlined. Finally, a number of integration strategies and key conditions of success to operationalize integrated service networks are suggested. PMID:16773157

From Kilimanjaro to the Himalayas: studies of health determinants in Third World communities.

PubMed

Cockroft, A

1998-01-01

Studies in communities in developing countries may seem far from occupational medicine in the UK, but there is much in common. Poverty and inequality, and the lack of control and choices that follow, are important causes of ill health. The methodology described in this paper is based on the concept that measurement should itself contribute to development and empower people. It combines quantitative data from large scale household surveys with qualitative data from focus groups, key informants and institutional reviews. In Nepal, malnutrition in children is seen to be related not only to feeding practices but also to the status of women. In Uganda, highlighting areas of poor service delivery in health and agriculture has initiated dialogue about improving local delivery of these services. In Tanzania, corruption in public services adversely affects everyday life; the survey results are part of an integrated strategy to tackle the problem.

Industry structures in private dental markets in Finland.

PubMed

Widström, E; Mikkola, H

2012-12-01

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

World Cup 2010 planning: an integration of public health and medical systems.

PubMed

Yancey, Arthur H; Fuhri, Peter D; Pillay, Yogan; Greenwald, Ian

2008-10-01

To present crucial stages of planning and the resources involved in the medical and health care that will address issues affecting the health and safety of all participants in the 2010 World Cup. Relevant literature reviews of mass gathering medical care supplemented experience of the authors in planning for previous similar events. Attention is focused on issues wherein effective planning requires the integration of public health practices with those of clinical emergency medical services. The tables that are included serve to illustrate the depth and breadth of planning as well as the organizational relationships required to execute care of a universally acceptable standard. This article offers guidance in planning for the 2010 World Cup health and emergency medical care, emphasizing the need for integration of public health and medical practices. It depicts the span of planning envisioned, the organizational relationships crucial to it, and emphasizes the necessity of an early start.

[Inequities in health in minority communities: diagnosis of the situation among the Francophone immigrants of Sudbury].

PubMed

Hien, Amélie; Lafontant, Jean

2013-06-06

This article aims to uncover health inequities related not only to living in a linguistic minority, but also to being an immigrant and living in a new environment with a cultural background different from that of the host community. This qualitative study presents the personal experiences of many Francophone immigrants in relation to services and health care in Sudbury and their perception about the quality and accessibility of these services and health care. Seventy-two (72) respondents aged between 18 and 65 years (45 men and 27 women) participated in this research through individual interviews and focus groups. The results show, among other things, that being immigrant and Francophone limits access to health services, affects the quality of these services and hinders being well supported when encountering health problems. Thus some individuals are not even able to give informed consent when making important decisions about their own health. The article makes recommendations that would allow access to better services and health care for immigrants, and would contribute to improving the health of the Canadian population of which they are an integral part.

The Effects of Yoga, Massage, and Reiki on Patient Well-Being at a Cancer Resource Center.

PubMed

Rosenbaum, Mark S; Velde, Jane

2016-06-01

Cancer resource centers offer patients a variety of therapeutic services. However, patients with cancer and cancer healthcare practitioners may not fully understand the specific objectives and benefits of each service. This research offers guidance to cancer healthcare practitioners on how they can best direct patients to partake in specific integrative therapies, depending on their expressed needs. This article investigates the effects of yoga, massage, and Reiki services administered in a cancer resource center on patients' sense of personal well-being. The results show how program directors at a cancer resource center can customize therapies to meet the needs of patients' well-being. The experimental design measured whether engaging in yoga, massage, or Reiki services affects the self-perceived well-being of 150 patients at a cancer resource center at two times. All three services helped decrease stress and anxiety, improve mood, and enhance cancer center patrons' perceived overall health and quality of life in a similar manner. Reiki reduced the pain of patients with cancer to a greater extent than either massage or yoga.

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

PubMed

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

2013-10-01

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

Psychological Community Integration of Individuals With Serious Mental Illness.

PubMed

Pahwa, Rohini; Kriegel, Liat

2018-06-01

As different facets of community integration as well as psychological and social integration are important dimensions of recovery for individuals with serious mental illness (SMI). The primary aim of the study was to explore psychological integration for individuals with SMI into the mental health and mainstream (i.e., non-mental health) communities and its association with their social integration into both communities. The study used self-report and egocentric social network data from 60 individuals with SMI receiving community-based mental health services. The primary findings indicated that social integration connected to service providers was associated with psychological integration in both mental health and mainstream communities. Our data suggest that in addition to providing services, providers are doing something meaningful to impact their clients' lives well beyond mental health services. The study supports a bifurcated conceptualization of psychological integration and provides a more complex understanding of the community integration concept.

[The operation of the health program SICALIDAD: the role of managers in primary care and hospitals].

PubMed

Granados-Cosme, José Arturo; Tetelboin-Henrion, Carolina; Torres-Cruz, César; Pineda-Pérez, Dayana; Villa-Contreras, Blanca Margarita

2011-01-01

To characterize the role of quality managers in health care units and health districts, identifying the constraints they experience in their performance. An interview guide and a questionnaire were carried out and were applied to quality managers in nine states as well as in Mexico City´s Health Services, in a Reference Federal Hospital and in a National Institute of Health. These instruments were analyzed using SPSS and Atlas.ti software. The activities done by the managers depend on the organizational level of services, which can be a care unit or the health jurisdiction. For each of these, we identified different order constraints that affect the performance of the role of management in the strategies to improve the quality of the services for population without social insurance, which together make up the government program called Integrated Quality Health System. Jurisdictional managers are the link between care units and state authorities in the management of information, while the medical units' managers drive operational strategies to improve the quality. Although the health program is implemented with the personal and infrastructure of the health system, it requires a greater institutionalization and strengthening of its structure and integration, as well as greater human and material resources.

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

PubMed

Ward, Vicky; Pinkney, Lisa; Fry, Gary

2016-09-08

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

Integrating Community Resources.

ERIC Educational Resources Information Center

Courtney, Linda J., Ed.

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

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

PubMed

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

2016-04-18

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

Efficacy of hospital in the home services providing care for patients admitted from emergency departments: an integrative review.

PubMed

Varney, Jane; Weiland, Tracey J; Jelinek, George

2014-06-01

Increases in emergency department (ED) demand may compromise patient outcomes, leading not only to overcrowding in the ED, increased ED waiting times and increased ED length of stay, but also compromising patient safety; the risk of adverse events is known to rise in the presence of overcrowding. Hospital in the home (HiTH) services may offer one means of reducing ED demand. This integrative review sought to assess the efficacy of admission-avoidance HiTH services that admit patients directly from the ED. Papers published between 1995 and 2013 were identified through searches of Medline, CINAHL and Google. English-language studies that assessed the efficacy of a HiTH service and that recruited at least one-third of the participants directly from the ED were included in the review. A HiTH service was considered one that provided health professional support to patients at home for a time-limited period, thus avoiding the need for hospitalization. Twenty-two articles met the inclusion criteria for this review. The interventions were diverse in terms of the clinical interventions delivered, the range and intensity of health professional input and the conditions treated. The studies included in the review found no effect on clinical outcomes, rates of adverse events or complications, although patient satisfaction and costs were consistently and favourably affected by HiTH treatment. Given evidence suggesting that HiTH services which recruit patients directly from the ED contribute to cost-savings, greater patient satisfaction and safety and efficacy outcomes that are at least equivalent to those associated with hospital-based care, the expansion of such programmes might therefore be considered a priority for policy makers.

Integrating complementary and alternative medicine into mainstream healthcare services: the perspectives of health service managers.

PubMed

Singer, Judy; Adams, Jon

2014-05-22

Complementary and alternative medicine (CAM) is increasingly included within mainstream integrative healthcare (IHC) services. Health service managers are key stakeholders central to ensuring effective integrative health care services. Yet, little research has specifically investigated the role or perspective of health service managers with regards to integrative health care services under their management. In response, this paper reports findings from an exploratory study focusing exclusively on the perspectives of health service managers of integrative health care services in Australia regarding the role of CAM within their service and the health service managers rational for incorporating CAM into clinical care. Health service managers from seven services were recruited using purposive and snowball sampling. Semi-structured interviews were conducted with the health service managers. The services addressed trauma and chronic conditions and comprised: five community-based programs including drug and alcohol rehabilitation, refugee mental health and women's health; and two hospital-based specialist services. The CAM practices included in the services investigated included acupuncture, naturopathy, Western herbal medicine and massage. Findings reveal that the health service managers in this study understand CAM to enhance the holistic capacity of their service by: filling therapeutic gaps in existing healthcare practices; by treating the whole person; and by increasing healthcare choices. Health service managers also identified CAM as addressing therapeutic gaps through the provision of a mind-body approach in psychological trauma and in chronic disease management treatment. Health service managers describe the addition of CAM in their service as enabling patients who would otherwise not be able to afford CAM to gain access to these treatments thereby increasing healthcare choices. Some health service managers expressly align the notion of treating the whole person within a health promotion model and focus on the relevance of diet and lifestyle factors as central to a CAM approach. From the perspectives of the health service managers, these findings contribute to our understanding around the rationale to include CAM within mainstream health services that deal with psychological trauma and chronic disease. The broader implications of this study can help assist in the development of health service policy on CAM integration in mainstream healthcare services.

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

PubMed

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

2001-01-01

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

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

PubMed Central

Joshi, Rohina; Negin, Joel

2018-01-01

Abstract Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle-income countries (LMICs). We adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for and capacity to implement integrated services. We searched Medline via Ovid, Web of Science and the Cochrane library using terms adapted from Dudley and Garner’s systematic review on integration in LMICs. From an initial list of 10 550 articles, 206 were selected for full-text review by two reviewers who independently reviewed articles and inductively extracted and synthesized themes related to health system preparedness. We identified five ‘context’ related categories and four health system ‘capability’ themes. The contextual enabling and constraining factors for frontline service integration were: (1) the organizational framework of frontline services, (2) health care worker preparedness, (3) community and client preparedness, (4) upstream logistics and (5) policy and governance issues. The intersecting health system capabilities identified were the need for: (1) sufficiently functional frontline health services, (2) sufficiently trained and motivated health care workers, (3) availability of technical tools and equipment suitable to facilitate integrated frontline services and (4) appropriately devolved authority and decision-making processes to enable frontline managers and staff to adapt integration to local circumstances. Moving beyond claims that integration is defined differently by different programs and thus unsuitable for comparison, this review demonstrates that synthesis is possible. It presents a common set of contextual factors and health system capabilities necessary for successful service integration which may be considered indicators of preparedness and could form the basis for an ‘integration preparedness tool’. PMID:29272396

The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: A systematic review.

PubMed

Hazen, Ankie C M; de Bont, Antoinette A; Boelman, Lia; Zwart, Dorien L M; de Gier, Johan J; de Wit, Niek J; Bouvy, Marcel L

2018-03-01

A non-dispensing pharmacist conducts clinical pharmacy services aimed at optimizing patients individual pharmacotherapy. Embedding a non-dispensing pharmacist in primary care practice enables collaboration, probably enhancing patient care. The degree of integration of non-dispensing pharmacists into multidisciplinary health care teams varies strongly between settings. The degree of integration may be a determinant for its success. This study investigates how the degree of integration of a non-dispensing pharmacist impacts medication related health outcomes in primary care. In this literature review we searched two electronic databases and the reference list of published literature reviews for studies about clinical pharmacy services performed by non-dispensing pharmacists physically co-located in primary care practice. We assessed the degree of integration via key dimensions of integration based on the conceptual framework of Walshe and Smith. We included English language studies of any design that had a control group or baseline comparison published from 1966 to June 2016. Descriptive statistics were used to correlate the degree of integration to health outcomes. The analysis was stratified for disease-specific and patient-centered clinical pharmacy services. Eighty-nine health outcomes in 60 comparative studies contributed to the analysis. The accumulated evidence from these studies shows no impact of the degree of integration of non-dispensing pharmacists on health outcomes. For disease specific clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 75%, 63% and 59%. For patient-centered clinical pharmacy services the percentage of improved health outcomes for none, partial and fully integrated NDPs is respectively 55%, 57% and 70%. Full integration adds value to patient-centered clinical pharmacy services, but not to disease-specific clinical pharmacy services. To obtain maximum benefits of clinical pharmacy services for patients with multiple medications and comorbidities, full integration of non-dispensing pharmacists should be promoted. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

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

PubMed

Wijesinghe, Thushanthi S; Wijesinghe, Pushpa Ranjan

2013-01-01

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

Missile Defense Agency (MDA) Annual Small Business Conference

DTIC Science & Technology

2010-05-27

Technology Mission Oriented Business Integrated Services (MOBIS) Professional Engineering Services (PES) Environmental Services Advertising & Integrated ... Marketing Solutions (AIMS) Financial and Business Solutions (FABS) Financial and Business Solutions (FABS) Human Resources and EEO Services Temporary

Systematic Approach to Better Understanding Integration Costs

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

Stark, Gregory B.

2015-09-01

This research presents a systematic approach to evaluating the costs of integrating new generation and operational procedures into an existing power system, and the methodology is independent of the type of change or nature of the generation. The work was commissioned by the U.S. Department of Energy and performed by the National Renewable Energy Laboratory to investigate three integration cost-related questions: (1) How does the addition of new generation affect a system's operational costs, (2) How do generation mix and operating parameters and procedures affect costs, and (3) How does the amount of variable generation (non-dispatchable wind and solar) impactmore » the accuracy of natural gas orders? A detailed operational analysis was performed for seven sets of experiments: variable generation, large conventional generation, generation mix, gas prices, fast-start generation, self-scheduling, and gas supply constraints. For each experiment, four components of integration costs were examined: cycling costs, non-cycling VO&M costs, fuel costs, and reserves provisioning costs. The investigation was conducted with PLEXOS production cost modeling software utilizing an updated version of the Institute of Electrical and Electronics Engineers 118-bus test system overlaid with projected operating loads from the Western Electricity Coordinating Council for the Sacramento Municipal Utility District, Puget Sound Energy, and Public Service Colorado in the year 2020. The test system was selected in consultation with an industry-based technical review committee to be a reasonable approximation of an interconnection yet small enough to allow the research team to investigate a large number of scenarios and sensitivity combinations. The research should prove useful to market designers, regulators, utilities, and others who want to better understand how system changes can affect production costs.« less

Storm Impact and Depression Among Older Adults Living in Hurricane Sandy-Affected Areas.

PubMed

Sirey, Jo Anne; Berman, Jacquelin; Halkett, Ashley; Giunta, Nancy; Kerrigan, Janice; Raeifar, Elmira; Artis, Amanda; Banerjee, Samprit; Raue, Patrick J

2017-02-01

Research on the impact of natural disasters on the mental health of older adults finds both vulnerabilities and resilience. We report on the rates of clinically significant depression among older adults (aged ≥60 years) living in areas affected by Hurricane Sandy in 2012 and the factors associated with mental health need. The Sandy Mobilization, Assessment, Referral and Treatment for Mental Health (SMART-MH) program integrates community outreach and needs assessments to identify older adults with mental health and aging service needs. Older adults with significant anxiety or depressive symptoms were offered short-term psychotherapy. Social service referrals were made directly to community agencies. All SMART-MH activities were offered in Spanish, Russian, Mandarin/Cantonese, and English. Across the full sample, 14% of participants screened positive for depression. Hurricane Sandy stressors predicted increased odds of depression, including storm injury, post-storm crime, and the total count of stressors. Outcomes varied significantly by age group, such that all Sandy-related variables remained significant for younger-old adults (aged 60-74 years), whereas only the loss of access to medical care was significant for older-old adults (aged ≥75 years). Storm-affected communities show higher rates of depressive symptoms than seen in the general population, with storm stressors affecting mental health needs differentially by age group. (Disaster Med Public Health Preparedness. 2017;11:97-109).

Factors affecting decision-making of patients choosing acupuncture in a public hospital.

PubMed

Sayampanathan, Andrew Arjun; Koh, Thean Howe Bryan; Kong, Keng He; Low, Yin Peng

2015-11-01

With increasing evidence to support its practice, acupuncture has been integrated within many hospitals around the world. The purpose of this study is to understand the factors affecting decision making of patients as they select acupuncture treatment for their medical conditions and symptoms within a public hospital. A qualitative study consisting of in depth interviews with 14 patients was conducted. All patients attended an acupuncture clinic within a public hospital. Data collected was analysed via thematic analysis. Four main factor groups affecting decision making of patients were identified- factors affecting the level and value of patient-centric care, the confidence and trust patients place within the acupuncture service, the presence of collaborative efforts between acupuncturists and Western medicine practitioners, and the knowledge, culture and belief society has regarding the role of acupuncture and Western medicine. All participants interviewed had more than one factor group present as enablers toward their eventual selection of acupuncture for ailment management. It was also noted that although the majority of participants had sufficient knowledge regarding acupuncture, there were a select few who had misperceptions or no knowledge regarding certain aspects of acupuncture. There may be certain patterns in the way patients choose to utilise acupuncture services in public hospitals. Further studies should also be carried out in other public hospitals to analyse the factor groups identified further.

Redesigning Children's Services: Mapping Interprofessional Social Capital

ERIC Educational Resources Information Center

Forbes, Joan

2009-01-01

This paper presents an analysis of the policy themes of service integration, social justice and social inclusion which underpin the integrated community schools policy initiative in Scotland. That initiative is identified as an important vehicle for the Scottish Executive Government's aim of integrating children's services with the overarching…

Changing ecosystem service values following technological change.

PubMed

Honey-Rosés, Jordi; Schneider, Daniel W; Brozović, Nicholas

2014-06-01

Research on ecosystem services has focused mostly on natural areas or remote places, with less attention given to urban ecosystem services and their relationship with technological change. However, recent work by urban ecologists and urban designers has more closely examined and appreciated the opportunities associated with integrating natural and built infrastructures. Nevertheless, a perception remains in the literature on ecosystem services that technology may easily and irreversibly substitute for services previously obtained from ecosystems, especially when the superiority of the engineered system motivated replacement in the first place. We emphasize that the expected tradeoff between natural and manufactured capital is false. Rather, as argued in other contexts, the adoption of new technologies is complementary to ecosystem management. The complementarity of ecosystem services and technology is illustrated with a case study in Barcelona, Spain where the installation of sophisticated water treatment technology increased the value of the ecosystem services found there. Interestingly, the complementarity between natural and built infrastructures may remain even for the very ecosystems that are affected by the technological change. This finding suggests that we can expect the value of ecosystem services to co-evolve with new technologies. Technological innovation can generate new opportunities to harness value from ecosystems, and the engineered structures found in cities may generate more reliance on ecosystem processes, not less.

Mental healthcare in Kenya: Exploring optimal conditions for capacity building

PubMed Central

Sands, Natisha; Rolley, John; Ndetei, David; Mansouri, Fethi

2014-01-01

The global burden of disease related to mental disorders is on the increase, with the World Health Organization (WHO) estimating that over 450 million people are affected worldwide. The Mental Health Global Action Program (mhGAP) was launched by the WHO in 2002 in order to address the widening gap in access to mental healthcare in low-income countries. Despite these efforts, access to mental healthcare in low-income countries remains poor and is often described as inadequate, inefficient and inequitable, with an 85% estimated treatment gap in low-income countries, as compared with 35% to 50% in high-income countries.In this article, the authors argue that integrating mental health services into primary healthcare settings through capacity building is vital with regard to achieving mhGAP goals. The article explores the challenges to and potential enablers for the improvement of the delivery of broad-based mental healthcare services in Kenya. The authors propose the integration of the conceptual dimensions of both the cosmopolitanism and capabilities approaches as a combined strategy for dealing with capacity building in heterogeneous settings such as Kenya. PMID:26245443

Mental healthcare in Kenya: exploring optimal conditions for capacity building.

PubMed

Marangu, Elijah; Sands, Natisha; Rolley, John; Ndetei, David; Mansouri, Fethi

2014-10-10

The global burden of disease related to mental disorders is on the increase, with the World Health Organization (WHO) estimating that over 450 million people are affected worldwide. The Mental Health Global Action Program (mhGAP) was launched by the WHO in 2002 in order to address the widening gap in access to mental healthcare in low-income countries. Despite these efforts, access to mental healthcare in low-income countries remains poor and is often described as inadequate, inefficient and inequitable, with an 85% estimated treatment gap in low-income countries, as compared with 35% to 50% in high-income countries.In this article, the authors argue that integrating mental health services into primary healthcare settings through capacity building is vital with regard to achieving mhGAP goals. The article explores the challenges to and potential enablers for the improvement of the delivery of broad-based mental healthcare services in Kenya. The authors propose the integration of the conceptual dimensions of both the cosmopolitanism and capabilities approaches as a combined strategy for dealing with capacity building in heterogeneous settings such as Kenya.

An Evaluation of an Integrated Model of Speech and Language Therapy in Public Health Practice for Early Language Development

ERIC Educational Resources Information Center

Smith, Clare; Gibbard, Deborah; Higgins, Louise

2017-01-01

Speech and language therapists (SLT) frequently operate in an integrated manner, working with other professionals in the delivery of services to children. Since the end of the 1990s within the UK SLTs have developed integrated services within the field of public health. This study reports an evaluation of an integrated model of service delivery…

The Arithmetic of Emotion: Integration of Incidental and Integral Affect in Judgments and Decisions

PubMed Central

Västfjäll, Daniel; Slovic, Paul; Burns, William J.; Erlandsson, Arvid; Koppel, Lina; Asutay, Erkin; Tinghög, Gustav

2016-01-01

Research has demonstrated that two types of affect have an influence on judgment and decision making: incidental affect (affect unrelated to a judgment or decision such as a mood) and integral affect (affect that is part of the perceiver’s internal representation of the option or target under consideration). So far, these two lines of research have seldom crossed so that knowledge concerning their combined effects is largely missing. To fill this gap, the present review highlights differences and similarities between integral and incidental affect. Further, common and unique mechanisms that enable these two types of affect to influence judgment and choices are identified. Finally, some basic principles for affect integration when the two sources co-occur are outlined. These mechanisms are discussed in relation to existing work that has focused on incidental or integral affect but not both. PMID:27014136

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

ERIC Educational Resources Information Center

Moore, Stephen

1992-01-01

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

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

PubMed

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

2014-01-01

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

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

NASA Astrophysics Data System (ADS)

Miharja, M.; Priadi, Y. N.

2018-05-01

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

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

PubMed

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

2017-05-01

Aim This study aimed to explore the ability of sexual health nurses working in the South West of England, to implement new learning within existing sexual health service delivery models. Drawing on Lipsky's account of street-level bureaucracy to conceptualise policy implementation, the impact of workforce learning on the development of integrated services across this region of the United Kingdom was assessed. In order to achieve the United Nations' goal of universal access to sexual health, it is essential for reproductive and sexual health, including HIV provision, to integrate into a single service. This integration requires a commitment to collaboration by service commissioners and an alignment of principles and values across sexual health and contraceptive services. UK health policy has embraced this holistic agenda but moves towards integrating historically separate clinical services, has presented significant workforce development challenges and influenced policy success. Employing a qualitative approach, the study included data from semi-structured telephone interviews and focus groups, and longitudinal data from pre- and post-intervention surveys, collected between September 2013 and September 2015. Data were collected from 88 nurses undertaking a workforce development programme and six of their service managers. Data were analysed using thematic analysis to identify consistent themes. Findings Nurses confirmed the role of new learning in enabling them to negotiate the political landscape but expressed frustration at their lack of agency in the integration agenda, exposing a clear dichotomy between the intentions of policy and the reality of practice. Nevertheless, using high levels of professional judgement and discretion practitioners managed the incongruence between policy and practice in order to deliver integrated services in the interests of patients. Workforce education, while essential for the transition to the delivery of integrated services, was insufficient to fulfil the sexual health agenda without a strengthening of public health.

[The challenges and opportunities of implementing outsourcing in private and public hospitals in Israel].

PubMed

Rahimi, Benny; Mizrahi, Ronit; Magnezi, Racheli

2011-01-01

Outsourcing is a method that enables an organization to focus on its expertise by transferring its other services to professionals who can fulfill them. In recent years, research has repeatedly shown that health services use a variety of outsourcing companies. To describe the experience acquired using outsourcing in public and private hospitals in Israel, and to present the factors, budgetary parameters, opportunities and problems affecting outsourcing. The questionnaire was sent to 36 hospitals in Israel, constituting 88.2% of all hospitals in Israel--private, public, H.M.O ("Clalit") and governmental. The response to the questionnaire reached 97.2% and revealed the following: 94% of the hospitals use outsourcing services in the following fields: security, cleaning, Laundry service, cafeterias, and I.T.; 42% of the hospitals assign 0-5% of their annual budget for outsourcing contracts. Private hospitals use more outsourcing services than public hospitals. The factors driving outsourcing are: cost restrictions (82.8%), operational flexibility (77%), and focus on the core business (74.2%). The potential advantages of outsourcing are: improvement in services 180.5%), customer satisfaction (72.2%), and cost reduction (69.4%). Difficulties affecting outsourcing are: dependence on external resources (83.3%] and internal organizational resistance (69.4%). The results of the outsourcing are lower costs, reduced number of personnel by 1-10% and high level of satisfaction. It seems that in recent years outsourcing is being used in hospitals and is central to the areas of infrastructure and logistics, as well as legal and medical services. Using outsourcing in hospitals provides opportunities for improved customer satisfaction, better focus for the hospital on its core activities and cost reduction. HospitaLs that succeed in synergetically integrating the external and the internal service providers will flourish. INNOVATION/VALUE: This research exposes, for the first time, the scope of contractual outsourcing in hospitals in Israel, and presents the dilemmas of utilizing this form of provision of services.

Applying Semantic Web Services and Wireless Sensor Networks for System Integration

NASA Astrophysics Data System (ADS)

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

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

Telerehabilitation Technologies: Accessibility and Usability

PubMed Central

Pramuka, Michael; van Roosmalen, Linda

2009-01-01

In the fields of telehealth and telemedicine, phone and/or video technologies are key to the successful provision of services such as remote monitoring and visits. How do these technologies affect service accessibility, effectiveness, quality, and usefulness when applied to rehabilitation services in the field of telerehabilitation? To answer this question, we provide a overview of the complex network of available technologies and discuss how they link to rehabilitation applications, services, and practices as well as to the telerehabilitation end-user. This white paper will first present the numerous professional considerations that shape the use of technology in telerehabilitation service and set it somewhat apart from telemedicine. It will then provide an overview of concepts essential to usability analysis; present a summary of various telerehabilitation technologies and their strengths and limitations, and consider how the technologies interface with end users’ clinical needs for service accessibility, effectiveness, quality, and usefulness. The paper will highlight a conceptual framework (including task analyses and usability issues) that underlies a functional match between telerehabilitation technologies, clinical applications, and end-user capabilities for telerehabilitation purposes. Finally, we will discuss pragmatic issues related to user integration of telerehabilitation technology versus traditional face-to-face approaches. PMID:25945165

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

PubMed Central

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

2014-01-01

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

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

PubMed

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

2014-01-01

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

77 FR 8956 - Surety Companies Acceptable on Federal Bonds: Integrity Mutual Insurance Company

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-15

... DEPARTMENT OF THE TREASURY Fiscal Service Surety Companies Acceptable on Federal Bonds: Integrity Mutual Insurance Company AGENCY: Financial Management Service, Fiscal Service, Department of the Treasury... hereby issued under 31 U.S.C. 9305 to the following company: Integrity Mutual Insurance Company (NAIC...

Technology Integration Support Levels for In-Service Teachers

ERIC Educational Resources Information Center

Williams, Mable Evans

2017-01-01

In-service teachers across the globe are expected to integrate technology in their respective instructional content area. The purpose of this qualitative study was to explore the perceptions of in-service teachers concerning building-level support for technology integration. Participants in the study were asked to participate in semi-structured…

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

ERIC Educational Resources Information Center

Crews, Moody E.; Hemby, K. Virginia

2009-01-01

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

Innovative use of influential prenatal counseling may improve breastfeeding initiation rates among WIC participants.

PubMed

Hildebrand, Deana A; McCarthy, Pam; Tipton, Debi; Merriman, Connie; Schrank, Melody; Newport, Melinda

2014-01-01

To determine whether integrating influence strategies (reciprocation, consistency, consensus, feeling liked, authority, and scarcity) throughout Chickasaw Nation Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics (1) changed participants' perception of the WIC experience and (2) affected breastfeeding initiation rates. Two-part, quasi-experimental design. Four WIC clinics. Parents and caregivers of children birth to 3 years. Behavior change intervention based on Social Cognitive Theory using Caildini's Principles of Influence. Traditional-model groups (control) received services prior to the intervention; influence-model groups (experimental) received services after initiation of the intervention. The preliminary demonstration project surveyed 2 groups to measure changes in their perceptions of the WIC environment. Secondary data analysis measured changes in breastfeeding initiation in 2 groups of postpartum women. Frequency analysis, independent sample t tests, chi-square for independence, step-wise logistic regression. The demonstration project resulted in 5 improved influence measures (P < .02), aligning with the influence principle of "feeling liked." The model had a small effect (φ = 0.10) in distinguishing breastfeeding initiation; women in the influence model were 1.5 times more likely (95% CI, 1.19-1.86; P < .05) to initiate breastfeeding compared with women in the traditional model, controlling for parity, mother's age, and race. Consistent with Social Cognitive Theory, changing the WIC environment by integrating influence principles may positively affect women's infant feeding decisions and behaviors, specifically breastfeeding initiation rates. Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Organisational culture and post-merger integration in an academic health centre: a mixed-methods study.

PubMed

Ovseiko, Pavel V; Melham, Karen; Fowler, Jan; Buchan, Alastair M

2015-01-22

Around the world, the last two decades have been characterised by an increase in the numbers of mergers between healthcare providers, including some of the most prestigious university hospitals and academic health centres. However, many mergers fail to bring the anticipated benefits, and successful post-merger integration in university hospitals and academic health centres is even harder to achieve. An increasing body of literature suggests that organisational culture affects the success of post-merger integration and academic-clinical collaboration. This paper reports findings from a mixed-methods single-site study to examine 1) the perceptions of organisational culture in academic and clinical enterprises at one National Health Service (NHS) trust, and 2) the major cultural issues for its post-merger integration with another NHS trust and strategic partnership with a university. From the entire population of 72 clinician-scientists at one of the legacy NHS trusts, 38 (53%) completed a quantitative Competing Values Framework survey and 24 (33%) also provided qualitative responses. The survey was followed up by semi-structured interviews with six clinician-scientists and a group discussion including five senior managers. The cultures of two legacy NHS trusts differed and were primarily distinct from the culture of the academic enterprise. Major cultural issues were related to the relative size, influence, and history of the legacy NHS trusts, and the implications of these for respective identities, clinical services, and finances. Strategic partnership with a university served as an important ameliorating consideration in reaching trust merger. However, some aspects of university entrepreneurial culture are difficult to reconcile with the NHS service delivery model and may create tension. There are challenges in preserving a more desirable culture at one of the legacy NHS trusts, enhancing cultures in both legacy NHS trusts during their post-merger integration, and in aligning academic and clinical cultures following strategic partnership with a university. The seeds of success may be found in current best practice, good will, and a near identical ideal of the future preferred culture. Strong, fair leadership will be required both nationally and locally for the success of mergers and post-merger integration in university hospitals and academic health centres.

A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings.

PubMed

Petersen, Inge; Lund, Crick; Bhana, Arvin; Flisher, Alan J

2012-01-01

BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. METHOD The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. RESULTS For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to £28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. CONCLUSION The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.

Perspectives of teachers regarding the integration of mathematics and science at the secondary school level

NASA Astrophysics Data System (ADS)

Zolnierczyk, Joanna Asia

The integration of mathematics and science in secondary schools in the 21st century continues to be an important topic of practice and research. The purpose of my research study, which builds on studies by Frykholm and Glasson (2005) and Berlin and White (2010), is to explore the potential constraints and benefits of integrating mathematics and science in Ontario secondary schools based on the perspectives of in-service and pre-service teachers with various math and/or science backgrounds. A qualitative and quantitative research design with an exploratory approach was used. The qualitative data was collected from a sample of 12 in-service teachers with various math and/or science backgrounds recruited from two school boards in Eastern Ontario. The quantitative and some qualitative data was collected from a sample of 81 pre-service teachers from the Queen's University Bachelor of Education (B.Ed) program. Semi-structured interviews were conducted with the in-service teachers while a survey and a focus group was conducted with the pre-service teachers. Once the data was collected, the qualitative data were abductively analyzed. For the quantitative data, descriptive and inferential statistics (one-way ANOVAs and Pearson Chi Square analyses) were calculated to examine perspectives of teachers regardless of teaching background and to compare groups of teachers based on teaching background. The findings of this study suggest that in-service and pre-service teachers have a positive attitude towards the integration of math and science and view it as valuable to student learning and success. The pre-service teachers viewed the integration as easy and did not express concerns to this integration. On the other hand, the in-service teachers highlighted concerns and challenges such as resources, scheduling, and time constraints. My results illustrate when teachers perceive it is valuable to integrate math and science and which aspects of the classroom benefit best from the integration. Furthermore, the results highlight barriers and possible solutions to better the integration of math and science. In addition to the benefits and constraints of integration, my results illustrate why some teachers may opt out of integrating math and science and the different strategies teachers have incorporated to integrate math and science in their classroom.

The provision of ecosystem services in response to global change: Evidences and applications.

PubMed

Lafortezza, Raffaele; Chen, Jiquan

2016-05-01

As a consequence of the global increase in economic and societal prosperity, ecosystems and natural resources have been substantially exploited, degraded, or even destroyed in the last century. To prevent further deprivation of the quality of ecosystems, the ecosystem services concept has become a central issue in environmental studies. A growing number of environmental agencies and organizations worldwide are now embracing integrated approaches to plan and manage ecosystems, sharing a goal to maintain the long-term provision of ecosystem services for sustainability. A daunting challenge in this process is to move from general pronouncements about the tremendous benefits that ecosystems provide to society to defensible assessments of their services. In other words, we must move beyond the scientific evidences of the ecosystem services concept to its practical applications. In this work, we discuss the theoretical foundations and applications of ecosystem services with a focus on the assessment of ecosystem service trade-offs and synergies at various spatial and temporal scales. Here, we offer examples of the main factors related to land use management that may affect the provision of ecosystem services and provide direction for future research on ecosystem services and related nature-based solutions. We also provide a briefing on the major topics covered in this Special Issue, which focuses on the provision of ecosystem services in the context of global change. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed

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

2018-03-22

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

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

PubMed

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

2017-06-01

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

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

NASA Astrophysics Data System (ADS)

Lu, Xiaodong; Mori, Kinji

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

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

PubMed Central

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

2006-01-01

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

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

PubMed

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

1998-11-01

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

The role of affect in consumer evaluation of health care services.

PubMed

Ng, Sandy; Russell-Bennett, Rebekah

2015-01-01

Health care services are typically consumed out of necessity, typically to recover from illness. While the consumption of health care services can be emotional given that consumers experience fear, hope, relief, and joy, surprisingly, there is little research on the role of consumer affect in health care consumption. We propose that consumer affect is a heuristic cue that drives evaluation of health care services. Drawing from cognitive appraisal theory and affect-as-information theory, this article tests a research model (N = 492) that investigates consumer affect resulting from service performance on subsequent service outcomes.

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

ERIC Educational Resources Information Center

Aburezeq, Ibtehal Mahmoud; Dweikat, Fawzi Fayez Ishtaiwa

2017-01-01

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

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

NASA Astrophysics Data System (ADS)

Wang, Xi Vincent; Wang, Lihui

2017-08-01

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

Social support needs identified by mothers affected by intimate partner violence.

PubMed

Letourneau, Nicole; Morris, Catherine Young; Stewart, Miriam; Hughes, Jean; Critchley, Kim A; Secco, Loretta

2013-09-01

In order to offer optimal supports and services for mothers affected by intimate partner violence (IPV), an understanding of these mothers' perceptions of support needs, resources, barriers to support, and preferences for support intervention is warranted. Moreover, the growing recognition of the effects of IPV on maternal-infant relationships and of the importance of these early relationships to long-term child health outcomes suggests interventions are needed to support optimal maternal-infant relationships in these families. Thus, 64 mothers exposed to IPV when their infants were below 12 months of age participated in a retrospective qualitative study to identify mothers' support needs, resources, barriers to support, and preferences for specific support interventions to promote optimal mother-infant relationships. Participants identified both personal needs (including needs for leaving or staying with the violent partner), along with intertwined needs to care for, and help, their infants cope with the experience of violence. Mothers reported that integrated services that include information and practical support from professionals with emotional and affirmation support from peers would promote positive, nurturing mother-infant relationships and healthy child development.

Electric vehicle (EV) storage supply chain risk and the energy market: A micro and macroeconomic risk management approach

NASA Astrophysics Data System (ADS)

Aguilar, Susanna D.

As a cost effective storage technology for renewable energy sources, Electric Vehicles can be integrated into energy grids. Integration must be optimized to ascertain that renewable energy is available through storage when demand exists so that cost of electricity is minimized. Optimization models can address economic risks associated with the EV supply chain- particularly the volatility in availability and cost of critical materials used in the manufacturing of EV motors and batteries. Supply chain risk can reflect itself in a shortage of storage, which can increase the price of electricity. We propose a micro-and macroeconomic framework for managing supply chain risk through utilization of a cost optimization model in combination with risk management strategies at the microeconomic and macroeconomic level. The study demonstrates how risk from the EVs vehicle critical material supply chain affects manufacturers, smart grid performance, and energy markets qualitatively and quantitatively. Our results illustrate how risk in the EV supply chain affects EV availability and the cost of ancillary services, and how EV critical material supply chain risk can be mitigated through managerial strategies and policy.

'All singing, all dancing': staff views on the integration of family planning and genitourinary medicine in Lothian, UK.

PubMed

Higgins, Martin; Chen, Eric Zhong; Gebbie, Ailsa E; Fernando, Imali; Milne, Dona; Cochrane, Rosemary

2014-10-01

UK policy documents advocate integrated approaches to sexual health service provision to ensure that everyone can access high-quality treatment. However, there is relatively little evidence to demonstrate any resultant benefits. The family planning and genitourinary medicine services in Lothian have been fully integrated and most care is now delivered from a purpose-built sexual health centre. We wished to study the views of staff on integrated sexual and reproductive care. Staff completed anonymous questionnaires before and after integration, looking at four main aspects: the patient pathway, specific patient groups, their own professional status, and their working environment. The surveys used a mixture of five-point Likert-type scales and open-ended questions. Over 50% of staff completed the surveys on each occasion. Six months after the new building opened, staff attitudes about the integrated service were mixed. Staff reported more stress and less opportunity for specialisation but there was no change in their sense of professional status or development. There were concerns about how well the integrated service met the needs of specific patient groups, notably women. These concerns co-existed with a verdict that overall service quality was no worse following integration. Staff views should form an important part of service redesign and integration projects. Although the results from the Lothian surveys suggest a perceived worsening of some aspects of the service, further evaluation is needed to unpick the different problems that have appeared under the catch-all term of 'integration'. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Integrating complementary and alternative medicine into mainstream healthcare services: the perspectives of health service managers

PubMed Central

2014-01-01

Background Complementary and alternative medicine (CAM) is increasingly included within mainstream integrative healthcare (IHC) services. Health service managers are key stakeholders central to ensuring effective integrative health care services. Yet, little research has specifically investigated the role or perspective of health service managers with regards to integrative health care services under their management. In response, this paper reports findings from an exploratory study focusing exclusively on the perspectives of health service managers of integrative health care services in Australia regarding the role of CAM within their service and the health service managers rational for incorporating CAM into clinical care. Methods Health service managers from seven services were recruited using purposive and snowball sampling. Semi-structured interviews were conducted with the health service managers. The services addressed trauma and chronic conditions and comprised: five community-based programs including drug and alcohol rehabilitation, refugee mental health and women’s health; and two hospital-based specialist services. The CAM practices included in the services investigated included acupuncture, naturopathy, Western herbal medicine and massage. Results Findings reveal that the health service managers in this study understand CAM to enhance the holistic capacity of their service by: filling therapeutic gaps in existing healthcare practices; by treating the whole person; and by increasing healthcare choices. Health service managers also identified CAM as addressing therapeutic gaps through the provision of a mind-body approach in psychological trauma and in chronic disease management treatment. Health service managers describe the addition of CAM in their service as enabling patients who would otherwise not be able to afford CAM to gain access to these treatments thereby increasing healthcare choices. Some health service managers expressly align the notion of treating the whole person within a health promotion model and focus on the relevance of diet and lifestyle factors as central to a CAM approach. Conclusions From the perspectives of the health service managers, these findings contribute to our understanding around the rationale to include CAM within mainstream health services that deal with psychological trauma and chronic disease. The broader implications of this study can help assist in the development of health service policy on CAM integration in mainstream healthcare services. PMID:24885066

Where Public Health Meets Human Rights: Integrating Human Rights into the Validation of the Elimination of Mother-to-Child Transmission of HIV and Syphilis.

PubMed

Kismödi, Eszter; Kiragu, Karusa; Sawicki, Olga; Smith, Sally; Brion, Sophie; Sharma, Aditi; Mworeko, Lilian; Iovita, Alexandrina

2017-12-01

In 2014, the World Health Organization (WHO) initiated a process for validation of the elimination of mother-to-child transmission (EMTCT) of HIV and syphilis by countries. For the first time in such a process for the validation of disease elimination, WHO introduced norms and approaches that are grounded in human rights, gender equality, and community engagement. This human rights-based validation process can serve as a key opportunity to enhance accountability for human rights protection by evaluating EMTCT programs against human rights norms and standards, including in relation to gender equality and by ensuring the provision of discrimination-free quality services. The rights-based validation process also involves the assessment of participation of affected communities in EMTCT program development, implementation, and monitoring and evaluation. It brings awareness to the types of human rights abuses and inequalities faced by women living with, at risk of, or affected by HIV and syphilis, and commits governments to eliminate those barriers. This process demonstrates the importance and feasibility of integrating human rights, gender, and community into key public health interventions in a manner that improves health outcomes, legitimizes the participation of affected communities, and advances the human rights of women living with HIV.

Integrative Review of the Supportive Care Needs of Arab People Affected by Cancer

PubMed Central

Alananzeh, Ibrahim; Levesque, Janelle; Kwok, Cannas; Everett, Bronwyn

2016-01-01

This review aimed to identify the unmet supportive care needs to conduct an integrative review of the literature, to identify the unmet supportive care needs of Arab people affected by cancer (patients and caregivers), and the impact of these needs on quality of life and psychosocial well-being. In July 2015 databases, search engines and electronic list servers were searched, with no limit on the year of publication. Reference lists of included articles and published reviews were also hand searched. Six studies met the inclusion criteria. Most studies examined the supportive care/unmet needs of Arab cancer patients and their family caregivers. Language, communication, information, and the need to get relief from dependency were the most frequently reported unmet needs among Arab cancer patients. For immigrant Arab patients, physical unmet needs were higher than other migrant groups and native Anglo-Australians. Arab caregivers’ unmet needs included concerns about providing suitable care for their family member, sharing their experience with other caregivers, obtaining information, and, in the case of pediatric cancers, dealing with siblings’ emotional reactions. The existing literature exploring the unmet supportive care needs of Arab people affected by cancer is limited suggesting that comprehensive studies are needed to enhance our understanding of these needs and to inform service planning. PMID:27981153

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

PubMed

Druss, Benjamin G; Goldman, Howard H

2018-04-25

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

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

ERIC Educational Resources Information Center

Center for Rural Pennsylvania, Harrisburg.

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

Forest health and global change.

PubMed

Trumbore, S; Brando, P; Hartmann, H

2015-08-21

Humans rely on healthy forests to supply energy, building materials, and food and to provide services such as storing carbon, hosting biodiversity, and regulating climate. Defining forest health integrates utilitarian and ecosystem measures of forest condition and function, implemented across a range of spatial scales. Although native forests are adapted to some level of disturbance, all forests now face novel stresses in the form of climate change, air pollution, and invasive pests. Detecting how intensification of these stresses will affect the trajectory of forests is a major scientific challenge that requires developing systems to assess the health of global forests. It is particularly critical to identify thresholds for rapid forest decline, because it can take many decades for forests to restore the services that they provide. Copyright © 2015, American Association for the Advancement of Science.

Training the 21st-Century Health Care Team: Maximizing Interprofessional Education Through Medical-Legal Partnership.

PubMed

Tobin-Tyler, Elizabeth; Teitelbaum, Joel

2016-06-01

For too long, many stakeholders in the health care delivery system have ignored the extent to which social determinants of health (SDH) are inextricably woven into and affect individual and population health. The health care system is undergoing a relatively rapid transformation, which has included in part an increasing recognition of SDH's effects. This recognition, in turn, has led to renewed calls for changing the way that physicians are trained and has accelerated medical education curricular reforms. This Perspective focuses on one such innovative method of team-based care and the opportunities for its integration into medical education: medical-legal partnership, a health care delivery model that embeds civil legal services into the spectrum of health care services provided to low-income or otherwise vulnerable patients and communities.

Health resources management and physician control in a San Francisco, California, hospital.

PubMed Central

Rosenstein, A. H.; Stier, M. M.

1991-01-01

The continued escalation in health care spending has caused money to become an increasingly limited resource, which may eventually affect the ability of health professionals to provide complete health care services. Health care payers have stressed efficiency and the appropriateness of health care measures and are putting greater financial pressures on health professionals by making them more accountable for services provided. Hospitals and physicians must take a more active role in monitoring health care delivery and work together to improve performance efficiency. Efficiency can be gained through a comprehensive program that emphasizes high-quality care and the effective use of health care resources. The Health Resource Management Program is a model for carrying out this function that integrates data analysis and physician input and education. Images PMID:2006564

The role of assisted self-help in services for alcohol-related disorders.

PubMed

Kavanagh, David J; Proctor, Dawn M

2011-06-01

Potentially harmful substance use is common, but many affected people do not receive treatment. Brief face-to-face treatments show impact, as do strategies to assist self-help remotely, by using bibliotherapies, computers or mobile phones. Remotely delivered treatments offer more sustained and multifaceted support than brief interventions, and they show a substantial cost advantage as users increase in number. They may also build skills, confidence and treatment fidelity in providers who use them in sessions. Engagement and retention remain challenges, but electronic treatments show promise in engaging younger populations. Recruitment may be assisted by integration with community campaigns or brief opportunistic interventions. However, routine use of assisted self-help by standard services faces significant challenges. Strategies to optimize adoption are discussed. Copyright © 2011. Published by Elsevier Ltd.

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

PubMed Central

2012-01-01

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

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

PubMed

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

2016-12-21

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

[Clinical integration in the chronic patient].

PubMed

Carretero-Alcántara, Luis; Comes-Górriz, Natividad; Borrás-López, Agustina; Rodríguez-Balo, Alberto; Seara-Aguilar, Germán

2014-01-01

Castilla-La Mancha Health Service is developing the integration of care levels due to the challenge of an aging population in the region. Aging is associated with chronic diseases and an increasing number of concomitant diseases. This poses a major care challenge care, with more fragile patients and new needs. This also requires a sustainable approach: the concurrence of several chronic diseases affects the cost of care, which is especially acute in times of severe economic crisis. One of the pillars of the strategy for dealing with chronic diseases in our region is care integration, in an effort to adapt the organization to the new needs. The Balanced Scorecard or Integrated Scorecard of the integration process was introduced as it has been designed. The integration of primary and hospital care at an organizational level has already been completed, and the development of integrated care processes has also been performed in order to achieve real integration at care level. To help finance this, a prospective capitation system is gradually being implemented, achieving a convergence of per capita costs in the different health areas integrated. Nurses has a key role in this process, their skills as educators and trainers in self-care, in the role of case managers of patients with particularly complex conditions, and the role of professional liaison to improve the transition between care areas and units. Copyright © 2013 Elsevier España, S.L. All rights reserved.

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

ERIC Educational Resources Information Center

Stöbe-Blossey, Sybille

2013-01-01

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

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

ERIC Educational Resources Information Center

Felts, John W., Jr.

2014-01-01

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

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

ERIC Educational Resources Information Center

Journal of American College Health, 2010

2010-01-01

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

Adopting Cloud Computing in the Pakistan Navy

DTIC Science & Technology

2015-06-01

administrative aspect is required to operate optimally, provide synchronized delivery of cloud services, and integrate multi-provider cloud environment...AND ABBREVIATIONS ANSI American National Standards Institute AWS Amazon web services CIA Confidentiality Integrity Availability CIO Chief...also adopted cloud computing as an integral component of military operations conducted either locally or remotely. With the use of 2 cloud services

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

PubMed

Washington-Brown, Linda; Ritchie, Arlene

2014-01-01

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

Developing a framework to assess the water quality and quantity impacts of climate change, shifting land use, and urbanization in a Midwestern agricultural landscape

NASA Astrophysics Data System (ADS)

Loheide, S. P.; Booth, E. G.; Kucharik, C. J.; Carpenter, S. R.; Gries, C.; Katt-Reinders, E.; Rissman, A. R.; Turner, M. G.

2011-12-01

Dynamic hydrological processes play a critical role in the structure and functioning of agricultural watersheds undergoing urbanization. Developing a predictive understanding of the complex interaction between agricultural productivity, ecosystem health, water quality, urban development, and public policy requires an interdisciplinary effort that investigates the important biophysical and social processes of the system. Our research group has initiated such a framework that includes a coordinated program of integrated scenarios, model experiments to assess the effects of changing drivers on a broad set of ecosystem services, evaluations of governance and leverage points, outreach and public engagement, and information management. Our geographic focus is the Yahara River watershed in south-central Wisconsin, which is an exemplar of water-related issues in the Upper Midwest. This research addresses three specific questions. 1) How do different patterns of land use, land cover, land management, and water resources engineering practices affect the resilience and sensitivity of ecosystem services under a changing climate? 2) How can regional governance systems for water and land use be made more resilient and adaptive to meet diverse human needs? 3) In what ways are regional human-environment systems resilient and in what ways are they vulnerable to potential changes in climate and water resources? A comprehensive program of model experiments and biophysical measurements will be utilized to evaluate changes in five freshwater ecosystem services (flood regulation, groundwater recharge, surface water quality, groundwater quality, and lake recreation) and five related ecosystem services (food crop yields, bioenergy crop yields, carbon storage in soil, albedo, and terrestrial recreation). Novel additions to existing biophysical models will allow us to simulate all components of the hydrological cycle as well as agricultural productivity, nitrogen and phosphorus transport, and lake water quality. The integrated model will be validated using a comprehensive observational database that includes soil moisture, evapotranspiration, stomatal conductance, streamflow, stream and lake water quality, and crop yields and productivity. Integrated scenarios will be developed to synthesize decision-maker perspectives, alternative approaches to resource governance, plausible trends in demographic and economic drivers, and model projections under alternate climate and land use regimes to understand future conditions of the watershed and its ecosystem services. The quantitative data and integrated scenarios will then be linked to evaluate governance of water and land use.

Consuming Web Services: A Yahoo! Newsfeed Reader

ERIC Educational Resources Information Center

Dadashzadeh, Mohammad

2010-01-01

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

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

PubMed Central

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

2006-01-01

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

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

PubMed Central

Ryu, Minwoo; Kim, Jaeho; Yun, Jaeseok

2015-01-01

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

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

PubMed

Ryu, Minwoo; Kim, Jaeho; Yun, Jaeseok

2015-01-19

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

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

Code of Federal Regulations, 2010 CFR

2010-01-01

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

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

PubMed

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

2017-08-01

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

Assessing soil ecosystem services using empirical indicators

NASA Astrophysics Data System (ADS)

Bodí, Merche B.; Struyf, Eric; Staes, Jan; Meire, Patrick

2014-05-01

Studying the soil from the ecosystem services (ES) approach is a way to embrace the complexity and multiple functions of the soil systems and its interactions with the environment and with humans. The ES approach is ideal for developing a sustainable and integrated land management and to concern people about the value of conserving soil. However, this approach is generally used up to know only for soil provisioning services as well as the potential for carbon storage, but not for other services such as soil erosion or water buffering. In addition, those studies carried out are focussed in coarse spatial scale, without identifying the spatial or temporal variability. One of the reasons of this bias arises from the difficulties of obtaining a broad and reliable dataset of indicators from empirical sources. This constrain is sorted out with the action of SOGLO project (the Soil System Under Global Change), an interuniversity attraction pole project (2012-2017) involving different universities from Belgium. The project brings the opportunity to obtain a unique soil dataset for an improved and integrated analysis of the feedbacks between the soil system and fluxes of sediment, carbon (C), nutrients and water in response to anthropogenic forcings at different spatial and temporal scales in experimental sites in both Brazil and in Belgium. Within this broad project, the objective of the present work is to elucidate how different land uses in Belgium (forest, grassland, cropland with conventional tillage and with reduced tillage both with crop rotation) affect the delivery and trade-off of soil ecosystem services. We did this by measuring and comparing a range of indicators of soil ecosystem services in different lands uses during a range of 5 years. Specifically we investigated quantity of SOC in the soil and DOC in the soil solution and at the discharge point (SOC storage service/water buffering services); Si, N, P in the soil, dissolved in the soil solution and at the discharge point (regulating of P, N, Si cycles/ water buffering services); infiltration capacity, water retention curves and soil erosion (soil stability/water buffering services) and vegetation cover (biomass production service). We then examined the relationships and trade off between services spatially and seasonally. The results will be given during at the conference session but our hypothesis is that the performance of soil services is related even seasonally, and the degradation of one service enhances de degradation of the others.

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

NASA Astrophysics Data System (ADS)

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

2012-05-01

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

From PCK to TPACK: Developing a Transformative Model for Pre-Service Science Teachers

NASA Astrophysics Data System (ADS)

Jang, Syh-Jong; Chen, Kuan-Chung

2010-12-01

New science teachers should be equipped with the ability to integrate and design the curriculum and technology for innovative teaching. How to integrate technology into pre-service science teachers' pedagogical content knowledge is the important issue. This study examined the impact on a transformative model of integrating technology and peer coaching for developing technological pedagogical and content knowledge (TPACK) of pre-service science teachers. A transformative model and an online system were designed to restructure science teacher education courses. Participants of this study included an instructor and 12 pre-service teachers. The main sources of data included written assignments, online data, reflective journals, videotapes and interviews. This study expanded four views, namely, the comprehensive, imitative, transformative and integrative views to explore the impact of TPACK. The model could help pre-service teachers develop technological pedagogical methods and strategies of integrating subject-matter knowledge into science lessons, and further enhanced their TPACK.

Cross-Layer Service Discovery Mechanism for OLSRv2 Mobile Ad Hoc Networks.

PubMed

Vara, M Isabel; Campo, Celeste

2015-07-20

Service discovery plays an important role in mobile ad hoc networks (MANETs). The lack of central infrastructure, limited resources and high mobility make service discovery a challenging issue for this kind of network. This article proposes a new service discovery mechanism for discovering and advertising services integrated into the Optimized Link State Routing Protocol Version 2 (OLSRv2). In previous studies, we demonstrated the validity of a similar service discovery mechanism integrated into the previous version of OLSR (OLSRv1). In order to advertise services, we have added a new type-length-value structure (TLV) to the OLSRv2 protocol, called service discovery message (SDM), according to the Generalized MANET Packet/Message Format defined in Request For Comments (RFC) 5444. Each node in the ad hoc network only advertises its own services. The advertisement frequency is a user-configurable parameter, so that it can be modified depending on the user requirements. Each node maintains two service tables, one to store information about its own services and another one to store information about the services it discovers in the network. We present simulation results, that compare our service discovery integrated into OLSRv2 with the one defined for OLSRv1 and with the integration of service discovery in Ad hoc On-demand Distance Vector (AODV) protocol, in terms of service discovery ratio, service latency and network overhead.

Cross-Layer Service Discovery Mechanism for OLSRv2 Mobile Ad Hoc Networks

PubMed Central

Vara, M. Isabel; Campo, Celeste

2015-01-01

Service discovery plays an important role in mobile ad hoc networks (MANETs). The lack of central infrastructure, limited resources and high mobility make service discovery a challenging issue for this kind of network. This article proposes a new service discovery mechanism for discovering and advertising services integrated into the Optimized Link State Routing Protocol Version 2 (OLSRv2). In previous studies, we demonstrated the validity of a similar service discovery mechanism integrated into the previous version of OLSR (OLSRv1). In order to advertise services, we have added a new type-length-value structure (TLV) to the OLSRv2 protocol, called service discovery message (SDM), according to the Generalized MANET Packet/Message Format defined in Request For Comments (RFC) 5444. Each node in the ad hoc network only advertises its own services. The advertisement frequency is a user-configurable parameter, so that it can be modified depending on the user requirements. Each node maintains two service tables, one to store information about its own services and another one to store information about the services it discovers in the network. We present simulation results, that compare our service discovery integrated into OLSRv2 with the one defined for OLSRv1 and with the integration of service discovery in Ad hoc On-demand Distance Vector (AODV) protocol, in terms of service discovery ratio, service latency and network overhead. PMID:26205272

Integrated (one-stop shop) youth health care: best available evidence and future directions.

PubMed

Hetrick, Sarah E; Bailey, Alan P; Smith, Kirsten E; Malla, Ashok; Mathias, Steve; Singh, Swaran P; O'Reilly, Aileen; Verma, Swapna K; Benoit, Laelia; Fleming, Theresa M; Moro, Marie Rose; Rickwood, Debra J; Duffy, Joseph; Eriksen, Trissel; Illback, Robert; Fisher, Caroline A; McGorry, Patrick D

2017-11-20

Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. Where evaluated, young people report having benefited from and being highly satisfied with these services. Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery.

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

ERIC Educational Resources Information Center

Salasin, Susan E.

2005-01-01

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

Measuring the degree of integration for an integrated service network

PubMed Central

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

2012-01-01

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

Beyond the Workshop: National Perspectives on Integrated Employment.

ERIC Educational Resources Information Center

McGaughey, Martha J.; Kiernan, William E.; McNally, Lorraine C.; Gilmore, Dana Scott; Keith, Geraldine R.

This report discusses the findings of a survey that explored integrated employment services of 643 day and employment service providers for individuals with disabilities. Specifically, the survey investigated: (1) services provided; (2) the prevalence of other nonwork services; (3) funding practices related to group and individual supported…

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

PubMed

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

2016-03-01

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

Projecting supply and demand of hydrologic ecosystem services under future climate conditions

NASA Astrophysics Data System (ADS)

Chiang, Li-Chi; Huang, Tao; Lee, Tsung-Yu

2014-05-01

Ecosystems provide essential goods and services, such as food, clean water, water purification, soil conservation and cultural services for human being. In a watershed, these water-related ecosystem goods and services can directly or indirectly benefit both local people and downstream beneficiaries through a reservoir. Water quality and quantity in a reservoir are of importance for agricultural, industrial and domestic uses. Under the impacts of climate and land use changes, both ecosystem service supply and demand will be affected by changes in precipitation patterns, temperature, urbanization and agricultural activities. However, the linkage between ecosystem service provisioning (ESP) and ecosystem service beneficiary (ESB), and scales of supply and demand of ecosystem services are not clear yet. Therefore, to investigate water-related ecosystem service supply under climate and land use change, we took the Xindian river watershed (303 km2) as a case study, where the Feitsui Reservoir provides hydro-power and daily domestic water use of 3,450,000 m3 for 3.46 million people in Taipei, Taiwan. We integrated a hydrological model (Soil and Water Assessment Tool, SWAT) and a land use change model (Conversion of Land Use and its Effects, CLUE-s) with future climate change scenarios derived from General Circulation Models (GCMs), to assess the changes in ecosystem service supply and demand at different hydrologic scales. The results will provide useful information for decision-making on future land use management and climate change adaptation strategies in the watersheds. Keywords: climate change, land use change, ecosystem service, watershed, scale

Urban ecosystem services: tree diversity and stability of tropospheric ozone removal.

PubMed

Manes, Fausto; Incerti, Guido; Salvatori, Elisabetta; Vitale, Marcello; Ricotta, Carlo; Costanza, Robert

2012-01-01

Urban forests provide important ecosystem services, such as urban air quality improvement by removing pollutants. While robust evidence exists that plant physiology, abundance, and distribution within cities are basic parameters affecting the magnitude and efficiency of air pollution removal, little is known about effects of plant diversity on the stability of this ecosystem service. Here, by means of a spatial analysis integrating system dynamic modeling and geostatistics, we assessed the effects of tree diversity on the removal of tropospheric ozone (O3) in Rome, Italy, in two years (2003 and 2004) that were very different for climatic conditions and ozone levels. Different tree functional groups showed complementary uptake patterns, related to tree physiology and phenology, maintaining a stable community function across different climatic conditions. Our results, although depending on the city-specific conditions of the studied area, suggest a higher function stability at increasing diversity levels in urban ecosystems. In Rome, such ecosystem services, based on published unitary costs of externalities and of mortality associated with O3, can be prudently valued to roughly US$2 and $3 million/year, respectively.

The design of a commercial space infrastructure

NASA Technical Reports Server (NTRS)

1989-01-01

Space Services and Logistics, Inc. represents the complete engineering design of a technically and financially viable commercial space company. The final proposal offers an economically sound program of space vehicles and systems designed to substantially affect a variety of space markets and produce a vertically integrated structure within the next 20 years. Throughout this design process, particular stress has been placed on attaining the highest possible levels of safety and reliability. The final program financial design requires a considerable initial outlay, but promises a relatively quick return on invested capital, culminating in large annual profits by the end of the 20-year scope of the cost outlook. The overall design has been extensively researched and was primarily driven by the present and near-term projected market demands for services uniquely or competitively offered only by space-oriented operations. Heretofore, available capabilities, rather than these market demands, have determined the degree and type of commercial market access. Removing this limitation through extensive use of modularity and reconfigurability allows the company to gear itself to the market, while still remaining extremely competitive with existing systems. The markets identified as lucrative, and that have governed much of the design requirements, are: low-cost launch services to LEO over a wide range of payload masses and inclinations; upper stage payload delivery from LEO to GEO; manned space operations and human transport to and from orbit; EVA assembly and maintenance of large space structures; satellite servicing and repair by both humans and telerobotic operations; a line of customized satellites designed for extended life and capable of reconfiguration or technology upgrade on orbit; small-scale microgravity experimentation and manufacturing supported by spacecraft retrieval capabilities for experimental specimens and manufactured goods; and a full-range of payload integration, testing, design, and support services before launch and once in orbit.

Integrated ecosystem services assessment: Valuation of changes due to sea level rise in Galveston Bay, Texas, USA.

PubMed

Yoskowitz, David; Carollo, Cristina; Pollack, Jennifer Beseres; Santos, Carlota; Welder, Kathleen

2017-03-01

The goal of the present study was to identify the potential changes in ecosystem service values provided by wetlands in Galveston Bay, Texas, USA, under the Intergovernmental Panel on Climate Change (IPCC) A1B max (0.69 m) sea level rise scenario. Built exclusively upon the output produced during the Sea Level Affecting Marshes Model 6 (SLAMM 6) exercise for the Galveston Bay region, this study showed that fresh marsh and salt marsh present a steady decline from 2009 (initial condition) to 2100. Fresh marsh was projected to undergo the biggest changes, with the loss of approximately 21% of its extent between 2009 and 2100 under the A1B max scenario. The percentages of change for salt marsh were less prominent at approximately 12%. This trend was also shown in the values of selected ecosystem services (disturbance regulation, waste regulation, recreation, and aesthetics) provided by these habitats. An ordinary least squares regression was used to calculate the monetary value of the selected ecosystem services provided by salt marsh and fresh marsh in 2009, and in 2050 and 2100 under the A1B max scenario. The value of the selected services showed potential monetary losses in excess of US$40 million annually in 2100, compared to 2009 for fresh marsh and more than $11 million for salt marsh. The estimates provided here are only small portions of what can be lost due to the decrease in habitat extent, and they highlight the need for protecting not only built infrastructure but also natural resources from sea level rise. Integr Environ Assess Manag 2017;13:431-443. © 2016 SETAC. © 2016 SETAC.

Challenges in access to health services and its impact on quality of life: a randomised population-based survey within Turkish speaking immigrants in London.

PubMed

Topal, Kenan; Eser, Erhan; Sanberk, Ismail; Bayliss, Elizabeth; Saatci, Esra

2012-01-26

There are a significant number of Turkish speaking immigrants living in London. Their special health issues including women's health, mental health, and alcohol and smoking habits has been assessed. The aim of this study was to explore the ongoing challenges in access to health care services and its impact on Quality of Life of immigrants. This cross-sectional population-based study was conducted between March and August 2010 with Turkish immigrants (n = 416) living in London. Of these, 308 (74%) were Turkish and 108 (26%) were Turkish Cypriots. All healthy or unhealthy adults of 17-65 years of age were enrolled. A structured questionnaire with 44 items in five subcategories and 26-items WHOQOL BREF were used. Mean duration of stay for Turkish Cypriots (26.9 ± 13.9 years) was significantly longer than Turkish immigrants (13.3 ± 7.5) (p < 0.001). Turkish immigrants (n = 108, 36.5%) need interpretation more often when using health services than Turkish Cypriots (n = 16, 15%) (p < 0.001). Multivariate analyses suggested significant effects of older age, non-homeownership, low socioeconomic class, poor access to health services, being ill, poor community integration and being obese on physical well-being and also significant effects of low income and poor community integration on perceived overall Quality of Life (WHOQOL) of the participants. The results of this study demonstrate how the health and well-being of members of the Turkish speaking community living in London are affected by social aspects of their lives. Providing culturally competent care and interpretation services and advocacy may improve the accessibility of the health care.

From Sociocultural Disintegration to Community Connectedness Dimensions of Local Community Concepts and Their Effects on Psychological Health of Its Residents

PubMed Central

Sørensen, Tom; Kleiner, Robert; Ngo, Paul; Sørensen, Andreas; Bøe, Nils

2013-01-01

In a series of community mental health promotion studies in Lofoten, Norway, the concept of sociocultural integration is used to describe properties of a local community that are related to people's psychological health. Starting with Durkheim's description of a cohesive society, we compare different concepts that are related to sociocultural integration, for example, sense of community, social capital, and social cohesion. We then examine the relationship of various individual oriented social psychological concepts to sociocultural integration. These concepts often share theoretical and operational definitions. The concept of sociocultural integration in the Lofoten studies was proved to be very valuable in understanding how the properties of a community can affect people's mental health and their social psychological properties. It has also shown its value in the planning of mental health services and demonstrating its success in concrete community-based mental health promotion projects. Thus they could make important contributions to further studies and actions in local communities where the intersection between the individual, their social network, and their local community occurs. PMID:24236288

39 CFR 230.26 - Do these rules affect the service of process requirements of the Federal Rules of Civil Procedure...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false Do these rules affect the service of process....26 Do these rules affect the service of process requirements of the Federal Rules of Civil Procedure... Rules of Civil Procedure regarding service of process. ...

Creating organizational value by leveraging the multihospital pharmacy enterprise.

PubMed

Schenkat, Dan; Rough, Steve; Hansen, Amanda; Chen, David; Knoer, Scott

2018-04-01

The results of a survey of multihospital pharmacy leaders are summarized, and a road map for creating organizational value with the pharmacy enterprise is presented. A survey was designed to evaluate the level of integration of pharmacy services across each system's multiple hospitals, determine the most commonly integrated services, determine whether value was quantified when services were integrated, collect common barriers for finding value through integration, and identify strategies for successfully overcoming these barriers. The comprehensive, 59-question survey was distributed electronically in September 2016 to the top pharmacy executive at approximately 160 multihospital systems located throughout the United States. Survey respondents indicated that health systems are taking a wide range of approaches to integrating services systemwide. Several themes emerged from the survey responses: (1) having a system-level pharmacy leader with solid-line reporting across the enterprise increased the likelihood of integrating pharmacy services effectively, (2) integration of pharmacy services across a multihospital system was unlikely to decrease the number of pharmacy full-time equivalents within the enterprise, and (3) significant opportunities exist for creating value for the multihospital health system with the pharmacy enterprise, particularly within 4 core areas: system-level drug formulary and clinical standardization initiatives, supply chain initiatives, electronic health record integration, and specialty and retail pharmacy services. Consistently demonstrating strong organizational leadership, entrepreneurialism, and the ability to create value for the organization will lead to the system-level pharmacy leader and the pharmacy enterprise being well-positioned to achieve positive outcomes for patients, payers, and the broader health system. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

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

ERIC Educational Resources Information Center

Somers, Marie-Andrée; Haider, Zeest

2017-01-01

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

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

ERIC Educational Resources Information Center

Somers, Marie-Andrée; Haider, Zeest

2017-01-01

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

An Overview of SASSCAL Activities Supporting Interdisciplinary Water Research in Southern Africa

NASA Astrophysics Data System (ADS)

Helmschrot, J.; Jürgens, N.

2013-12-01

Climate change will affect current water resources in sub-Saharan Africa. Considering projected climate scenarios, the overall challenge in the southern African region is to secure water at sufficient quality and quantity for both, the stability of ecosystems with their functions and services as well as for human well-being (potable water, irrigation water, and water for industrial use). Thus, improved understanding of the linkages between hydrological (including hydro-geological) components of ecosystems and society is needed as a precondition to develop sustainable management strategies for integrated water resources management in this data scarce region. Funded by the German Ministry of Education and Research (BMBF), 87 research projects of the SASSCAL Initiative (Southern African Science Service Centre for Climate Change and Adaptive Land Management) focus on providing information and services allowing for a better understanding and assessment of the impact of climate and land management changes in five thematic areas, namely climate, water, agriculture, forestry and biodiversity. Water-related research activities in SASSCAL aim to improve our knowledge on the complex interactions and feedbacks between surface and groundwater dynamics and resources as well as land surface processes in selected regions of the participating countries (Angola, Botswana, Namibia, South Africa and Zambia). The main objective of this joint and integrated research effort is to develop reliable hydrological and hydro-geological baseline data along with a set of analytical methods to strengthen the research capacity of the water sector of the Southern African region. Thereby, SASSCAL contributes to the implemention of integrated water resources management strategies for improved trans-boundary river management and resources usage in the perspective of global climate and land management changes. Here, we present an overview and first results of ongoing studies conducted by various SASSCAL research teams. Specifically addressed is the installation of 30 Automatic Weather Stations in Angola, Botswana and Zambia which will notably improve regional data availability. We further introduce case studies on flood monitoring using remote sensing products, hydrological risks assessments and early warning systems for floods, integrated hydrological modeling efforts, groundwater-surface water interactions and various hydrological process studies in different ecosystems, all at various spatial (local, regional, national and international) and temporal (short-term, long-term, climate projection) scales. With this variety of examples we demonstrate our interdisciplinary research approach as the prerequisite to address the complexity of interacting drivers and processes affecting our land and water resources. The integration of these joint research efforts with findings from other thematic areas, e.g. in the field of optimized land management, deforestation and restoration, ecosystem stability and resilience, climate projections, food production and security, will allow for a better understanding and assessment of global change related environmental threats and resulting societal challenges in the Southern African region.

The implementation of integrated care: the empirical validation of the Development Model for Integrated Care

PubMed Central

2011-01-01

Background Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the integration of care. We have empirically validated this model in practice by assessing the relevance, implementation and plans of the elements in three integrated care service settings in The Netherlands: stroke, acute myocardial infarct (AMI), and dementia. Methods Based on the DMIC, a survey was developed for integrated care coordinators. We invited all Dutch stroke and AMI-services, as well as the dementia care networks to participate, of which 84 did (response rate 83%). Data were collected on relevance, presence, and year of implementation of the 89 elements. The data analysis was done by means of descriptive statistics, Chi Square, ANOVA and Kruskal-Wallis H tests. Results The results indicate that the integrated care practice organizations in all three care settings rated the nine clusters and 89 elements of the DMIC as highly relevant. The average number of elements implemented was 50 ± 18, 42 ± 13, and 45 ± 22 for stroke, acute myocardial infarction, and dementia care services, respectively. Although the dementia networks were significantly younger, their numbers of implemented elements were comparable to those of the other services. The analyses of the implementation timelines showed that the older integrated care services had fewer plans for further implementation than the younger ones. Integrated care coordinators stated that the DMIC helped them to assess their integrated care development in practice and supported them in obtaining ideas for expanding their integrated care activities. Conclusions Although the patient composites and the characteristics of the 84 participating integrated care services differed considerably, the results confirm that the clusters and the vast majority of DMIC elements are relevant to all three groups. Therefore, the DMIC can serve as a general quality management tool for integrated care. Applying the model in practice can help in steering further implementations as well as the development of new integrated care practices. PMID:21801428

The implementation of integrated care: the empirical validation of the Development Model for Integrated care.

PubMed

Minkman, Mirella M N; Vermeulen, Robbert P; Ahaus, Kees T B; Huijsman, Robbert

2011-07-30

Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the integration of care. We have empirically validated this model in practice by assessing the relevance, implementation and plans of the elements in three integrated care service settings in The Netherlands: stroke, acute myocardial infarct (AMI), and dementia. Based on the DMIC, a survey was developed for integrated care coordinators. We invited all Dutch stroke and AMI-services, as well as the dementia care networks to participate, of which 84 did (response rate 83%). Data were collected on relevance, presence, and year of implementation of the 89 elements. The data analysis was done by means of descriptive statistics, Chi Square, ANOVA and Kruskal-Wallis H tests. The results indicate that the integrated care practice organizations in all three care settings rated the nine clusters and 89 elements of the DMIC as highly relevant. The average number of elements implemented was 50 ± 18, 42 ± 13, and 45 ± 22 for stroke, acute myocardial infarction, and dementia care services, respectively. Although the dementia networks were significantly younger, their numbers of implemented elements were comparable to those of the other services. The analyses of the implementation timelines showed that the older integrated care services had fewer plans for further implementation than the younger ones. Integrated care coordinators stated that the DMIC helped them to assess their integrated care development in practice and supported them in obtaining ideas for expanding their integrated care activities. Although the patient composites and the characteristics of the 84 participating integrated care services differed considerably, the results confirm that the clusters and the vast majority of DMIC elements are relevant to all three groups. Therefore, the DMIC can serve as a general quality management tool for integrated care. Applying the model in practice can help in steering further implementations as well as the development of new integrated care practices.

Ecological approaches to human nutrition.

PubMed

DeClerck, Fabrice A J; Fanzo, Jessica; Palm, Cheryl; Remans, Roseline

2011-03-01

Malnutrition affects a large number of people throughout the developing world. Approaches to reducing malnutrition rarely focus on ecology and agriculture to simultaneously improve human nutrition and environmental sustainability. However, evidence suggests that interdisciplinary approaches that combine the knowledge bases of these disciplines can serve as a central strategy in alleviating hidden hunger for the world's poorest. To describe the role that ecological knowledge plays in alleviating hidden hunger, considering human nutrition as an overlooked ecosystem service. We review existing literature and propose a framework that expands on earlier work on econutrition. We provide novel evidence from case studies conducted by the authors in western Kenya and propose a framework for interdisciplinary collaboration to alleviate hidden hunger, increase agricultural productivity, and improve environmental sustainability. Our review supports the concept that an integrated approach will impact human nutrition. We provide evidence that increased functional agrobiodiversity can alleviate anemia, and interventions that contribute to environmental sustainability can have both direct and indirect effects on human health and nutritional well-being. Integrated and interdisciplinary approaches are critical to reaching development goals. Ecologists must begin to consider not only how their field can contribute to biodiversity conservation, but also, the relationship between biodiversity and provisioning of nontraditional ecosystem services such as human health. Likewise, nutritionists and agronomists must recognize that many of the solutions to increasing human wellbeing and health can best be achieved by focusing on a healthy environment and the conservation of ecosystem services.

Does it matter what you call it? A randomized trial of language used to describe palliative care services.

PubMed

Maciasz, R M; Arnold, R M; Chu, E; Park, S Y; White, D B; Vater, L B; Schenker, Y

2013-12-01

Integration of palliative care into oncology practice remains suboptimal. Misperceptions about the meaning of palliative care may negatively impact utilization. We assessed whether the term and/or description of palliative care services affected patient views. 2x2 between-subject randomized factorial telephone survey of 169 patients with advanced cancer. Patients were randomized into one of four groups that differed by name (supportive care vs. palliative care) and description (patient-centered vs. traditional). Main outcomes (0-10 Likert scale) were patient understanding, impressions, perceived need, and intended use of services. When compared to palliative care, the term supportive care was associated with better understanding (7.7 vs. 6.8; p = 0.021), more favorable impressions (8.4 vs. 7.3; p = 0.002), and higher future perceived need (8.6 vs. 7.7; p = 0.017). There was no difference in outcomes between traditional and patient-centered descriptions. In adjusted linear regression models, the term supportive care remained associated with more favorable impressions (p = 0.003) and higher future perceived need (p = 0.022) when compared to palliative care. Patients with advanced cancer view the name supportive care more favorably than palliative care. Future efforts to integrate principles of palliative medicine into oncology may require changing impressions of palliative care or substituting the term supportive care.

The Ultimate Big Data Enterprise Initiative: Defining Functional Capabilities for an International Information System (IIS) for Orbital Space Data (OSD)

NASA Astrophysics Data System (ADS)

Raygan, R.

Global collaboration in support of an International Information System (IIS) for Orbital Space Data (OSD) literally requires a global enterprise. As with many information technology enterprise initiatives attempting to coral the desires of business with the budgets and limitations of technology, Space Situational Awareness (SSA) includes many of the same challenges: 1) Adaptive / Intuitive Dash Board that facilitates User Experience Design for a variety of users. 2) Asset Management of hundreds of thousands of objects moving at thousands of miles per hour hundreds of miles in space. 3) Normalization and integration of diverse data in various languages, possibly hidden or protected from easy access. 4) Expectations of near real-time information availability coupled with predictive analysis to affect decisions before critical points of no return, such as Space Object Conjunction Assessment (CA). 5) Data Ownership, management, taxonomy, and accuracy. 6) Integrated metrics and easily modified algorithms for "what if" analysis. This paper proposes an approach to define the functional capabilities for an IIS for OSD. These functional capabilities not only address previously identified gaps in current systems but incorporate lessons learned from other big data, enterprise, and agile information technology initiatives that correlate to the space domain. Viewing the IIS as the "data service provider" allows adoption of existing information technology processes which strengthen governance and ensure service consumers certain levels of service dependability and accuracy.

The excess health care costs of KardioPro, an integrated care program for coronary heart disease prevention.

PubMed

Becker, Christian; Holle, Rolf; Stollenwerk, Björn

2015-06-01

Coronary heart disease (CHD) is a major cause of death and important driver of health care costs. Recent German health care reforms have promoted integrated care contracts allowing statutory health insurance providers more room to organize health care provision. One provider offers KardioPro, an integrated primary care-based CHD prevention program. As insurance providers should be aware of the financial consequences when developing optional programs, this study aims to analyze the costs associated with KardioPro participation. 13,264 KardioPro participants were compared with a propensity score-matched control group. Post-enrollment health care costs were calculated based on routine data over a follow-up period of up to 4 years. For those people who incurred costs, KardioPro participation was significantly associated with increased physician costs (by 33%), reduced hospital costs (by 19%), and reduced pharmaceutical costs (by 16%). Overall costs were increased by 4%, but this was not significant. Total excess costs per observation year were €131 per person (95% confidence interval: [€-36.5; €296]). Overall, KardioPro likely affected treatment as the program increased costs of physician services and reduced costs of hospital services. Further effects of substituting potential inpatient care with increased outpatient care might become fully apparent only over a longer time horizon. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Integrating Solar PV in Utility System Operations: Analytical Framework and Arizona Case Study

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

Wu, Jing; Botterud, Audun; Mills, Andrew

2015-06-01

A systematic framework is proposed to estimate the impact on operating costs due to uncertainty and variability in renewable resources. The framework quantifies the integration costs associated with subhourly variability and uncertainty as well as day-ahead forecasting errors in solar PV (photovoltaics) power. A case study illustrates how changes in system operations may affect these costs for a utility in the southwestern United States (Arizona Public Service Company). We conduct an extensive sensitivity analysis under different assumptions about balancing reserves, system flexibility, fuel prices, and forecasting errors. We find that high solar PV penetrations may lead to operational challenges, particularlymore » during low-load and high solar periods. Increased system flexibility is essential for minimizing integration costs and maintaining reliability. In a set of sensitivity cases where such flexibility is provided, in part, by flexible operations of nuclear power plants, the estimated integration costs vary between $1.0 and $4.4/MWh-PV for a PV penetration level of 17%. The integration costs are primarily due to higher needs for hour-ahead balancing reserves to address the increased sub-hourly variability and uncertainty in the PV resource. (C) 2015 Elsevier Ltd. All rights reserved.« less

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

ERIC Educational Resources Information Center

Spaulding, Michael

2013-01-01

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

Pollination and seed dispersal are the most threatened processes of plant regeneration

NASA Astrophysics Data System (ADS)

Neuschulz, Eike Lena; Mueller, Thomas; Schleuning, Matthias; Böhning-Gaese, Katrin

2016-07-01

Plant regeneration is essential for maintaining forest biodiversity and ecosystem functioning, which are globally threatened by human disturbance. Here we present the first integrative meta-analysis on how forest disturbance affects multiple ecological processes of plant regeneration including pollination, seed dispersal, seed predation, recruitment and herbivory. We analysed 408 pairwise comparisons of these processes between near-natural and disturbed forests. Human impacts overall reduced plant regeneration. Importantly, only processes early in the regeneration cycle that often depend on plant-animal interactions, i.e. pollination and seed dispersal, were negatively affected. Later processes, i.e. seed predation, recruitment and herbivory, showed overall no significant response to human disturbance. Conserving pollination and seed dispersal, including the animals that provide these services to plants, should become a priority in forest conservation efforts globally.

Customer Decision Making in Web Services with an Integrated P6 Model

NASA Astrophysics Data System (ADS)

Sun, Zhaohao; Sun, Junqing; Meredith, Grant

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

Federal Efforts to Define and Advance Telehealth—A Work in Progress

PubMed Central

Pruitt, Sherilyn; Jacobs, Jessica; Harris, Yael; Bott, David M.; Riley, William; Lamer, Christopher; Oliver, Anthony L.

2014-01-01

Abstract Background: The integration of telecommunications and information systems in healthcare is not new or novel; indeed, it is the current practice of medicine and has been an integral part of medicine in remote locations for several decades. The U.S. Government has made a significant investment, measured in hundreds of millions of dollars, and therefore has a strong presence in the integration of telehealth/telemedicine in healthcare. However, the terminologies and definitions in the lexicon vary across agencies and departments of the U.S. Government. The objective of our survey was to identify and evaluate the definitions of telehealth/telemedicine across the U.S. Government to provide a better understanding of what each agency or department means when it uses these terms. Methodology: The U.S. Government, under the leadership of the Health Resources and Services Administration in the U.S. Department of Health and Human Services, established the Federal Telemedicine (FedTel) Working Group, through which all members responded to a survey on each agency or department's definition and use of terms associated with telehealth. Results and Conclusions: Twenty-six agencies represented by more than 100 individuals participating in the FedTel Working Group identified seven unique definitions of telehealth in current use across the U.S. Government. Although many definitions are similar, there are nuanced differences that reflect each organization's legislative intent and the population they serve. These definitions affect how telemedicine has been or is being applied across the healthcare landscape, reflecting the U.S. Government's widespread and influential role in healthcare access and service delivery. The evidence base suggests that a common nomenclature for defining telemedicine may benefit efforts to advance the use of this technology to address the changing nature of healthcare and new demands for services expected as a result of health reform. PMID:24502793

Distributed spatial information integration based on web service

NASA Astrophysics Data System (ADS)

Tong, Hengjian; Zhang, Yun; Shao, Zhenfeng

2008-10-01

Spatial information systems and spatial information in different geographic locations usually belong to different organizations. They are distributed and often heterogeneous and independent from each other. This leads to the fact that many isolated spatial information islands are formed, reducing the efficiency of information utilization. In order to address this issue, we present a method for effective spatial information integration based on web service. The method applies asynchronous invocation of web service and dynamic invocation of web service to implement distributed, parallel execution of web map services. All isolated information islands are connected by the dispatcher of web service and its registration database to form a uniform collaborative system. According to the web service registration database, the dispatcher of web services can dynamically invoke each web map service through an asynchronous delegating mechanism. All of the web map services can be executed at the same time. When each web map service is done, an image will be returned to the dispatcher. After all of the web services are done, all images are transparently overlaid together in the dispatcher. Thus, users can browse and analyze the integrated spatial information. Experiments demonstrate that the utilization rate of spatial information resources is significantly raised thought the proposed method of distributed spatial information integration.

Distributed spatial information integration based on web service

NASA Astrophysics Data System (ADS)

Tong, Hengjian; Zhang, Yun; Shao, Zhenfeng

2009-10-01

Spatial information systems and spatial information in different geographic locations usually belong to different organizations. They are distributed and often heterogeneous and independent from each other. This leads to the fact that many isolated spatial information islands are formed, reducing the efficiency of information utilization. In order to address this issue, we present a method for effective spatial information integration based on web service. The method applies asynchronous invocation of web service and dynamic invocation of web service to implement distributed, parallel execution of web map services. All isolated information islands are connected by the dispatcher of web service and its registration database to form a uniform collaborative system. According to the web service registration database, the dispatcher of web services can dynamically invoke each web map service through an asynchronous delegating mechanism. All of the web map services can be executed at the same time. When each web map service is done, an image will be returned to the dispatcher. After all of the web services are done, all images are transparently overlaid together in the dispatcher. Thus, users can browse and analyze the integrated spatial information. Experiments demonstrate that the utilization rate of spatial information resources is significantly raised thought the proposed method of distributed spatial information integration.

Bringing ecosystem services into integrated water resources management.

PubMed

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

2013-11-15

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

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

ERIC Educational Resources Information Center

Baillie, Susan; And Others

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

Integrating nutrition services into primary care

PubMed Central

Crustolo, Anne Marie; Kates, Nick; Ackerman, Sari; Schamehorn, Sherri

2005-01-01

PROBLEM BEING ADDRESSED Nutrition services can have an important role in prevention and management of many conditions seen by family physicians, but access to these services in primary care is limited. OBJECTIVE OF PROGRAM To integrate specialized nutrition services into the offices of family physicians in Hamilton, Ont, in order to improve patient access to those services, to expand the range of problems seen in primary care, and to increase collaboration between family physicians and registered dietitians. PROGRAM DESCRIPTION Registered dietitians were integrated into the offices of 80 family physicians. In collaboration with physicians, they assessed, treated, and consulted on a variety of nutrition-related problems. A central management team coordinated the dietitians’ activities. CONCLUSION Registered dietitians can augment and complement family physicians’ activities in preventing, assessing, and treating nutrition-related problems. This model of shared care can be applied to integrating other specialized services into primary care practices. PMID:16805083

DISTANT EARLY WARNING SYSTEM for Tsunamis - A wide-area and multi-hazard approach

NASA Astrophysics Data System (ADS)

Hammitzsch, Martin; Lendholt, Matthias; Wächter, Joachim

2010-05-01

The DEWS (Distant Early Warning System) [1] project, funded under the 6th Framework Programme of the European Union, has the objective to create a new generation of interoperable early warning systems based on an open sensor platform. This platform integrates OGC [2] SWE [3] compliant sensor systems for the rapid detection of hazardous events, like earthquakes, sea level anomalies, ocean floor occurrences, and ground displacements in the case of tsunami early warning. Based on the upstream information flow DEWS focuses on the improvement of downstream capacities of warning centres especially by improving information logistics for effective and targeted warning message aggregation for a multilingual environment. Multiple telecommunication channels will be used for the dissemination of warning messages. Wherever possible, existing standards have been integrated. The Command and Control User Interface (CCUI), a rich client application based on Eclipse RCP (Rich Client Platform) [4] and the open source GIS uDig [5], integrates various OGC services. Using WMS (Web Map Service) [6] and WFS (Web Feature Service) [7] spatial data are utilized to depict the situation picture and to integrate a simulation system via WPS (Web Processing Service) [8] to identify affected areas. Warning messages are compiled and transmitted in the OASIS [9] CAP (Common Alerting Protocol) [10] standard together with addressing information defined via EDXL-DE (Emergency Data Exchange Language - Distribution Element) [11]. Internal interfaces are realized with SOAP [12] web services. Based on results of GITEWS [13] - in particular the GITEWS Tsunami Service Bus [14] - the DEWS approach provides an implementation for tsunami early warning systems but other geological paradigms are going to follow, e.g. volcanic eruptions or landslides. Therefore in future also multi-hazard functionality is conceivable. The specific software architecture of DEWS makes it possible to dock varying sensors to the system and to extend the CCUI with hazard specific functionality. The presentation covers the DEWS project, the system architecture and the CCUI in conjunction with details of information logistics. The DEWS Wide Area Centre connecting national centres to allow the international communication and warning exchange is presented also. REFERENCES: [1] DEWS, www.dews-online.org [2] OGC, www.opengeospatial.org [3] SWE, www.opengeospatial.org/projects/groups/sensorweb [4] Eclipse RCP, www.eclipse.org/home/categories/rcp.php [5] uDig, udig.refractions.net [6] WMS, www.opengeospatial.org/standards/wms [7] WFS, www.opengeospatial.org/standards/wfs [8] WPS, www.opengeospatial.org/standards/wps [9] OASIS, www.oasis-open.org [10] CAP, www.oasis-open.org/specs/#capv1.1 [11] EDXL-DE, www.oasis-open.org/specs/#edxlde-v1.0 [12] SOAP, www.w3.org/TR/soap [13] GITEWS (German Indonesian Tsunami Early Warning System) is a project of the German Federal Government to aid the recon¬struction of the tsunami-prone Indian Ocean region, www.gitews.org [14] The Tsunami Service Bus is the GITEWS sensor system integration platform offering standardised services for the detection and monitoring of tsunamis

Tackling community integration in mental health home visit integration in Finland.

PubMed

Raitakari, Suvi; Haahtela, Riikka; Juhila, Kirsi

2016-09-01

Integration - and its synonym inclusion - is emphasised in the western welfare states and in the European Union in particular. Integration is also a central topic in the social sciences and in current mental health and homelessness research and practice. As mental healthcare has shifted from psychiatric hospitals to the community, it has inevitably become involved with housing and integration issues. This article explores how community integration is understood and tackled in mental health floating support services (FSSs) and, more precisely, in service user-practitioner home visit interaction. The aim, through shedding light on how the idea of integration is present and discussed in front-line mental health practices, is to offer a 'template' on how we might, in a systematic and reflective way, develop community integration research and practice. The analysis is based on ethnomethodological and micro-sociological interaction research. The research settings are two FSSs located in a large Finnish city. The data contain 24 audio-recorded and transcribed home visits conducted in 2011 and 2012 with 16 different service users. The study shows how the participants in service user-practitioner interaction give meaning to community integration and make decisions about how it should (or should not) be enhanced in each individual case. This activity is called community integration work in action. Community integration work in action is based on various dimensions of integration: getting out of the house, participating in group activities and getting along with those involved in one's life and working life. Additionally, the analysis demonstrates how community integration work is accomplished by discursive devices (resistance, positioning, excuses and justifications, delicacy and advice-giving). The article concludes that community integration is about interaction: it is not only service users' individual challenge but also a social challenge, our challenge. © 2015 John Wiley & Sons Ltd.

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

PubMed

Walsh, A M

1998-01-01

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

Development of WMS Capabilities to Support NASA Disasters Applications and App Development

NASA Astrophysics Data System (ADS)

Bell, J. R.; Burks, J. E.; Molthan, A.; McGrath, K. M.

2013-12-01

During the last year several significant disasters have occurred such as Superstorm Sandy on the East coast of the United States, and Typhoon Bopha in the Phillipines, along with several others. In support of these disasters NASA's Short-term Prediction Research and Transition (SPoRT) Center delivered various products derived from satellite imagery to help in the assessment of damage and recovery of the affected areas. To better support the decision makers responding to the disasters SPoRT quickly developed several solutions to provide the data using open Geographical Information Service (GIS) formats. Providing the data in open GIS standard formats allowed the end user to easily integrate the data into existing Decision Support Systems (DSS). Both Tile Mapping Service (TMS) and Web Mapping Service (WMS) were leveraged to quickly provide the data to the end-user. Development of the deliver methodology allowed quick response to rapidly developing disasters and enabled NASA SPoRT to bring science data to decision makers in a successful research to operations transition.

Development of WMS Capabilities to Support NASA Disasters Applications and App Development

NASA Technical Reports Server (NTRS)

Bell, Jordan R.; Burks, Jason E.; Molthan, Andrew L.; McGrath, Kevin M.

2013-01-01

During the last year several significant disasters have occurred such as Superstorm Sandy on the East coast of the United States, and Typhoon Bopha in the Phillipines, along with several others. In support of these disasters NASA's Short-term Prediction Research and Transition (SPoRT) Center delivered various products derived from satellite imagery to help in the assessment of damage and recovery of the affected areas. To better support the decision makers responding to the disasters SPoRT quickly developed several solutions to provide the data using open Geographical Information Service (GIS) formats. Providing the data in open GIS standard formats allowed the end user to easily integrate the data into existing Decision Support Systems (DSS). Both Tile Mapping Service (TMS) and Web Mapping Service (WMS) were leveraged to quickly provide the data to the end-user. Development of the deliver methodology allowed quick response to rapidly developing disasters and enabled NASA SPoRT to bring science data to decision makers in a successful research to operations transition.

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

PubMed

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

2014-03-01

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

Structural integrity of engineering composite materials: a cracking good yarn.

PubMed

Beaumont, Peter W R; Soutis, Costas

2016-07-13

Predicting precisely where a crack will develop in a material under stress and exactly when in time catastrophic fracture of the component will occur is one the oldest unsolved mysteries in the design and building of large-scale engineering structures. Where human life depends upon engineering ingenuity, the burden of testing to prove a 'fracture safe design' is immense. Fitness considerations for long-life implementation of large composite structures include understanding phenomena such as impact, fatigue, creep and stress corrosion cracking that affect reliability, life expectancy and durability of structure. Structural integrity analysis treats the design, the materials used, and figures out how best components and parts can be joined, and takes service duty into account. However, there are conflicting aims in the complete design process of designing simultaneously for high efficiency and safety assurance throughout an economically viable lifetime with an acceptable level of risk. This article is part of the themed issue 'Multiscale modelling of the structural integrity of composite materials'. © 2016 The Author(s).

State of knowledge about energy development impacts on North American rangelands: An integrative approach.

PubMed

Kreuter, Urs P; Iwaasa, Alan D; Theodori, Gene L; Ansley, R James; Jackson, Robert B; Fraser, Lauchlan H; Naeth, M Anne; McGillivray, Susan; Moya, Edmundo Garcia

2016-09-15

To reduce dependence on foreign oil reserves, there has been a push in North America to develop alternative domestic energy resources. Relatively undeveloped renewable energy resources include biofuels and wind and solar energy, many of which occur predominantly on rangelands. Rangelands are also key areas for natural gas development from shales and tight sand formations. Accordingly, policies aimed at greater energy independence are likely to affect the delivery of crucial ecosystem services provided by rangelands. Assessing and dealing with the biophysical and socio-economic effects of energy development on rangeland ecosystems require an integrative and systematic approach that is predicated on a broad understanding of diverse issues related to energy development. In this article, we present a road map for developing an integrative assessment of energy development on rangelands in North America. We summarize current knowledge of socio-economic and biophysical aspects of rangeland based energy development, and we identify knowledge gaps and monitoring indicators to fill these knowledge gaps. Copyright © 2016 Elsevier Ltd. All rights reserved.

Social integration and age-related decline in lung function.

PubMed

Crittenden, Crista N; Murphy, Michael L M; Cohen, Sheldon

2018-05-01

We tested the hypothesis that social integration, measured as number of social roles, is associated with less age-related loss of lung function, an important marker of health and longevity. We also investigated possible psychological factors through which social integration might influence lung health. Data were analyzed from the Health and Retirement Study (ages 52-94, n = 4,224). Each additional social role reported at baseline was associated with less of a decline in lung function between baseline and the follow-up assessment four years later. The association withstood controls for demographics, weight, and height and was mediated by more positive and less negative affect and lower rates of cigarette smoking and more physical activity. Roles were mostly substitutable, with both high (spouse, parent, friends, relatives) and low (employee, religious service attendee, volunteer, members of other groups) intimacy roles independently contributing to less age-related decline in lung function. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Map as a Service: A Framework for Visualising and Maximising Information Return from Multi-Modal Wireless Sensor Networks

PubMed Central

Hammoudeh, Mohammad; Newman, Robert; Dennett, Christopher; Mount, Sarah; Aldabbas, Omar

2015-01-01

This paper presents a distributed information extraction and visualisation service, called the mapping service, for maximising information return from large-scale wireless sensor networks. Such a service would greatly simplify the production of higher-level, information-rich, representations suitable for informing other network services and the delivery of field information visualisations. The mapping service utilises a blend of inductive and deductive models to map sense data accurately using externally available knowledge. It utilises the special characteristics of the application domain to render visualisations in a map format that are a precise reflection of the concrete reality. This service is suitable for visualising an arbitrary number of sense modalities. It is capable of visualising from multiple independent types of the sense data to overcome the limitations of generating visualisations from a single type of sense modality. Furthermore, the mapping service responds dynamically to changes in the environmental conditions, which may affect the visualisation performance by continuously updating the application domain model in a distributed manner. Finally, a distributed self-adaptation function is proposed with the goal of saving more power and generating more accurate data visualisation. We conduct comprehensive experimentation to evaluate the performance of our mapping service and show that it achieves low communication overhead, produces maps of high fidelity, and further minimises the mapping predictive error dynamically through integrating the application domain model in the mapping service. PMID:26378539

Integrated socio-environmental modelling: A test case in coastal Bangladesh

NASA Astrophysics Data System (ADS)

Lazar, Attila

2013-04-01

Delta regions are vulnerable with their populations and ecosystems facing multiple threats in the coming decades through extremes of poverty, environmental and ecological stress and land degradation. External and internal processes initiate these threats/changes and results in for example water quality and health risk issues, declining agricultural productivity and sediment starvation all of which directly affecting the local population. The ESPA funded "Assessing Health, Livelihoods, Ecosystem Services and Poverty Alleviation In Populous Deltas" project (2012-16) aims to provide policy makers with the knowledge and tools to enable them to evaluate the effects of policy decisions on people's livelihoods. It considers coastal Bangladesh in the Ganges-Brahmaputra-Meghna Delta: one of the world's most dynamic and significant deltas. This is being done by a multidisciplinary and multinational team of policy analysts, social and natural scientists and engineers using a participatory, holistic approach to formally evaluate ecosystem services and poverty in the context of the wide range of changes that are occurring. An integrated model with relevant feedbacks is being developed to explore options for management strategies and policy formulation for ecosystem services, livelihoods and health in coastal Bangladesh. This requires the continuous engagement with stakeholders through the following steps: (1) system characterisation, (2) research question definition, (3) data and model identification, (4) model validation and (5) model application. This presentation will focus on the first three steps. Field-based social science and governance related research are on the way. The bio-physical models have been selected and some are already set up for the study area. These allow preliminary conceptualisation of the elements and linkages of the deltaic socio-environmental system and thus the preliminary structure of the integrated model. This presentation describes these steps though the coastal Bangladesh test case.

Containment and storage of uranium hexafluoride at US Department of Energy uranium enrichment plants

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

Barlow, C.R.; Alderson, J.H.; Blue, S.C.

Isotopically depleted UF{sub 6} (uranium hexafluoride) accumulates at a rate five to ten times greater than the enriched product and is stored in steel vessels at the enrichment plant sites. There are approximately 55,000 large cylinders now in storage at Paducah, Kentucky; Portsmouth, Ohio; and Oak Ridge, Tennessee. Most of them contain a nominal 14 tons of depleted UF{sub 6}. Some of these cylinders have been in the unprotected outdoor storage environment for periods approaching 40 years. Storage experience, supplemented by limited corrosion data, suggests a service life of about 70 years under optimum conditions for the 48-in. diameter, 5/16-in.-wallmore » pressure vessels (100 psi working pressure), using a conservative industry-established 1/4-in.-wall thickness as the service limit. In the past few years, however, factors other than atmospheric corrosion have become apparent that adversely affect the serviceability of small numbers of the storage containers and that indicate the need for a managed program to ensure maintenance ofcontainment integrity for all the cylinders in storage. The program includes periodic visual inspections of cylinders and storage yards with documentation for comparison with other inspections, a group of corrosion test programs to permit cylinder life forecasts, and identification of (and scheduling for remedial action) situations in which defects, due to handling damage or accelerated corrosion, can seriously shorten the storage life or compromise the containment integrity of individual cylinders. The program also includes rupture testing to assess the effects of certain classes of damage on overall cylinder strength, aswell as ongoing reviews of specifications, procedures, practices, and inspection results to effect improvements in handling safety, containment integrity, and storage life.« less

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

PubMed Central

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

2014-01-01

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

A discrete event simulation model to evaluate the use of community services in the treatment of patients with Parkinson's disease in the United Kingdom.

PubMed

Lebcir, Reda; Demir, Eren; Ahmad, Raheelah; Vasilakis, Christos; Southern, David

2017-01-18

The number of people affected by Parkinson's disease (PD) is increasing in the United Kingdom driven by population ageing. The treatment of the disease is complex, resource intensive and currently there is no known cure to PD. The National Health Service (NHS), the public organisation delivering healthcare in the UK, is under financial pressures. There is a need to find innovative ways to improve the operational and financial performance of treating PD patients. The use of community services is a new and promising way of providing treatment and care to PD patients at reduced cost than hospital care. The aim of this study is to evaluate the potential operational and financial benefits, which could be achieved through increased integration of community services in the delivery of treatment and care to PD patients in the UK without compromising care quality. A Discrete Event Simulation model was developed to represent the PD care structure including patients' pathways, treatment modes, and the mix of resources required to treat PD patients. The model was parametrised with data from a large NHS Trust in the UK and validated using information from the same trust. Four possible scenarios involving increased use of community services were simulated on the model. Shifting more patients with PD from hospital treatment to community services will reduce the number of visits of PD patients to hospitals by about 25% and the number of PD doctors and nurses required to treat these patients by around 32%. Hospital based treatment costs overall should decrease by 26% leading to overall savings of 10% in the total cost of treating PD patients. The simulation model was useful in predicting the effects of increased use of community services on the performance of PD care delivery. Treatment policies need to reflect upon and formalise the use of community services and integrate these better in PD care. The advantages of community services need to be effectively shared with PD patients and carers to help inform management choices and care plans.

Evaluating Ecosystem Services for Reducing Groundwater Nitrate Contamination: Nitrate Attenuation in the Unsaturated and Saturated Zones

NASA Astrophysics Data System (ADS)

Wang, J.

2013-12-01

Nitrates are the most common type of groundwater contamination in agricultural regions. Environmental policies targeting nitrates have focused on input control (e.g., restricted fertilizer application), intermediate loads control (e.g., reduce nitrate leached from crop fields), and final loads control (e.g., reduce catchment nitrate loads). Nitrate loads can be affected by hydrological processes in both unsaturated and saturated zones. Although many of these processes have been extensively investigated in literature, they are commonly modeled as exogenous to farm management. A couple of recent studies by scientists from the Lawrence Livermore National Laboratory show that in some situations nitrate attenuation processes in the unsaturated/saturated zone, particularly denitrification, can be intensified by certain management practices to mitigate nitrate loads. Therefore, these nitrate attenuation processes can be regarded as a set of ecosystem services that farmers can take advantage of to reduce their cost of complying with environmental policies. In this paper, a representative California dairy farm is used as a case study to show how such ecosystem attenuation services can be framed within the farm owner's decision-making framework as an option for reducing groundwater nitrate contamination. I develop an integrated dynamic model, where the farmer maximizes discounted net farm profit over multiple periods subject to environmental regulations. The model consists of three submodels: animal-waste-crop, hydrologic, and economic model. In addition to common choice variables such as irrigation, fertilization, and waste disposal options, the farmer can also endogenously choose from three water sources: surface water, deep groundwater (old groundwater in the deep aquifer that is not affected by farm effluent in the short term), and shallow groundwater (drainage water that can be recycled via capture wells at the downstream end of the farm). The capture wells not only recycle wastewater, but can also increase the likelihood of denitrification. Thus the farmer essentially can choose whether, and to which extent, to install capture wells and take advantage of the ecosystem attenuation services. Decision rules from the dynamic optimization model demonstrate best management practices for the farm to improve its economic and environmental performance. I further use an economic valuation technique to value these services. Under the Millennium Ecosystem Assessment framework, nitrate attenuation in the unsaturated and saturated zone provides regulatory ecosystem services to humans, mainly nutrient regulation and waste treatment. With the integrated farm model, the production function approach is adopted to get the economic value of these regulatory services. The results highlight the significant role the environment can play in nitrate pollution control and potential benefits from designing policies that acknowledge this role. The most desirable policies are those that create incentive for farmers to use potential ecosystem services, which significantly reduce environmental compliance costs and increase social welfare.

Wellness Centre: An Evidence-Guided Approach to Delivering Culturally Relevant Community Psychogeriatric Services for Chinese Elders

PubMed Central

Chan, Kar C.; Sadavoy, Joel

2012-01-01

Ethnic elders are commonly reluctant to access mental health services and their mental health problems are often overlooked and detected late in the course of illness. Prior studies identified major barriers to ethnic seniors accessing appropriate mental health care demonstrating that language and cultural beliefs cannot be ignored if effective mental health services are to be provided to patients from diverse cultural groups. These are particularly important when care is needed by less acculturated immigrant ethnic seniors for whom language barriers are often greatest. Differences in conceptions of mental distress affect ethnic seniors' choice of help-seeking and often discourage or divert aged persons from utilizing mainstream conventional psychiatric care. Despite the extensive need for appropriate service models for ethnic populations, there have been limited data and models to illustrate how these programs can be systematically and effectively integrated within the mainstream mental health service framework. This paper describes an innovative, mainstream, community-based psychogeriatric service delivery model developed for Chinese seniors in Toronto, Canada, aiming at improving their access to care and enhancing earlier mental health problem detection. The important concepts and strategies of designing and operating a culturally acceptable program are illustrated supported by program data and the challenges analyzed. PMID:23762771

Teaching Advanced Leadership Skills in Community Service (ALSCS) to medical students.

PubMed

Goldstein, Adam O; Calleson, Diane; Bearman, Rachel; Steiner, Beat D; Frasier, Pamela Y; Slatt, Lisa

2009-06-01

Inadequate access to health care, lack of health insurance, and significant health disparities reflect crises in health care affecting all of society. Training U.S. physicians to possess not only clinical expertise but also sufficient leadership skills is essential to solve these problems and to effectively improve health care systems. Few models in the undergraduate medical curriculum exist for teaching students how to combine needed leadership competencies with actual service opportunities.The Advanced Leadership Skills in Community Service (ALSCS) selective developed in response to the shortage of leadership models and leadership training for medical students. The ALSCS selective is designed specifically to increase students' leadership skills, with an emphasis on community service. The selective integrates classroom-based learning, hands-on application of learned skills, and service learning. More than 60 medical students have participated in the selective since inception. Short-term outcomes demonstrate an increase in students' self-efficacy around multiple dimensions of leadership skills (e.g., fundraising, networking, motivating others). Students have also successfully completed more than a dozen leadership and community service projects. The selective offers an innovative model of a leadership-skills-based course that can have a positive impact on leadership skill development among medical school students and that can be incorporated into the medical school curriculum.

Interaction complexity matters: disentangling services and disservices of ant communities driving yield in tropical agroecosystems

PubMed Central

Wielgoss, Arno; Tscharntke, Teja; Rumede, Alfianus; Fiala, Brigitte; Seidel, Hannes; Shahabuddin, Saleh; Clough, Yann

2014-01-01

Owing to complex direct and indirect effects, impacts of higher trophic levels on plants is poorly understood. In tropical agroecosystems, ants interact with crop mutualists and antagonists, but little is known about how this integrates into the final ecosystem service, crop yield. We combined ant exclusion and introduction of invasive and native-dominant species in cacao agroecosystems to test whether (i) ant exclusion reduces yield, (ii) dominant species maximize certain intermediate ecosystem services (e.g. control of specific pests) rather than yield, which depends on several, cascading intermediate services and (iii) even, species-rich ant communities result in highest yields. Ants provided services, including reduced leaf herbivory and fruit pest damage and indirect pollination facilitation, but also disservices, such as increased mealybug density, phytopathogen dissemination and indirect pest damage enhancement. Yields were highest with unmanipulated, species-rich, even communities, whereas ant exclusion decreased yield by 27%. Introduction of an invasive-dominant ant decreased species density and evenness and resulted in 34% lower yields, whereas introduction of a non-invasive-dominant species resulted in similar species density and yields as in the unmanipulated control. Species traits and ant community structure affect services and disservices for agriculture in surprisingly complex ways, with species-rich and even communities promoting highest yield. PMID:24307667

Mapping Stormwater Retention in the Cities: A Flexible Model for Data-Scarce Environments

NASA Astrophysics Data System (ADS)

Hamel, P.; Keeler, B.

2014-12-01

There is a growing demand for understanding and mapping urban hydrological ecosystem services, including stormwater retention for flood mitigation and water quality improvement. Progress in integrated urban water management and low impact development in Western countries increased our understanding of how grey and green infrastructure interact to enhance these services. However, valuation methods that account for a diverse group of beneficiaries are typically not made explicit in urban water management models. In addition, the lack of spatial data on the stormwater network in developing countries makes it challenging to apply state-of-the-art models needed to understand both the magnitude and spatial distribution of the stormwater retention service. To fill this gap, we designed the Urban InVEST stormwater retention model, a tool that complements the suite of InVEST software models to quantify and map ecosystem services. We present the model structure emphasizing the data requirements from a user's perspective and the representation of services and beneficiaries. We illustrate the model application with two case studies in a data-rich (New York City) and data-scarce environment. We discuss the difference in the level of information obtained when less resources (data, time, or expertise) are available, and how this affects multiple ecosystem service assessments that the tool is ultimately designed for.

Colombian health care system: results on equity for five health dimensions, 2003-2008.

PubMed

Ruiz Gómez, Fernando; Zapata Jaramillo, Teana; Garavito Beltrán, Liz

2013-02-01

To assess the change in five health equity dimensions for the Colombian health system: health condition, social health insurance coverage, health services utilization, quality, and health expenditure. A common standardization methodology was used to assess equity in countries in the western hemisphere. Data come from the Colombian Life Quality Survey. After indirect standardization, concentration indices and horizontal inequity were estimated. A decomposition analysis was developed. Aggregate household monthly expenditure per equivalent adult was considered as the standard of living. Results show important progress in equity with regard to social health insurance affiliation, access to medicine and curative services, and perception of the quality of health care service. Important gaps persist, which affect poorer populations, especially their perception of having a bad health condition and their access to preventive medical and dental services. The Colombian model needs to advance in implementing preventive public health strategies to cope with increasing demand concomitant with increased social insurance coverage. The population's access to total services in cases of chronic illness and oral health services must increase and benefit plans must be integrated while preserving the recorded achievements in equity. Decomposition of the concentration index shows that inequities are mostly explained by socioeconomic variables and not by health-related factors.

Military Youth and the Deployment Cycle: Emotional Health Consequences and Recommendations for Intervention

PubMed Central

Esposito-Smythers, Christianne; Wolff, Jennifer; Lemmon, Keith M.; Bodzy, Mary; Swenson, Rebecca R.; Spirito, Anthony

2011-01-01

The United States military force includes over 2.2 million volunteer service members. Three out of five service members who are deployed or are preparing for deployment have spouses and/or children. Stressors associated with the deployment cycle can lead to depression, anxiety, and behavior problems in children, as well as psychological distress in the military spouse. Further, the emotional and behavioral health of family members can affect the psychological functioning of the military service member during the deployment and re-integration periods. Despite widespread acknowledgement of the need for emotional and behavioral health services for youth from military families, many professionals in a position to serve them struggle with how to best respond and select appropriate interventions. The purpose of this paper is to provide an empirically-based and theoretically informed review to guide service provision and the development of evidence based treatments for military youth in particular. This review includes an overview of stressors associated with the deployment cycle, emotional and behavioral health consequences of deployment on youth and their caretaking parent, and existing preventative and treatment services for youth from military families. It concludes with treatment recommendations for older children and adolescents experiencing emotional and behavioral health symptoms associated with the deployment cycle. PMID:21707172

Impact of measles supplementary immunisation activities on utilisation of maternal and child health services in low-income and middle-income countries.

PubMed

Postolovska, Iryna; Helleringer, Stéphane; Kruk, Margaret E; Verguet, Stéphane

2018-01-01

Measles supplementary immunisation activities (SIAs) are an integral component of measles elimination in low-income and middle-income countries (LMICs). Despite their success in increasing vaccination coverage, there are concerns about their negative consequences on routine services. Few studies have conducted quantitative assessments of SIA impact on utilisation of health services. We analysed the impact of SIAs on utilisation of selected maternal and child health services using Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 28 LMICs, where at least one SIA occurred over 2000-2014. Logistic regressions were conducted to investigate the association between SIAs and utilisation of the following services: facility delivery, postnatal care and outpatient sick child care (for fever, diarrhoea, cough). SIAs do not appear to significantly impact utilisation of maternal and child services. We find a reduction in care-seeking for treatment of child cough (OR 0.67; 95% CI 0.48 to 0.95); and a few significant effects at the country level, suggesting the need for further investigation of the idiosyncratic effects of SIAs in each country. The paper contributes to the debate on vertical versus horizontal programmes to ensure universal access to vaccination. Measles SIAs do not seem to affect care-seeking for critical conditions.

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

PubMed

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

2012-12-01

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

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.

Integrating Prevention of Mother to Child HIV Transmission competencies into the nursing curriculum: Methodological lessons from a university-based undergraduate programme.

PubMed

Mbombo, Nomafrench; Bimerew, Million

2012-11-14

South Africa (SA) has the highest number of women infected with HIV and AIDS during pregnancy, which results in more than 70 000 infected babies being born each year AIDS is the major contributor to maternal and child morbidities and mortalities in the country. To combat this, the SA government has developed a national policy to prevent mother-to-child HIV transmission (PMTCT). However, for effective implementation of this policy, there is a dire need for a competent, skilled health worker to render the service. In response to this, the School of Nursing at the University of the Western Cape has integrated PMTCT competencies into the undergraduate Bachelor of Nursing Science curriculum. In this paper, we described teaching and learning approaches used to integrate PMTCT competencies, including the skills laboratory methodology and case-based learning, as well as a portfolio of evidence assessment tool. A quantitative descriptive design was used to analyse data collected from students in regard to assessment of PMTCT competencies achieved. The study used the conceptual framework of Lenburg's competency outcomes and performance assessment model, which focuses on competency development and assessment in a clinical environment. HIV competencies, including PMTCT, should be integrated both theoretically and at service delivery into other nursing and midwifery competencies, including assessment strategies. Provincial policies in provision of antiretrovirals by nurses and midwives become barriers to successful implementation of PMTCT, resulting in limited learning opportunities for students to practice PMTCT competencies. Further research is required to assess an attribute, affect, which is another prong for competencies.

From SARS to strategic actions reframing systems.

PubMed

Macdonald, Marilyn T

2004-09-01

The developed world responds to new and re-emerging diseases through the discovery of medications. Disease can be transmitted around the world in a day, but the development of medications does not occur at this rate. The world has one environment and the focus in health care must be on identifying factors in this environment that coalesce to produce disease. The aim of this paper is to introduce the integrative model of environmental health and explore its potential to illuminate the Toronto SARS experience. SARS affected people on three continents in a matter of days. Response to this new disease varied from one area to another and was dependent upon the level of integration of health services and communication across services. The present focus of the health care system is on treating the results of disease rather than the causative factors. Reacting to a new disease had grave social and economic consequences. The time for a new global environmental approach to health is now. The Toronto SARS experience was examined using the integrative model of environmental health and the upstream perspective as exemplars to interrupt the traditional approach to disease. All health care providers share the responsibility to learn about and to understand how our environment creates disease. This knowledge comes through research on topics such as; chemicals, pesticides, soil erosion, killing of forests, contamination of water, destabilization of climate, and social disruption from wars. Health care systems in the developed world continue to focus on the treatment of disease. A global ecological initiative for an integrated disease prevention system must be negotiated among nations.

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

ERIC Educational Resources Information Center

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

2016-01-01

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

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

PubMed

Bates, Jason; Sharratt, Martin; King, John

2014-01-01

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

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

ERIC Educational Resources Information Center

Stoops, Jack W.; Hull, Janis L.

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-02

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

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

ERIC Educational Resources Information Center

Beschorner, Beth; Kruse, Jerrid

2016-01-01

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

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

ERIC Educational Resources Information Center

Shaqour, Ali Zuhdi H.

2005-01-01

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

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

ERIC Educational Resources Information Center

Robinson, Mark; Atkinson, Mary; Downing, Dick

2008-01-01

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

Psychosocial impact of visual impairment and coping strategies in female ex-Service personnel.

PubMed

Stevelink, Sharon A M; Fear, N T

2016-04-01

To examine how vision loss affects the psychosocial well-being of female ex-Service personnel and how they cope with their visual impairment. A cross-sectional study was conducted consisting of two study phases. During phase 1, a questionnaire was undertaken via the telephone with nine female ex-Service personnel (all under 55 years of age) using clinical screening measures to identify the probable presence of the following mental health disorders: depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder Assessment), post-traumatic stress disorder (PTSD, PTSD Checklist-Civilian) and alcohol misuse (Alcohol Use Disorders Identification Test). In phase 2, eight of the participants were interviewed face to face regarding the impact being visually impaired had had on their daily lives. Approximately 1 in 10 women screened positive for probable depression, probable PTSD or alcohol misuse; 1 in 5 fulfilled the criteria for probable anxiety disorder. Participants struggled to adjust to the loss of vision and its impact on their lives. They reported low self-esteem, feeling down and social withdrawal. As time went by, the women were able to apply various coping strategies such as having a positive attitude, relearning skills and integrating low vision aids in their daily routine. However, some coping strategies, such as alcohol misuse and lack of help-seeking when needed, hindered participants' success in adjusting to their visual impairment. Sustaining a visual impairment negatively affects psychosocial well-being in female ex-Service personnel. Over time, participants learnt to cope with the challenges and limitations associated with being visually impaired. 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/

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

NASA Astrophysics Data System (ADS)

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

2015-01-01

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

Behavioral Health Integration in Large Multi-group Pediatric Practice.

PubMed

Schlesinger, Abigail Boden

2017-03-01

There is increasing interest in methods to improve access to behavioral health services for children and adolescents. Children's Community Pediatric Behavioral Health Service (CCPBHS) is an integrated behavioral health service whose method of (a) creating a leadership team with empowered administrative and clinical stakeholders who can act on a commitment to change and (b) having a clear mission statement with integrated administrative and clinical care processes can serve as a model for implementing integration efforts within the medical home. Community Pediatrics Behavioral Health Service (CPBHS) is a sustainable initiative that improved the utilization of physical health and behavioral health systems for youth and improved the utilization of evidence-based interventions for youth served in primary care.

Integrated Employee Assistance Program/Managed Behavioral Healthcare Benefits: Relationship with Access and Client Characteristics

PubMed Central

Merrick, Elizabeth S. Levy; Hodgkin, Dominic; Horgan, Constance M.; Hiatt, Deirdre; McCann, Bernard; Azzone, Vanessa; Zolotusky, Galina; Ritter, Grant; Reif, Sharon; McGuire, Thomas G.

2009-01-01

This study examined service user characteristics and determinants of access for enrollees in integrated EAP/behavioral health versus standard managed behavioral health care plans. A national managed behavioral health care organization’s claims data from 2004 were used. Integrated plan service users were more likely to be employees rather than dependents, and to be diagnosed with adjustment disorder. Logistic regression analyses found greater likelihood in integrated plans of accessing behavioral health services (OR 1.20, CI 1.17–1.24), and substance abuse services specifically (OR 1.23, CI 1.06–1.43). Results are consistent with the concept that EAP benefits may increase access and address problems earlier. PMID:19690952

Integrated employee assistance program/managed behavioral health care benefits: relationship with access and client characteristics.

PubMed

Levy Merrick, Elizabeth S; Hodgkin, Dominic; Horgan, Constance M; Hiatt, Deirdre; McCann, Bernard; Azzone, Vanessa; Zolotusky, Galina; Ritter, Grant; Reif, Sharon; McGuire, Thomas G

2009-11-01

This study examined service user characteristics and determinants of access for enrollees in integrated EAP/behavioral health versus standard managed behavioral health care plans. A national managed behavioral health care organization's claims data from 2004 were used. Integrated plan service users were more likely to be employees rather than dependents, and to be diagnosed with adjustment disorder. Logistic regression analyses found greater likelihood in integrated plans of accessing behavioral health services (OR 1.20, CI 1.17-1.24), and substance abuse services specifically (OR 1.23, CI 1.06-1.43). Results are consistent with the concept that EAP benefits may increase access and address problems earlier.

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

PubMed

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

1999-08-01

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

Flood Warning and Forecasting System in Slovakia

NASA Astrophysics Data System (ADS)

Leskova, Danica

2016-04-01

In 2015, it finished project Flood Warning and Forecasting System (POVAPSYS) as part of the flood protection in Slovakia till 2010. The aim was to build POVAPSYS integrated computerized flood forecasting and warning system. It took a qualitatively higher level of output meteorological and hydrological services in case of floods affecting large territorial units, as well as local flood events. It is further unfolding demands on performance and coordination of meteorological and hydrological services, troubleshooting observation, evaluation of data, fast communication, modeling and forecasting of meteorological and hydrological processes. Integration of all information entering and exiting to and from the project POVAPSYS provides Hydrological Flood Forecasting System (HYPOS). The system provides information on the current hydrometeorological situation and its evolution with the generation of alerts and notifications in case of exceeding predefined thresholds. HYPOS's functioning of the system requires flawless operability in critical situations while minimizing the loss of its key parts. HYPOS is a core part of the project POVAPSYS, it is a comprehensive software solutions based on a modular principle, providing data and processed information including alarms, in real time. In order to achieve full functionality of the system, in proposal, we have put emphasis on reliability, robustness, availability and security.

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

PubMed

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

2018-01-01

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

The application of epidemiology in national veterinary services: Challenges and threats in Brazil.

PubMed

Gonçalves, Vitor Salvador Picão; de Moraes, Geraldo Marcos

2017-02-01

The application of epidemiology in national veterinary services must take place at the interface between science and politics. Animal health policy development and implementation require attention to macro-epidemiology, the study of economic, social and policy inputs that affect the distribution and impact of animal or human disease at the national level. The world has changed fast over the last three decades including the delivery of veterinary services, their remit and the challenges addressed by public and animal health policies. Rethinking the role of public services and how to make public programs more efficient has been at the heart of the political discussion. The WTO through its SPS Agreement has changed the way in which national veterinary services operate and how trade decisions are made. Most low and middle income countries are still struggling to keep up with the new international scene. Some of these countries, such as Brazil, have very important livestock industries and are key to the global food systems. Over the last two decades, Brazil became a leading player in exports of livestock products, including poultry, and this created a strong pressure on the national veterinary services to respond to trade demands, leading to focus animal health policies on the export-driven sector. During the same period, Brazil has gone a long way in the direction of integrating epidemiology with veterinary services. Epidemiology groups grew at main universities and have been working with government to provide support to animal health policy. The scope and quality of the applied epidemiological work improved and focused on complex data analysis and development of technologies and tools to solve specific disease problems. Many public veterinary officers were trained in modern epidemiological methods. However, there are important institutional bottlenecks that limit the impact of epidemiology in evidence-based decision making. More complex challenges require high levels of expertise in veterinary epidemiology, as well as institutional models that provide an appropriate environment for building and sustaining capacity in national veterinary services. Integrating epidemiology with animal health policy is a great opportunity if epidemiologists can understand the real issues, including the socio-economic dimensions of disease management, and focus on innovation and production of knowledge. It may be a trap if epidemiologists are restricted to answering specific decision-making questions and policy makers perceive their role exclusively as data analysts or providers of technological solutions. Fostering solutions for complex issues is key to successful integration with policy making. Copyright © 2016 Elsevier B.V. All rights reserved.

The Core Services of the European Plate Observing System (EPOS)

NASA Astrophysics Data System (ADS)

Hoffmann, T. L.; Euteneuer, F. H.; Lauterjung, J.

2013-12-01

The ESFRI project European Plate Observing System (EPOS) was launched in November 2010 and has now completed its year 3 of the four-year preparatory phase. EPOS will create a single sustainable, permanent observation infrastructure, integrating existing geophysical monitoring networks, local observatories and experimental laboratories in Europe and adjacent regions. EPOS' technical Work Package 6 has developed a three layer architectural model for the construction of the EPOS Core Services (CS) during the subsequent implementation phase. The Poster will present and detail on these three layers, consisting of the EPOS Integrated Core Services (ICS), the Thematic Core Services (TCS) and the existing National Research Infrastructures & Data Centers. The basic layer of the architecture is established by the National Research Infrastructures (RIs) & Data Centers, which generate data and information and are responsible for the operation of the instrumentation. National RIs will provide their data to the Thematic Cores Services. The Thematic Core Services constitute the community layer of EPOS architecture and they will: 1) consist of existing (e.g. ORFEUS, EMSC), developing (e.g. EUREF/GNSS) or still to be developed Service Providers for specific thematic communities, as represented within EPOS through the technical EPOS Working Groups (e.g., seismology, volcanology, geodesy, geology, analytic labs for rock physics, geomagnetism, geo-resources ... and many others), 2) provide data services to specific communities, 3) link the National Research Infrastructures to the EPOS Integrated Services, 4) include Service Providers (e.g. OneGeology+, Intermagnet) that may be merely linked or partially integrated and 5) consist of Integrated Laboratories and RIs spanning multiple EPOS disciplines and taking advantage of other existing Thematic Services. The EPOS Integrated Services constitute the ICT layer of the EPOS portal and they will: 1) provide access to multidisciplinary data from different EPOS Thematic Core Services and from the National RIs & Data Centers, 2) provide access to data products, synthetic data from simulations, data processing and data visualization tools, 3) serve science, industry, education, government, legal and other stakeholders in an integrated fashion through the EPOS User Interface, and 4) provide a variety of ICT technological services including (but not being limited) to discovery functions, data mining, access to modeling tools and high performance computing, and training & tutorials.

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

PubMed

Sutherland, Ross

2012-01-01

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

Effects of ship-induced waves on aquatic ecosystems.

PubMed

Gabel, Friederike; Lorenz, Stefan; Stoll, Stefan

2017-12-01

Most larger water bodies worldwide are used for navigation, and the intensity of commercial and recreational navigation is expected to further increase. Navigation profoundly affects aquatic ecosystems. To facilitate navigation, rivers are trained and developed, and the direct effects of navigation include chemical and biological impacts (e.g., inputs of toxic substances and dispersal of non-native species, respectively). Furthermore, propagating ships create hydrodynamic alterations, often simply summarized as waves. Although ship-induced waves are recognized as influential stressors, knowledge on their effects is poorly synthesized. We present here a review on the effects of ship-induced waves on the structure, function and services of aquatic ecosystems based on more than 200 peer reviewed publications and technical reports. Ship-induced waves act at multiple organizational levels and different spatial and temporal scales. All the abiotic and biotic components of aquatic ecosystems are affected, from the sediment and nutrient budget to the planktonic, benthic and fish communities. We highlight how the effects of ship-induced waves cascade through ecosystems and how different effects interact and feed back into the ecosystem finally leading to altered ecosystem services and human health effects. Based on this synthesis of wave effects, we discuss strategies for mitigation. This may help to develop scientifically based and target-oriented management plans for navigational waters that optimize abiotic and biotic integrity and their ecosystem services and uses. Copyright © 2017 Elsevier B.V. All rights reserved.

A state policy framework for integrating health and social services.

PubMed

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

2014-07-01

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

Extending software repository hosting to code review and testing

NASA Astrophysics Data System (ADS)

Gonzalez Alvarez, A.; Aparicio Cotarelo, B.; Lossent, A.; Andersen, T.; Trzcinska, A.; Asbury, D.; Hłimyr, N.; Meinhard, H.

2015-12-01

We will describe how CERN's services around Issue Tracking and Version Control have evolved, and what the plans for the future are. We will describe the services main design, integration and structure, giving special attention to the new requirements from the community of users in terms of collaboration and integration tools and how we address this challenge when defining new services based on GitLab for collaboration to replace our current Gitolite service and Code Review and Jenkins for Continuous Integration. These new services complement the existing ones to create a new global "development tool stack" where each working group can place its particular development work-flow.

The Alternative Peer Group: A Developmentally Appropriate Recovery Support Model for Adolescents.

PubMed

Nash, Angela; Collier, Crystal

2016-01-01

Recovery as the goal for substance use disorder treatment has been a key component of the Substance Abuse and Mental Health Services Administration's mission for the past decade. Consistent with their mission, there is a call for research and development of recovery-oriented systems of care to support affected individuals through all stages of the recovery process. Evidence is emerging to support recovery practice and research for adults, but recovery-oriented models for adolescents are scant. The Alternative Peer Group (APG) is a comprehensive adolescent recovery support model that integrates recovering peers and prosocial activities into evidence-based clinical practice. Employing APG participants' own words, this article will describe the essential elements and three theoretical frameworks underlying the APG model to illustrate how the APG serves as a developmentally appropriate recovery support service for adolescents with substance use disorder.

CLUB FORMATION MECHANISM FOR TRANSPORT-COMMUNITY CREDIT CARDS

NASA Astrophysics Data System (ADS)

Ding, Yue; Kobayashi, Kiyoshi; Nishida, Junji; Yoshida, Mamoru

In this paper, the roles of transport-community cards jointly issued by a public transport firm and retails are investigated as a means to vitalize an obsolescence shopping center located in a middle of a city. When both the price of goods supplied by the retails and the transport fares affect the consumers' behavior, there exist pecuniary externality between the behaviors of the retails and transport firms. The introduction of a transport-community cards system enables to integrate a basket of goods and transport service into a single commodity; thus, the pecuniary externality can be internalized by price coordination. In addition, the paper clarifies theoretically that the transport firm initiatively decides the price of the transportation service and the retails transfer their incomes to the transport firm so that they are induced to jointly issue the transport-community cards.

Partnerships Between Health Care and Legal Providers in the Veterans Health Administration.

PubMed

Tsai, Jack; Middleton, Margaret; Retkin, Randye; Johnson, Cindy; Kenneally, Kevin; Sherman, Scott; Rosenheck, Robert A

2017-04-01

Medical-legal partnerships (MLPs) represent an innovative service model in which lawyers are integrated into health care teams to address diverse legal problems that affect vulnerable populations. The Veterans Health Administration (VHA) operates the largest safety-net health care system in the country and serves many low-income and disabled veterans who could benefit from MLP services. In this column, the authors describe the development and operations of MLPs at four VHA medical centers that serve veterans who are homeless or who have serious mental illness. The authors also briefly report on the characteristics of 700 veterans served by these MLPs from 2014 to 2016. MLPs can fit within the interdisciplinary, comprehensive system of care provided by VHA, and they offer opportunities to expand VHA-community partnerships to address social determinants of health.

An integrated study of earth resources in the state of California based on ERTS-1 and supporting aircraft data

NASA Technical Reports Server (NTRS)

Colwell, R. N.; Thorley, G. A.; Burgy, R. H.; Schubert, G.; Estes, J. E.; Bowden, L. W.; Algazi, V. R.; Wildman, W. E.; Huntington, G. L. (Principal Investigator)

1972-01-01

There are no author-identified significant results in this report. Results of an integrated study of earth resources in the state of California using ERTS-1 and supporting aircraft data are presented. Areas of investigation cover (1) regional agricultural surveys; (2) solving water resource management problems; (3) resource management in Northern California using ERTS-1 data; (4) analysis of river meanders; (5) assessment and monitoring change in west side of the San Joaquin Valley and central coastal zone of state; (6) assessment and monitoring of changes in Southern California environment; (7) digital handling and processing of ERTS-1 data; (8) use of ERTS-1 data in educational and applied research programs of the Agricultural Extension Service; and (9) identification, classification, and mapping of salt affected soils.

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

PubMed

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

2013-08-01

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

An introduction to family-centred services for children affected by HIV and AIDS.

PubMed

Richter, Linda

2010-06-23

Family-centred services in the context of HIV/AIDS acknowledge a broad view of a "family system" and ideally include comprehensive treatment and care, community agencies and coordinated case management. The importance of family-centred care for children affected by HIV/AIDS has been recognized for some time. There is a clear confluence of changing social realities and the needs of children in families affected by HIV and AIDS, but a change of paradigm in rendering services to children through families, in both high-prevalence and concentrated epidemic settings, has been slow to emerge.Despite a wide variety of model approaches, interventions, whether medical or psychosocial, still tend to target individuals rather than families. It has become clear that an individualistic approach to children affected by HIV and AIDS leads to confusion and misdirection of the global, national and local response. The almost exclusive focus on orphans, defined initially as a child who had lost one or both parents to AIDS, has occluded appreciation of the broader impact on children exposed to risk in other ways and the impact of the epidemic on families, communities and services for children. In addition, it led to narrowly focused, small-scale social welfare and case management approaches with little impact on government action, global and national policy, integration with health and education interventions, and increased funding.National social protection programmes that strengthen families are now established in several countries hard hit by AIDS, and large-scale pilots are underway in others. These efforts are supported by international and national development agencies, increasingly by governments and, more recently, by UNAIDS and the global AIDS community.There is no doubt that this is the beginning of a road and that there is still a long way to go, including basic research on families, family interventions, and effectiveness and costs of family-centred approaches. It is also clear that many of the institutions that are intended to serve families sometimes fail and frequently even combat non-traditional families.

Service collaboration and hospital cost performance: direct and moderating effects.

PubMed

Proenca, E Jose; Rosko, Michael D; Dismuke, Clara E

2005-12-01

Growing reliance on service provision through systems and networks creates the need to better understand the nature of the relationship between service collaboration and hospital performance and the conditions that affect this relationship. We examine 1) the effects of service provision through health systems and health networks on hospital cost performance and 2) the moderating effects of market conditions and service differentiation on the collaboration-cost relationship. We used moderated regression analysis to test the direct and moderating effects. Data on 1368 private hospitals came from the 1998 AHA Annual Survey, Medicare Cost Reports, and Solucient. Service collaboration was measured as the proportion of hospital services provided at the system level and at the network level. Market conditions were measured by the levels of managed care penetration and competition in the hospital's market. The proportion of hospital services provided at the system level had a negative relationship with hospital cost. The relationship was curvilinear for network use. Degree of managed care penetration moderated the relationship between network-based collaboration and hospital cost. The benefits of service collaboration through systems and networks, as measured by reduced cost, depend on degree of collaboration rather than mere membership. In loosely structured collaborations such as networks, costs reduce initially but increase later as the extent of collaboration increases. The effect of network-based collaboration is also tempered by managed care penetration. These effects are not seen in more tightly integrated forms such as systems.

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

ERIC Educational Resources Information Center

Womble, Myra N.; Adams, Elaine

2016-01-01

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

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

PubMed Central

2014-01-01

Background Based on practices in commercial organizations and public services, healthcare organizations are using service charters to inform patients about the quality of service they can expect and to increase patient-centeredness. In the Netherlands, an integrated regional stroke service involving five organizations has developed and implemented a single service charter. The purpose of this study is to determine the organizational enablers for the effective development and implementation of this service charter. Methods We have conducted an exploratory qualitative study using Grounded Theory to determine the organizational enablers of charter development and implementation. Individual semi-structured interviews were held with all members of the steering committee and the taskforce responsible for the service charter. In these twelve interviews, participants were retrospectively asked for their opinions of the enablers. Interview transcripts have been analysed using Glaser’s approach of substantive coding consisting of open and selective coding in order to develop a framework of these enablers. A tabula rasa approach was used without any preconceived frameworks used in the coding process. Results We have determined seven categories of enablers formed of a total of 27 properties. The categories address a broad spectrum of enablers dealing with the basic foundations for cooperation, the way to manage the project’s organization and the way to implement the service charter. In addition to the enablers within each individual organization, enablers that reflect the whole chain seem to be important for the effective development and implementation of this service charter. Strategic alignment of goals within the chain, trust between organizations, willingness to cooperate and the extent of process integration are all important properties. Conclusions This first exploratory study into the enablers of the effective development and implementation was based on a single case study in the Netherlands. This is the only integrated care chain using a single service charter that we could find. Nevertheless, the results of our explorative study provide an initial framework for the development and implementation of service charters in integrated care settings. This research contributes to the literature on service charters, on patient-centeredness in integrated care and on the implementation of innovations. PMID:24678839

42 CFR 421.304 - Medicare integrity program contractor functions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... services for which Medicare payment may be made either directly or indirectly. (b) Auditing, settling and.... 421.304 Section 421.304 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE CONTRACTING Medicare Integrity Program...

Integrated Marketing Communications

ERIC Educational Resources Information Center

Black, Jim

2004-01-01

Integration has become a cliche in enrollment management and student services circles. The term is used to describe everything from integrated marketing to seamless services. Often, it defines organizational structures, processes, student information systems, and even communities. In Robert Sevier's article in this issue of "College and…

42 CFR 455.236 - Renewal of a contract.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid Integrity Program § 455.236 Renewal of a contract. (a) CMS specifies the initial contract term in the Medicaid integrity audit program...

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

DTIC Science & Technology

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

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

PubMed Central

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

2015-01-01

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

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

PubMed Central

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

2017-01-01

Abstract Background The frequency in which HIV and AIDS and mental health problems co-exist, and the complex bi-directional relationship between them, highlights the need for effective care models combining services for HIV and mental health. Here, we present a systematic review that synthesizes the literature on interventions and approaches integrating these services. Methods This review was part of a larger systematic review on integration of services for HIV and non-communicable diseases. Eligible studies included those that described or evaluated an intervention or approach aimed at integrating HIV and mental health care. We searched multiple databases from inception until October 2015, independently screened articles identified for inclusion, conducted data extraction, and assessed evaluative papers for risk of bias. Results Forty-five articles were eligible for this review. We identified three models of integration at the meso and micro levels: single-facility integration, multi-facility integration, and integrated care coordinated by a non-physician case manager. Single-site integration enhances multidisciplinary coordination and reduces access barriers for patients. However, the practicality and cost-effectiveness of providing a full continuum of specialized care on-site for patients with complex needs is arguable. Integration based on a collaborative network of specialized agencies may serve those with multiple co-morbidities but fragmented and poorly coordinated care can pose barriers. Integrated care coordinated by a single case manager can enable continuity of care for patients but requires appropriate training and support for case managers. Involving patients as key actors in facilitating integration within their own treatment plan is a promising approach. Conclusion This review identified much diversity in integration models combining HIV and mental health services, which are shown to have potential in yielding positive patient and service delivery outcomes when implemented within appropriate contexts. Our review revealed a lack of research in low- and middle- income countries, and was limited to most studies being descriptive. Overall, studies that seek to evaluate and compare integration models in terms of long-term outcomes and cost-effectiveness are needed, particularly at the health system level and in regions with high HIV and AIDS burden. PMID:29106512

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

PubMed Central

2011-01-01

Background In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Results Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in duration. Conclusions Despite evidence about what inhibits and facilitates integrated working there was limited evidence about what the outcomes of different approaches to integrated care between health service and care homes might be. The majority of studies only achieved integrated working at the patient level of care and the focus on health service defined problems and outcome measures did not incorporate the priorities of residents or acknowledge the skills of care home staff. There is a need for more research to understand how integrated working is achieved and to test the effect of different approaches on cost, staff satisfaction and resident outcomes. PMID:22115126

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.

SOA-based model for value-added ITS services delivery.

PubMed

Herrera-Quintero, Luis Felipe; Maciá-Pérez, Francisco; Marcos-Jorquera, Diego; Gilart-Iglesias, Virgilio

2014-01-01

Integration is currently a key factor in intelligent transportation systems (ITS), especially because of the ever increasing service demands originating from the ITS industry and ITS users. The current ITS landscape is made up of multiple technologies that are tightly coupled, and its interoperability is extremely low, which limits ITS services generation. Given this fact, novel information technologies (IT) based on the service-oriented architecture (SOA) paradigm have begun to introduce new ways to address this problem. The SOA paradigm allows the construction of loosely coupled distributed systems that can help to integrate the heterogeneous systems that are part of ITS. In this paper, we focus on developing an SOA-based model for integrating information technologies (IT) into ITS to achieve ITS service delivery. To develop our model, the ITS technologies and services involved were identified, catalogued, and decoupled. In doing so, we applied our SOA-based model to integrate all of the ITS technologies and services, ranging from the lowest-level technical components, such as roadside unit as a service (RSUAAS), to the most abstract ITS services that will be offered to ITS users (value-added services). To validate our model, a functionality case study that included all of the components of our model was designed.

An assessment of the impact of climate adaptation measures to reduce flood risk on ecosystem services.

PubMed

Verburg, Peter H; Koomen, Eric; Hilferink, Maarten; Pérez-Soba, Marta; Lesschen, Jan Peter

Measures of climate change adaptation often involve modification of land use and land use planning practices. Such changes in land use affect the provision of various ecosystem goods and services. Therefore, it is likely that adaptation measures may result in synergies and trade-offs between a range of ecosystems goods and services. An integrative land use modelling approach is presented to assess such impacts for the European Union. A reference scenario accounts for current trends in global drivers and includes a number of important policy developments that correspond to on-going changes in European policies. The reference scenario is compared to a policy scenario in which a range of measures is implemented to regulate flood risk and protect soils under conditions of climate change. The impacts of the simulated land use dynamics are assessed for four key indicators of ecosystem service provision: flood risk, carbon sequestration, habitat connectivity and biodiversity. The results indicate a large spatial variation in the consequences of the adaptation measures on the provisioning of ecosystem services. Synergies are frequently observed at the location of the measures itself, whereas trade-offs are found at other locations. Reducing land use intensity in specific parts of the catchment may lead to increased pressure in other regions, resulting in trade-offs. Consequently, when aggregating the results to larger spatial scales the positive and negative impacts may be off-set, indicating the need for detailed spatial assessments. The modelled results indicate that for a careful planning and evaluation of adaptation measures it is needed to consider the trade-offs accounting for the negative effects of a measure at locations distant from the actual measure. Integrated land use modelling can help land use planning in such complex trade-off evaluation by providing evidence on synergies and trade-offs between ecosystem services, different policy fields and societal demands.

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

PubMed Central

2014-01-01

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

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2014-03-01

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

Imperceptible watermarking for security of fundus images in tele-ophthalmology applications and computer-aided diagnosis of retina diseases.

PubMed

Singh, Anushikha; Dutta, Malay Kishore

2017-12-01

The authentication and integrity verification of medical images is a critical and growing issue for patients in e-health services. Accurate identification of medical images and patient verification is an essential requirement to prevent error in medical diagnosis. The proposed work presents an imperceptible watermarking system to address the security issue of medical fundus images for tele-ophthalmology applications and computer aided automated diagnosis of retinal diseases. In the proposed work, patient identity is embedded in fundus image in singular value decomposition domain with adaptive quantization parameter to maintain perceptual transparency for variety of fundus images like healthy fundus or disease affected image. In the proposed method insertion of watermark in fundus image does not affect the automatic image processing diagnosis of retinal objects & pathologies which ensure uncompromised computer-based diagnosis associated with fundus image. Patient ID is correctly recovered from watermarked fundus image for integrity verification of fundus image at the diagnosis centre. The proposed watermarking system is tested in a comprehensive database of fundus images and results are convincing. results indicate that proposed watermarking method is imperceptible and it does not affect computer vision based automated diagnosis of retinal diseases. Correct recovery of patient ID from watermarked fundus image makes the proposed watermarking system applicable for authentication of fundus images for computer aided diagnosis and Tele-ophthalmology applications. Copyright © 2017 Elsevier B.V. All rights reserved.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-02-01

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

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

PubMed

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

2013-01-11

There is broad consensus on the value of integration of HIV services and reproductive health services in regions of the world with generalised HIV/AIDS epidemics and high reproductive morbidity. Integration is thought to increase access to and uptake of health services; and improves their efficiency and cost-effectiveness through better use of available resources. However, there is still very limited empirical literature on health service providers and how they experience and operationalize integration. This qualitative study was conducted among frontline health workers to explore provider experiences with integration in order to ascertain their significance to the performance of integrated health facilities. Semi-structured in-depth interviews were conducted with 32 frontline clinical officers, registered nurses, and enrolled nurses in Kitui district (Eastern province) and Thika and Nyeri districts (Central province) in Kenya. The study was conducted in health facilities providing integrated HIV and reproductive health services (post-natal care and family planning). All interviews were conducted in English, transcribed and analysed using Nvivo 8 qualitative data analysis software. Providers reported delivering services in provider-level and unit-level integration, as well as a combination of both. Provider experiences of actual integration were mixed. At personal level, providers valued skills enhancement, more variety and challenge in their work, better job satisfaction through increased client-satisfaction. However, they also felt that their salaries were poor, they faced increased occupational stress from: increased workload, treating very sick/poor clients, and less quality time with clients. At operational level, providers reported increased service uptake, increased willingness among clients to take an HIV test, and reduced loss of clients. But the majority also reported infrastructural and logistic deficiencies (insufficient physical room space, equipment, drugs and other medical supplies), as well as increased workload, waiting times, contact session times and low staffing levels. The success of integration primarily depends on the performance of service providers which, in turn, depends on a whole range of facilitative organisational factors. The central Ministry of Health should create a coherent policy environment, spearhead strategic planning and ensure availability of resources for implementation at lower levels of the health system. Health facility staffing norms, technical support, cost-sharing policies, clinical reporting procedures, salary and incentive schemes, clinical supply chains, and resourcing of health facility physical space upgrades, all need attention. Yet, despite these system challenges, this study has shown that integration can have a positive motivating effect on staff and can lead to better sharing of workload - these are important opportunities that deserve to be built on.

Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use.

PubMed

Bartels, Stephen J; Coakley, Eugenie H; Zubritsky, Cynthia; Ware, James H; Miles, Keith M; Areán, Patricia A; Chen, Hongtu; Oslin, David W; Llorente, Maria D; Costantino, Giuseppe; Quijano, Louise; McIntyre, Jack S; Linkins, Karen W; Oxman, Thomas E; Maxwell, James; Levkoff, Sue E

2004-08-01

The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients. This multisite randomized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics. Primary care patients 65 years old or older (N=24,930) were screened. The final study group consisted of 2,022 patients (mean age=73.5 years; 26% female; 48% ethnic minority) with depression (N=1,390), anxiety (N=70), at-risk alcohol use (N=414), or dual diagnosis (N=148) who were randomly assigned to integrated care (mental health and substance abuse providers co-located in primary care; N=999) or enhanced referral to specialty mental health/substance abuse clinics (i.e., facilitated scheduling, transportation, payment; N=1,023). Seventy-one percent of patients engaged in treatment in the integrated model compared with 49% in the enhanced referral model. Integrated care was associated with more mental health and substance abuse visits per patient (mean=3.04) relative to enhanced referral (mean=1.91). Overall, greater engagement was predicted by integrated care and higher mental distress. For depression, greater engagement was predicted by integrated care and more severe depression. For at-risk alcohol users, greater engagement was predicted by integrated care and more severe problem drinking. For all conditions, greater engagement was associated with closer proximity of mental health/substance abuse services to primary care. Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics. These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services.

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

PubMed Central

García-Valls, Marisol; Touahria, Imad Eddine

2017-01-01

Medical and eHealth systems are progressively realized in the context of standardized architectures that support safety and ease the integration of the heterogeneous (and often proprietary) medical devices and sensors. The Integrated Clinical Environment (ICE) architecture appeared recently with the goal of becoming a common framework for defining the structure of the medical applications as concerns the safe integration of medical devices and sensors. ICE is simply a high level architecture that defines the functional blocks that should be part of a medical system to support interoperability. As a result, the underlying communication backbone is broadly undefined as concerns the enabling software technology (including the middleware) and associated algorithms that meet the ICE requirements of the flexible integration of medical devices and services. Supporting the on line composition of services in a medical system is also not part of ICE; however, supporting this behavior would enable flexible orchestration of functions (e.g., addition and/or removal of services and medical equipment) on the fly. iLandis one of the few software technologies that supports on line service composition and reconfiguration, ensuring time-bounded transitions across different service orchestrations; it supports the design, deployment and on line reconfiguration of applications, which this paper applies to service-based eHealth domains. This paper designs the integration between ICE architecture and iLand middleware to enhance the capabilities of ICE with on line service composition and the time-bounded reconfiguration of medical systems based on distributed services. A prototype implementation of a service-based eHealth system for the remote monitoring of patients is described; it validates the enhanced capacity of ICE to support dynamic reconfiguration of the application services. Results show that the temporal cost of the on line reconfiguration of the eHealth application is bounded, achieving a low overhead resulting from the addition of ICE compliance. PMID:28594371

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

PubMed

García-Valls, Marisol; Touahria, Imad Eddine

2017-06-08

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

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

PubMed Central

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

2000-01-01

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

Progress in the development of integrated mental health care in Scotland

PubMed Central

Woods, Kevin; McCollam, Allyson

2002-01-01

Abstract The development of integrated care through the promotion of ‘partnership working’ is a key policy objective of the Scottish Executive, the administration responsible for health services in Scotland. This paper considers the extent to which this goal is being achieved in mental health services, particularly those for people with severe and enduring mental illness. Distinguishing between the horizontal and vertical integration of services, exploratory research was conducted to assess progress towards this objective by examining how far a range of functional activities in Primary Care Trusts (PCTs) and their constituent Local Health Care Co-operatives (LHCCs) were themselves becoming increasingly integrated. All PCTs in Scotland were surveyed by postal questionnaire, and followed up by detailed telephone interviews. Six LHCC areas were selected for detailed case study analysis. A Reference Group was used to discuss and review emerging themes from the fieldwork. The report suggests that faster progress is being made in the horizontal integration of services between health and social care organisations than is the case for vertical integration between primary health care and specialist mental health care services; and that there are significant gaps in the extent to which functional activities within Trusts are changing to support the development of integrated care. A number of models are briefly considered, including the idea of ‘intermediate care’ that might speed the process of integration. PMID:16896397

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

PubMed

Berdine, Hildegarde J; Skomo, Monica L

2012-01-01

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

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

PubMed

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

2014-09-01

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

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

PubMed

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

2016-05-23

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

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

PubMed Central

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

2016-01-01

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

A Geospatial Information Grid Framework for Geological Survey.

PubMed

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

2015-01-01

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

A Geospatial Information Grid Framework for Geological Survey

PubMed Central

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

2015-01-01

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

The Socio-ecological Fit of Human Responses to Environmental Degradation: An Integrated Assessment Methodology.

PubMed

Briassoulis, Helen

2015-12-01

The scientific and policy interest in the human responses to environmental degradation usually focuses on responses sensu stricto and 'best practices' that potentially abate degradation in affected areas. The transfer of individual, discrete instruments and 'best practices' to different contexts is challenging, however, because socio-ecological systems are complex and environmental degradation is contextual and contingent. To sensibly assess the effectiveness of formal and informal interventions to combat environmental degradation, the paper proposes an integrative, non-reductionist analytic, the 'response assemblage', for the study of 'responses-in-context,' i.e., products of human decisions to utilize environmental resources to satisfy human needs in socio-ecological systems. Response assemblages are defined as geographically and historically unique, provisional, open, territorial wholes, complex compositions emerging from processes of assembling biophysical and human components, including responses sensu stricto, from affected focal and other socio-ecological systems, to serve human goals, one of which may be combatting environmental degradation. The degree of match among the components, called the socio-ecological fit of the response assemblage, indicates how effectively their contextual and contingent interactions maintain the socio-ecological resilience, promote sustainable development, and secure the continuous provision of ecosystem services in a focal socio-ecological system. The paper presents a conceptual approach to the analysis of the socio-ecological fit of response assemblages and details an integrated assessment methodology synthesizing the resilience, assemblage, and 'problem of fit' literature. Lastly, it summarizes the novelty, value, and policy relevance of conceptualizing human responses as response assemblages and of the integrated assessment methodology, reconsiders 'best practices' and suggests selected future research directions.

The Socio-ecological Fit of Human Responses to Environmental Degradation: An Integrated Assessment Methodology

NASA Astrophysics Data System (ADS)

Briassoulis, Helen

2015-12-01

The scientific and policy interest in the human responses to environmental degradation usually focuses on responses sensu stricto and `best practices' that potentially abate degradation in affected areas. The transfer of individual, discrete instruments and `best practices' to different contexts is challenging, however, because socio-ecological systems are complex and environmental degradation is contextual and contingent. To sensibly assess the effectiveness of formal and informal interventions to combat environmental degradation, the paper proposes an integrative, non-reductionist analytic, the `response assemblage', for the study of `responses-in-context,' i.e., products of human decisions to utilize environmental resources to satisfy human needs in socio-ecological systems. Response assemblages are defined as geographically and historically unique, provisional, open, territorial wholes, complex compositions emerging from processes of assembling biophysical and human components, including responses sensu stricto, from affected focal and other socio-ecological systems, to serve human goals, one of which may be combatting environmental degradation. The degree of match among the components, called the socio- ecological fit of the response assemblage, indicates how effectively their contextual and contingent interactions maintain the socio-ecological resilience, promote sustainable development, and secure the continuous provision of ecosystem services in a focal socio-ecological system. The paper presents a conceptual approach to the analysis of the socio-ecological fit of response assemblages and details an integrated assessment methodology synthesizing the resilience, assemblage, and `problem of fit' literature. Lastly, it summarizes the novelty, value, and policy relevance of conceptualizing human responses as response assemblages and of the integrated assessment methodology, reconsiders `best practices' and suggests selected future research directions.

An integrative review and evidence-based conceptual model of the essential components of pre-service education.

PubMed

Johnson, Peter; Fogarty, Linda; Fullerton, Judith; Bluestone, Julia; Drake, Mary

2013-08-28

With decreasing global resources, a pervasive critical shortage of skilled health workers, and a growing disease burden in many countries, the need to maximize the effectiveness and efficiency of pre-service education in low-and middle-income countries has never been greater. We performed an integrative review of the literature to analyse factors contributing to quality pre-service education and created a conceptual model that shows the links between essential elements of quality pre-service education and desired outcomes. The literature contains a rich discussion of factors that contribute to quality pre-service education, including the following: (1) targeted recruitment of qualified students from rural and low-resource settings appears to be a particularly effective strategy for retaining students in vulnerable communities after graduation; (2) evidence supports a competency-based curriculum, but there is no clear evidence supporting specific curricular models such as problem-based learning; (3) the health workforce must be well prepared to address national health priorities; (4) the role of the preceptor and preceptors' skills in clinical teaching, identifying student learning needs, assessing student learning, and prioritizing and time management are particularly important; (5) modern, Internet-enabled medical libraries, skills and simulation laboratories, and computer laboratories to support computer-aided instruction are elements of infrastructure meriting strong consideration; and (6) all students must receive sufficient clinical practice opportunities in high-quality clinical learning environments in order to graduate with the competencies required for effective practice. Few studies make a link between PSE and impact on the health system. Nevertheless, it is logical that the production of a trained and competent staff through high-quality pre-service education and continuing professional development activities is the foundation required to achieve the desired health outcomes. Professional regulation, deployment practices, workplace environment upon graduation and other service delivery contextual factors were analysed as influencing factors that affect educational outcomes and health impact. Our model for pre-service education reflects the investments that must be made by countries into programmes capable of leading to graduates who are competent for the health occupations and professions at the time of their entry into the workforce.

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

PubMed

2007-11-30

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

STRS Radio Service Software for NASA's SCaN Testbed

NASA Technical Reports Server (NTRS)

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

2012-01-01

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

STRS Radio Service Software for NASA's SCaN Testbed

NASA Technical Reports Server (NTRS)

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

2013-01-01

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

42 CFR 455.232 - Medicaid integrity audit program contractor functions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Medicaid integrity audit program contractor functions. 455.232 Section 455.232 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid...

42 CFR 455.232 - Medicaid integrity audit program contractor functions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Medicaid integrity audit program contractor functions. 455.232 Section 455.232 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid...

42 CFR 455.232 - Medicaid integrity audit program contractor functions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Medicaid integrity audit program contractor functions. 455.232 Section 455.232 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid...

42 CFR 455.232 - Medicaid integrity audit program contractor functions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid integrity audit program contractor functions. 455.232 Section 455.232 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid...

A Multi-Scale Integrated Approach to Representing Watershed Systems: Significance and Challenges

NASA Astrophysics Data System (ADS)

Kim, J.; Ivanov, V. Y.; Katopodes, N.

2013-12-01

A range of processes associated with supplying services and goods to human society originate at the watershed level. Predicting watershed response to forcing conditions has been of high interest to many practical societal problems, however, remains challenging due to two significant properties of the watershed systems, i.e., connectivity and non-linearity. Connectivity implies that disturbances arising at any larger scale will necessarily propagate and affect local-scale processes; their local effects consequently influence other processes, and often convey nonlinear relationships. Physically-based, process-scale modeling is needed to approach the understanding and proper assessment of non-linear effects between the watershed processes. We have developed an integrated model simulating hydrological processes, flow dynamics, erosion and sediment transport, tRIBS-OFM-HRM (Triangulated irregular network - based Real time Integrated Basin Simulator-Overland Flow Model-Hairsine and Rose Model). This coupled model offers the advantage of exploring the hydrological effects of watershed physical factors such as topography, vegetation, and soil, as well as their feedback mechanisms. Several examples investigating the effects of vegetation on flow movement, the role of soil's substrate on sediment dynamics, and the driving role of topography on morphological processes are illustrated. We show how this comprehensive modeling tool can help understand interconnections and nonlinearities of the physical system, e.g., how vegetation affects hydraulic resistance depending on slope, vegetation cover fraction, discharge, and bed roughness condition; how the soil's substrate condition impacts erosion processes with an non-unique characteristic at the scale of a zero-order catchment; and how topographic changes affect spatial variations of morphologic variables. Due to feedback and compensatory nature of mechanisms operating in different watershed compartments, our conclusion is that a key to representing watershed systems lies in an integrated, interdisciplinary approach, whereby a physically-based model is used for assessments/evaluations associated with future changes in landuse, climate, and ecosystems.

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

PubMed

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

2016-05-23

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

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

PubMed Central

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

2016-01-01

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

Ecological dynamics across the Arctic associated with recent climate change.

PubMed

Post, Eric; Forchhammer, Mads C; Bret-Harte, M Syndonia; Callaghan, Terry V; Christensen, Torben R; Elberling, Bo; Fox, Anthony D; Gilg, Olivier; Hik, David S; Høye, Toke T; Ims, Rolf A; Jeppesen, Erik; Klein, David R; Madsen, Jesper; McGuire, A David; Rysgaard, Søren; Schindler, Daniel E; Stirling, Ian; Tamstorf, Mikkel P; Tyler, Nicholas J C; van der Wal, Rene; Welker, Jeffrey; Wookey, Philip A; Schmidt, Niels Martin; Aastrup, Peter

2009-09-11

At the close of the Fourth International Polar Year, we take stock of the ecological consequences of recent climate change in the Arctic, focusing on effects at population, community, and ecosystem scales. Despite the buffering effect of landscape heterogeneity, Arctic ecosystems and the trophic relationships that structure them have been severely perturbed. These rapid changes may be a bellwether of changes to come at lower latitudes and have the potential to affect ecosystem services related to natural resources, food production, climate regulation, and cultural integrity. We highlight areas of ecological research that deserve priority as the Arctic continues to warm.

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

PubMed

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

2015-08-01

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

Is integrated care associated with service costs and admission rates to institutional settings? An observational study of community mental health teams for older people in England.

PubMed

Wilberforce, Mark; Tucker, Sue; Brand, Christian; Abendstern, Michele; Jasper, Rowan; Challis, David

2016-11-01

To evaluate the association between the degree of integration in community mental health teams (CMHTs) and: (i) the costs of service provision; (ii) rates of mental health inpatient and care home admission. An observational study of service use and admissions to institutional care was undertaken for a prospectively-sampled cohort of patients from eight CMHTs in England. Teams were chosen to represent 'high' or 'low' levels of integrated working practice and patients were followed-up for seven months. General linear models were used to estimate service costs and the likelihood of institutional admission. Patients supported by high integration teams received services costing an estimated 44% more than comparable patients in low integration teams. However, after controlling for case mix, no significant differences were found in the likelihood of admission to mental health inpatient wards or care homes between team types. Integrated mental health and social care teams appeared to facilitate greater access to community care services, but no consequent association was found with community tenure. Further research is required to identify the necessary and sufficient components of integrated community mental health care, and its effect on a wider range of outcomes using patient-reported measures. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.

Mental disorders and work integration: a retrospective study in a northern italian town.

PubMed

Buizza, Chiara; Pioli, Rosaria; Lecchi, Sara; Bonetto, Chiara; Bartoli, Anna; Taglietti, Renzo; Ghilardi, Alberto; Riva, Eugenio

2013-01-01

THE PRESENT STUDY WAS CONDUCTED IN A VOCATIONAL INTEGRATION SERVICE OF A NORTHERN ITALIAN TOWN WITH TWO MAJOR AIMS: to assess vocational integration programs undertaken from 1(st) January 2004 to 1(st) January 2007; and to identify job tenure-associated predictors. This is a retrospective study; we collected data such as gender, age, duration, type and outcome of the vocational integration program, and number of interventions performed by the vocational integration service. Self-report questionnaires were also used to assess the satisfaction of users, caregivers, practitioners, and of the company contacts involved in the study. The service has enrolled 84 users during the observation period. Out of these users, 64.3% of them still had their jobs after three years. Users, caregivers and company contacts expressed high levels of satisfaction for the support received by the vocational integration service. The company expressed less satisfaction for the collaboration received by the Departments of Mental Health (DMHs) that coached the users. The only variable associated to the outcome was the number of interventions that the users received before their placement on the job. Despite all the limits of this study, its results show that the chance of taking advantage of a supported job placement service has likely proven itself effective in helping people with mental disorders to obtain and maintain a competitive employment. Our results, however, also point to the necessity of implementing newer strategies meant to develop a greater integration among all services dealing with mentally ill people.

High rates of Unintended Pregnancies among Young Women Sex Workers in Conflict-affected Northern Uganda: The Social Contexts of Brothels/Lodges and Substance Use.

PubMed

Duff, Putu; Muzaaya, Godfrey; Muldoon, Katherine; Dobrer, Sabina; Akello, Monika; Birungi, Josephine; Shannon, Kate

2017-06-01

This study aimed to examine the correlates of unintended pregnancies among young women sex workers in conflict-affected northern Uganda. Data were drawn from the Gulu Sexual Health Study, a cross-sectional study of young women engaged in sex work. Bivariable and multivariable logistic regression was used to examine the correlates of ever having an unintended pregnancy. Among 400 sex workers (median age=20 years; IQR 19-25), 175 (43.8%) reported at least one unintended pregnancy. In multivariable analysis, primarily servicing clients in lodges/brothels [Adjusted Odds Ratio (AOR= 2.24; 95% Confidence Interval: 1.03-4.84)], hormonal contraceptive usage [AOR=1.68; 95%CI 1.11-2.59] and drug/alcohol use while working [AOR= 1.64; 95%CI 1.04-2.60] were positively correlated with previous unintended pregnancy. Given that unintended pregnancy is an indicator of unmet reproductive health need, these findings highlight a need for improved access to integrated reproductive health and HIV services, catered to sex workers' needs. Sex work-led strategies (e.g., peer outreach) should be considered, alongside structural strategies and education targeting brothel/lodge owners and managers.

Distributed denial of service (DDoS) attack in cloud- assisted wireless body area networks: a systematic literature review.

PubMed

Latif, Rabia; Abbas, Haider; Assar, Saïd

2014-11-01

Wireless Body Area Networks (WBANs) have emerged as a promising technology that has shown enormous potential in improving the quality of healthcare, and has thus found a broad range of medical applications from ubiquitous health monitoring to emergency medical response systems. The huge amount of highly sensitive data collected and generated by WBAN nodes requires an ascendable and secure storage and processing infrastructure. Given the limited resources of WBAN nodes for storage and processing, the integration of WBANs and cloud computing may provide a powerful solution. However, despite the benefits of cloud-assisted WBAN, several security issues and challenges remain. Among these, data availability is the most nagging security issue. The most serious threat to data availability is a distributed denial of service (DDoS) attack that directly affects the all-time availability of a patient's data. The existing solutions for standalone WBANs and sensor networks are not applicable in the cloud. The purpose of this review paper is to identify the most threatening types of DDoS attacks affecting the availability of a cloud-assisted WBAN and review the state-of-the-art detection mechanisms for the identified DDoS attacks.

Factors affecting employment among people with mobility disabilities in South Korea.

PubMed

Park, Soo-Kyung; Yoon, Jae-Young; Henderson, Terrence

2007-03-01

Employment provides not only income but also opportunities for social participation. This is especially important for people with disabilities, but the employment of disabled people in many countries is subject to significant barriers. This study examines the actual state of employment of people with mobility disabilities in Korea and which characteristics affect employment among people with mobility disabilities. Analysis of responses to the Community Integration Questionnaire and independent variables among the study participants showed that the rate of employment among people with mobility disabilities (34.2%) is much lower than that of the general population (60.3%), with only 13.2% in full-time positions. Gender appeared to be a statistically significant factor influencing employment. Other demographic characteristics such as age, level of education and cohabitation did not influence employment in this study, but people with less severe disability had a higher probability of being employed. Disability acceptance appeared to be a vital factor in the process of vocational rehabilitation. The use of vocational rehabilitation services did not have a significant effect on employment. These results suggest that the role of the formal services system in the employment process of disabled people is insufficient.

Effectiveness of Computerized Decision Support Systems Linked to Electronic Health Records: A Systematic Review and Meta-Analysis

PubMed Central

Kwag, Koren H.; Lytras, Theodore; Bertizzolo, Lorenzo; Brandt, Linn; Pecoraro, Valentina; Rigon, Giulio; Vaona, Alberto; Ruggiero, Francesca; Mangia, Massimo; Iorio, Alfonso; Kunnamo, Ilkka; Bonovas, Stefanos

2014-01-01

We systematically reviewed randomized controlled trials (RCTs) assessing the effectiveness of computerized decision support systems (CDSSs) featuring rule- or algorithm-based software integrated with electronic health records (EHRs) and evidence-based knowledge. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects. Information on system design, capabilities, acquisition, implementation context, and effects on mortality, morbidity, and economic outcomes were extracted. Twenty-eight RCTs were included. CDSS use did not affect mortality (16 trials, 37395 patients; 2282 deaths; risk ratio [RR] = 0.96; 95% confidence interval [CI] = 0.85, 1.08; I2 = 41%). A statistically significant effect was evident in the prevention of morbidity, any disease (9 RCTs; 13868 patients; RR = 0.82; 95% CI = 0.68, 0.99; I2 = 64%), but selective outcome reporting or publication bias cannot be excluded. We observed differences for costs and health service utilization, although these were often small in magnitude. Across clinical settings, new generation CDSSs integrated with EHRs do not affect mortality and might moderately improve morbidity outcomes. PMID:25322302

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

ERIC Educational Resources Information Center

2003

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

Towards a Service-Oriented Enterprise: The Design of a Cloud Business Integration Platform in a Medium-Sized Manufacturing Enterprise

ERIC Educational Resources Information Center

Stamas, Paul J.

2013-01-01

This case study research followed the two-year transition of a medium-sized manufacturing firm towards a service-oriented enterprise. A service-oriented enterprise is an emerging architecture of the firm that leverages the paradigm of services computing to integrate the capabilities of the firm with the complementary competencies of business…

Physician Satisfaction With Integrated Behavioral Health in Pediatric Primary Care.

PubMed

Hine, Jeffrey F; Grennan, Allison Q; Menousek, Kathryn M; Robertson, Gail; Valleley, Rachel J; Evans, Joseph H

2017-04-01

As the benefits of integrated behavioral health care services are becoming more widely recognized, this study investigated physician satisfaction with ongoing integrated psychology services in pediatric primary care clinics. Data were collected across 5 urban and 6 rural clinics and demonstrated the specific factors that physicians view as assets to having efficient access to a pediatric behavioral health practitioner. Results indicated significant satisfaction related to quality and continuity of care and improved access to services. Such models of care may increase access to care and reduce other service barriers encountered by individuals and their families with behavioral health concerns (ie, those who otherwise would seek services through referrals to traditional tertiary care facilities).

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

NASA Astrophysics Data System (ADS)

Wattawa, Scott

1995-11-01

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

Dual diagnosis capability in mental health and addiction treatment services: An assessment of programs across multiple state systems

PubMed Central

McGovern, Mark P.; Lambert-Harris, Chantal; Gotham, Heather J.; Claus, Ronald E.; Xie, Haiyi

2012-01-01

Despite increased awareness of the benefits of integrated services for persons with co-occurring substance use and psychiatric disorders, estimates of the availability of integrated services vary widely. The present study utilized standardized measures of program capacity to address co-occurring disorders, the Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) indexes, and sampled 256 programs across the United States. Approximately 18% of addiction treatment and 9% of mental health programs met criteria for dual diagnosis capable services. This is the first report on public access to integrated services using objective measures. PMID:23183873

A Mixed Methods Comparison of Teacher Education Faculty Perceptions of the Integration of Technology into Their Courses and Student Feedback on Technology Proficiency

ERIC Educational Resources Information Center

Teclehaimanot, Berhane; Mentzer, Gale; Hickman, Torey

2011-01-01

Results from previous studies on pre-service teacher technology integration and faculty perceptions of technology integration within the teacher education program at a medium-sized, Midwestern university are compared to account for the self-reported lack of confidence pre-service teachers have integrating technology into their teaching. Also…

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

The influence of health-specific social network site use on the psychological well-being of cancer-affected people.

PubMed

Erfani, Seyedezahra Shadi; Blount, Yvette; Abedin, Babak

2016-05-01

We aimed to explore and examine how and in what ways the use of social network sites (SNSs) can improve health outcomes, specifically better psychological well-being, for cancer-affected people. Qualitative semi-structured interviews were conducted with users of the Ovarian Cancer Australia Facebook page (OCA Facebook), the exemplar SNS used in this study. Twenty-five women affected by ovarian cancer who were users of OCA Facebook were interviewed. A multi-theory perspective was employed to interpret the data. Most of the study participants used OCA Facebook daily. Some users were passive and only observed created content, while other users actively posted content and communicated with other members. Analysis showed that the use of this SNS enhanced social support for users, improved the users' experiences of social connectedness, and helped users learn and develop social presence, which ultimately improved their psychological well-being. The strong theoretical underpinning of our research and empirically derived results led to a new understanding of the capacity of SNSs to improve psychological well-being. Our study provides evidence showing how the integration of these tools into existing health services can enhance patients' psychological well-being. This study also contributes to the body of knowledge on the implications of SNS use for improving the psychological well-being of cancer-affected people. This research assessed the relationship between the use of SNSs, specifically OCA Facebook, and the psychological well-being of cancer-affected people. The study confirmed that using OCA Facebook can improve psychological well-being by demonstrating the potential value of SNSs as a support service in the healthcare industry. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

How do climatic and management factors affect agricultural ecosystem services? A case study in the agro-pastoral transitional zone of northern China.

PubMed

Qiao, Jianmin; Yu, Deyong; Wu, Jianguo

2018-02-01

Agricultural ecosystem management needs to ensure food production and minimize soil erosion and nitrogen (N) leaching under climate change and increasingly intensive human activity. Thus, the mechanisms through which climatic and management factors affect crop production, soil erosion, and N leaching must be understood in order to ensure food security and sustainable agricultural development. In this study, we adopted the GIS-based Environmental Policy Integrated Climate (EPIC) model to simulate crop production, soil erosion, and N leaching, and used a partial least squares regression model to evaluate the contributions of climate variables (solar radiation, precipitation, wind speed, relative humidity, and maximum and minimum temperature) and management factors (irrigation, fertilization, and crop cultivation area) on agricultural ecosystem services (AES) in the agro-pastoral transitional zone (APTZ) of northern China. The results indicated that crop production and N leaching markedly increased, whereas soil erosion declined from 1980 to 2010 in the APTZ. Management factors had larger effects on the AES than climate change. Among the climatic variables, daily minimum temperature was the most important contributor to the variations in ecosystem services of wheat, maize, and rice. Spatial changes in the cultivated area most affected crop production, soil erosion, and N leaching for majority of the cultivated areas of the three crops, except for the wheat-cultivated area, where the dominant factor for N leaching was fertilization. Although a tradeoff existed between crop production and negative environmental effects, compromises were possible. These findings provide new insights into the effects of climatic and management factors on AES, and have practical implications for improving crop production while minimizing negative environmental impacts. Copyright © 2017 Elsevier B.V. All rights reserved.

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

PubMed

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

2005-01-01

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

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

PubMed

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

2004-01-01

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

FORCEnet Net Centric Architecture - A Standards View

DTIC Science & Technology

2006-06-01

SHARED SERVICES NETWORKING/COMMUNICATIONS STORAGE COMPUTING PLATFORM DATA INTERCHANGE/INTEGRATION DATA MANAGEMENT APPLICATION...R V I C E P L A T F O R M S E R V I C E F R A M E W O R K USER-FACING SERVICES SHARED SERVICES NETWORKING/COMMUNICATIONS STORAGE COMPUTING PLATFORM...E F R A M E W O R K USER-FACING SERVICES SHARED SERVICES NETWORKING/COMMUNICATIONS STORAGE COMPUTING PLATFORM DATA INTERCHANGE/INTEGRATION

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2015-01-01

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

Yavapai College Integrated Master Plan.

ERIC Educational Resources Information Center

Yavapai Coll., Prescott, AZ.

This integrated master plan for Yavapai College (Arizona) includes the following six key components: (1) district services overview; (2) educational services plan; (3) human resources plan; (4) information technology services; (5) facilities plan; and (6) financial plan. The master plan was developed as a result of discussions and meetings with…

Literacy Enrichment and Technology Integration in Pre-Service Teacher Education

ERIC Educational Resources Information Center

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

2014-01-01

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

76 FR 16776 - Advisory Group on Prevention, Health Promotion, and Integrative and Public Health; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-25

... Integrative and Public Health; Notice of Meeting AGENCY: Department of Health and Human Services, Office of... United States Public Health Service. ACTION: Notice. SUMMARY: In accordance with Section 10(a) of the... Integrative and Public [[Page 16777

Integrating emergency services in an urban health system.

PubMed

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

2000-03-01

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

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

PubMed

DeMuro, P R; Owens, J F

1994-01-01

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

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

PubMed

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

2015-03-04

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

Affect integration and reflective function: clarification of central conceptual issues.

PubMed

Solbakken, Ole André; Hansen, Roger Sandvik; Monsen, Jon Trygve

2011-07-01

The importance of affect regulation, modulation or integration for higher-order reflection and adequate functioning is increasingly emphasized across different therapeutic approaches and theories of change. These processes are probably central to any psychotherapeutic endeavor, whether explicitly conceptualized or not, and in recent years a number of therapeutic approaches have been developed that explicitly target them as a primary area of change. However, there still is important lack of clarity in the field regarding the understanding and operationalization of affect integration, particularly when it comes to specifying underlying mechanisms, the significance of different affect states, and the establishment of operational criteria for measurement. The conceptual relationship between affect integration and reflective function thus remains ambiguous. The present article addresses these topics, indicating ways in which a more complex and exhaustive understanding of integration of affect, cognition and behavior can be attained.

Trade-offs in water and carbon ecosystem services with land-use changes in grasslands.

PubMed

Kim, John H; Jobbágy, Esteban G; Jackson, Robert B

2016-09-01

Increasing pressures for food, fiber, and fuel continue to drive global land-use changes. Efforts to optimize ecosystem services under alternative land uses are often hampered by the complex interactions and trade-offs among them. We examined the effects of land-use changes on ecosystem carbon storage and groundwater recharge in grasslands of Argentina and the United States to (1) understand the relationships between both services, (2) predict their responses to vegetation shifts across environmental gradients, and (3) explore how market or policy incentives for ecosystem services could affect land-use changes. A trade-off of ecosystem services was evident in most cases, with woody encroachment increasing carbon storage (+29 Mg C/ha) but decreasing groundwater recharge (-7.3 mm/yr) and conversions to rain-fed cultivation driving opposite changes (-32 Mg C/ha vs. +13 mm/yr). In contrast, crops irrigated with ground water tended to reduce both services compared to the natural grasslands they replaced. Combining economic values of the agricultural products together with the services, we highlight potentials for relatively modest financial incentives for ecosystem services to abate land-use changes and for incentives for carbon to drive land-use decisions over those of water. Our findings also identify key opportunities and caveats for some win-win and lose-lose land-use changes for more integrative and sustainable strategies for land management. © 2016 by the Ecological Society of America.

42 CFR 93.217 - Office of Research Integrity or ORI.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Office of Research Integrity or ORI. 93.217 Section 93.217 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH EFFECTS STUDIES OF HAZARDOUS SUBSTANCES RELEASES AND FACILITIES PUBLIC HEALTH SERVICE...

Service Animals in School. Position Statement

ERIC Educational Resources Information Center

Garret, Jennifer; Teskey, Carmen; Duncan, Kay; Strasser, Kathy

2014-01-01

It is the position of the National Association of School Nurses (NASN) that registered school nurses (hereinafter referred to as school nurses) are integral to the team planning process necessary to successfully integrate "service animals" into schools. A request to bring a service animal into the school setting presents questions due to…

Colleges' Experiences: Integrating Support Services for Military Veterans

ERIC Educational Resources Information Center

Karp, Melinda Mechur; Klempin, Serena

2017-01-01

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

Teaching Service Modelling to a Mixed Class: An Integrated Approach

ERIC Educational Resources Information Center

Deng, Jeremiah D.; Purvis, Martin K.

2015-01-01

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

Building Bridges Symposium. Linking the Disciplines During Pre-Service Teacher Education.

ERIC Educational Resources Information Center

Daugherty, Michael; Foehr, Regina; Haynes, Thomas; McBride, Lawrence

This paper is further subtitled "Presentations of integrated units of instruction by interdisciplinary teams of pre-service teacher education students showcasing student-developed curriculum integration ideas." The units include the following: "Get Your Kicks on Route 66" (integrating Family and Consumer Sciences, Business, and Industrial…

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

ERIC Educational Resources Information Center

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

2015-01-01

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

Academic Research Integration System

ERIC Educational Resources Information Center

Surugiu, Iula; Velicano, Manole

2008-01-01

This paper comprises results concluding the research activity done so far regarding enhanced web services and system integration. The objective of the paper is to define the software architecture for a coherent framework and methodology for enhancing existing web services into an integrated system. This document presents the research work that has…

Energy efficiency through integrated environmental management.

PubMed

Benromdhane, Souad Ahmed

2015-05-01

Integrated environmental management became an economic necessity after industrial development proved to be unsustainable without consideration of environmental direct and indirect impacts. Energy dependency and air pollution along with climate change grew into major challenges facing developed and developing countries alike. Thus, a new global market structure emerged and changed the way we do trade. The search intensified for alternatives to petroleum. However, scientists, policy makers, and environmental activists agreed to focus on strategic conservation and optimization of energy use. Environmental concerns will remain partially unaddressed with the current pace of consumption because greenhouse gas emissions will continue to rise with economic growth. This paper discusses energy efficiency, steady integration of alternative sources, and increased use of best available technologies. Energy criteria developed for environmental labeling certification are presented. Our intention is to encourage manufacturers and service providers to supply consumers with less polluting and energy-consuming goods and services, inform consumers of the environmental and energy impacts, and thereby instill sustainable and responsible consumption. As several programs were initiated in developed countries, environmental labeling requirements created barriers to many exports manufactured in developing countries, affecting current world trade and putting more pressure on countries to meet those requirements. Defining an institutional and legal framework of environmental labeling is a key challenge in implementing such programs for critical economic sectors like tourism, textiles, and food production where energy needs are the most important aspect to control. A case study of Tunisia and its experience with eco-labeling is presented.

Frail elderly patients. New model for integrated service delivery.

PubMed Central

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

2003-01-01

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

Challenges of service-dog ownership for families with autistic children: lessons for veterinary practitioners.

PubMed

Burrows, Kristen E; Adams, Cindy L

2008-01-01

The purpose of this paper is to describe the challenges of service-dog ownership for families with autistic children. Through a qualitative interview process, this study has found that the integration of a service dog into a home environment is a highly dynamic and interactive process with numerous benefits and challenges. Public-access issues, learning to interpret dog behavior, the time constraints of increased social interactions, and the time of year the dog is placed into the family are important components affecting parental satisfaction. Parent, family, and child challenges included the dog being extra work, finding added time to maintain training, financing care for the dog, and the impact on family dynamics. These factors and challenges were appraised in order to understand the impact that they could have on the perceived success of the placement, parental satisfaction, and the dog itself. Despite the effects and consequences of these challenges, the parents overwhelmingly reported that having a service dog to keep their child safe and to provide companionship was well worth the many inconveniences of service-dog ownership. Most importantly, attention needs to be drawn to these challenges to promote the safety of both the child and the dog, minimize stress on the family, and encourage veterinary support of these highly dynamic relationships.

A Phenomenological Study of the Impact of Pre-Service and Inservice Training Regarding the Integration of Twenty-First Century Technologies into Selected Teachers' Instruction

ERIC Educational Resources Information Center

Clark, Christopher

2013-01-01

The purpose of this transcendental phenomenological study is to understand how in-service teachers with three to five years of experience perceive their pre-service and in-service training regarding the integration of twenty-first century technology into their instruction. Twenty participants from a rural public school system in southeast North…

From NHS Choices to the integrated customer service platform.

PubMed

Gann, Bob; Grant, Maria J

2013-03-01

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

Integrated HIV care and service engagement among people living with HIV who use drugs in a setting with a community-wide treatment as prevention initiative: a qualitative study in Vancouver, Canada

PubMed Central

Collins, Alexandra B; Parashar, Surita; Hogg, Robert S; Fernando, Saranee; Worthington, Catherine; McDougall, Patrick; Turje, Rosalind Baltzer; McNeil, Ryan

2017-01-01

Abstract Introduction: Social-structural inequities impede access to, and retention in, HIV care among structurally vulnerable people living with HIV (PLHIV) who use drugs. The resulting disparities in HIV-related outcomes among PLHIV who use drugs pose barriers to the optimization of HIV treatment as prevention (TasP) initiatives. We undertook this study to examine engagement with, and impacts of, an integrated HIV care services model tailored to the needs of PLHIV who use drugs in Vancouver, Canada – a setting with a community-wide TasP initiative. Methods: We conducted qualitative interviews with 30 PLHIV who use drugs recruited from the Dr. Peter Centre, an HIV care facility operating under an integrated services model and harm reduction approach. We employed novel analytical techniques to analyse participants’ service trajectories within this facility to understand how this HIV service environment influences access to, and retention in, HIV care among structurally vulnerable PLHIV who use drugs. Results: Our findings demonstrate that participants’ structural vulnerability shaped their engagement with the HIV care facility that provided access to resources that facilitated retention in HIV care and antiretroviral treatment adherence. Additionally, the integrated service environment helped reduce burdens associated with living in extreme poverty by meeting participants’ subsistence (e.g. food, shelter) needs. Moreover, access to multiple supports created a structured environment in which participants could develop routine service use patterns and have prolonged engagement with supportive care services. Our findings demonstrate that low-barrier service models can mitigate social and structural barriers to HIV care and complement TasP initiatives for PLHIV who use drugs. Conclusions: These findings highlight the critical role of integrated service models in promoting access to health and support services for structurally vulnerable PLHIV. Complementing structural interventions with integrated service models that are tailored to the needs of structurally vulnerable PLHIV who use drugs will be pursuant to the goals of TasP. PMID:28426185

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

ERIC Educational Resources Information Center

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

2008-01-01

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

Modeling service time reliability in urban ferry system

NASA Astrophysics Data System (ADS)

Chen, Yifan; Luo, Sida; Zhang, Mengke; Shen, Hanxia; Xin, Feifei; Luo, Yujie

2017-09-01

The urban ferry system can carry a large number of travelers, which may alleviate the pressure on road traffic. As an indicator of its service quality, service time reliability (STR) plays an essential part in attracting travelers to the ferry system. A wide array of studies have been conducted to analyze the STR of land transportation. However, the STR of ferry systems has received little attention in the transportation literature. In this study, a model was established to obtain the STR in urban ferry systems. First, the probability density function (PDF) of the service time provided by ferry systems was constructed. Considering the deficiency of the queuing theory, this PDF was determined by Bayes’ theorem. Then, to validate the function, the results of the proposed model were compared with those of the Monte Carlo simulation. With the PDF, the reliability could be determined mathematically by integration. Results showed how the factors including the frequency, capacity, time schedule and ferry waiting time affected the STR under different degrees of congestion in ferry systems. Based on these results, some strategies for improving the STR were proposed. These findings are of great significance to increasing the share of ferries among various urban transport modes.