A Pilot Study for Gainful Employment in Home Economics. Final Report. Volume I.

ERIC Educational Resources Information Center

Cozine, June; And Others

The major purpose of the study was to develop and test curriculum materials for three entry level gainful employment courses: Child Care Services, Clothing Services, Food Services. A second objective was to formulate recommendations for policies and procedures to follow in initiating and developing gainful employment programs in home economics.…

Understanding Malaysian Pre-Service Teachers Mathematical Content Knowledge and Pedagogical Content Knowledge

ERIC Educational Resources Information Center

Leong, Kwan Eu; Meng, Chew Cheng; Rahim, Suzieleez Syrene Abdul

2015-01-01

This article seeks to present findings from the analysis of the TEDS-M reports on the mathematical content knowledge (MCK) and pedagogical content knowledge (PCK) of the pre-service teachers in Malaysia. The main objective of this study was to investigate the level of teaching knowledge attained by the Malaysian pre-service primary and secondary…

Physical activity levels of older adults receiving a home care service.

PubMed

Burton, Elissa; Lewin, Gill; Boldy, Duncan

2013-04-01

The 3 study objectives were to compare the activity levels of older people who had received a restorative home care service with those of people who had received "usual" home care, explore the predictors of physical activity in these 2 groups, and determine whether either group met the minimum recommended activity levels for their age group. A questionnaire was posted to 1,490 clients who had been referred for a home care service between 2006 and 2009. Older people who had received a restorative care service were more active than those who had received usual care (p = .049), but service group did not predict activity levels when other variables were adjusted for in a multiple regression. Younger individuals who were in better physical condition, with good mobility and no diagnosis of depression, were more likely to be active. Investigation of alternatives to the current exercise component of the restorative program is needed.

78 FR 18481 - Project-Level Predecisional Administrative Review Process

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-27

... Administrative Review Process AGENCY: Forest Service, USDA. ACTION: Final rule. SUMMARY: The United States... process by which the public may file objections seeking predecisional administrative review for proposed... for a predecisional objection process. Section 428 further directs the Secretary to apply these...

Multi-registration of software library resources

DOEpatents

Archer, Charles J [Rochester, MN; Blocksome, Michael A [Rochester, MN; Ratterman, Joseph D [Rochester, MN; Smith, Brian E [Rochester, MN

2011-04-05

Data communications, including issuing, by an application program to a high level data communications library, a request for initialization of a data communications service; issuing to a low level data communications library a request for registration of data communications functions; registering the data communications functions, including instantiating a factory object for each of the one or more data communications functions; issuing by the application program an instruction to execute a designated data communications function; issuing, to the low level data communications library, an instruction to execute the designated data communications function, including passing to the low level data communications library a call parameter that identifies a factory object; creating with the identified factory object the data communications object that implements the data communications function according to the protocol; and executing by the low level data communications library the designated data communications function.

An Integrated Model of Patient and Staff Satisfaction Using Queuing Theory

PubMed Central

Mousavi, Ali; Clarkson, P. John; Young, Terry

2015-01-01

This paper investigates the connection between patient satisfaction, waiting time, staff satisfaction, and service time. It uses a variety of models to enable improvement against experiential and operational health service goals. Patient satisfaction levels are estimated using a model based on waiting (waiting times). Staff satisfaction levels are estimated using a model based on the time spent with patients (service time). An integrated model of patient and staff satisfaction, the effective satisfaction level model, is then proposed (using queuing theory). This links patient satisfaction, waiting time, staff satisfaction, and service time, connecting two important concepts, namely, experience and efficiency in care delivery and leading to a more holistic approach in designing and managing health services. The proposed model will enable healthcare systems analysts to objectively and directly relate elements of service quality to capacity planning. Moreover, as an instrument used jointly by healthcare commissioners and providers, it affords the prospect of better resource allocation. PMID:27170899

An Integrated Model of Patient and Staff Satisfaction Using Queuing Theory.

PubMed

Komashie, Alexander; Mousavi, Ali; Clarkson, P John; Young, Terry

2015-01-01

This paper investigates the connection between patient satisfaction, waiting time, staff satisfaction, and service time. It uses a variety of models to enable improvement against experiential and operational health service goals. Patient satisfaction levels are estimated using a model based on waiting (waiting times). Staff satisfaction levels are estimated using a model based on the time spent with patients (service time). An integrated model of patient and staff satisfaction, the effective satisfaction level model, is then proposed (using queuing theory). This links patient satisfaction, waiting time, staff satisfaction, and service time, connecting two important concepts, namely, experience and efficiency in care delivery and leading to a more holistic approach in designing and managing health services. The proposed model will enable healthcare systems analysts to objectively and directly relate elements of service quality to capacity planning. Moreover, as an instrument used jointly by healthcare commissioners and providers, it affords the prospect of better resource allocation.

The impact of technological intensity of service provision on physician expenditures: an exploratory investigation.

PubMed

Roham, Mehrdad; Gabrielyan, Anait R; Archer, Norman P; Grignon, Michel L; Spencer, Byron G

2014-10-01

Advances in technology and subsequent changes in clinical practice can lead to increases in healthcare costs. Our objective is to assess the impact that changes in the technological intensity of physician-provided health services have had on the age pattern of both the volume of services provided and the average expenditures associated with them. We based our analysis on age-sex-specific patient-level administrative records of diagnoses and treatments. These records include virtually all physician services provided in the province of Ontario, Canada in a 10-year span ending in 2004 and their associated costs. An algorithm is developed to classify services and their costs into three levels of technological intensity. We find that while the overall age-standardized level and cost of services per capita have decreased, the volume and cost of high technologically intensive treatments have increased, especially among older patients. Copyright © 2013 John Wiley & Sons, Ltd.

ADJUSTMENT, MAINTENANCE, AND REPAIR OF TILLAGE, PLANTING, SPRAYING, AND FERTILIZING MACHINERY. AGRICULTURAL MACHINERY--SERVICE OCCUPATIONS, MODULE NUMBER 10.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Center for Vocational and Technical Education.

THE PURPOSE OF THIS GUIDE IS TO HELP TEACHERS PREPARE POSTSECONDARY-LEVEL STUDENTS FOR THE AGRICULTURAL MACHINERY SERVICE OCCUPATIONS AS PARTS MEN, MECHANICS, MECHANIC'S HELPERS, AND SERVICE SUPERVISORS. IT WAS DESIGNED BY A NATIONAL TASK FORCE ON THE BASIS OF RESEARCH FROM STATE STUDIES. THE MAJOR OBJECTIVE IS TO DEVELOP (1) STUDENT UNDERSTANDING…

Users' Satisfaction with Library Information Resources and Services: A Case Study College of Health Sciences Library Niger Delta University, Amassoma, Nigeria

ERIC Educational Resources Information Center

Tiemo, Pereware Aghwotu; Ateboh, Benedict Alaowei

2016-01-01

This study investigated users' satisfaction with library information resources and services at the College of Health Sciences (CHS) library Niger Delta University, Nigeria. The objective was to determine the level of users satisfaction with library information resources and services. 2 (two) research questions were formulated to guide the study.…

14 CFR 323.9 - Objections to notices.

Code of Federal Regulations, 2011 CFR

2011-01-01

... DOT action requested. (3) The schedules, routes, carriers, and aircraft types for all air... include in their objections facts to support the suggested level of essential air service (e.g., traffic... on air transportation). (Approved by the Office of Management and Budget under control number 3024...

14 CFR 323.9 - Objections to notices.

Code of Federal Regulations, 2010 CFR

2010-01-01

... DOT action requested. (3) The schedules, routes, carriers, and aircraft types for all air... include in their objections facts to support the suggested level of essential air service (e.g., traffic... on air transportation). (Approved by the Office of Management and Budget under control number 3024...

Exploratory Factor Analyses of the CAHPS® Hospital Pilot Survey Responses across and within Medical, Surgical, and Obstetric Services

PubMed Central

O'Malley, A James; Zaslavsky, Alan M; Hays, Ron D; Hepner, Kimberly A; Keller, San; Cleary, Paul D

2005-01-01

Objectives To estimate the associations among hospital-level scores from the Consumer Assessments of Healthcare Providers and Systems (CAHPS®) Hospital pilot survey within and across different services (surgery, obstetrics, medical), and to evaluate differences between hospital- and patient-level analyses. Data Source CAHPS Hospital pilot survey data provided by the Centers for Medicare and Medicaid Services. Study Design Responses to 33 questionnaire items were analyzed using patient- and hospital-level exploratory factor analytic (EFA) methods to identify both a patient-level and hospital-level composite structures for the CAHPS Hospital survey. The latter EFA was corrected for patient-level sampling variability using a hierarchical model. We compared results of these analyses with each other and to separate EFAs conducted at the service level. To quantify the similarity of assessments across services, we compared correlations of different composites within the same service with those of the same composite across different services. Data Collection Cross-sectional data were collected during the summer of 2003 via mail and telephone from 19,720 patients discharged from November 2002 through January 2003 from 132 hospitals in three states. Principal Findings Six factors provided the best description of inter-item covariation at the patient level. Analyses that assessed variability across both services and hospitals suggested that three dimensions provide a parsimonious summary of inter-item covariation at the hospital level. Hospital-level factor structures also differed across services; as much variation in quality reports was explained by service as by composite. Conclusions Variability of CAHPS scores across hospitals can be reported parsimoniously using a limited number of composites. There is at least as much distinct information in composite scores from different services as in different composite scores within each service. Because items cluster slightly differently in the different services, service-specific composites may be more informative when comparing patients in a given service across hospitals. When studying individual-level variability, a more differentiated structure is probably more appropriate. PMID:16316439

Care pathways as boundary objects between primary and secondary care: Experiences from Norwegian home care services.

PubMed

Håland, Erna; Røsstad, Tove; Osmundsen, Tonje C

2015-11-01

The need for integration of healthcare services and collaboration across organisational boundaries is highlighted as a major challenge within healthcare in many countries. Care pathways are often presented as a solution to this challenge. In this article, we study a project of developing, introducing and using a care pathway across healthcare levels focusing on older home-dwelling patients in need of home care services after hospital discharge. In so doing, we use the concept of boundary object, as described by Star and Griesemer, to explore how care pathways can act as tools for translation between specialist healthcare services and home care services. Based on interviews with participants in the project, we find that response to existing needs, local tailoring, involvement and commitment are all crucial for the care pathway to function as a boundary object in this setting. Furthermore, the care pathway, as we argue, can be used to push boundaries just as much as it can be used as a tool for bridging across them, thus potentially contributing to a more equal relationship between specialist healthcare services and home care services. © The Author(s) 2015.

Offering-level strategy formulation in health service organizations.

PubMed

Pointer, D D

1990-01-01

One of six different strategies must be selected for a health service offering to provide consumers with distinctive value and achieve sustainable competitive advantage in a market or market segment. Decisions must be made regarding objectives sought, market segmentation, market scope, and the customer-value proposition that will be pursued.

Financial Management of Libraries: Past Trends and Future Prospects.

ERIC Educational Resources Information Center

Roberts, Stephen A.

2003-01-01

The financial environment within library and information services is reviewed and a structure for financial management is presented based on funding source and level of commercial activity. Objectives for financial management of library and information services is developed and reviewed in light of future trends and stakeholder perspectives.…

Bilingual Human Services Educational Consortium. Final Report.

ERIC Educational Resources Information Center

Maine Univ., Orono. Bangor Community Coll.

This report presents results of the third year of a project designed to enhance employability and career mobility of limited English speaking Franco-American adults in jobs providing services for the elderly. The first section states project objectives of the college-level, credit-bearing program conducted at five university campuses: (1) to…

Long-term care-service use and increases in care-need level among home-based elderly people in a Japanese urban area.

PubMed

Koike, Soichi; Furui, Yuji

2013-04-01

The objective of this study was to examine the effects of home-based long-term care insurance services on an increase in care need levels and discuss its policy implications. We analyzed care need certification and long-term care service use data for 3006 non-institutionalized elderly persons in a Tokyo ward effective as of October 2009 and 2010. Individual care need assessment intervals and their corresponding changes in care need level were calculated from data at two data acquisition points of care need assessment. Those who had been certified but did not use any long-term care insurance service were defined as the control group. The Cox proportionate hazard model was used to determine whether the use of a long-term care insurance service is associated with increased care need level. After adjusting for sex, age, and care need level, the hazard ratio for the probability of increased care need level among service users was calculated as 0.75 (95% confidence interval, 0.64-0.88; p < 0.001). Home-based long-term care service use may prevent an increase in care need level. Administrative data on care need certification and services use could be an effective tool for evaluating the long-term care insurance system. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Social Capital, Acculturation, Mental Health, and Perceived Access to Services among Mexican American Women

ERIC Educational Resources Information Center

Valencia-Garcia, Dellanira; Simoni, Jane M.; Alegria, Margarita; Takeuchi, David T.

2012-01-01

Objective: We examined whether individual-level social capital--the intangible resources in a community available through membership in social networks or other social structures and perceived trust in the community--was associated with acculturation, depression and anxiety symptoms, and perceived access to services among women of Mexican…

Evaluating the Feasibility of Using Remote Technology for Cochlear Implants

ERIC Educational Resources Information Center

Goehring, Jenny L.; Hughes, Michelle L.; Baudhuin, Jacquelyn L.

2012-01-01

The use of remote technology to provide cochlear implant services has gained popularity in recent years. This article contains a review of research evaluating the feasibility of remote service delivery for recipients of cochlear implants. To date, published studies have determined that speech-processor programming levels and other objective tests…

Formulating Social Policy vis-a-vis Immigrants: Win-Win or Zero-Sum Game?

ERIC Educational Resources Information Center

Kissam, Ed

This paper examines the effectiveness of social services provided to Mexican immigrants in rural California. In addition, the paper offers recommendations for service delivery models and for rethinking the objectives of immigrant social policy. At the most basic level, current social program planning and associated analyses of policy options fail…

Results from the 2009 Michigan Farm to School Survey: Participation Grows from 2004

ERIC Educational Resources Information Center

Colasanti, Kathryn J. A.; Matts, Colleen; Hamm, Michael W.

2012-01-01

Objective: This study investigated changes in Michigan school food service directors' farm to school (FTS) participation levels and perspectives since a 2004 survey and factors that would facilitate FTS expansion. Design: Electronic survey census of all Michigan school food service directors. Setting: Michigan kindergarten-12th grade schools.…

Predictors of Competitive Employment among Consumers with Co-Occurring Mental and Substance Use Disorders

ERIC Educational Resources Information Center

Biegel, David E.; Stevenson, Lauren D.; Beimers, David; Ronis, Robert J.; Boyle, Patrick

2010-01-01

Objectives: This study examines consumer and agency level predictors of competitive employment for consumers with co-occurring disorders. Methods: The study sample included 191 consumers from mental health agencies receiving Integrated Dual Diagnosis Treatment services, including a subgroup which was referred for Supported Employment Services.…

Markov Task Network: A Framework for Service Composition under Uncertainty in Cyber-Physical Systems.

PubMed

Mohammed, Abdul-Wahid; Xu, Yang; Hu, Haixiao; Agyemang, Brighter

2016-09-21

In novel collaborative systems, cooperative entities collaborate services to achieve local and global objectives. With the growing pervasiveness of cyber-physical systems, however, such collaboration is hampered by differences in the operations of the cyber and physical objects, and the need for the dynamic formation of collaborative functionality given high-level system goals has become practical. In this paper, we propose a cross-layer automation and management model for cyber-physical systems. This models the dynamic formation of collaborative services pursuing laid-down system goals as an ontology-oriented hierarchical task network. Ontological intelligence provides the semantic technology of this model, and through semantic reasoning, primitive tasks can be dynamically composed from high-level system goals. In dealing with uncertainty, we further propose a novel bridge between hierarchical task networks and Markov logic networks, called the Markov task network. This leverages the efficient inference algorithms of Markov logic networks to reduce both computational and inferential loads in task decomposition. From the results of our experiments, high-precision service composition under uncertainty can be achieved using this approach.

Strategic management of Public Hospitals' medical services.

PubMed

Hao, Aimin; Yi, Tao; Li, Xia; Wei, Lei; Huang, Pei; Xu, Xinzhou; Yi, Lihua

2016-01-01

Purpose: The quality of medical services provided by competing public hospitals is the primary consideration of the public in determining the selection of a specific hospital for treatment. The main objective of strategic planning is to improve the quality of public hospital medical services. This paper provides an introduction to the history, significance, principles and practices of public hospital medical service strategy, as well as advancing the opinion that public hospital service strategy must not merely aim to produce but actually result in the highest possible level of quality, convenience, efficiency and patient satisfaction.

Scheduling multimedia services in cloud computing environment

NASA Astrophysics Data System (ADS)

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

2018-02-01

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

Constructing and Implementing a Four Tier Test about Static Electricity to Diagnose Pre-service Elementary School Teacher’ Misconceptions

NASA Astrophysics Data System (ADS)

Hermita, N.; Suhandi, A.; Syaodih, E.; Samsudin, A.; Isjoni; Johan, H.; Rosa, F.; Setyaningsih, R.; Sapriadil; Safitri, D.

2017-09-01

We have already constructed and implemented the diagnostic test formed in the four tier test to diagnose pre-service elementary teachers’ misconceptions about static electricity. The method which is utilized in this study is 3D-1I (Define, Design, Develop and Implementation) conducted to the pre-service elementary school teachers. The number of respondents involved in the study is 78 students of PGSD FKIP Universitas Riau. The data was collected by administering diagnostic test items in the form of four tier test. The result indicates that there are several misconceptions related to static electricity concept, these include: 1) Electrostatic objects cannot attract neutral objects, 2) A neutral object is an object that does not contain an electrical charge, and 3) the magnitude of the tensile force between two charged objects depends on the size of the charge. Moreover, the research’s results establish that the diagnostic test is able to analyse number of misconceptions and classify level of understanding pre-service elementary school teachers that is scientific knowledge, misconception, lack knowledge, and error. In conclusion, the diagnostic test item in the form of four tier test has already been constructed and implemented to diagnose students’ conceptions on static electricity.

The structure of the clouds distributed operating system

NASA Technical Reports Server (NTRS)

Dasgupta, Partha; Leblanc, Richard J., Jr.

1989-01-01

A novel system architecture, based on the object model, is the central structuring concept used in the Clouds distributed operating system. This architecture makes Clouds attractive over a wide class of machines and environments. Clouds is a native operating system, designed and implemented at Georgia Tech. and runs on a set of generated purpose computers connected via a local area network. The system architecture of Clouds is composed of a system-wide global set of persistent (long-lived) virtual address spaces, called objects that contain persistent data and code. The object concept is implemented at the operating system level, thus presenting a single level storage view to the user. Lightweight treads carry computational activity through the code stored in the objects. The persistent objects and threads gives rise to a programming environment composed of shared permanent memory, dispensing with the need for hardware-derived concepts such as the file systems and message systems. Though the hardware may be distributed and may have disks and networks, the Clouds provides the applications with a logically centralized system, based on a shared, structured, single level store. The current design of Clouds uses a minimalist philosophy with respect to both the kernel and the operating system. That is, the kernel and the operating system support a bare minimum of functionality. Clouds also adheres to the concept of separation of policy and mechanism. Most low-level operating system services are implemented above the kernel and most high level services are implemented at the user level. From the measured performance of using the kernel mechanisms, we are able to demonstrate that efficient implementations are feasible for the object model on commercially available hardware. Clouds provides a rich environment for conducting research in distributed systems. Some of the topics addressed in this paper include distributed programming environments, consistency of persistent data and fault-tolerance.

Packet utilisation definitions for the ESA XMM mission

NASA Technical Reports Server (NTRS)

Nye, H. R.

1994-01-01

XMM, ESA's X-Ray Multi-Mirror satellite, due for launch at the end of 1999 will be the first ESA scientific spacecraft to implement the ESA packet telecommand and telemetry standards and will be the first ESOC-controlled science mission to take advantage of the new flight control system infrastructure development (based on object-oriented design and distributed-system architecture) due for deployment in 1995. The implementation of the packet standards is well defined at packet transport level. However, the standard relevant to the application level (the ESA Packet Utilization Standard) covers a wide range of on-board 'services' applicable in varying degrees to the needs of XMM. In defining which parts of the ESA PUS to implement, the XMM project first considered the mission objectives and the derived operations concept and went on to identify a minimum set of packet definitions compatible with these aspects. This paper sets the scene as above and then describes the services needed for XMM and the telecommand and telemetry packet types necessary to support each service.

Personal Goals as Predictors of Intended Classroom Goals: Comparing Elementary and Secondary School Pre-Service Teachers

ERIC Educational Resources Information Center

Daniels, Lia M.; Frenzel, Anne C.; Stupnisky, Robert H.; Stewart, Tara L.; Perry, Raymond P.

2013-01-01

Background and Aims: The literature documents fewer classroom mastery goal structures in secondary school compared to elementary. However, little is known about how personal achievement goals may influence classroom goal structures. This is especially true at the level of pre-service teachers. Our objective was to investigate if pre-service…

78 FR 69123 - Draft Long Range Transportation Plan for U.S. Fish and Wildlife Service Lands in the Midwest Region

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-18

... decision-making. Establish a vision, mission, goals, and objectives for transportation planning in the... as a pilot project for the implementation of a region-level transportation planning process within... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R3-R-2012-N270; FXRS85550300000-XXX...

Feasibility of Expanding Services for Very Young Children in the Public Mental Health Setting

ERIC Educational Resources Information Center

Knapp, Penelope K.; Ammen, Sue; Arstein-Kerslake, Cindy; Poulsen, Marie Kanne; Mastergeorge, Ann

2007-01-01

Objective: A quality-improvement study evaluated the feasibility of training mental health providers to provide mental health screening and relationship-based intervention to expand services for children 0 to 5 years of age in eight California county mental health systems from November 2002 to June 2003. State-level training was provided to more…

Model for the evaluation of drug-dispensing services in primary health care

PubMed Central

Sartor, Vanessa de Bona; de Freitas, Sergio Fernando Torres

2014-01-01

OBJECTIVE To develop a model for evaluating the efficacy of drug-dispensing service in primary health care. METHODS An efficacy criterion was adopted to determine the level of achievement of the service objectives. The evaluation model was developed on the basis of a literature search and discussions with experts. The applicability test of the model was conducted in 15 primary health care units in the city of Florianópolis, state of Santa Catarina, in 2010, and data were recorded in structured and pretested questionnaires. RESULTS The model developed was evaluated using five dimensions of analysis for analysis. The model was suitable for evaluating service efficacy and helped to identify the critical points of each service dimension. CONCLUSIONS Adaptations to the data collection technique may be required to adjust for the reality and needs of each situation. The evaluation of the drug-dispensing service should promote adequate access to medications supplied through the public health system. PMID:25372174

Reexamining competitive priorities: Empirical study in service sector

NASA Astrophysics Data System (ADS)

Idris, Fazli; Mohammad, Jihad

2015-02-01

The general objective of this study is to validate the multi-level concept of competitive priorities using reflective-formative model at a higher order for service industries. An empirical study of 228 firms from 9 different service industries is conducted to answer the objective of this study. Partial least square analysis with SmartPLS 2.0 was used to perform the analysis. Finding revealed six priorities: cost, flexibility, delivery, quality talent management, quality tangibility, and innovativeness. It emerges that quality are expanded into two types; one is related to managing talent for process improvement and the second one is the physical appearance and tangibility of the service quality. This study has confirmed competitive priorities as formative second-order hierarchical latent construct by using rigorous empirical evidence. Implications, limitation and suggestion for future research are accordingly discussed in this paper.

Developmental and Behavioral Needs and Service Use for Young Children in Child Welfare

PubMed Central

Stahmer, Aubyn C.; Leslie, Laurel K.; Hurlburt, Michael; Barth, Richard P.; Webb, Mary Bruce; Landsverk, John; Zhang, Jinjin

2006-01-01

Objective To determine the level of developmental and behavioral need in young children entering child welfare (CW), estimate early intervention services use, and examine variation in need and service use based on age and level of involvement with CW by using a national probability sample in the United States. Methods As part of the National Survey of Child and Adolescent Well-Being, data were collected on 2813 children <6 years old for whom possible abuse or neglect was investigated by CW agencies. Analyses used descriptive statistics to determine developmental and behavioral needs across 5 domains (cognition, behavior, communication, social, and adaptive functioning) and service use. Logistic regression was used to examine the relationship between independent variables (age, gender, race-ethnicity, maltreatment history, level of CW involvement, and developmental or behavior problems) and service use. Results Results indicate that age and level of CW involvement predict service use when controlling for need. Both toddlers (41.8%) and preschoolers (68.1%) in CW have high developmental and behavioral needs; however, few children are receiving services for these issues (22.7% overall). Children that remain with their biological parents have similar needs to those in out-of-home care but are less likely to use services. Children <3 years of age are least likely to use services. Conclusions Children referred to CW have high developmental and behavioral need regardless of the level of CW involvement. Both age and level of involvement influence service use when controlling for need. Mechanisms need to be developed to address disparities in access to intervention. PMID:16199698

Relation Between the Level of American Indian and Alaska Native Diabetes Education Program Services and Quality-of-Care Indicators

PubMed Central

Noonan, Carolyn; Goldberg, Jack H.; Valdez, S. Lorraine; Brown, Tammy L.; Manson, Spero M.; Acton, Kelly

2008-01-01

Objectives. We examined the relation between the level of diabetes education program services in the Indian Health Service (IHS) and indicators of the quality of diabetes care to determine if more-comprehensive diabetes services were associated with better quality of diabetes care. Methods. In this cross-sectional study, we used the IHS Integrated Diabetes Education Recognition Program to rank program services into 1 of 3 levels of comprehensiveness, ranging from lowest (developmental) to highest (integrated). We compared quality-of-care indicators among programs of differing levels with the 2001 IHS Diabetes Care and Outcomes Audit. Quality indicators included patients having recommended yearly examinations, education, and laboratory tests and achieving recommended levels of intermediate outcomes of care. Results. Most of the 86 participating programs were classified at or below the developmental level; only 9 programs (11%) were ranked at higher levels. After adjusting for patient characteristics, program factors, and correlation of patients within programs, we associated programs that were more comprehensive with higher completion rates of yearly lipid and hemoglobin A1C tests (P < .05). Conclusions. System-wide improvements in diabetes education are associated with better diabetes care. The results can help inform the development of diabetes education programs. PMID:18511737

Conscientious objection to sexual and reproductive health services: international human rights standards and European law and practice.

PubMed

Zampas, Christina; Andión-Ibañez, Ximena

2012-06-01

The practice of conscientious objection often arises in the area of individuals refusing to fulfil compulsory military service requirements and is based on the right to freedom of thought, conscience and religion as protected by national, international and regional human rights law. The practice of conscientious objection also arises in the field of health care, when individual health care providers or institutions refuse to provide certain health services based on religious, moral or philosophical objections. The use of conscientious objection by health care providers to reproductive health care services, including abortion, contraceptive prescriptions, and prenatal tests, among other services is a growing phenomena throughout Europe. However, despite recent progress from the European Court of Human Rights on this issue (RR v. Poland, 2011), countries and international and regional bodies generally have failed to comprehensively and effectively regulate this practice, denying many women reproductive health care services they are legally entitled to receive. The Italian Ministry of Health reported that in 2008 nearly 70% of gynaecologists in Italy refuse to perform abortions on moral grounds. It found that between 2003 and 2007 the number of gynaecologists invoking conscientious objection in their refusal to perform an abortion rose from 58.7 percent to 69.2 percent. Italy is not alone in Europe, for example, the practice is prevalent in Poland, Slovakia, and is growing in the United Kingdom. This article outlines the international and regional human rights obligations and medical standards on this issue, and highlights some of the main gaps in these standards. It illustrates how European countries regulate or fail to regulate conscientious objection and how these regulations are working in practice, including examples of jurisprudence from national level courts and cases before the European Court of Human Rights. Finally, the article will provide recommendations to national governments as well as to international and regional bodies on how to regulate conscientious objection so as to both respect the practice of conscientious objection while protecting individual's right to reproductive health care.

Willingness to pay for physician services at a primary contact in Ukraine: results of a contingent valuation study.

PubMed

Danyliv, Andriy; Pavlova, Milena; Gryga, Irena; Groot, Wim

2013-06-08

The existence of quasi-formal and informal payments in the Ukrainian health care system jeopardizes equity and creates barriers to access to proper care. Patient payment policies that better match patient preferences are necessary. We analyze the potential and feasibility of official patient charges for public health care services in Ukraine by studying the patterns of fee acceptability, ability and willingness to pay (WTP) for public health care among population groups. We use contingent valuation data collected from 303 respondents representative of the adult Ukrainian population. Three decision points were separated: objection to pay, inability to pay, and level of positive non-zero WTP. These decisions were studied for relations with quality profiles of the services, and socio-demographic characteristics of the respondents and their households. The likelihood to object to pay is mostly determined by the quality characteristics of the services. Objection to pay is not related to corresponding behavior in real life. The likelihood of being unable to pay is associated with older age, lower income, and a larger share of household members with no income. The level of positive WTP is positively related to income (+7% per 1000 UAH increase in income) and is lower for people who visited a doctor but did not pay (-22%). Rather substantial WTP levels (between 0.9% and 1.9% of household income) for one visit to physician indicate a potential for official patient charges in Ukraine. User fees may cover a substantial share of personnel cost in the out-patient sector. The patterns of inability to pay support well designed exemption criteria based on age, income, and other aspects of economic status. The WTP patterns highlight the necessity for payments that are proportional to income. Other methodological and policy implications are discussed.

Career Education Program: Geneva Area City Schools. [Grade 6 Units: Food Production, Ecology, Mind and Body, and Food Services].

ERIC Educational Resources Information Center

Geneva Area City Schools, OH.

Four curriculum units for the sixth grade level focus on: (1) food production and nutrition, (2) food services, (3) physical and mental health, and (4) environmental conservation. Each unit's behavioral unit objectives emphasize career possibilities in the industries related to the unit's topic. A chart format is used to list suggested content…

The Impact of Local Environmental Health Capacity on Foodborne Illness Morbidity in Maryland

PubMed Central

Resnick, Beth A.; Fox, Mary A.; McGready, John; Yager, James P.; Burke, Thomas A.

2011-01-01

Objectives. We evaluated the relationship between local food protection capacity and service provision in Maryland's 24 local food protection programs (FPPs) and incidence of foodborne illness at the county level. Methods. We conducted regression analyses to determine the relationship between foodborne illness and local FPP characteristics. We used the Centers for Disease Control and Prevention's FoodNet and Maryland Department of Health and Mental Hygiene outbreak data set, along with data on Maryland's local FPP capacity (workforce size and experience levels, budget) and service provision (food service facility inspections, public notification programs). Results. Counties with higher capacity, such as larger workforce, higher budget, and greater employee experience, had fewer foodborne illnesses. Counties with better performance and county-level regulations, such as high food service facility inspection rates and requiring certified food manager programs, respectively, had lower rates of illness. Conclusions. Counties with strong local food protection capacity and services can protect the public from foodborne illness. Research on public health services can enhance our understanding of the food protection infrastructure, and the effectiveness of food protection programs in preventing foodborne illness. PMID:21750282

Multi-Tier Mental Health Program for Refugee Youth

ERIC Educational Resources Information Center

Ellis, B. Heidi; Miller, Alisa B.; Abdi, Saida; Barrett, Colleen; Blood, Emily A.; Betancourt, Theresa S.

2013-01-01

Objective: We sought to establish that refugee youths who receive a multi-tiered approach to services, Project SHIFA, would show high levels of engagement in treatment appropriate to their level of mental health distress, improvements in mental health symptoms, and a decrease in resource hardships. Method: Study participants were 30 Somali and…

Pre-Service Teachers' Knowledge and Teaching Comfort Levels for Agricultural Science and Technology Objectives

ERIC Educational Resources Information Center

Wingenbach, Gary J.; White, Judith McIntosh; Degenhart, Shannon; Pannkuk, Tim; Kujawski, Jenna

2007-01-01

Self-efficacy beliefs are defined as context-specific assessments of one's competence to perform specific tasks, influence one's efforts, persistence, and resilience to succeed in a given task. Such beliefs are important determinants when considering agricultural science teachers' subject matter knowledge, teaching comfort levels, and their…

Toronto's 2-1-1 healthcare services for immigrant populations.

PubMed

Cortinois, Andrea A; Glazier, Richard H; Caidi, Nadia; Andrews, Gavin; Herbert-Copley, Mary; Jadad, Alejandro R

2012-12-01

Although access to information on health services is particularly important for recent immigrants, numerous studies have shown that their use of information and referral services is limited. This study explores the role played by 2-1-1 Toronto in supporting recent immigrants. The study objectives were to (1) understand whether 2-1-1 Toronto is reaching and supporting recent immigrants and (2) gain a better appreciation of the information needs of this population group. A phone survey was conducted in 2005-2006 to collect information on 2-1-1 users' characteristics and levels of satisfaction. Survey data were compared (in 2006) with census data to assess their representativeness. To achieve Objective 2, semistructured qualitative interviews were conducted and analyzed in 2006-2007, with a subset of Spanish-speaking callers. Recent immigrants were overrepresented among 2-1-1 callers. However, the survey population was substantially younger and had higher levels of formal education than the general population. Health-related queries represented almost one third of the total. The survey showed very high levels of satisfaction with the service. Many interviewees described their first experiences with the Canadian healthcare system negatively. Most of them had relied on disjointed, low-quality information sources. They trusted 2-1-1 but had discovered it late. Results are mixed in terms of 2-1-1's support to immigrants. A significant percentage of users do not take full advantage of the service. The service could become the information "entry point" for recent immigrants if it was able to reach them early in the resettlement process. Proactive, community-oriented work and a more creative use of technology could help. Copyright © 2012 American Journal of Preventive Medicine. All rights reserved.

US objectives generally achieved at broadcasting satellite international conference. Improvements can help in future conferences

NASA Astrophysics Data System (ADS)

1984-08-01

The implementation of broadcasting satellite service for the Western Hemisphere was planned. Broadcasting satellites transmit television programs and other information services from Earth orbit to home or office antennas. At the request of the Senate Appropriations Subcommittee on Commerce, Justice, State and the Judiciary, GAO reviewed conference results as compared to established conference objectives and examined the interagency coordination of U.S. participation in this international conference. The United States basically achieved its two most important conference objectives: adopting a technically and procedurally flexible plan for broadcasting satellite service and obtaining a sufficient allocation of satellite orbit slots and frequencies to meet domestic needs. The U.S. was unable, however, to obtain agreement on adopting a maximum signal power level for satellites. The Department of State could improve its preparation, internal coordination, and administrative support for future international conferences and recommends actions to the Secretary of State to improve its international telecommunications activities.

Application of Multiprotocol Medical Imaging Communications and an Extended DICOM WADO Service in a Teleradiology Architecture

PubMed Central

Koutelakis, George V.; Anastassopoulos, George K.; Lymberopoulos, Dimitrios K.

2012-01-01

Multiprotocol medical imaging communication through the Internet is more flexible than the tight DICOM transfers. This paper introduces a modular multiprotocol teleradiology architecture that integrates DICOM and common Internet services (based on web, FTP, and E-mail) into a unique operational domain. The extended WADO service (a web extension of DICOM) and the other proposed services allow access to all levels of the DICOM information hierarchy as opposed to solely Object level. A lightweight client site is considered adequate, because the server site of the architecture provides clients with service interfaces through the web as well as invulnerable space for temporary storage, called as User Domains, so that users fulfill their applications' tasks. The proposed teleradiology architecture is pilot implemented using mainly Java-based technologies and is evaluated by engineers in collaboration with doctors. The new architecture ensures flexibility in access, user mobility, and enhanced data security. PMID:22489237

The Association Between Higher Social Support and Lower Depressive Symptoms Among Aging Services Clients is Attenuated at Higher Levels of Functional Impairment

PubMed Central

Van Orden, Kimberly A.; Yan, Li; Podgorski, Carol A.; Conwell, Yeates

2015-01-01

Objective Adults seeking services from the Aging Services Provider Network (ASPN) are at risk for depression. ASPN clients also have high prevalence of both functional impairments and social morbidities. Study of the relationships between these factors may inform the development of interventions for depression in this service setting. Methods We interviewed 373 older adults accessing ASPN services and assessed depression symptom severity, functional impairment (instrumental activities of daily living and activities of daily living), and social support. Results Lower social support and greater functional impairment were associated with greater depressive symptoms. At a high level of functional impairment, the inverse associations between indices of social support and depressive symptoms were attenuated. Conclusions Results suggest that older adults with more severe functional impairment may benefit somewhat less from increased social support with respect to depression symptom severity. PMID:25663607

A Integrated Service Platform for Remote Sensing Image 3D Interpretation and Draughting based on HTML5

NASA Astrophysics Data System (ADS)

LIU, Yiping; XU, Qing; ZhANG, Heng; LV, Liang; LU, Wanjie; WANG, Dandi

2016-11-01

The purpose of this paper is to solve the problems of the traditional single system for interpretation and draughting such as inconsistent standards, single function, dependence on plug-ins, closed system and low integration level. On the basis of the comprehensive analysis of the target elements composition, map representation and similar system features, a 3D interpretation and draughting integrated service platform for multi-source, multi-scale and multi-resolution geospatial objects is established based on HTML5 and WebGL, which not only integrates object recognition, access, retrieval, three-dimensional display and test evaluation but also achieves collection, transfer, storage, refreshing and maintenance of data about Geospatial Objects and shows value in certain prospects and potential for growth.

Career Education Program: Geneva Area City Schools. [Grade 2 Units: Postal Services, Our Homes, Clothing, Community Helpers, and Custodians In Our Lives].

ERIC Educational Resources Information Center

Geneva Area City Schools, OH.

Five curriculum units for the second grade level focus on: (1) clothing producers and suppliers, and the clothing industry; (2) postal service workers and the postal system; (3) janitorial workers; (4) workers who build, furnish, and maintain homes and the housing industry; and (5) various community workers. Behavioral unit objectives emphasize…

A Comparative Study of Directly Selected, In-Service Promoted and Online Selected Subject Specialists Regarding Teaching Effectiveness in Kohat Division, Pakistan

ERIC Educational Resources Information Center

Suleman, Qaiser; Gul, Rizwana

2015-01-01

The main objective of the study was to compare the teaching effectiveness of directly selected, in-service promoted and online selected subject specialists teaching at higher secondary school level in Kohat Division, Pakistan. The target population of the study was the higher secondary school students in Kohat Division, Pakistan. A sample of 600…

Basic Course Deskbook. Volume 1: Client Services

DTIC Science & Technology

2002-03-01

objection has been sustained. U-19 e. Veterans with career tenure. Veterans with career civil service tenure have job retention rights over all other...federal workers in the same competitive level. Veterans with career-conditional tenure do not have job retention rights over non-veterans with...2101 et seq., does require record retention pursuant to National Archives and Records Administration schedules. When this outline was printed, the

Setting Physicians' Prices in FFS Medicare: An Economic Perspective

PubMed Central

Dowd, Bryan; Feldman, Roger; Nyman, John; Town, Bob

2006-01-01

Recent policy discussions by the Medicare Payment Advisory Commission (MedPAC) regarding physician prices in the traditional fee-for-service (FFS) Medicare Program reflect movement toward a market pricing model. Earlier objectives such as sustainable levels of spending have given way to concerns over the relationship between fees and actual costs, access to care, and the importance of demand and supply in local markets. An important objective in other policy settings is economically efficient distribution of services. We explain the meaning of economic efficiency for Medicare physician prices and explore difficulties one might encounter in pursuing economic efficiency, as well as the cost of not pursuing it. PMID:17427848

Contracting for intensive care services.

PubMed

Dorman, S

1996-01-01

Purchasers will increasingly expect clinical services in the NHS internal market to provide objective measures of their benefits and cost effectiveness in order to maintain or develop current funding levels. There is limited scientific evidence to demonstrate the clinical effectiveness of intensive care services in terms of mortality/morbidity. Intensive care is a high-cost service and studies of cost-effectiveness need to take account of case-mix variations, differences in admission and discharge policies, and other differences between units. Decisions over development or rationalisation of intensive care services should be based on proper outcome studies of well defined patient groups. The purchasing function itself requires development in order to support effective contracting.

Standard formatted data units-control authority procedures

NASA Technical Reports Server (NTRS)

1991-01-01

The purpose of this document is to establish a set of minimum and optional requirements for the implementation of Control Authority (CA) organizations within and among the Agencies participating in the Consultative Committee for Space Data Systems (CCSDS). By satisfying these requirements, the resultant cooperating set of CA organizations will produce a global CA service supporting information transfer with digital data under the Standard Formatted Data Unit (SFDU) concept. This service is primarily accomplished through the registration, permanent archiving, and dissemination of metadata in the form of Metadata Objects (MDO) that assist in the interpretation of data objects received in SFDU form. This Recommendation addresses the responsibilities, services, and interface protocols for a hierarchy of CA organizations. The top level, consisting of the CCSDS Secretariat and its operational agent, is unique and primarily provides a global coordination function. The lower levels are Agency CA organizations that have primary responsibility for the registration, archiving, and dissemination of MDOs. As experience is gained and technology evolves, the CA Procedures will be extended to include enhanced services and their supporting protocols. In particular, it is anticipated that eventually CA organizations will be linked via networks on a global basis, and will provide requestors with online automated access to CA services. While this Recommendation does not preclude such operations, it also does not recommend the specific protocols to be used to ensure global compatibility of these services. These recommendations will be generated as experience is gained.

Using Incentives to Align Individual Choice with Organiztional Objectives

DTIC Science & Technology

2009-10-01

International Personality Item Pool – facet level items - Subject pool » University Students – 1st generation college – 18-24 years old, smaller sample 30... Services , Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be...organizational objectives • 4 sets of experiments - Multi-attribute Auction » Precursor to Assignment Incentive Pay (AIP) - Cafeteria Style

Acquiring Semantically Meaningful Models for Robotic Localization, Mapping and Target Recognition

DTIC Science & Technology

2014-12-21

information, including suggesstions for reducing this burden, to Washington Headquarters Services , Directorate for Information Operations and Reports, 1215...Representations • Point features tracking • Recovery of relative motion, visual odometry • Loop closure • Environment models, sparse clouds of points...that co- occur with the object of interest Chair-Background Table-Background Object Level Segmentation Jaccard Index Silber .[5] 15.12 RenFox[4

Nursing Home Staffing Requirements and Input Substitution: Effects on Housekeeping, Food Service, and Activities Staff

PubMed Central

Bowblis, John R; Hyer, Kathryn

2013-01-01

Objective To study the effect of minimum nurse staffing requirements on the subsequent employment of nursing home support staff. Data Sources Nursing home data from the Online Survey Certification and Reporting (OSCAR) System merged with state nurse staffing requirements. Study Design Facility-level housekeeping, food service, and activities staff levels are regressed on nurse staffing requirements and other controls using fixed effect panel regression. Data Extraction Method OSCAR surveys from 1999 to 2004. Principal Findings Increases in state direct care and licensed nurse staffing requirements are associated with decreases in the staffing levels of all types of support staff. Conclusions Increased nursing home nurse staffing requirements lead to input substitution in the form of reduced support staffing levels. PMID:23445455

The Effect of Racial Socialization on Urban African American Use of Child Mental Health Services

PubMed Central

Cavaleri, Mary A.; Rodriguez, James; McKay, Mary M.

2009-01-01

SUMMARY Objective To examine how parental endorsement of racial socialization parenting practices relates to child mental health service use among an urban sample of African American families. Methods A cross-sectional sample of urban African American parents (n = 96) provided ratings of their beliefs concerning various dimensions of racial socialization constructs, i.e., spiritual or religious coping (SRC), extended family caring (EFC), cultural pride reinforcement (CPR), and assessed regarding their use of child mental health services. Results At the multivariate level, the use of child mental health services was significantly positively associated with moderate levels of endorsement of SRC and EFC. Inversely, scores in the moderate range of CPR were associated with a reduced likelihood of child mental health service use. Conclusion Parental endorsement of racial socialization parenting practices appear to play a salient role in child mental health service use among an urban African American families. Further research with larger and more representative samples should be pursued. PMID:20228964

An integrated supply chain model for new products with imprecise production and supply under scenario dependent fuzzy random demand

NASA Astrophysics Data System (ADS)

Nagar, Lokesh; Dutta, Pankaj; Jain, Karuna

2014-05-01

In the present day business scenario, instant changes in market demand, different source of materials and manufacturing technologies force many companies to change their supply chain planning in order to tackle the real-world uncertainty. The purpose of this paper is to develop a multi-objective two-stage stochastic programming supply chain model that incorporates imprecise production rate and supplier capacity under scenario dependent fuzzy random demand associated with new product supply chains. The objectives are to maximise the supply chain profit, achieve desired service level and minimise financial risk. The proposed model allows simultaneous determination of optimum supply chain design, procurement and production quantities across the different plants, and trade-offs between inventory and transportation modes for both inbound and outbound logistics. Analogous to chance constraints, we have used the possibility measure to quantify the demand uncertainties and the model is solved using fuzzy linear programming approach. An illustration is presented to demonstrate the effectiveness of the proposed model. Sensitivity analysis is performed for maximisation of the supply chain profit with respect to different confidence level of service, risk and possibility measure. It is found that when one considers the service level and risk as robustness measure the variability in profit reduces.

Audiology practice management in South Africa: What audiologists know and what they should know

PubMed Central

Kritzinger, Alta; Soer, Maggi

2015-01-01

Background In future, the South African Department of Health aims to purchase services from accredited private service providers. Successful private audiology practices can assist to address issues of access, equity and quality of health services. It is not sufficient to be an excellent clinician, since audiology practices are businesses that must also be managed effectively. Objective The objective was to determine the existing and required levels of practice management knowledge as perceived by South African audiologists. Method An electronic descriptive survey was used to investigate audiology practice management amongst South African audiologists. A total of 147 respondents completed the survey. Results were analysed by calculating descriptive statistics. The Z-proportional test was used to identify significant differences between existing and required levels of practice management knowledge. Results Significant differences were found between existing and required levels of knowledge regarding all eight practice management tasks, particularly legal and ethical issues and marketing and accounting. There were small differences in the knowledge required for practice management tasks amongst respondents working in public and private settings. Conclusion Irrespective of their work context, respondents showed that they need significant expansion of practice management knowledge in order to be successful, to compete effectively and to make sense of a complex marketplace. PMID:26809158

Spatial Skill Profile of Mathematics Pre-Service Teachers

NASA Astrophysics Data System (ADS)

Putri, R. O. E.

2018-01-01

This study is aimed to investigate the spatial intelligence of mathematics pre-service teachers and find the best instructional strategy that facilitates this aspect. Data were collected from 35 mathematics pre-service teachers. The Purdue Spatial Visualization Test (PSVT) was used to identify the spatial skill of mathematics pre-service teachers. Statistical analysis indicate that more than 50% of the participants possessed spatial skill in intermediate level, whereas the other were in high and low level of spatial skill. The result also shows that there is a positive correlation between spatial skill and mathematics ability, especially in geometrical problem solving. High spatial skill students tend to have better mathematical performance compare to those in two other levels. Furthermore, qualitative analysis reveals that most students have difficulty in manipulating geometrical objects mentally. This problem mostly appears in intermediate and low-level spatial skill students. The observation revealed that 3-D geometrical figures is the best method that can overcome the mentally manipulation problem and develop the spatial visualization. Computer application can also be used to improve students’ spatial skill.

A national study of transitional hospital services in mental health.

PubMed Central

Dorwart, R A; Hoover, C W

1994-01-01

OBJECTIVES. Shifts in care for the seriously mentally ill from inpatient to community-based treatment have highlighted the importance of transitional care. Our objectives were to document the kinds and quantity of transitional services provided by psychiatric hospitals nationally and to assess the impact of hospital type (psychiatric vs general), ownership (public vs private), case mix, and revenue source on provision of these services. METHODS. A national sample of nonfederal inpatient mental health facilities (n = 915) was surveyed in 1988, and data were analyzed by using multiple regression. RESULTS. Half (46%) of the facilities surveyed provided patient follow-up of 1 week or less, and almost all (93%) conducted team review of discharge plans, but 74% provided no case management services. Hospital type was the most consistent predictor of transitional care, with psychiatric hospitals providing more of these services than general hospitals. Severity of illness, level of nonfederal funding, urbanicity, and teaching hospital affiliation were positively associated with provision of case management. CONCLUSIONS. Transitional care services for mentally ill patients leaving the hospital were found to be uneven and often inadequate. Reasons for broad variation in services are discussed. PMID:8059877

Patients'/Clients' Expectation Toward and Satisfaction from Pharmacy Services

PubMed Central

Ayalew, Mohammed Biset; Taye, Kaleab; Asfaw, Daniel; Lemma, Bethlehem; Dadi, Filagot; Solomon, Habtamu; Tazeze, Haile; Tsega, Bayew

2017-01-01

Objective: Satisfaction is becoming a popular health-care quality indicator as it reflects the reality of service or care provided. The aim of this study was to assess the level of patients' expectation toward and satisfaction from pharmacy service provided and to identify associated factor that might affect their expectation and satisfaction. Methods: A cross-sectional study was conducted on 287 patients, who were served in five pharmacies of Gondar University Hospital in May 2015. Data regarding socio-demographic characteristics and parameters that measure patients' expectation and satisfaction were collected through interview using the Amharic version of the questionnaire. Data were entered into SPSS version 21, and descriptive statistics, cross-tabs, and binary logistic regressions were utilized. P < 0.05 was used to declare association. Findings: Among 287 respondents involved in the study, 149 (51.9%) claimed to be satisfied with the pharmacy service and setting. Two hundred and twenty-nine (79.4%) respondents have high expectation toward gaining good services. Even though significant association was observed between the pharmacy type and patients level of satisfaction, sociodemographic characteristics of a patient were not found to predict the level of satisfaction. There is a higher level of expectation among study participants who earn higher income per month (>(2000 Ethiopian birr [ETB]) than those who get less income (<1000 ETB). Conclusion: Although patients have a higher level of expectation toward pharmacy services, their satisfaction from the service was found to be low. PMID:28331862

Clients’ perception and satisfaction toward service provided by pharmacy professionals at a teaching hospital in Ethiopia

PubMed Central

Teshome Kefale, Adane; Hagos Atsebah, Gebru; Ayele Mega, Teshale

2016-01-01

Background Evaluation of client’s perception and satisfaction with pharmacy services is important to identify specific areas of the service that need improvement in achieving high-quality pharmacy services. It also helps to detect the gaps in the current pharmaceutical services provision. Objective To assess clients’ perception and satisfaction toward service provided by pharmacy professionals at Mizan-Tepi University Teaching Hospital. Methods A cross-sectional study design was employed from March 8 to 24, 2016. A semistructured questionnaire was used to assess clients’ perception and satisfaction toward service provided by pharmacy professionals. The data collected were entered into Epi data 3.1, cleaned, and transported into and analyzed using SPSS version 20. Logistic regression was employed to determine associated factors, and statistical significance was considered at p-value <0.05. Results Among 384 respondents, 53.1% were male. Of the total participants, 63.8% had good perception and 36.2% had poor perception toward pharmacy services. With regard to satisfaction, 52.6% of the respondents were satisfied and 47.4% were unsatisfied by the pharmaceutical services. Sociodemographic variables such as educational level (p=0.000), occupation (p=0.031), payment for service (p=0.002), and reasons the respondents seek service (p=0.001) showed statistically significant association with the level of perception. Clients’ satisfaction was found to be significantly associated with educational level (p=0.002) and reason for seeking service (p=0.016). Conclusion and recommendation This study showed that the overall mean perception and satisfaction of clients in Mizan-Tepi University Teaching Hospital was low, even though it was above the mean level of perception and satisfaction. Action has to be taken to improve the perception and satisfaction of clients with the services provided in the pharmacy section. PMID:29354544

Help-Seeking among Male Employees in Japan: Influence of Workplace Climate and Distress

PubMed Central

Maekawa, Yumiko; Ramos-Cejudo, Juan; Kanai, Atsuko

2016-01-01

Objectives: Although using mental health services is an effective way to cope with work-related stressors and diseases, many employees do not utilize these services despite service improvements in recent years. The present study aimed to investigate the interaction effects of workplace climate and distress on help-seeking attitudes, and elucidate the reasons for mental health service underutilization in Japan. Methods: A questionnaire was distributed to 650 full-time male Japanese employees. Hierarchical multiple regression analysis was used to investigate interaction effects of workplace climate and distress on help-seeking. Results: Results showed that the association between workplace climate and help-seeking attitudes differed depending on employee distress level. For employees experiencing low levels of distress, openness to seeking treatment increased with a higher evaluation of the mental health services available at the workplace. However, the same did not hold true for employees experiencing high levels of distress. Instead, openness to seeking treatment decreased with perceived risk for career disadvantage for high distress employees. Additionally, negative values for seeking treatment in highly distressed employees decreased only when services were perceived as valuable, and the risk to their career was perceived as low. Conclusions: Overall, these findings indicate that distress distorts the perception of social support, which may lead to underutilization of available services. Assessing employees' distress levels and tailoring adequate interventions could facilitate help-seeking in male employees. PMID:27725378

Use of Spatial Epidemiology and Hot Spot Analysis to Target Women Eligible for Prenatal Women, Infants, and Children Services

PubMed Central

Krawczyk, Christopher; Gradziel, Pat; Geraghty, Estella M.

2014-01-01

Objectives. We used a geographic information system and cluster analyses to determine locations in need of enhanced Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Program services. Methods. We linked documented births in the 2010 California Birth Statistical Master File with the 2010 data from the WIC Integrated Statewide Information System. Analyses focused on the density of pregnant women who were eligible for but not receiving WIC services in California’s 7049 census tracts. We used incremental spatial autocorrelation and hot spot analyses to identify clusters of WIC-eligible nonparticipants. Results. We detected clusters of census tracts with higher-than-expected densities, compared with the state mean density of WIC-eligible nonparticipants, in 21 of 58 (36.2%) California counties (P < .05). In subsequent county-level analyses, we located neighborhood-level clusters of higher-than-expected densities of eligible nonparticipants in Sacramento, San Francisco, Fresno, and Los Angeles Counties (P < .05). Conclusions. Hot spot analyses provided a rigorous and objective approach to determine the locations of statistically significant clusters of WIC-eligible nonparticipants. Results helped inform WIC program and funding decisions, including the opening of new WIC centers, and offered a novel approach for targeting public health services. PMID:24354821

Objections to routine clinical outcomes measurement in mental health services: any evidence so far?

PubMed

MacDonald, Alastair J D; Trauer, Tom

2010-12-01

Routine clinical outcomes measurement (RCOM) is gaining importance in mental health services. To examine whether criticisms published in advance of the development of RCOM have been borne out by data now available from such a programme. This was an observational study of routine ratings using HoNOS65+ at inception/admission and again at discharge in an old age psychiatry service from 1997 to 2008. Testable hypotheses were generated from each criticism amenable to empirical examination. Inter-rater reliability estimates were applied to observed differences between scores between community and ward patients using resampling. Five thousand one hundred eighty community inceptions and 862 admissions had HoNOS65+ ratings at referral/admission and discharge. We could find no evidence of gaming (artificially worse scores at inception and better at discharge), selection, attrition or detection bias, and ratings were consistent with diagnosis and level of service. Anticipated low levels of inter-rater reliability did not vitiate differences between levels of service. Although only hypotheses testable from within RCOM data were examined, and only 46% of eligible episodes had complete outcomes data, no evidence of the alleged biases were found. RCOM seems valid and practical in mental health services.

Research Challenges in Managing and Using Service Level Agreements

NASA Astrophysics Data System (ADS)

Rana, Omer; Ziegler, Wolfgang

A Service Level Agreement (SLA) represents an agreement between a service user and a provider in the context of a particular service provision. SLAs contain Quality of Service properties that must be maintained by a provider, and as agreed between a provider and a user/client. These are generally defined as a set of Service Level Objectives (SLOs). These properties need to be measurable and must be monitored during the provision of the service that has been agreed in the SLA. The SLA must also contain a set of penalty clauses specifying what happens when service providers fail to deliver the pre-agreed quality. Hence, an SLA may be used by both a user and a provider - from a user perspective, an SLA defines what is required - often defined using non-functional attributes of service provision. From a providers perspective, an SLA may be used to support capacity planning - especially if a provider is making it's capability available to multiple users. An SLA may be used by a client and provider to manage their behaviour over time - for instance, to optimise their long running revenue (cost) or QoS attributes (such as execution time), for instance. The lifecycle of an SLA is outlined, along with various uses of SLAs to support infrastructure management. A discussion about WS-Agreement - the emerging standard for specifying SLAs - is also provided.

Evaluation of quality of routine physical examination in urban public basic schools in Khartoum State, Sudan.

PubMed

Alfadeel, Mona A; Hamid, Yassin H M; El Fadeel, Ogail Ata; Salih, Karimeldin M A

2015-01-01

The objectives of this study are to identify the availability of the service logistics in basic public schools (structure as quality concept), to assess steps of physical examination according to the ministry of health guidelines (process as quality concept) and to measure satisfaction of service consumers (pupils) and service providers (teacher and doctors). The study involved seven localities in Sudan using questionnaires and observations. The structure in form of material and human resources was not well maintained, equally the process and procedure of medical examination did not well fit with rules of quality, however, the satisfaction level was within the accepted level. As far as structure, process and outcome were concerned, we are still below the standards in developed countries for many reasons but the level of satisfaction in the present study is more or less similar as in else studies.

Universal health coverage and user charges.

PubMed

Smith, Peter C

2013-10-01

There has been an explosion of interest in the concept of ‘universal health coverage’, fuelled by publication of the World Health Report 2010. This paper argues that the system of user charges for health services is a fundamental determinant of levels of coverage. A charge can lead to a loss of utility in two ways. Citizens who are deterred from using services by the charge will suffer an adverse health impact. And citizens who use the service will suffer a loss of wealth. The role of social health insurance is threefold: to reduce households’ financial risk associated with sickness; to promote enhanced access to needed health services; and to contribute to societal equity objectives, through an implicit financial transfer from rich to poor and healthy to sick. In principle, an optimal user charge policy can ensure that the social health insurance funds are used to best effect in pursuit of these objectives. This paper calls for a fundamental rethink of attitudes and policy towards user charges.

Aspects of the Health Inspection Authority in the People's Republic of China.

PubMed

Ma, Sha; Chen, Gang; Tan, B-K

2015-05-20

In China, there was a pressing need to establish a governmental agency to oversee the organizations that provide public health and medical services. The Chinese Health Inspection Authority (HIA), a relatively independent organization functioning at each administrative level (provincial, municipal, and county), was mandated to conduct 11 health inspection functions to maintain efficient public health and medical services. These functions include issuing health permit, conducting health supervision and inspection, health testing and evaluation, case investigation, complaint handling, managing public health crisis, monitoring and safeguarding public health at major public events, enforcing supervision and inspection compliance, public health education, information management, and team training and management. Since the reform of the health inspection system by the Ministry of Health in 2000, the HIA underwent a series of changes and transitions. This study aimed to describe and assess the five factors that were considered to be important for meeting service delivery objectives of the HIA in the People's Republic of China. A total of 604 HIAs, sampled across three geographical regions of China at three administrative levels, participated in a cross-sectional survey conducted in 2013. Descriptive statistics were used to analyze the status of mandated operations, manpower, revenue and expenditures, and institutional infrastructure. Differences in these characteristics across the geographical regions and administrative levels were compared. On average, the HIAs had not fully implemented the 11 mandated functions at any administrative levels. Governmental financial allocations were the main sources of revenue. Three primary personnel employment models coexisted and most employed the quasi-civil service employment model. The institutional infrastructure did not meet governmental mandated standards with respect to building area or the number and types of equipment available to conduct key functions. In 2012, the majority of the HIAs in China at the provincial, municipal, and county levels did not meet the mandated requirements, although positive indications toward meeting these requirements were observed. It is necessary for the government to pay more attention to institutional resources (buildings, equipment, and the level of the staff's educational attainment) and ensure that the HIAs can meet their service delivery objectives.

The Costs of Scaling Up HIV Prevention for High Risk Groups: Lessons Learned from the Avahan Programme in India

PubMed Central

Chandrashekar, Sudhashree; Guinness, Lorna; Pickles, Michael; Shetty, Govindraj Y.; Alary, Michel; Vickerman, Peter; Vassall, Anna

2014-01-01

Objective The study objective is to measure, analyse costs of scaling up HIV prevention for high-risk groups in India, in order to assist the design of future HIV prevention programmes in South Asia and beyond. Design Prospective costing study. Methods This study is one of the most comprehensive studies of the costs of HIV prevention for high-risk groups to date in both its scope and size. HIV prevention included outreach, sexually transmitted infections (STI) services, condom provision, expertise enhancement, community mobilisation and enabling environment activities. Economic costs were collected from 138 non-government organisations (NGOs) in 64 districts, four state level lead implementing partners (SLPs), and the national programme level (Bill and Melinda Gates Foundation (BMGF)) office over four years using a top down costing approach, presented in US$ 2011. Results Mean total unit costs (2004–08) per person reached at least once a year and per monthly contact were US$ 235(56–1864) and US$ 82(12–969) respectively. 35% of the cost was incurred by NGOs, 30% at the state level SLP and 35% at the national programme level. The proportion of total costs by activity were 34% for expertise enhancement, 37% for programme management (including support and supervision), 22% for core HIV prevention activities (outreach and STI services) and 7% for community mobilisation and enabling environment activities. Total unit cost per person reached fell sharply as the programme expanded due to declining unit costs above the service level (from US$ 477 per person reached in 2004 to US$ 145 per person reached in 2008). At the service level also unit costs decreased slightly over time from US$ 68 to US$ 64 per person reached. Conclusions Scaling up HIV prevention for high risk groups requires significant investment in expertise enhancement and programme administration. However, unit costs decreased with programme expansion in spite of an increase in the scope of activities. PMID:25203052

A multi-objective sustainable model for transportation asset management practices : final report.

DOT National Transportation Integrated Search

2015-12-01

Transportation Asset Management (TAM) practices has gained popularity in the United States and worldwide with the aim to provide the required level of service for the transportation infrastructure network in the most cost-effective manner. However, T...

Highway user expectations for ITD winter maintenance.

DOT National Transportation Integrated Search

2014-07-01

Providing a high Level of Service (LOS) to ensure the safety and mobility for the traveling public is a key objective for winter : maintenance operations. The goal of this research was to obtain a better understanding of Idaho highway users expect...

Service-learning in nursing education: its impact on leadership and social justice.

PubMed

Groh, Carla J; Stallwood, Lynda G; Daniels, John J

2011-01-01

Although studies suggest that service-learning is positive for students, findings reported are primarily qualitative. A convenience sample of 306 senior-level nursing students completed the Service-Learning Self-Evaluation Tool (SLSET) pre- and post-service-learning experience over a six-year span. The constructs measured were leadership skills and social justice. Paired t-tests were calculated. Statistically significant differences were noted between pre- and post-service-learning experience, with students rating themselves higher on leadership and social justice items after the experience. Cronbach's alpha for leadership and social justice were greater than 0.80. Service-learning as an educational methodology that combines community service with academic learning objectives is a viable strategy for facilitating leadership skills and increased awareness of social justice issues in nursing students.

Racial/Ethnic Disparities in the Use of Mental Health Services in Poverty Areas

PubMed Central

Chow, Julian Chun-Chung; Jaffee, Kim; Snowden, Lonnie

2003-01-01

Objectives. This study examined racial/ethnic disparities in mental health service access and use at different poverty levels. Methods. We compared demographic and clinical characteristics and service use patterns of Whites, Blacks, Hispanics, and Asians living in low-poverty and high-poverty areas. Logistic regression models were used to assess service use patterns of minority racial/ethnic groups compared with Whites in different poverty areas. Results. Residence in a poverty neighborhood moderates the relationship between race/ethnicity and mental health service access and use. Disparities in using emergency and inpatient services and having coercive referrals were more evident in low-poverty than in high-poverty areas. Conclusions. Neighborhood poverty is a key to understanding racial/ethnic disparities in the use of mental health services. PMID:12721146

Cooperative fuzzy games approach to setting target levels of ECs in quality function deployment.

PubMed

Yang, Zhihui; Chen, Yizeng; Yin, Yunqiang

2014-01-01

Quality function deployment (QFD) can provide a means of translating customer requirements (CRs) into engineering characteristics (ECs) for each stage of product development and production. The main objective of QFD-based product planning is to determine the target levels of ECs for a new product or service. QFD is a breakthrough tool which can effectively reduce the gap between CRs and a new product/service. Even though there are conflicts among some ECs, the objective of developing new product is to maximize the overall customer satisfaction. Therefore, there may be room for cooperation among ECs. A cooperative game framework combined with fuzzy set theory is developed to determine the target levels of the ECs in QFD. The key to develop the model is the formulation of the bargaining function. In the proposed methodology, the players are viewed as the membership functions of ECs to formulate the bargaining function. The solution for the proposed model is Pareto-optimal. An illustrated example is cited to demonstrate the application and performance of the proposed approach.

Cooperative Fuzzy Games Approach to Setting Target Levels of ECs in Quality Function Deployment

PubMed Central

Yang, Zhihui; Chen, Yizeng; Yin, Yunqiang

2014-01-01

Quality function deployment (QFD) can provide a means of translating customer requirements (CRs) into engineering characteristics (ECs) for each stage of product development and production. The main objective of QFD-based product planning is to determine the target levels of ECs for a new product or service. QFD is a breakthrough tool which can effectively reduce the gap between CRs and a new product/service. Even though there are conflicts among some ECs, the objective of developing new product is to maximize the overall customer satisfaction. Therefore, there may be room for cooperation among ECs. A cooperative game framework combined with fuzzy set theory is developed to determine the target levels of the ECs in QFD. The key to develop the model is the formulation of the bargaining function. In the proposed methodology, the players are viewed as the membership functions of ECs to formulate the bargaining function. The solution for the proposed model is Pareto-optimal. An illustrated example is cited to demonstrate the application and performance of the proposed approach. PMID:25097884

Contextual Predictors of Mental Health Service Use Among Children Open to Child Welfare

PubMed Central

Leslie, Laurel K.; Landsverk, John; Barth, Richard P.; Burns, Barbara J.; Gibbons, Robert D.; Slymen, Donald J.; Zhang, Jinjin

2006-01-01

Background Children involved with child welfare systems are at high risk for emotional and behavioral problems. Many children with identified mental health problems do not receive care, especially ethnic/minority children. Objective To examine how patterns of specialty mental health service use among children involved with child welfare vary as a function of the degree of coordination between local child welfare and mental health agencies. Design Specialty mental health service use for 1 year after contact with child welfare was examined in a nationally representative cohort of children aged 2 to 14 years. Predictors of service use were modeled at the child/family and agency/county levels. Child- and agency-level data were collected between October 15,1999, and April 30, 2001. Setting Ninety-seven US counties. Participants A total of 2823 child welfare cases (multiple informants) from the National Survey of Child and Adolescent Well-being and agency-level key informants from the participating counties. Main Outcome Measures Specialty mental health service use during the year after contact with the child welfare system. Results Only 28.3% of children received specialty mental health services during the year, although 42.4% had clinical-level Child Behavior Checklist scores. Out-of-home placement, age, and race/ethnicity were strong predictors of service use rates, even after controlling for Child Behavior Checklist scores. Increased coordination between local child welfare and mental health agencies was associated with stronger relationships between Child Behavior Checklist scores and service use and decreased differences in rates of service use between white and African American children. Conclusions Younger children and those remaining in their homes could benefit from increased specialty mental health services. They have disproportionately low rates of service use, despite high levels of need. Increases in interagency coordination may lead to more efficient allocation of service resources to children with the greatest need and to decreased racial/ethnic disparities. PMID:15583113

Willingness to pay for physician services at a primary contact in Ukraine: results of a contingent valuation study

PubMed Central

2013-01-01

Background The existence of quasi-formal and informal payments in the Ukrainian health care system jeopardizes equity and creates barriers to access to proper care. Patient payment policies that better match patient preferences are necessary. We analyze the potential and feasibility of official patient charges for public health care services in Ukraine by studying the patterns of fee acceptability, ability and willingness to pay (WTP) for public health care among population groups. Methods We use contingent valuation data collected from 303 respondents representative of the adult Ukrainian population. Three decision points were separated: objection to pay, inability to pay, and level of positive non-zero WTP. These decisions were studied for relations with quality profiles of the services, and socio-demographic characteristics of the respondents and their households. Results The likelihood to object to pay is mostly determined by the quality characteristics of the services. Objection to pay is not related to corresponding behavior in real life. The likelihood of being unable to pay is associated with older age, lower income, and a larger share of household members with no income. The level of positive WTP is positively related to income (+7% per 1000 UAH increase in income) and is lower for people who visited a doctor but did not pay (−22%). Conclusions Rather substantial WTP levels (between 0.9% and 1.9% of household income) for one visit to physician indicate a potential for official patient charges in Ukraine. User fees may cover a substantial share of personnel cost in the out-patient sector. The patterns of inability to pay support well designed exemption criteria based on age, income, and other aspects of economic status. The WTP patterns highlight the necessity for payments that are proportional to income. Other methodological and policy implications are discussed. PMID:23758839

Trade Study: Storing NASA HDF5/netCDF-4 Data in the Amazon Cloud and Retrieving Data Via Hyrax Server Data Server

NASA Technical Reports Server (NTRS)

Habermann, Ted; Gallagher, James; Jelenak, Aleksandar; Potter, Nathan; Lee, Joe; Yang, Kent

2017-01-01

This study explored three candidate architectures with different types of objects and access paths for serving NASA Earth Science HDF5 data via Hyrax running on Amazon Web Services (AWS). We studied the cost and performance for each architecture using several representative Use-Cases. The objectives of the study were: Conduct a trade study to identify one or more high performance integrated solutions for storing and retrieving NASA HDF5 and netCDF4 data in a cloud (web object store) environment. The target environment is Amazon Web Services (AWS) Simple Storage Service (S3). Conduct needed level of software development to properly evaluate solutions in the trade study and to obtain required benchmarking metrics for input into government decision of potential follow-on prototyping. Develop a cloud cost model for the preferred data storage solution (or solutions) that accounts for different granulation and aggregation schemes as well as cost and performance trades.We will describe the three architectures and the use cases along with performance results and recommendations for further work.

Primary Care Performance Measurement and Reporting at a Regional Level: Could a Matrix Approach Provide Actionable Information for Policy Makers and Clinicians?

PubMed Central

Langton, Julia M.; Wong, Sabrina T.; Johnston, Sharon; Abelson, Julia; Ammi, Mehdi; Burge, Fred; Campbell, John; Haggerty, Jeannie; Hogg, William; Wodchis, Walter P.

2016-01-01

Objective: Primary care services form the foundation of modern healthcare systems, yet the breadth and complexity of services and diversity of patient populations may present challenges for creating comprehensive primary care information systems. Our objective is to develop regional-level information on the performance of primary care in Canada. Methods: A scoping review was conducted to identify existing initiatives in primary care performance measurement and reporting across 11 countries. The results of this review were used by our international team of primary care researchers and clinicians to propose an approach for regional-level primary care reporting. Results: We found a gap between conceptual primary care performance measurement frameworks in the peer-reviewed literature and real-world primary care performance measurement and reporting activities. We did not find a conceptual framework or analytic approach that could readily form the foundation of a regional-level primary care information system. Therefore, we propose an approach to reporting comprehensive and actionable performance information according to widely accepted core domains of primary care as well as different patient population groups. Conclusions: An approach that bridges the gap between conceptual frameworks and real-world performance measurement and reporting initiatives could address some of the potential pitfalls of existing ways of presenting performance information (i.e., by single diseases or by age). This approach could produce meaningful and actionable information on the quality of primary care services. PMID:28032823

From Policy to Practice: Implementation of Treatment for Substance Misuse in Québec Primary Healthcare Clinics

PubMed Central

Maynard, Serge; Campbell, Emily; Boodhoo, Katie; Gauthier, Gail; Xenocostas, Spyridoula; Charney, Dara A.

2015-01-01

Background and Objectives: In 2007, the Québec Ministry of Health issued a policy document that specifically mandated the development of addiction treatment services including screening, brief interventions and referral (SBIR) to be delivered by primary healthcare clinics throughout Québec. The current study examined the level of implementation of SBIR one year following the end of the mandate (2007–2012). Approach: Semi-structured interviews were conducted with 45 participants from 21 primary health and social service centres throughout the province. Qualitative analysis was used to evaluate the level of success each centre had in implementing SBIR and to identify organizational measures that contributed to successful implementation. Results: The results show that Québec primary health and social service centres had limited success in their efforts to integrate SBIR into their services. A comparative analysis of the centres, categorized according to their level of implementation, revealed the presence of significant organizational- and staff-level factors, including the creation of formal action plans that were conducive to the successful implementation of SBIR in primary care. Conclusion: The findings highlight the importance of offering support and guidance, as well as a menu of specific practices that are likely to assist primary health and social services centres to implement SBIR. At the organizational level, the adoption of local action plans and formal service trajectories offers a framework that allows for horizontal and vertical integration of new practices. PMID:26742118

The internal audit of clinical areas: a pilot of the internal audit methodology in a health service emergency department.

PubMed

Brown, Alison; Santilli, Mario; Scott, Belinda

2015-12-01

Governing bodies of health services need assurance that major risks to achieving the health service objectives are being controlled. Currently, the main assurance mechanisms generated within the organization are through the review of implementation of policies and procedures and review of clinical audits and quality data. The governing bodies of health services need more robust, objective data to inform their understanding of the control of clinical risks. Internal audit provides a methodological framework that provides independent and objective assurance to the governing body on the control of significant risks. The article describes the pilot of the internal audit methodology in an emergency unit in a health service. An internal auditor was partnered with a clinical expert to assess the application of clinical criteria based on best practice guidelines. The pilot of the internal audit of a clinical area was successful in identifying significant clinical risks that required further management. The application of an internal audit methodology to a clinical area is a promising mechanism to gain robust assurance at the governance level regarding the management of significant clinical risks. This approach needs further exploration and trial in a range of health care settings. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

School bus’s level of service in Malang City

NASA Astrophysics Data System (ADS)

Hariyani, S.

2017-06-01

School Bus began operated on the 12th of January 2015. Provision of school buses is expected to reduce not only the use of vehicles by students, but it is also to reduce the number of traffic jams. Malang school bus facilities provided by the Department of Transport in cooperation with the Department of Education to serve students in elementary school, junior and senior high schools. After the service running two years, based on the preliminary observation not all students are interested in using the school bus. The research objective was to measure the school bus’s level service. The method to measure school bus’s level of service was used Importance Performance analysis (IPA). The results showed that through IPA, it can be concluded that school bus’s level of service in Malang City have been able to serve students/customers with the mean of degree suitability (Tki) is 111. Meanwhile it must be observed and get more attention to improve by government, attributes which is lies in the first quadrant or concentrate here (attribute Adequate space, Seating capacity, Availability trash can, Passenger facility down in points, The availability of information boards in each bus stop, Availability public telephone in each bus stop, and Availability CCTV in each bus), in order to increase its performance.

Task 28: Web Accessible APIs in the Cloud Trade Study

NASA Technical Reports Server (NTRS)

Gallagher, James; Habermann, Ted; Jelenak, Aleksandar; Lee, Joe; Potter, Nathan; Yang, Muqun

2017-01-01

This study explored three candidate architectures for serving NASA Earth Science Hierarchical Data Format Version 5 (HDF5) data via Hyrax running on Amazon Web Services (AWS). We studied the cost and performance for each architecture using several representative Use-Cases. The objectives of the project are: Conduct a trade study to identify one or more high performance integrated solutions for storing and retrieving NASA HDF5 and Network Common Data Format Version 4 (netCDF4) data in a cloud (web object store) environment. The target environment is Amazon Web Services (AWS) Simple Storage Service (S3).Conduct needed level of software development to properly evaluate solutions in the trade study and to obtain required benchmarking metrics for input into government decision of potential follow-on prototyping. Develop a cloud cost model for the preferred data storage solution (or solutions) that accounts for different granulation and aggregation schemes as well as cost and performance trades.

A spatial model to quantify the mortality impact of service delivery in Sub-Saharan Africa: an ecological design utilizing data from South Africa

PubMed Central

2013-01-01

Background Sub Saharan Africa is confronted with a wide range of interlinked health and economic problems that include high levels of mortality and poor service delivery. The objective of the paper is to develop a spatial model for Sub-Saharan Africa that can quantify the mortality impact of (poor) service delivery at sub-district level in order to integrate related health and local level policy interventions. In this regard, an expanded composite service delivery index was developed, and the data were analysed using a Bayesian Poisson spatial model. Results The results indicate significant differences in the risk of mortality and poor service delivery at sub-district level. In particular, the results indicate clusters of high mortality and poor service delivery in two of the bigger, poorer provinces with large rural communities. Conversely, two of the wealthier provinces have lower levels of mortality and higher levels of service delivery, but income inequality is more widespread. The bivariate and multivariate models, moreover, reflect significant positive linkages (p < 0.01) between increased mortality and poor service delivery after adjusting for HIV/AIDS, income inequality, population density and the protective influence of metropolitan areas. Finally, the hypothesized provision of a basket of services reduced the mortality rate in South Africa’s 248 sub-districts by an average of 5.3 (0.3-15.4) deaths per 1000. Conclusion The results indicate that the model can accurately plot mortality and service delivery “hotspots’ at sub-district level, as well as explain their associations and causality. A mortality reduction index shows that mortality in the highest risk sub-districts can be reduced by as much as 15.4 deaths per 1000 by providing a range of basic services. The ability to use the model in a wider SSA context and elsewhere is also feasible given the innovative use of available databases. Finally, the paper illustrates the importance of developing policy in SSA that can simultaneously solve both economic and health problems. PMID:23425437

A spatial model to quantify the mortality impact of service delivery in Sub-Saharan Africa: an ecological design utilizing data from South Africa.

PubMed

Sartorius, Kurt; Sartorius, Benn K D

2013-02-20

Sub Saharan Africa is confronted with a wide range of interlinked health and economic problems that include high levels of mortality and poor service delivery. The objective of the paper is to develop a spatial model for Sub-Saharan Africa that can quantify the mortality impact of (poor) service delivery at sub-district level in order to integrate related health and local level policy interventions. In this regard, an expanded composite service delivery index was developed, and the data were analysed using a Bayesian Poisson spatial model. The results indicate significant differences in the risk of mortality and poor service delivery at sub-district level. In particular, the results indicate clusters of high mortality and poor service delivery in two of the bigger, poorer provinces with large rural communities. Conversely, two of the wealthier provinces have lower levels of mortality and higher levels of service delivery, but income inequality is more widespread. The bivariate and multivariate models, moreover, reflect significant positive linkages (p < 0.01) between increased mortality and poor service delivery after adjusting for HIV/AIDS, income inequality, population density and the protective influence of metropolitan areas. Finally, the hypothesized provision of a basket of services reduced the mortality rate in South Africa's 248 sub-districts by an average of 5.3 (0.3-15.4) deaths per 1000. The results indicate that the model can accurately plot mortality and service delivery "hotspots' at sub-district level, as well as explain their associations and causality. A mortality reduction index shows that mortality in the highest risk sub-districts can be reduced by as much as 15.4 deaths per 1000 by providing a range of basic services. The ability to use the model in a wider SSA context and elsewhere is also feasible given the innovative use of available databases. Finally, the paper illustrates the importance of developing policy in SSA that can simultaneously solve both economic and health problems.

78 FR 34031 - Burned Area Emergency Response, Forest Service

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-06

...) Evaluate potential threats to critical values; (2) determine the risk level for each threat; (3) identify... actions that meet the objectives; (6) evaluate potential response actions on likelihood for timely... stabilization actions. Improved the descriptive guidelines for employing response actions involving...

Remodelling Marketing Communications in an Internet Environment.

ERIC Educational Resources Information Center

Rowley, Jennifer

2001-01-01

Argues that the Internet demands a significant review of approaches to marketing communications, or promotion, as both the strategic and tactical levels. Highlights include electronic business and electronic commerce; comparing organizational and consumer markets; service development; objectives of marketing communications; and questions for…

Area-Level Socioeconomic Gradients in Overweight and Obesity in a Community-Derived Cohort of Health Service Users - A Cross-Sectional Study.

PubMed

Bonney, Andrew; Mayne, Darren J; Jones, Bryan D; Bott, Lawrence; Andersen, Stephen E J; Caputi, Peter; Weston, Kathryn M; Iverson, Don C

2015-01-01

Overweight and obesity lead to higher probability of individuals accessing primary care but adiposity estimates are rarely available at regional levels to inform health service planning. This paper analyses a large, community-derived clinical database of objectively measured body mass index (BMI) to explore relationships with area-level socioeconomic disadvantage for informing regional level planning activities. The study included 91776 adults who had BMI objectively measured between 1 July 2009 and 30 June 2011 by a single pathology provider. Demographic data and BMI were extracted and matched to 2006 national census socioeconomic data using geocoding. Adjusted odds-ratios for overweight and obesity were calculated using sex-stratified logistic regression models with socioeconomic disadvantage of census collection district of residence as the independent variable. The prevalence of overweight or obesity was 79.2% (males) and 65.8% (females); increased with age to 74 years; and was higher in rural (74%) versus urban areas (71.4%) (p<0.001). Increasing socioeconomic disadvantage was associated with increasing prevalence of overweight (p<0.0001), obesity (p<0.0001) and overweight or obesity (p<0.0001) in women and obesity (p<0.0001) in men. Socioeconomic disadvantage was unrelated to overweight (p = 0.2024) and overweight or obesity (p = 0.4896) in males. It is feasible to link routinely-collected clinical data, representative of a discrete population, with geographic distribution of disadvantage, and to obtain meaningful area-level information useful for targeting interventions to improve population health. Our results demonstrate novel area-level socioeconomic gradients in overweight and obesity relevant to regional health service planning.

Discrimination and Mental Health–Related Service Use in a National Study of Asian Americans

PubMed Central

Chen, Juan; Gee, Gilbert C.; Fabian, Cathryn G.; Takeuchi, David T.

2010-01-01

Objectives. We examined the association between perceived discrimination and use of mental health services among a national sample of Asian Americans. Methods. Our data came from the National Latino and Asian American Study, the first national survey of Asian Americans. Our sample included 600 Chinese, 508 Filipinos, 520 Vietnamese, and 467 other Asians (n=2095). We used logistic regression to examine the association between discrimination and formal and informal service use and the interactive effect of discrimination and English language proficiency. Results. Perceived discrimination was associated with more use of informal services, but not with less use of formal services. Additionally, higher levels of perceived discrimination combined with lower English proficiency were associated with more use of informal services. Conclusions. The effect of perceived discrimination and language proficiency on service use indicates a need for more bilingual services and more collaborations between formal service systems and community resources. PMID:20299649

Logistic Model to Support Service Modularity for the Promotion of Reusability in a Web Objects-Enabled IoT Environment.

PubMed

Kibria, Muhammad Golam; Ali, Sajjad; Jarwar, Muhammad Aslam; Kumar, Sunil; Chong, Ilyoung

2017-09-22

Due to a very large number of connected virtual objects in the surrounding environment, intelligent service features in the Internet of Things requires the reuse of existing virtual objects and composite virtual objects. If a new virtual object is created for each new service request, then the number of virtual object would increase exponentially. The Web of Objects applies the principle of service modularity in terms of virtual objects and composite virtual objects. Service modularity is a key concept in the Web Objects-Enabled Internet of Things (IoT) environment which allows for the reuse of existing virtual objects and composite virtual objects in heterogeneous ontologies. In the case of similar service requests occurring at the same, or different locations, the already-instantiated virtual objects and their composites that exist in the same, or different ontologies can be reused. In this case, similar types of virtual objects and composite virtual objects are searched and matched. Their reuse avoids duplication under similar circumstances, and reduces the time it takes to search and instantiate them from their repositories, where similar functionalities are provided by similar types of virtual objects and their composites. Controlling and maintaining a virtual object means controlling and maintaining a real-world object in the real world. Even though the functional costs of virtual objects are just a fraction of those for deploying and maintaining real-world objects, this article focuses on reusing virtual objects and composite virtual objects, as well as discusses similarity matching of virtual objects and composite virtual objects. This article proposes a logistic model that supports service modularity for the promotion of reusability in the Web Objects-enabled IoT environment. Necessary functional components and a flowchart of an algorithm for reusing composite virtual objects are discussed. Also, to realize the service modularity, a use case scenario is studied and implemented.

Logistic Model to Support Service Modularity for the Promotion of Reusability in a Web Objects-Enabled IoT Environment

PubMed Central

Chong, Ilyoung

2017-01-01

Due to a very large number of connected virtual objects in the surrounding environment, intelligent service features in the Internet of Things requires the reuse of existing virtual objects and composite virtual objects. If a new virtual object is created for each new service request, then the number of virtual object would increase exponentially. The Web of Objects applies the principle of service modularity in terms of virtual objects and composite virtual objects. Service modularity is a key concept in the Web Objects-Enabled Internet of Things (IoT) environment which allows for the reuse of existing virtual objects and composite virtual objects in heterogeneous ontologies. In the case of similar service requests occurring at the same, or different locations, the already-instantiated virtual objects and their composites that exist in the same, or different ontologies can be reused. In this case, similar types of virtual objects and composite virtual objects are searched and matched. Their reuse avoids duplication under similar circumstances, and reduces the time it takes to search and instantiate them from their repositories, where similar functionalities are provided by similar types of virtual objects and their composites. Controlling and maintaining a virtual object means controlling and maintaining a real-world object in the real world. Even though the functional costs of virtual objects are just a fraction of those for deploying and maintaining real-world objects, this article focuses on reusing virtual objects and composite virtual objects, as well as discusses similarity matching of virtual objects and composite virtual objects. This article proposes a logistic model that supports service modularity for the promotion of reusability in the Web Objects-enabled IoT environment. Necessary functional components and a flowchart of an algorithm for reusing composite virtual objects are discussed. Also, to realize the service modularity, a use case scenario is studied and implemented. PMID:28937590

Utilizing the NASA Data-enhanced Investigations for Climate Change Education Resource for Elementary Pre-service Teachers in a Technology Integration Education Course.

NASA Astrophysics Data System (ADS)

Howard, E. M.; Moore, T.; Hale, S. R.; Hayden, L. B.; Johnson, D.

2014-12-01

The preservice teachers enrolled in the EDUC 203 Introduction to Computer Instructional Technology course, primarily for elementary-level had created climate change educational lessons based upon their use of the NASA Data-enhanced Investigations for Climate Change Education (DICCE). NASA climate education datasets and tools were introduced to faculty of Minority Serving Institutions through a grant from the NASA Innovations in Climate Education program. These lessons were developed to study various ocean processes involving phytoplankton's chlorophyll production over time for specific geographic areas using the Giovanni NASA software tool. The pre-service teachers had designed the climate change content that will assist K-4 learners to identify and predict phytoplankton sources attributed to sea surface temperatures, nutrient levels, sunlight, and atmospheric carbon dioxide associated with annual chlorophyll production. From the EDUC 203 course content, the preservice teachers applied the three phases of the technology integration planning (TIP) model in developing their lessons. The Zunal website (http://www.zunal.com) served as a hypermedia tool for online instructional delivery in presenting the climate change content, the NASA climate datasets, and the visualization tools used for the production of elementary learning units. A rubric was developed to assess students' development of their webquests to meet the overall learning objectives and specific climate education objectives. Accompanying each webquest is a rubric with a defined table of criteria, for a teacher to assess students completing each of the required tasks for each lesson. Two primary challenges of technology integration for elementary pre-service teachers were 1) motivating pre-service teachers to be interested in climate education and 2) aligning elementary learning objectives with the Next Generation science standards of climate education that are non-existent in the Common Core State Standards.

Determining the Computer Literacy Levels of Vocational Teachers in Southern Nevada and Developing a Computer In-Service Program for Vocational Teachers.

ERIC Educational Resources Information Center

Pomeroy, James L.

A study was conducted to achieve the following objectives: (1) to determine the computer skills level of the vocational teachers in Southern Nevada; (2) to design a computer literacy inservice program targeting the specific instructional needs of vocational teachers with deficient skills; (3) to develop a plan for evaluating the inservice training…

Assessment of the Policy Guidelines for the Teaching and Learning of Geography at the Senior High School Level in Ghana

ERIC Educational Resources Information Center

Ababio, Bethel T.; Dumba, Hillary

2014-01-01

This article empirically assessed the extent to which geography teachers adhered to the Ghana Education Service policy guidelines on the teaching of geography at the Senior High School Level in Ghana. Census survey was used to collect data from seven geography teachers because of the researchers' objective of gaining a quick insight into the…

O/MN Budget Execution at U.S. Naval Shore Activities: A Model for Improving Resource Allocation.

DTIC Science & Technology

1981-12-01

those objective. Is thus for tie, B r d*nateet ennhanced written ai ti 1 fiquoA by the Commaul9 fco VARIANCE RIPIA3ATION PORN ...of each requirement to be prioritized. Needs/desires of all concerned are discussed and classified. [ Family Service Center Director] Under present...obligation of end year sweep up of funds. [Admin. Officer/Director Family Service Center] More knowledge of operational level problems. [Budget Analyst

Ongoing child welfare services: Understanding the relationship of worker and organizational characteristics to service provision.

PubMed

Lwin, Kristen; Fluke, John; Trocmé, Nico; Fallon, Barbara; Mishna, Faye

2018-06-01

Ongoing child welfare services are put in place after completion of the initial maltreatment investigation when there is a perceived need to mitigate the risk of future harm. The knowledge of how clinical, worker, and organizational characteristics interact with this decision to provide ongoing child welfare services is not well integrated in the research literature. Using secondary data from the Canadian Incidence Study of Reported Child Abuse and Neglect-2008, this study's primary objective is to understand the relationship of clinical, worker, and organizational characteristics to the decision to transfer a case to ongoing child welfare services and their relative contribution to the transfer decision in Canada. Findings indicate that several clinical level variables are associated with families receiving ongoing services. Additionally, organizational factors, such as type of services offered by the organization and the number of employee support programs available to workers, significantly predicted the decision to transfer a case to ongoing services. While no worker factors, such as education, amount of training, experience, or caseload, were associated with ongoing service receipt, the intraclass correlation coefficient of the final three-level parsimonious model indicated substantial clustering at the worker level. Results indicate that Canadian child welfare workers make decisions differently based on factors not available in the current study and that what would be deemed as important worker characteristics do not necessarily predict this outcome. Findings and implications for future research are discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

Stochastic multi-objective auto-optimization for resource allocation decision-making in fixed-input health systems.

PubMed

Bastian, Nathaniel D; Ekin, Tahir; Kang, Hyojung; Griffin, Paul M; Fulton, Lawrence V; Grannan, Benjamin C

2017-06-01

The management of hospitals within fixed-input health systems such as the U.S. Military Health System (MHS) can be challenging due to the large number of hospitals, as well as the uncertainty in input resources and achievable outputs. This paper introduces a stochastic multi-objective auto-optimization model (SMAOM) for resource allocation decision-making in fixed-input health systems. The model can automatically identify where to re-allocate system input resources at the hospital level in order to optimize overall system performance, while considering uncertainty in the model parameters. The model is applied to 128 hospitals in the three services (Air Force, Army, and Navy) in the MHS using hospital-level data from 2009 - 2013. The results are compared to the traditional input-oriented variable returns-to-scale Data Envelopment Analysis (DEA) model. The application of SMAOM to the MHS increases the expected system-wide technical efficiency by 18 % over the DEA model while also accounting for uncertainty of health system inputs and outputs. The developed method is useful for decision-makers in the Defense Health Agency (DHA), who have a strategic level objective of integrating clinical and business processes through better sharing of resources across the MHS and through system-wide standardization across the services. It is also less sensitive to data outliers or sampling errors than traditional DEA methods.

Institutional Efficiency in Selected Universities in Uganda

ERIC Educational Resources Information Center

Amina, Nakimuli; Turyahebwa, Abanis

2015-01-01

Universities are accountable This study looked into Institutional Efficiency in selected Universities in Central Uganda. The study was guided by the following objectives; Determine the level of institutional efficiency of the universities in terms of educational efficiency; research efficiency and community service efficiency. The study employed…

Cost and time benefits for using subsurface utility engineering in Louisiana : research project capsule.

DOT National Transportation Integrated Search

2016-04-01

The objectives of this research are: to establish a record of all major projects : where DOTD has used SUE services in the past (SUE quality levels depicted : in Figure 1), including : interviews with various : DOTD personnel, : utility companies, an...

Erectable space platform for space sciences and applications

NASA Technical Reports Server (NTRS)

1979-01-01

The specific objectives of the study were to: (1) identify a viable conceptual design for the service module/platform; (2) assess the technology issues that must be faced in planning development; and (3) prepare an initial plan for bringing critical technologies up to acceptable levels.

Bi-Objective Modelling for Hazardous Materials Road–Rail Multimodal Routing Problem with Railway Schedule-Based Space–Time Constraints

PubMed Central

Sun, Yan; Lang, Maoxiang; Wang, Danzhu

2016-01-01

The transportation of hazardous materials is always accompanied by considerable risk that will impact public and environment security. As an efficient and reliable transportation organization, a multimodal service should participate in the transportation of hazardous materials. In this study, we focus on transporting hazardous materials through the multimodal service network and explore the hazardous materials multimodal routing problem from the operational level of network planning. To formulate this problem more practicably, minimizing the total generalized costs of transporting the hazardous materials and the social risk along the planned routes are set as the optimization objectives. Meanwhile, the following formulation characteristics will be comprehensively modelled: (1) specific customer demands; (2) multiple hazardous material flows; (3) capacitated schedule-based rail service and uncapacitated time-flexible road service; and (4) environmental risk constraint. A bi-objective mixed integer nonlinear programming model is first built to formulate the routing problem that combines the formulation characteristics above. Then linear reformations are developed to linearize and improve the initial model so that it can be effectively solved by exact solution algorithms on standard mathematical programming software. By utilizing the normalized weighted sum method, we can generate the Pareto solutions to the bi-objective optimization problem for a specific case. Finally, a large-scale empirical case study from the Beijing–Tianjin–Hebei Region in China is presented to demonstrate the feasibility of the proposed methods in dealing with the practical problem. Various scenarios are also discussed in the case study. PMID:27483294

Health financing for universal coverage and health system performance: concepts and implications for policy

PubMed Central

2013-01-01

Abstract Unless the concept is clearly understood, “universal coverage” (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization’s World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level. PMID:23940408

Health financing for universal coverage and health system performance: concepts and implications for policy.

PubMed

Kutzin, Joseph

2013-08-01

Unless the concept is clearly understood, "universal coverage" (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization's World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level.

LEO cooperative multi-spacecraft refueling mission optimization considering J2 perturbation and target's surplus propellant constraint

NASA Astrophysics Data System (ADS)

Zhao, Zhao; Zhang, Jin; Li, Hai-yang; Zhou, Jian-yong

2017-01-01

The optimization of an LEO cooperative multi-spacecraft refueling mission considering the J2 perturbation and target's surplus propellant constraint is studied in the paper. First, a mission scenario is introduced. One service spacecraft and several target spacecraft run on an LEO near-circular orbit, the service spacecraft rendezvouses with some service positions one by one, and target spacecraft transfer to corresponding service positions respectively. Each target spacecraft returns to its original position after obtaining required propellant and the service spacecraft returns to its original position after refueling all target spacecraft. Next, an optimization model of this mission is built. The service sequence, orbital transfer time, and service position are used as deign variables, whereas the propellant cost is used as the design objective. The J2 perturbation, time constraint and the target spacecraft's surplus propellant capability constraint are taken into account. Then, a hybrid two-level optimization approach is presented to solve the formulated mixed integer nonlinear programming (MINLP) problem. A hybrid-encoding genetic algorithm is adopted to seek the near optimal solution in the up-level optimization, while a linear relative dynamic equation considering the J2 perturbation is used to obtain the impulses of orbital transfer in the low-level optimization. Finally, the effectiveness of the proposed model and method is validated by numerical examples.

The Italian National Health Service expenditure on workplace prevention and safety (2006-2013): a national-level analysis.

PubMed

Signorelli, C; Riccò, M; Odone, A

2016-01-01

The World Health Organization (WHO) stated that countries' health policies should give high priority to primary prevention of occupational health hazards. Scant data are available on health expenditure on workplace prevention and safety services and on its impact on occupational health outcomes in Italy and in other European countries. objective of the present study was to systematically retrieve, analyse and critically appraise the available national-level data on public health expenditure on workplace prevention and safety services as well as to correlate them with occupational health outcomes. National-level data on total public health expenditure on prevention services, its share spent on workplace prevention and safety services as well as on number of workers receiving appropriate health surveillance were derived from the national public health expenditure monitoring system over a 8-year study period (2006-2013). An analytic approach was adopted to explore the association between health expenditure and occupational health services supply. The Italian National Health Service spends almost € 5 billion per year on preventive care, of which 13.3% are spent on workplace prevention and safety programmes (€ 645 million, € 10.6 per capita). There is wide heterogeneity between Italian regions. Our findings are useful for health systems and policies analysis, national and international comparisons as well as for health policy makers to plan, implement and monitor occupational health prevention programmes.

Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey

PubMed Central

Pachankis, John E.; Hatzenbuehler, Mark L.; Hickson, Ford; Weatherburn, Peter; Berg, Rigmor C.; Marcus, Ulrich; Schmidt, Axel J.

2016-01-01

Objective Substantial country-level variation exists in prejudiced attitudes towards male homosexuality and in the extent to which countries promote the unequal treatment of MSM through discriminatory laws. The impact and underlying mechanisms of country-level stigma on odds of diagnosed HIV, sexual opportunities, and experience of HIV-prevention services, needs and behaviours have rarely been examined, however. Design Data come from the European MSM Internet Survey (EMIS), which was administered between June and August 2010 across 38 European countries (N =174 209). Methods Country-level stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of attitudes held by the citizens of each country. We also assessed concealment, HIV status, number of past 12-month male sex partners, and eight HIV-preventive services, knowledge, and behavioural outcomes. Results MSM living in countries with higher levels of stigma had reduced odds of diagnosed HIV and fewer partners but higher odds of sexual risk behaviour, unmet prevention needs, not using testing services, and not discussing their sexuality in testing services. Sexual orientation concealment mediated associations between country-level stigma and these outcomes. Conclusion Country-level stigma may have historically limited HIV transmission opportunities among MSM, but by restricting MSM’s public visibility, it also reduces MSM’s ability to access HIV-preventive services, knowledge and precautionary behaviours. These findings suggest that MSM in European countries with high levels of stigma are vulnerable to HIV infection. Although they have less opportunity to identify and contact other MSM, this might change with emerging technologies. PMID:26035323

Patterns of coordination and clinical outcomes: a study of surgical services.

PubMed Central

Young, G J; Charns, M P; Desai, K; Khuri, S F; Forbes, M G; Henderson, W; Daley, J

1998-01-01

OBJECTIVE: To test the hypothesis that surgical services combining relatively high levels of feedback and programming approaches to the coordination of surgical staff would have better quality of care than surgical services using low levels of both coordination approaches as well as those surgical service using low levels of either coordination approach. STUDY SETTING: A study sample of 44 academically affiliated surgical services that are part of the Department of Veterans Affairs. STUDY DESIGN: In a cross-sectional analysis, surgical services were assigned to one of three groups based on their scores on feedback and programming coordination measures: high on both measures; high on one measure, low on the other; and low on both. Univariate and multivariate analyses were used to assess differences among these groups with respect to three quality indicators: risk-adjusted mortality, risk-adjusted morbidity, and staff perceptions of quality. DATA COLLECTION/EXTRACTION METHODS: Risk-adjusted mortality and morbidity came from an outcomes reporting program within the Department of Veterans Affairs that entails the prospective collection of clinical data from patient charts. Data on coordination practices and perceived quality came from a survey of surgical staff at each of the 44 participating surgical services. PRINCIPAL FINDINGS: The group of surgical services using high feedback and high programming had the best perceived quality. This group also had the lowest morbidity, but the difference was statistically significant with respect to only one of the two other groups: the group with low feedback and low programming. No significant group differences were found for mortality. CONCLUSIONS: Study results provide partial support for the hypothesis that high levels of feedback and programming should be combined for optimal quality of care. Study results also suggest that staff coordination is more important for improving morbidity than mortality in surgical services. PMID:9865218

DoDs Efforts to Consolidate Data Centers Need Improvement

DTIC Science & Technology

2016-03-29

Consolidation Initiative, February 26, 2010. 3 Green IT minimizes negative environmental impact of IT operations by ensuring that computers and computer-related...objectives for consolidating data centers. DoD’s objectives were to: • reduce cost; • reduce environmental impact ; • improve efficiency and service levels...number of DoD data centers. Finding A DODIG-2016-068 │ 7 information in DCIM, the DoD CIO did not confirm whether those changes would impact DoD’s

Determinants of farmers' choice for veterinary service providers in Nepal Mountains.

PubMed

Lamichhane, Dirga Kumar; Shrestha, Sabina

2012-08-01

This study was aimed to analyze factors that affect farmers' choice for major actors of veterinary service providers in village areas of Kaski district of Nepal, with the objective of identifying choice-specific attributes which could be addressed for improving the penetration of professional veterinary services in village areas. The information was obtained from 125 farmers using a structured questionnaire. A proportional hazard model was used for data analysis because of its ability to accommodate the attributes of both the chooser and the choice simultaneously. The results showed that village animal health workers (VAHWs) were the most preferred service providers followed by veterinarians and mid-level technicians. The farmers' age and education level had a significant but inverse relationship with the probability of choosing any of the three service providers. From our study, we found that the main choice-specific attributes with a significant impact on the choice probability was the distance to the preferred service provider. Since there was a high preference for VAHW, this suggests the possibility of poorly trained service providers dominating veterinary service market in village areas of Kaski district. Hence, the efforts put forward in the legalization of VAHW system in Nepal should first address the constraints that obstruct the accessibility of professional veterinary service providers in village areas.

Next generation satellite communications networks

NASA Astrophysics Data System (ADS)

Garland, P. J.; Osborne, F. J.; Streibl, I.

The paper introduces two potential uses for new space hardware to permit enhanced levels of signal handling and switching in satellite communication service for Canada. One application involves increased private-sector services in the Ku band; the second supports new personal/mobile services by employing higher levels of handling and switching in the Ka band. First-generation satellite regeneration and switching experiments involving the NASA/ACTS spacecraft are described, where the Ka band and switching satellite network problems are emphasized. Second-generation satellite development is outlined based on demand trends for more packet-based switching, low-cost earth stations, and closed user groups. A demonstration mission for new Ka- and Ku-band technologies is proposed, including the payload configuration. The half ANIK E payload is shown to meet the demonstration objectives, and projected to maintain a fully operational payload for at least 10 years.

Structured decision making as a method for linking quantitative decision support to community fundamental objectives

EPA Science Inventory

Decision support intended to improve ecosystem sustainability requires that we link stakeholder priorities directly to quantitative tools and measures of desired outcomes. Actions taken at the community level can have large impacts on production and delivery of ecosystem service...

Role Orientation of Certified Athletic Trainers at Institutions of Higher Education

ERIC Educational Resources Information Center

Brumels, Kirk; Beach, Andrea

2008-01-01

Objective: This study examined the role orientation hierarchy among teaching, research, service, and administrative responsibilities of certified athletic trainers (ATCs) employed at the collegiate level. Design and Setting: Four single response role orientation questions regarding their actual, ideal, promoted, and most appropriate role…

Educational Goals and Results, 1982-83.

ERIC Educational Resources Information Center

Wilson, Morris D.; Baldwin, Robert

As a function of Des Moines, Iowa's, planning and management system for improving educational services through coordinated, continuous planning and evaluation at all levels from superintendent to classroom teacher, this report measures the success of district administration and individual schools in achieving stated objectives for 1982-83. Five…

Satisfaction of healthy pregnant women receiving short message service via mobile phone for prenatal support: A randomized controlled trial.

PubMed

Jareethum, Rossathum; Titapant, Vitaya; Chantra, Tienthai; Sommai, Viboonchart; Chuenwattana, Prakong; Jirawan, Chatchainoppakhun

2008-04-01

The main objective was to compare the satisfaction levels of antenatal care between healthy pregnant women who received short message service (SMS) via mobile phone for prenatal support, and those who did not. The second objective was to compare the confidence, anxiety levels and also pregnancy outcomes. A randomized controlled trial. 68 healthy pregnant women who attended the antenatal clinic and delivered at Siriraj Hospital, who met the inclusion criterias between May 2007 and October 2007, were enrolled and randomly allocated into two random groups. The study group received two SMS messages per week from 28 weeks of gestation until giving birth. The other group was pregnant women who did not receive SMS. Both groups had the same antenatal and perinatal care. The satisfaction, confidence and anxiety scores were evaluated using a questionnaire at the postpartum ward. The pregnancy outcomes were also compared in these two groups. The satisfaction levels of the women who received prenatal support in SMS messages, were significantly higher than those of who did not receive the messages both in the antenatal period (9.25 vs. 8.00, p < 0.001) and during labor (9.09 vs. 7.90, p = 0.007). In the SMS using group, the confidence level was'higher (8.91 vs. 7.79, p = 0.001) and the anxiety level was lower (2.78 vs. 4.93, p = 0.002) than the control group n the antenatal period, however no diference in pregnancy outcomes were found. The present study shows the higher satisfaction level of pregnant women who received SMS via mobile phone during their antenatal service when compared with the general antenatal care group. The study also show the higher confidence level and lower anxiety level in the antenatal period but no difference in pregnancy outcomes.

Provision of oral hygiene services as a potential method for preventing periodontal disease and control hypertension and diabetes in a community health centre in Korea.

PubMed

Kim, Nam-Hee; Lee, Ga-Yeong; Park, Su-Kyung; Kim, Yeun-Ju; Lee, Min-Young; Kim, Chun-Bae

2018-05-01

This study aimed to evaluate the effects of a community-based oral hygiene service on general and periodontal health indicators of patients with hypertension and type 2 diabetes mellitus visiting a community health centre in Korea. The study used a one-group pretest-posttest and interrupted time-series design. A total of 151 participants (45% male), with a mean age of 63 ± 8.4 years, were included in the study; these included patients with hypertension (62%), diabetes (12%) and both hypertension and diabetes (26%). Two dental hygienists dedicated 2 days per week to this project, providing oral hygiene services to 10-13 participants per day. Four oral hygiene service sessions were provided per patient. The objective oral hygiene status and subjective self-reported periodontal status were compared before and after the service. The changes in blood pressure and glycosylated haemoglobin levels were also assessed. A lower frequency of subjective swelling was reported at the fourth session (37.9%) compared to the first (55.6%) session. Further, significantly fewer cases of calculus and bleeding were observed (p < .05), and significantly more patients reported having no gum problems at the fourth session (43.1% vs. 27.2%; p < .05) than at the first session. Finally, the participants maintained stable blood pressures at each of the four sessions, and their glycosylated haemoglobin levels were significantly lower at the fourth session. In conclusion, the findings of this study suggest that community oral hygiene services provided by dental hygienists can promote objective oral hygiene and subjective periodontal status in the local community, and may help in the control of hypertension and diabetes. © 2017 John Wiley & Sons Ltd.

Implementation of the free maternity services policy and its implications for health system governance in Kenya

PubMed Central

Smith, Helen

2017-01-01

Introduction To move towards universal health coverage, the government of Kenya introduced free maternity services in all public health facilities in June 2013. User fees are, however, important sources of income for health facilities and their removal has implications for the way in which health facilities are governed. Objective To explore how implementation of Kenya’s financing policy has affected the way in which the rules governing health facilities are made, changed, monitored and enforced. Methods Qualitative research was carried out using semistructured interviews with 39 key stakeholders from six counties in Kenya: 10 national level policy makers, 10 county level policy makers and 19 implementers at health facilities. Participants were purposively selected using maximum variation sampling. Data analysis was informed by the institutional analysis framework, in which governance is defined by the rules that distribute roles among key players and shape their actions, decisions and interactions. Results Lack of clarity about the new policy (eg, it was unclear which services were free, leading to instances of service user exploitation), weak enforcement mechanisms (eg, delayed reimbursement to health facilities, which led to continued levying of service charges) and misaligned incentives (eg, the policy led to increased uptake of services thereby increasing the workload for health workers and health facilities losing control of their ability to generate and manage their own resources) led to weak policy implementation, further complicated by the concurrent devolution of the health system. Conclusion The findings show the consequences of discrepancies between formal institutions and informal arrangements. In introducing new policies, policy makers should ensure that corresponding institutional (re)arrangements, enforcement mechanisms and incentives are aligned with the objectives of the implementers. PMID:29177098

Factors Influencing Abortion Decision-Making Processes among Young Women

PubMed Central

Frederico, Mónica; Michielsen, Kristien; Decat, Peter

2018-01-01

Background: Decision-making about if and how to terminate a pregnancy is a dilemma for young women experiencing an unwanted pregnancy. Those women are subject to sociocultural and economic barriers that limit their autonomy and make them vulnerable to pressures that influence or force decisions about abortion. Objective: The objective of this study was to explore the individual, interpersonal and environmental factors behind the abortion decision-making process among young Mozambican women. Methods: A qualitative study was conducted in Maputo and Quelimane. Participants were identified during a cross-sectional survey with women in the reproductive age (15–49). In total, 14 women aged 15 to 24 who had had an abortion participated in in-depth interviews. A thematic analysis was used. Results: The study found determinants at different levels, including the low degree of autonomy for women, the limited availability of health facilities providing abortion services and a lack of patient-centeredness of health services. Conclusions: Based on the results of the study, the authors suggest strategies to increase knowledge of abortion rights and services and to improve the quality and accessibility of abortion services in Mozambique. PMID:29438335

Community Determinants of Latinos’ Use of Mental Health Services

PubMed Central

Aguilera, Adrian; Regeser López, Steven

2014-01-01

Objective This study examined the role of community in understanding Latino adults’ (18–64 years of age) use of community mental health services. Methods Service utilization data from the Los Angeles County Department of Mental Health were analyzed from 2003 in two service provider areas. Demographic data, including foreign-born status, language, education, and income for the Latino population, were obtained from the 2000 U.S. Census. The study sample consisted of 4,133 consumers of mental health services in 413 census tracts from an established immigrant community and 4,156 consumers of mental health services in 204 census tracts from a recent immigrant community. Negative binomial regression analyses were conducted to examine associations between locales, community characteristics, and use of services. Results Community of residence and foreign-born status were significantly associated with Latinos’ service use. Latinos from the established immigrant community were more likely to use services than Latinos from the recent immigrant community. Across both communities, census tracts with a higher percentage of foreign-born noncitizen residents showed lower service use. Within the established immigrant community, as income levels increased there was little change in utilization. In contrast, in the recent immigrant community, as income levels increased utilization rates increased as well (β=.001, p<.001). Conclusions The findings point out the importance of locale and community determinants in understanding Latinos’ use of public mental health services. PMID:18378840

The HCBS Taxonomy: A New Language for Classifying Home- and Community-Based Services

PubMed Central

Peebles, Victoria; Bohl, Alex

2014-01-01

Introduction As states make home- and community-based services (HCBS) more accessible, researchers have become more interested in understanding service use and spending. Because state Medicaid programs differ in the types of services they offer and in how they report these services, analyzing HCBS at the national level is challenging. Objective Describe the HCBS taxonomy and present findings on HCBS waiver expenditures and users. Data This brief analyzed fee-for-service claims from 28 approved states in 2010 Medicaid Analytic eXtract (MAX) files. We summed all expenditures and counted the unique number of users across each HCBS taxonomy service and category. Methods The taxonomy was developed jointly by Truven Health (at that time Thomson Reuters) and Mathematica Policy Research, with stakeholder input, and reviewed using procedure codes. Today, the taxonomy is organized by 18 categories and over 60 specific services. Findings For calendar year 2010, 28 states spent almost $23.6 billion on HCBS, with 80 percent of expenditures categorized as round-the-clock, home-based, and day services. Other services, such as case management, or equipment, modifications, and technology were widely used, but are not particularly costly and do not account for a large proportion of expenditures in every state. Conclusions By providing a common language, the taxonomy presents detailed information on services and makes it easier to assess and identify state-level variation for HCBS. PMID:25343057

Listening to food workers: Factors that impact proper health and hygiene practice in food service

PubMed Central

Clegg Smith, Katherine; Neff, Roni A.; Pollack, Keshia M.; Ensminger, Margaret

2015-01-01

Background Foodborne disease is a significant problem worldwide. Research exploring sources of outbreaks indicates a pronounced role for food workers' improper health and hygiene practice. Objective To investigate food workers' perceptions of factors that impact proper food safety practice. Method Interviews with food service workers in Baltimore, MD, USA discussing food safety practices and factors that impact implementation in the workplace. A social ecological model organizes multiple levels of influence on health and hygiene behavior. Results Issues raised by interviewees include factors across the five levels of the social ecological model, and confirm findings from previous work. Interviews also reveal many factors not highlighted in prior work, including issues with food service policies and procedures, working conditions (e.g., pay and benefits), community resources, and state and federal policies. Conclusion Food safety interventions should adopt an ecological orientation that accounts for factors at multiple levels, including workers' social and structural context, that impact food safety practice. PMID:26243248

Building a community-academic partnership to improve health outcomes in an underserved community.

PubMed

McCann, Eileen

2010-01-01

East Garfield Park, IL, is an impoverished community with 59.7% of residents falling below twice the poverty level and 42.6% of its children in poverty. In 2001, the leading causes of hospitalizations were heart disease (10.3%), diabetes (2%), and asthma (3.9%), all of which occur at frequencies 33% greater than the Chicago average. Finally, a review of the health care facilities in the community suggests that there is a need for accessible primary health care services in the area. The purpose of this project was to improve health outcomes in an impoverished, underserved community with documented health care needs and lack of adequate health care services by creating a community-academic partnership to provide on-site, interdisciplinary, health care services within an established and trusted community-based social service agency, Marillac House. The short-term objectives for this project included creating a community-academic partnership between Marillac House and Colleges of Nursing, Medicine, and Health Sciences; providing comprehensive health care services; and developing an innovative clinical education model for interdisciplinary care across specialties. Long-term objectives included providing preventative services; evidenced-based management of acute and chronic illness; evaluating client's health outcomes; and creating a sustainability plan for the long-term success of the health center.

Video Relay Service for Signing Deaf - Lessons Learnt from a Pilot Study

NASA Astrophysics Data System (ADS)

Ponsard, Christophe; Sutera, Joelle; Henin, Michael

The generalization of high speed Internet, efficient compression techniques and low cost hardware have resulted in low cost video communication since the year 2000. For the Deaf community, this enables native communication in sign language and a better communication with hearing people over the phone. This implies that Video Relay Service can take over the old Text Relay Service which is less natural and requires mastering written language. A number of such services have developed throughout the world. The objectives of this paper are to present the experience gained in the Walloon Region of Belgium, to share a number of lessons learnt, and to provide recommendations at the technical, user adoption and political levels. A survey of video relay services around the world is presented together with the feedback from users both before and after using the pilot service.

Equity of access to specialist chronic fatigue syndrome (CFS/ME) services in England (2008–2010): a national survey and cross-sectional study

PubMed Central

Collin, Simon M; Sterne, Jonathan A C; Hollingworth, William; May, Margaret T; Crawley, Esther

2012-01-01

Objectives Provision of National Health Service (NHS) specialist chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) services in England has been deemed patchy and inconsistent. Our objective was to explore variation in the provision of NHS specialist CFS/ME services and to investigate whether access is related to measures of deprivation and inequality. Design Survey of all CFS/ME clinical teams in England, plus cross-sectional data from a subset of teams. Setting Secondary care. Outcome measures We used clinic activity data from CFS/ME clinical teams in England to describe provision of specialist CFS/ME services (referral, assessment and diagnosis rates per 1000 adults per year) during 2008–2011 according to Primary Care Trust (PCT) population estimates, and to investigate whether use of services was related to PCT-level measures of deprivation and inequality. We used postcode data from seven services to investigate variation in provision by deprivation. Results Clinic activity data were obtained from 93.9% (46/49) of clinical teams in England which between them received referrals from 84.9% (129/152) of PCTs. 12 PCTs, covering a population of 2.08 million adults, provided no specialist CFS/ME service. There was a six-fold variation in referral and assessment rates between services which could not be explained by PCT-level measures of deprivation and inequality. The median assessment rate in 2010 was 0.25 (IQR 0.17, 0.35) per 1000 adults per year. 91.9% (IQR 76.5%, 100.0%) of adults assessed were diagnosed with CFS/ME. Postcode data from seven clinical teams showed that assessment rates were equal across deprivation quartiles for four teams but were 40–50% lower in the most deprived compared with the most affluent areas for three teams. Conclusions Two million adults in England do not have access to a specialist CFS/ME service. In some areas which do have a specialist service, access is inequitable. This inequity may worsen with the impending fragmentation of NHS commissioning across England. PMID:22899647

['NischE - Nicht von schlechten Eltern' - Evaluation of a Multidisciplinary Teamwork Approach to Support Children in Families with Mentally Ill Parents].

PubMed

Nienaber, A; Wieskus-Friedemann, E; Kliem, S; Hoppmann, J; Kemper, U; Löhr, M; Kronmüller, K-T; Wabnitz, P

2017-02-01

Objective: Evaluation of a project offering low-threshold anonymous counseling services jointly by mental health services and child and youth services to support children in families with mentally ill parents Methods: Evaluating performance data and completed questionnaires returned by parents included in the project. Results: Between 2011-2014, 150 families received up to 10 sessions of family-oriented counseling. The survey results indicate a high level of satisfaction with the services of the cooperation project. The vast majority of respondents said that they would recommend this service to others or would themselves take advantage of the services again. Conclusion: A collaboration of service providers from psychiatry and child and youth welfare department resulting in continuous availability of counseling with a common family medical perspective represents a forward-looking model for families with a mentally ill parent. © Georg Thieme Verlag KG Stuttgart · New York.

Cardio-Vascular Disease and Cancer

PubMed Central

Mitchell-Fearon, K.; Willie-Tyndale, D.; Waldron, N.; Holder-Nevins, D.; James, K.; Laws, H.; Eldemire-Shearer, D.

2015-01-01

Objective: To report the level of utilization of clinical preventive services by older adults in Jamaica and to identify independent factors associated with utilization. Method: A nationally representative, community-based survey of 2,943 older adults was undertaken. Utilization frequency for six preventive, cardiovascular or cancer-related services was calculated. Logistic regression models were used to determine the independent factors associated with each service. Results: A dichotomy in annual utilization rates exists with cardiovascular services having much higher uptake than those for cancer (83.1% for blood pressure, 76.7% blood glucose, 68.1% cholesterol, 35.1% prostate, 11.3% mammograms, and 9.6% papanicolaou smears). Age, source of routine care, and having a chronic disease were most frequently associated with uptake. Discussion: Education of providers and patients on the need for utilizing preventive services in older adults is important. Improved access to services in the public sector may also help increase uptake of services. PMID:28138475

Public meeting: Western New York Nuclear Service Center options study. [Problem of West Valley plant

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

None

This document is a transcript of the meeting, with additional written comments. The main topic is the West Valley Processing Plant and how to dispose of it and its high-level wastes. Objective is to get public input on this topic. (DLC)

Brevard District Plan for Career Education Development.

ERIC Educational Resources Information Center

Thomas, Olive W.

The Brevard County Plan was written to include goals and objectives for the years 1974-77. Goals for 1974-75 include promoting the career education concept in all district schools (emphasizing the various career education elements at appropriate grade levels), setting up placement services, coordinating county and district goals, program…

Strategic plan creates a blueprint for budgeting.

PubMed

Cook, D

1990-05-01

Effective healthcare organizations develop budgets that reflect and support a strategic plan. Senior managers set a framework that expresses the hospital's future strategic objectives. The budget enables executives to determine which specific service lines are profitable or unprofitable. Administrators and clinicians at all levels are involved in the budgeting process.

Advertising Design. Art Education: 6693.07.

ERIC Educational Resources Information Center

Raia, Frank A.

This introductory, secondary level course in advertising design provides a vocational orientation to art education. The concern of the course is the eventual use of commercial art--to persuade consumers to buy goods and services. Objectives of the course include competencies in the technical aspects of commercial art and an awareness of consumer…

Institutional Research Needs for U. S. Community Colleges.

ERIC Educational Resources Information Center

Washington State Board for Community Coll. Education, Seattle. Research and Planning Office.

Seven problem areas where research is needed critically at the two-year institution level are identified: (1) establish reliability and stability of MIS/data base; (2) find reliable predictive instruments and/or formulae; (3) analyze support services and academic assistance objectives; (4) develop research methods to evaluate curricula; (5)…

Life Contentment and Mental Health Care Satisfaction

ERIC Educational Resources Information Center

Prince, Jonathan D.

2005-01-01

Objective: It is now well documented that satisfaction with mental health services is influenced by a variety of other factors (e.g., race, diagnosis, functioning level). Because of a generally brighter outlook, this study examined whether care satisfaction is also influenced by contentment in housing, social relations, or existence in general.…

How High School Coursework Predicts Introductory College-Level Course Success

ERIC Educational Resources Information Center

Woods, Chenoa S.; Park, Toby; Hu, Shouping; Betrand Jones, Tamara

2018-01-01

Objective: In recent years, developmental education (DE) reform has led to a restructuring of the placement process, redesigning of course instructional modalities, or implementing student support services to supplement developmental coursework. In Florida, recent legislative changes allowed students to opt out of placement testing and enroll…

Collection Evaluation and Acquisition Budgets: A Kaleidoscope in the Making.

ERIC Educational Resources Information Center

Osburn, Charles B.

1992-01-01

Discusses library collection evaluation and its relationship to the acquisitions budget. Topics addressed include the publishing industry; library services that are more user centered; acquisition of versus access to sources of information and knowledge; the concept of value; library accountability; objectives and setting priorities; and levels of…

Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma

PubMed Central

Galvagno, Samuel M.; Haut, Elliott R.; Zafar, S. Nabeel; Millin, Michael G.; Efron, David T.; Koenig, George J.; Baker, Susan P.; Bowman, Stephen M.; Pronovost, Peter J.; Haider, Adil H.

2012-01-01

Context Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted. Objective To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries. Design, Setting, and Participants Retrospective cohort study involving 223 475 patients older than 15 years, having an injury severity score higher than 15, and sustaining blunt or penetrating trauma that required transport to US level I or II trauma centers and whose data were recorded in the 2007–2009 versions of the American College of Surgeons National Trauma Data Bank. Interventions Transport by helicopter or ground emergency services to level I or level II trauma centers. Main Outcome Measures Survival to hospital discharge and discharge disposition. Results A total of 61 909 patients were transported by helicopter and 161 566 patients were transported by ground. Overall, 7813 patients (12.6%) transported by helicopter died compared with 17 775 patients (11%) transported by ground services. Before propensity score matching, patients transported by helicopter to level I and level II trauma centers had higher Injury Severity Scores. In the propensity score–matched multivariable regression model, for patients transported to level I trauma centers, helicopter transport was associated with an improved odds of survival compared with ground transport (odds ratio [OR], 1.16; 95% CI, 1.14–1.17; P<.001; absolute risk reduction [ARR], 1.5%). For patients transported to level II trauma centers, helicopter transport was associated with an improved odds of survival (OR, 1.15; 95% CI, 1.13–1.17; P < .001; ARR, 1.4%). A greater proportion (18.2%) of those transported to level I trauma centers by helicopter were discharged to rehabilitation compared with 12.7% transported by ground services (P < .001), and 9.3% transported by helicopter were discharged to intermediate facilities compared with 6.5% by ground services (P < .001). Fewer patients transported by helicopter left level II trauma centers against medical advice (0.5% vs 1.0%, P < .001). Conclusion Among patients with major trauma admitted to level I or level II trauma centers, transport by helicopter compared with ground services was associated with improved survival to hospital discharge after controlling for multiple known confounders. PMID:22511688

Introducing health gains in location-allocation models: A stochastic model for planning the delivery of long-term care

NASA Astrophysics Data System (ADS)

Cardoso, T.; Oliveira, M. D.; Barbosa-Póvoa, A.; Nickel, S.

2015-05-01

Although the maximization of health is a key objective in health care systems, location-allocation literature has not yet considered this dimension. This study proposes a multi-objective stochastic mathematical programming approach to support the planning of a multi-service network of long-term care (LTC), both in terms of services location and capacity planning. This approach is based on a mixed integer linear programming model with two objectives - the maximization of expected health gains and the minimization of expected costs - with satisficing levels in several dimensions of equity - namely, equity of access, equity of utilization, socioeconomic equity and geographical equity - being imposed as constraints. The augmented ε-constraint method is used to explore the trade-off between these conflicting objectives, with uncertainty in the demand and delivery of care being accounted for. The model is applied to analyze the (re)organization of the LTC network currently operating in the Great Lisbon region in Portugal for the 2014-2016 period. Results show that extending the network of LTC is a cost-effective investment.

Profile of women who carried out smoking cessation treatment: a systematic review

PubMed Central

Pereira, Caroline Figueira; de Vargas, Divane

2015-01-01

OBJECTIVE Analyze the profile of women, in health services, who carry out treatment for smoking cessation. METHODS Systematic review that used the following sources of information: Cummulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Biblioteca Virtual em Saúde (BVS), Scopus and Web of Science. We included quantitative studies that addressed the characterization of women, in health services, who carried out treatment for smoking cessation, resulting in 12 articles for analysis. The assessment of the methodological quality of the studies was performed using the instrument MAStARI from Joanna Briggs Institute. RESULTS The predominant profile of women who carried out treatment for smoking cessation in health services was composed of white, married, employed, and highly level educated women. Women who carried out the treatment for smoking cessation in specialized services had a more advanced age, were white, were married and had a diagnosis of depression. The quality level of most studies was moderate. CONCLUSIONS The profile of women who carry out treatment for smoking cessation, either in general or specialized health services, is composed of white, married, and highly level educated women. Publications about smoking women are scarce and the lack of Brazilian studies characterizing the profile of women who start treatment for smoking cessation shows the need for studies that explore this subject. PMID:26247386

Profile of women who carried out smoking cessation treatment: a systematic review.

PubMed

Pereira, Caroline Figueira; de Vargas, Divane

2015-01-01

OBJECTIVE Analyze the profile of women, in health services, who carry out treatment for smoking cessation. METHODS Systematic review that used the following sources of information: Cummulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Biblioteca Virtual em Saúde (BVS), Scopus and Web of Science. We included quantitative studies that addressed the characterization of women, in health services, who carried out treatment for smoking cessation, resulting in 12 articles for analysis. The assessment of the methodological quality of the studies was performed using the instrument MAStARI from Joanna Briggs Institute. RESULTS The predominant profile of women who carried out treatment for smoking cessation in health services was composed of white, married, employed, and highly level educated women. Women who carried out the treatment for smoking cessation in specialized services had a more advanced age, were white, were married and had a diagnosis of depression. The quality level of most studies was moderate. CONCLUSIONS The profile of women who carry out treatment for smoking cessation, either in general or specialized health services, is composed of white, married, and highly level educated women. Publications about smoking women are scarce and the lack of Brazilian studies characterizing the profile of women who start treatment for smoking cessation shows the need for studies that explore this subject.

Assessment of the responsiveness of a public health service from the perspective of older adults

PubMed Central

Melo, Denise da Silva; Martins, René Duarte; de Jesus, Renata Patrícia Freitas Soares; Samico, Isabella Chagas; Santo, Antônio Carlos Gomes do Espírito

2017-01-01

ABSTRACT OBJECTIVE To assess the quality of health care of older adults using as a parameter the assessment of the responsiveness of the service. METHODS This is a descriptive cross-sectional study conducted in a reference unit of the Brazilian Unified Health System at the outpatient level. The sample was probabilistic and had 385 older adults; data collection occurred in 2014. The domains assessed were: choice, autonomy, confidentiality, dignity, communication, physical facilities, and fast service. To this end, we used Pearson correlation test and Fisher’s exact test. RESULTS The domains of dignity, confidentiality, and communication reached the highest level of adequate responsiveness. On the other hand, freedom of choice and fast service received the worst assessments. Participation in decision-making regarding treatment was significantly lower among the older adults who had no education. In addition, the older adults that self-reported as black receive a lower quality of care regarding clear explanation and respected privacy in the appointment, when compared to users of any other race. CONCLUSIONS Although most domains studied have receive a positive assessment, we have found a need for an equal care by the health professionals, regardless of race, education level, or any other adjective characteristic of older adults, users of public health services. PMID:28678911

Social Capital, Acculturation, Mental Health, and Perceived Access to Services among Mexican American Women

PubMed Central

Valencia-Garcia, Dellanira; Simoni, Jane M.; Alegría, Margarita; Takeuchi, David T.

2012-01-01

Objective We examined whether individual-level social capital--the intangible resources in a community available through membership in social networks or other social structures and perceived trust in the community—was associated with acculturation; depression and anxiety symptoms; and perceived access to services among women of Mexican ancestry. Method Recruited through venue-based targeted sampling in King County, WA, 205 women of Mexican descent age 18 to 64 years who differed in socioeconomic status and nativity completed a cross-sectional survey. Half completed the survey in Spanish and half in English. Structural equation modeling was used for model testing. Results Social capital increased with level of acculturation and was negatively related to depression and anxiety; it had no direct association with perceived access to services. Social capital mediated the relation between acculturation and both depression and anxiety symptoms. Acculturation had no direct association with psychological distress but was directly associated with perceived access to services. This community sample of women reported high levels of psychological distress, with 20–26% of women meeting diagnostic criteria for depression or anxiety. Conclusions Social capital can be assessed at the individual level, increases with acculturation, and may be a potential target for interventions to improve mental health among Mexican American women residing in the U.S. PMID:22329824

A periodic review integrated inventory model with controllable safety stock and setup cost under service level constraint and distribution-free demand

NASA Astrophysics Data System (ADS)

Kurdhi, N. A.; Jamaluddin, A.; Jauhari, W. A.; Saputro, D. R. S.

2017-06-01

In this study, we consider a stochastic integrated manufacturer-retailer inventory model with service level constraint. The model analyzed in this article considers the situation in which the vendor and the buyer establish a long-term contract and strategic partnership to jointly determine the best strategy. The lead time and setup cost are assumed can be controlled by an additional crashing cost and an investment, respectively. It is assumed that shortages are allowed and partially backlogged on the buyer’s side, and that the protection interval (i.e., review period plus lead time) demand distribution is unknown but has given finite first and second moments. The objective is to apply the minmax distribution free approach to simultaneously optimize the review period, the lead time, the setup cost, the safety factor, and the number of deliveries in order to minimize the joint total expected annual cost. The service level constraint guarantees that the service level requirement can be satisfied at the worst case. By constructing Lagrange function, the analysis regarding the solution procedure is conducted, and a solution algorithm is then developed. Moreover, a numerical example and sensitivity analysis are given to illustrate the proposed model and to provide some observations and managerial implications.

Inequalities in Use of Health Services among Jews and Arabs in Israel

PubMed Central

Baron-Epel, Orna; Garty, Noga; Green, Manfred S

2007-01-01

Objectives To compare the levels of utilization of health services in Jews and Arabs taking into account differences in levels of socioeconomic status (SES) in a country with a National Health Insurance Law (NHIL). Data Source/Study Setting A cross-sectional National Health Interview Survey was carried out in Israel based on a random sample of telephone numbers as part of the EUROHIS project (WHO European Health Interview Survey 2003–2004). Study Design A random telephone survey included 9,352 interviews. Questions included use of health care services, health status, and socioeconomic variables. Principal Findings After adjusting for sex, age, income, education, marital status, and self-reported chronic diseases, Arabs more often reported visiting a family physician (odds ratio [OR] = 1.56, 95 percent confidence interval [CI] = 1.35–1.81) and less often reported visiting a specialist (OR = 0.73, 95 percent CI = 0.60–0.89) compared with Jews. In addition, the odds ratio for hospitalization was similar among Arabs and Jews (OR = 1.16, 95 percent CI = 0.97–1.38). SES was associated with utilization of health care services only in the Jewish population. Conclusions A different pattern of utilization of health care services was observed in Arabs and Jews. This was not explained by differences in socioeconomic levels. More research is needed regarding the distribution of services between Jews and Arabs. PMID:17489901

Ghana: training non-physician personnel for Maternal Child Health and Family Health.

PubMed

Boohene, E

1982-01-01

The government of Ghana has set the goal of extending health care coverage to 80% of its population and effectively attacking 80% of the disease problems affecting Ghanaians by 1990. To reach these objectives, the Ministry of Health (MOH) plans to focus on maternal and child health and family planning which are seen to be 2 areas which most affect a healthy life. The primary health care (PHC) approach to health care delivery, making basic health services accessible to the majority of the people, has been emphasized. The PHC system is service, rather than facility oriented, but nonetheless relies on the MOH's already existing network of health posts and centers. The 3 levels of health care delivery workers in the PHC system are: 1) community health workers; 2) auxiliary staff; and 3) professional staff. Community health workers are responsible for basic preventive and curative services and rely on the aid of community-selected health aides and traditional birth attendants. Auxiliary health workers, operating at the local council level, represent the 1st referral point, and also provide training and supervision for community level workers. Professional workers conduct administrative, training and supervisory functions while serving as the backstop health service. Training strategy relies on the training of regional staff who in turn will organize district level staff in their respective regions, to be followed by a relay of training down to the more local levels.

Goals and Objectives to Optimize the Value of an Acute Pain Service in Perioperative Pain Management.

PubMed

Le-Wendling, Linda; Glick, Wesley; Tighe, Patrick

2017-12-01

As newer pharmacologic and procedural interventions, technology, and data on outcomes in pain management are becoming available, effective acute pain management will require a dedicated Acute Pain Service (APS) to help determine the most optimal pain management plan for the patients. Goals for pain management must take into consideration the side effect profile of drugs and potential complications of procedural interventions. Multiple objective optimization is the combination of multiple different objectives for acute pain management. Simple use of opioids, for example, can reduce all pain to minimal levels, but at what cost to the patient, the medical system, and to public health as a whole? Many models for APS exist based on personnel's skills, knowledge and experience, but effective use of an APS will also require allocation of time, space, financial, and personnel resources with clear objectives and a feedback mechanism to guide changes to acute pain medicine practices to meet the constantly evolving medical field. Physician-based practices have the advantage of developing protocols for the management of low-variability, high-occurrence scenarios in addition to tailoring care to individual patients with high-variability, low-occurrence scenarios. Frequent feedback and data collection/assessment on patient outcomes is essential in evaluating the efficacy of the Acute Pain Service's intervention in improving patient outcomes in the acute and perioperative setting.

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

Earth Science Data Fusion with Event Building Approach

NASA Technical Reports Server (NTRS)

Lukashin, C.; Bartle, Ar.; Callaway, E.; Gyurjyan, V.; Mancilla, S.; Oyarzun, R.; Vakhnin, A.

2015-01-01

Objectives of the NASA Information And Data System (NAIADS) project are to develop a prototype of a conceptually new middleware framework to modernize and significantly improve efficiency of the Earth Science data fusion, big data processing and analytics. The key components of the NAIADS include: Service Oriented Architecture (SOA) multi-lingual framework, multi-sensor coincident data Predictor, fast into-memory data Staging, multi-sensor data-Event Builder, complete data-Event streaming (a work flow with minimized IO), on-line data processing control and analytics services. The NAIADS project is leveraging CLARA framework, developed in Jefferson Lab, and integrated with the ZeroMQ messaging library. The science services are prototyped and incorporated into the system. Merging the SCIAMACHY Level-1 observations and MODIS/Terra Level-2 (Clouds and Aerosols) data products, and ECMWF re- analysis will be used for NAIADS demonstration and performance tests in compute Cloud and Cluster environments.

A comprehensive Laboratory Services Survey of State Public Health Laboratories.

PubMed

Inhorn, Stanley L; Wilcke, Burton W; Downes, Frances Pouch; Adjanor, Oluwatosin Omolade; Cada, Ronald; Ford, James R

2006-01-01

In November 2004, the Association of Public Health Laboratories (APHL) conducted a Comprehensive Laboratory Services Survey of State Public Health Laboratories (SPHLs) in order to establish the baseline data necessary for Healthy People 2010 Objective 23-13. This objective aims to measure the increase in the proportion of health agencies that provide or assure access to comprehensive laboratory services to support essential public health services. This assessment addressed only SPHLs and served as a baseline to periodically evaluate the level of improvement in the provision of laboratory services over the decade ending 2010. The 2004 survey used selected questions that were identified as key indicators of provision of comprehensive laboratory services. The survey was developed in consultation with the Centers for Disease Control and Prevention National Center for Health Statistics, based on newly developed data sources. Forty-seven states and one territory responded to the survey. The survey was based on the 11 core functions of SPHLs as previously defined by APHL. The range of performance among individual laboratories for the 11 core functions (subobjectives) reflects the challenging issues that have confronted SPHLs in the first half of this decade. APHL is now working on a coordinated effort with other stakeholders to create seamless state and national systems for the provision of laboratory services in support of public health programs. These services are necessary to help face the threats raised by the specter of terrorism, emerging infections, and natural disasters.

Dental Workforce Availability and Dental Services Utilization in Appalachia: A Geospatial Analysis

PubMed Central

Feng, Xue; Sambamoorthi, Usha; Wiener, R. Constance

2016-01-01

Objectives There is considerable variation in dental services utilization across Appalachian counties, and a plausible explanation is that individuals in some geographical areas do not utilize dental care due to dental workforce shortage. We conducted an ecological study on dental workforce availability and dental services utilization in Appalachia. Methods We derived county-level (n = 364) data on demographic, socio-economic characteristics and dental services utilization in Appalachia from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) using person-level data. We obtained county-level dental workforce availability and physician-to-population ratio estimates from Area Health Resource File, and linked them to the county-level BRFSS data. The dependent variable was the proportion using dental services within the last year in each county (ranging from 16.6% to 91.0%). We described the association between dental workforce availability and dental services utilization using ordinary least squares regression and spatial regression techniques. Spatial analyses consisted of bivariate Local Indicators of Spatial Association (LISA) and geographically weighted regression (GWR). Results Bivariate LISA showed that counties in the central and southern Appalachian regions had significant (p < .05) low-low spatial clusters (low dental workforce availability, low percent dental services utilization). GWR revealed considerable local variations in the association between dental utilization and dental workforce availability. In the multivariate GWR models, 8.5% (t-statistics >1.96) and 13.45% (t-statistics >1.96) of counties showed positive and statistically significant relationships between the dental services utilization and workforce availability of dentists and dental hygienists, respectively. Conclusions Dental workforce availability was associated with dental services utilization in the Appalachian region; however, this association was not statistically significant in all counties. The findings suggest that program and policy efforts to improve dental services utilization need to focus on factors other than increasing the dental workforce availability for many counties in Appalachia. PMID:27957773

Measuring Socioeconomic Differences in Use of Health Care Services by Wealth Versus by Income

PubMed Central

Allin, Sara; Masseria, Cristina

2009-01-01

Objectives. We compared the extent of socioeconomic differences in use of health care services based on wealth (i.e., accumulated assets) as the socioeconomic ranking variable with the extent of differences based on income to explore the sensitivity of the estimates of equity to the choice of the socioeconomic indicator. Methods. We used data from the Health and Retirement Study in the United States and the Survey of Health, Ageing, and Retirement in Europe to estimate levels of income- and wealth-related disparity in use of physician and dental services among adults 50 or older in 12 countries. Results. We found socioeconomic differences in use of physician services after standardizing for need in about half of the countries studied. No consistent pattern in levels of disparity measured by wealth versus those measured by income was found. However, the rich were significantly more likely to use dental services in all countries. Wealth-related differences in dental service use were consistently higher than were income-related differences. Conclusions. We found some support for wealth as a more sensitive indicator of socioeconomic status among older adults than was income. Wealth may thus allow more accurate measurements of socioeconomic differences in use of health care services for this population. PMID:19150899

Coordination between child welfare agencies and mental health providers, children's service use, and outcomes

PubMed Central

Bai, Yu; Wells, Rebecca; Hillemeier, Marianne M.

2009-01-01

Objective Interorganizational relationships (IORs) between child welfare agencies and mental health service providers may facilitate mental health treatment access for vulnerable children. This study investigates whether IORs are associated with greater use of mental health services and improvement in mental health status for children served by the child welfare system. Methods This was a longitudinal analysis of data from a 36 month period in the National Survey of Child and Adolescent Well-Being (NSCAW). The sample consisted of 1,613 children within 75 child welfare agencies who were 2 years or older and had mental health problems at baseline. IOR intensity was measured as the number of coordination approaches between each child welfare agency and mental health service providers. Separate weighted multilevel logistic regression models tested associations between IORs and service use and outcomes, respectively. Results Agency level factors accounted for 9% of the variance in the probability of service use and 12% of mental health improvement. Greater intensity of IORs was associated with higher likelihood of both service use and mental health improvement. Conclusions Having greater numbers of ties with mental health providers may help child welfare agencies improve children's mental health service access and outcomes. Practice Implications Policymakers should develop policies and initiatives to encourage a combination of different types of organizational ties between child welfare and mental health systems. For instance, information sharing at the agency level in addition to coordination at the case level may improve the coordination necessary to serve these vulnerable children. PMID:19473702

Information Persistence Services Designed to Support Home Care

PubMed Central

Queirós, Alexandra; Augusto, Filipe; Rodríguez, Yosvany Llerena; Cardoso, Carlos; Grade, José Miguel; Quintas, João

2015-01-01

Background Due to the challenges faced by health and social care systems, in particular those related to actual demographic trends, home care emerges as a potentially cost-effective solution to answer the needs of citizens, and to allow the reallocation of resources to alternatives to hospitalization or institutionalization. Objective Home care services require cooperation between different actors, including health and social caregivers, care receivers, and their informal caregivers (eg, relatives or friends), across time, space, and organizational boundaries. Therefore, it is foreseeable that eHealth services can contribute to their improvement. The aim of this study is to evaluate information persistence services based on the Reference Information Model (RIM) of the Health Level Seven (HL7) version 3 to support formal caregivers, both health and social care providers, and informal caregivers in the context of home care services. Methods A pilot study was set up involving two Portuguese institutions that provide home care services for the elderly. Defining of information requirements was performed according to a comprehensive process. This included a review of the literature, observations of work activities, interviews with caregivers, care receivers and their relatives, analysis of paper documentation related to care receivers’ histories, health conditions and care plans, and brainstorming groups involving specialized professionals. Following this, information objects were implemented and validated. Results The methodological approach, as well as the information persistence services, proved to be robust and adequate to specify, implement, and validate different types of information objects related to home care services for the elderly. This study also reinforces the application of the RIM of the HL7 version 3 beyond the strict scope of health care, allowing the persistence of not only health care information, but also information related to social assistance activities. Conclusions This study contributes to the ongoing efforts related to the development of eHealth applications to improve the cooperation among formal health care and social caregivers, as well as care receivers and their informal caregivers. PMID:25757462

Analyzing the Environmental Impacts of Laptop Enclosures Using Screening-Level Life Cycle Assessment to Support Sustainable Consumer Electronics

EPA Science Inventory

With the ever-increasing amount of consumer electronics in service, it is essential industries and policy-makers work together to develop ways to manufacture more environmentally sustainable IT products which meet the needs of society. The objective of this study was to better un...

75 FR 9850 - Tank Level Probing Radars in the Frequency Band 77-81 GHz

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-04

... National Radio Astronomy Observatory (NRAO) states that it would not object to the Ohmart/VEGA waiver if it Frequency Band of Operation. Authorized operations in the 77-81 GHz band currently include radio astronomy... operations in this band would have on authorized services. Regarding radio astronomy, the Commission observes...

Automotive Modules. Vocational Behavioral Objectives: A Guide for Individualizing Instruction.

ERIC Educational Resources Information Center

Westinghouse Learning Corp., New York, NY.

The curriculum guide deals with automotive repair skills at the secondary level of vocational education and industrial arts. It addresses the subject in behavioral terms, as prominent components of the career education concept. Presenting four skill modules, auto body repair, gas engine repair, service, and diesel engine mechanics, the objectives…

Innovative solutions: sample financial management business plan: neurosurgical intensive care unit.

PubMed

Villanueva-Baldonado, Analiza; Barrett-Sheridan, Shirley E

2010-01-01

This article describes one institution's intention to implement a financial management business plan for a neurosurgical intensive care unit in a level I trauma center. The financial objective of this proposed business plan includes a service increase in the patient population requiring critical care in a way that will help control costs.

Severity of Mental Health Impairment and Trajectories of Improvement in an Integrated Primary Care Clinic

ERIC Educational Resources Information Center

Bryan, Craig J.; Corso, Meghan L.; Corso, Kent A.; Morrow, Chad E.; Kanzler, Kathryn E.; Ray-Sannerud, Bobbie

2012-01-01

Objective: To model typical trajectories for improvement among patients treated in an integrated primary care behavioral health service, multilevel models were used to explore the relationship between baseline mental health impairment level and eventual mental health functioning across follow-up appointments. Method: Data from 495 primary care…

A service relation model for web-based land cover change detection

NASA Astrophysics Data System (ADS)

Xing, Huaqiao; Chen, Jun; Wu, Hao; Zhang, Jun; Li, Songnian; Liu, Boyu

2017-10-01

Change detection with remotely sensed imagery is a critical step in land cover monitoring and updating. Although a variety of algorithms or models have been developed, none of them can be universal for all cases. The selection of appropriate algorithms and construction of processing workflows depend largely on the expertise of experts about the "algorithm-data" relations among change detection algorithms and the imagery data used. This paper presents a service relation model for land cover change detection by integrating the experts' knowledge about the "algorithm-data" relations into the web-based geo-processing. The "algorithm-data" relations are mapped into a set of web service relations with the analysis of functional and non-functional service semantics. These service relations are further classified into three different levels, i.e., interface, behavior and execution levels. A service relation model is then established using the Object and Relation Diagram (ORD) approach to represent the multi-granularity services and their relations for change detection. A set of semantic matching rules are built and used for deriving on-demand change detection service chains from the service relation model. A web-based prototype system is developed in .NET development environment, which encapsulates nine change detection and pre-processing algorithms and represents their service relations as an ORD. Three test areas from Shandong and Hebei provinces, China with different imagery conditions are selected for online change detection experiments, and the results indicate that on-demand service chains can be generated according to different users' demands.

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

NASA Astrophysics Data System (ADS)

Missikoff, Michele; Taglino, Francesco

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

Provision of Telemedicine Services by Community Health Centers

PubMed Central

Sharac, Jessica; Jacobs, Feygele

2014-01-01

The objective of this study was to assess the use of telemedicine services at community health centers. A national survey was distributed to all federally qualified health centers to gather data on their use of health information technology, including telemedicine services. Over a third of responding health centers (37%) provided some type of telemedicine service while 63% provided no telemedicine services. A further analysis that employed ANOVA and chi-square tests to assess differences by the provision of telemedicine services (provided no telemedicine services, provided one telemedicine service, and provided two or more telemedicine services) found that the groups differed by Meaningful Use compliance, location, percentage of elderly patients, mid-level provider, medical, and mental health staffing ratios, the percentage of patients with diabetes with good blood sugar control, and state and local funds per patient and per uninsured patient. This article presents the first national estimate of the use of telemedicine services at community health centers. Further study is needed to determine how to address factors, such as reimbursement and provider shortages, that may serve as obstacles to further expansion of telemedicine services use by community health centers. PMID:25422721

Noncommunicable diseases and the use of health services: analysis of the National Health Survey in Brazil

PubMed Central

Malta, Deborah Carvalho; Bernal, Regina Tomie Ivata; Lima, Margareth Guimarães; de Araújo, Silvânia Suely Caribé; da Silva, Marta Maria Alves; Freitas, Maria Imaculada de Fátima; Barros, Marilisa Berti de Azevedo

2017-01-01

ABSTRACT OBJECTIVE To assess whether sex, education level, and health insurance affect the use of health services among the adult Brazilian population with chronic noncommunicable diseases (NCD). METHODS Data from a cross-sectional survey were analyzed, the National Health Survey (PNS). Frequency of use of services in the population that referred at least one NCD were compared with the frequency from a population that did not report NCD, according to sex, education level, health insurance, and NCD number (1, 2, 3, 4, or more). The prevalence and prevalence ratios were calculated crude and adjusted for sex, age, region, and 95% confidence intervals. RESULTS The presence of a noncommunicable disease was associated with increase in hospitalizations in the last 12 months, in 1.7 times (95%CI 1.53–1.9). Failing to perform usual activities in the last two weeks for health reasons was 3.1 times higher in NCD carriers (95%CI 2.78–3.46); while the prevalence of medical consultation in the last 12 months was 1.26 times higher (95%CI 1.24–1.28). NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level. CONCLUSIONS NCD carriers make more use of health services, as well as women, people with higher number of comorbidities, with health insurance, and higher education level. PMID:28591353

A User-Centric Knowledge Creation Model in a Web of Object-Enabled Internet of Things Environment

PubMed Central

Kibria, Muhammad Golam; Fattah, Sheik Mohammad Mostakim; Jeong, Kwanghyeon; Chong, Ilyoung; Jeong, Youn-Kwae

2015-01-01

User-centric service features in a Web of Object-enabled Internet of Things environment can be provided by using a semantic ontology that classifies and integrates objects on the World Wide Web as well as shares and merges context-aware information and accumulated knowledge. The semantic ontology is applied on a Web of Object platform to virtualize the real world physical devices and information to form virtual objects that represent the features and capabilities of devices in the virtual world. Detailed information and functionalities of multiple virtual objects are combined with service rules to form composite virtual objects that offer context-aware knowledge-based services, where context awareness plays an important role in enabling automatic modification of the system to reconfigure the services based on the context. Converting the raw data into meaningful information and connecting the information to form the knowledge and storing and reusing the objects in the knowledge base can both be expressed by semantic ontology. In this paper, a knowledge creation model that synchronizes a service logistic model and a virtual world knowledge model on a Web of Object platform has been proposed. To realize the context-aware knowledge-based service creation and execution, a conceptual semantic ontology model has been developed and a prototype has been implemented for a use case scenario of emergency service. PMID:26393609

A User-Centric Knowledge Creation Model in a Web of Object-Enabled Internet of Things Environment.

PubMed

Kibria, Muhammad Golam; Fattah, Sheik Mohammad Mostakim; Jeong, Kwanghyeon; Chong, Ilyoung; Jeong, Youn-Kwae

2015-09-18

User-centric service features in a Web of Object-enabled Internet of Things environment can be provided by using a semantic ontology that classifies and integrates objects on the World Wide Web as well as shares and merges context-aware information and accumulated knowledge. The semantic ontology is applied on a Web of Object platform to virtualize the real world physical devices and information to form virtual objects that represent the features and capabilities of devices in the virtual world. Detailed information and functionalities of multiple virtual objects are combined with service rules to form composite virtual objects that offer context-aware knowledge-based services, where context awareness plays an important role in enabling automatic modification of the system to reconfigure the services based on the context. Converting the raw data into meaningful information and connecting the information to form the knowledge and storing and reusing the objects in the knowledge base can both be expressed by semantic ontology. In this paper, a knowledge creation model that synchronizes a service logistic model and a virtual world knowledge model on a Web of Object platform has been proposed. To realize the context-aware knowledge-based service creation and execution, a conceptual semantic ontology model has been developed and a prototype has been implemented for a use case scenario of emergency service.

Identifying meaning and perceived level of satisfaction within the context of work.

PubMed

Brown, Angie; Kitchell, Molly; O'Neill, Tiffany; Lockliear, Jennifer; Vosler, Alyson; Kubek, Dayna; Dale, Lucinda

2001-01-01

OBJECTIVE: The primary objectives of this study were to identify sources of meaning for individuals within the context of a work environment, and to compare varied sources of meaning for individuals with high and low work satisfaction levels. METHOD: Participants were chosen based on satisfaction levels in employment, full-time employment status within an organization for at least one year, and diversity in the work setting. Data were gathered through a series of interviews and observations of the participants' workplaces. A comparative analysis of transcribed interviews was conducted by the researchers and with an expert occupational therapy faculty panel. From these analyses, the researchers developed work narratives for a mechanical engineer, a high school teacher, an employee of mechanical services, and a career service counselor. RESULTS: Emerging themes from the work narratives indicated that the various meanings employees found in work had an effect on their perceived levels of job satisfaction. Participants conveyed that organization identification, financial benefits, independent decision-making, reciprocal respect, opportunities for creativity, and maintaining significant relationships outside of work enhanced meaning and satisfaction. CONCLUSIONS: The worker role is a significant source of an individual's identity, meaning, and satisfaction in life. Professionals in various fields can work with employers to develop meaningful work environments for increased job satisfaction, greater motivation for work, increased productivity, and decreased employee turnover.

A descriptive study of access to services in a random sample of Canadian rural emergency departments

PubMed Central

Fleet, Richard; Poitras, Julien; Maltais-Giguère, Julie; Villa, Julie; Archambault, Patrick

2013-01-01

Objective To examine 24/7 access to services and consultants in a sample of Canadian rural emergency departments (EDs). Design Cross-sectional study—mixed methods (structured interview, survey and government data bases) with random sampling of hospitals. Setting Canadian rural EDs (rural small town (RST) definition—Statistics Canada). Participants 28% (95/336) of Canadian rural EDs providing 24/7 physician coverage located in hospitals with acute care hospitalisation beds. Main outcome measures General characteristics of the rural EDs, information about 24/7 access to consultants, equipment and services, and the proportion of rural hospitals more than 300 km from levels 1 and 2 trauma centres. Results Of the 336 rural EDs identified, 122 (36%) were randomly selected and contacted. Overall, 95 EDs participated in the study (participation rate, 78%). Hospitals had, on an average, 23 acute care beds, 7 ED stretchers and 13 500 annual ED visits. The proportion of rural hospitals with local access to the following 24/7 services was paediatrician, 5%; obstetrician, 10%; psychiatrist, 11%; internist, 12%; intensive care unit, 17%; CT scanner, 20%; surgeon, 26%; ultrasound, 28%; basic X-ray, 97% and laboratory services, 99%. Forty-four per cent and 54% of the RST EDs were more than 300 km from a level 1 and level 2 trauma centre, respectively. Conclusions This is the first study describing the services available in Canadian rural EDs. Apart from basic laboratory and X-ray services, most rural EDs have limited access to consultants, advanced imaging and critical care services. A detailed study is needed to evaluate the impact of these limited services on patient outcomes, costs and interfacility transport demands. PMID:24285633

Reducing Second Gram-Negative Antibiotic Therapy on Pediatric Oncology and Hematopoietic Stem Cell Transplantation Services.

PubMed

Wattier, Rachel L; Levy, Emily R; Sabnis, Amit J; Dvorak, Christopher C; Auerbach, Andrew D

2017-09-01

OBJECTIVE To evaluate interventions to reduce avoidable antibiotic use on pediatric oncology and hematopoietic stem cell transplantation (HSCT) services. DESIGN Interrupted time series. SETTING Academic pediatric hospital with separate oncology and HSCT services. PARTICIPANTS Children admitted to the services during baseline (October 2011-August 2013) and 2 intervention periods, September 2013-June 2015 and July 2015-June 2016, including 1,525 oncology hospitalizations and 301 HSCT hospitalizations. INTERVENTION In phase 1, we completed an update of the institutional febrile neutropenia (FN) guideline for the pediatric oncology service, recommending first-line β-lactam monotherapy rather than routine use of 2 gram-negative agents. Phase 2 included updating the HSCT service FN guideline and engagement with a new pediatric antimicrobial stewardship program. The use of target antibiotics (tobramycin and ciprofloxacin) was measured in days of therapy per 1,000 patient days collected from administrative data. Intervention effects were evaluated using interrupted time series with segmented regression. RESULTS Phase 1 had mixed effects-long-term reduction in tobramycin use (97% below projected at 18 months) but rebound with increasing slope in ciprofloxacin use (+18% per month). Following phase 2, tobramycin and ciprofloxacin use on the oncology service were both 99% below projected levels at 12 months. On the HSCT service, tobramycin use was 99% below the projected level and ciprofloxacin use was 96% below the projected level at 12 months. CONCLUSIONS Locally adapted guidelines can facilitate practice changes in oncology and HSCT settings. More comprehensive and ongoing interventions, including follow-up education, feedback, and engagement of companion services may be needed to sustain changes. Infect Control Hosp Epidemiol 2017;38:1039-1047.

Unmet reproductive health needs among women in some West African countries: a systematic review of outcome measures and determinants.

PubMed

Ayanore, Martin Amogre; Pavlova, Milena; Groot, Wim

2016-01-16

Identifying relevant measures of women's reproductive health needs is critical to improve women's chances of service utilization. The study aims to systematically review and analyze the adequacy of outcome measures and determinants applied in previous studies for assessing women reproductive health needs across West Africa. Evidence on outcomes and determinants of unmet reproductive health needs among women of childbearing age in diverse multicultural, religious, and ethnic settings in West African countries was systematically reviewed. The review included recent English language publications (from January 2009 - March 2014). Clinical studies particularly on obstetric care services and reproductive services in relation to HIV/AIDS were excluded. We acknowledge the possibility to have excluded non-English publications and yet-to-be-published articles related to the study aim and objectives. Outcomes and determinants were assessed and defined at three main levels; contraceptive use, obstetric care, and antenatal care utilization. Results show increasing unmet need for women's reproductive health needs. Socio-cultural norms and practices resulting in discontinuation of service use, economic constraints, travel distance to access services and low education levels of women were found to be key predictors of service utilization for contraception, antenatal and obstetric care services. Outcome measures were mainly assessed based on service utilization, satisfaction, cost, and quality of services available as core measures across the three levels assessed in this review. Evidence from this review indicates that currently applied measures of women's reproductive health needs might be inadequate in attaining best maternal outcomes since they appear rather broad. More support and research for developing and advancing context-related measures may help to improve women's maternal health.

The Process of Parallelizing the Conjunction Prediction Algorithm of ESA's SSA Conjunction Prediction Service Using GPGPU

NASA Astrophysics Data System (ADS)

Fehr, M.; Navarro, V.; Martin, L.; Fletcher, E.

2013-08-01

Space Situational Awareness[8] (SSA) is defined as the comprehensive knowledge, understanding and maintained awareness of the population of space objects, the space environment and existing threats and risks. As ESA's SSA Conjunction Prediction Service (CPS) requires the repetitive application of a processing algorithm against a data set of man-made space objects, it is crucial to exploit the highly parallelizable nature of this problem. Currently the CPS system makes use of OpenMP[7] for parallelization purposes using CPU threads, but only a GPU with its hundreds of cores can fully benefit from such high levels of parallelism. This paper presents the adaptation of several core algorithms[5] of the CPS for general-purpose computing on graphics processing units (GPGPU) using NVIDIAs Compute Unified Device Architecture (CUDA).

Health outcomes are about choices and values: an economic perspective on the health outcomes movement.

PubMed

Shiell, A

1997-01-01

The aim of the health outcomes movement is to reorientate health services so that the spotlight shines less on what is done and more on what is achieved. The health outcomes movement, thus far, has been most successful in addressing what appear to be technical questions relating to the measurement and analysis of health outcomes and in placing their routine use on the agenda of clinical practice and health services planning. If there is one lesson to be drawn from an economic perspective, however, it is that health outcomes are about values and not just technicalities. The need to make choices forces one to consider whether what is achieved is also what is most valued. The success of health service delivery, be it at a clinical, planning or systems level, must therefore be measured against agreed objectives. It follows that time must be taken to establish what patients and the community want from their health services and what each is prepared to give up to achieve its ends. Value judgements are unavoidable. The challenge lies not in measuring the outcomes of health interventions but in deciding what the objectives of the health system ought to be.

The AskIT Service Desk: A Model for Improving Productivity and Reducing Costs

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

Ashcraft, Phillip Lynn; Fogle, Blythe G.; Cummings, Susan M.

This was prepared for the business process improvement presentation to the Department of Energy. Los Alamos National Laboratory provides a single point of contact, the AskIT Service Desk, to address issues that impact customer productivity. At the most basic level, what customers want is for their calls to be received, to get a response from a knowledgeable analyst, and to have their issues resolved and their requests fulfilled. Providing a centralized, single point of contact service desk makes initiating technical or business support simple for the customer and improves the odds of immediately resolving the issue or correctly escalating themore » request to the next support level when necessary. Fulfilling customer requests through automated workflow also improves customer productivity and reduces costs. Finally, customers should be provided the option to solve their own problems through easy access to self-help resources such as frequently asked questions (FAQs) and how-to guides. To accomplish this, everyone who provides and supports services must understand how these processes and functions work together. Service providers and those who support services must “speak the same language” and share common objectives. The Associate Directorate for Business Innovation (ADBI) began the journey to improve services by selecting a known service delivery framework (Information Technology Infrastructure Library, or ITIL). From this framework, components that contribute significant business value were selected.« less

[Caries morbidity in the odonto-stomatologic services in Yaounde, Cameroon].

PubMed

Bengondoi, M C; Ngoa, S; Onana, J; Ewo, C; Bengono, G

2006-06-01

In our regions, it is believed that dental decay is an illness without prestige or danger for the life. It's the reason of teeth loss and many complications. The objective of this study was to valuate the morbidity of this pathology in odonto-stomatology services. With an average of 4.5 teeth decays per person and a morbidity index of 0.15; dental carie concern all socio-professional levels, without distinction of age or sex. Women seem more vulnerable to teeth decay, and they consult services more than men. We are potential edentulous because of dental decay, if preventive and training measures in mouth and tooth healths are not taken in our country.

Establishment and Implementation of a Required Medication Therapy Management Advanced Pharmacy Practice Experience

PubMed Central

Gilliam, Eric; Thompson, Megan; Vande Griend, Joseph

2017-01-01

Objective. To develop a community pharmacy-based medication therapy management (MTM) advanced pharmacy practice experience (APPE) that provides students with skills and knowledge to deliver entry-level pharmacy MTM services. Design. The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences (SSPPS) partnered with three community pharmacy chains to establish this three-week, required MTM APPE. Students completed the American Pharmacists Association MTM Certificate Course prior to entering the APPE. Students were expected to spend 90% or more of their time at this experience working on MTM interventions, using store MTM platforms. Assessment. All 151 students successfully completed this MTM APPE, and each received a passing evaluation from their preceptor. Preceptor evaluations of students averaged above four (entry-level practice) on a five-point Likert scale. The majority of students reported engagement in MTM services for more than 80% of the time on site. Students’ self-reporting of their ability to perform MTM interventions improved after participation in the APPE. Conclusion. The SSPPS successfully implemented a required MTM APPE, preparing students for entry-level delivery of MTM services. PMID:28381896

Explaining the heterogeneity in average costs per HIV/AIDS patient in Nigeria: The role of supply-side and service delivery characteristics

PubMed Central

Amanze, Ogbonna O.; La Hera-Fuentes, Gina; Silverman-Retana, Omar; Contreras-Loya, David; Ashefor, Gregory A.; Ogungbemi, Kayode M.

2018-01-01

Objective We estimated the average annual cost per patient of ART per facility (unit cost) in Nigeria, described the variation in costs across facilities, and identified factors associated with this variation. Methods We used facility-level data of 80 facilities in Nigeria, collected between December 2014 and May 2015. We estimated unit costs at each facility as the ratio of total costs (the sum of costs of staff, recurrent inputs and services, capital, training, laboratory tests, and antiretroviral and TB treatment drugs) divided by the annual number of patients. We applied linear regressions to estimate factors associated with ART cost per patient. Results The unit ART cost in Nigeria was $157 USD nationally and the facility-level mean was $231 USD. The study found a wide variability in unit costs across facilities. Variations in costs were explained by number of patients, level of care, task shifting (shifting tasks from doctors to less specialized staff, mainly nurses, to provide ART) and provider´s competence. The study illuminated the potentially important role that management practices can play in improving the efficiency of ART services. Conclusions Our study identifies characteristics of services associated with the most efficient implementation of ART services in Nigeria. These results will help design efficient program scale-up to deliver comprehensive HIV services in Nigeria by distinguishing features linked to lower unit costs. PMID:29718906

Does courtesy bias affect how clients report on objective and subjective measures of family planning service quality? A comparison between facility- and home-based interviews.

PubMed

Hameed, Waqas; Ishaque, Muhammad; Gul, Xaher; Siddiqui, Junaid-Ur-Rehman; Hussain, Sharmeen; Hussain, Wajahat; Ahmed, Aftab; Balal, Asma

2017-01-01

Despite a general understanding that exit interviews being conducted at service providers' facilities may influence clients' responses favorably to health professionals, there is very little evidence available that demonstrates the extent to which this problem exists. This study aimed at assessing and comparing clients' perceptions of the quality of family planning services and their satisfaction levels between facility- and home-based interviews. A cross-sectional survey was conducted among clients receiving family planning services across three service delivery channels - nongovernmental organization (NGO) clinics, social franchise (SF) centers, and outreach camps. The survey took place from December 2015 to January 2016 in 70 districts across all four provinces of Pakistan. A total of 2,807 clients were interviewed, of whom 1,404 clients were interviewed at health facilities after receiving services and 1,403 were interviewed at their homes within 3 days of method uptake. Overall, we found no significant differences between the characteristics of study participants interviewed at health facilities or at home. The findings suggested that experiences reported in exit surveys at facilities were strongly biased positively. This was true for both experiential (service quality) and perception-based (satisfaction) questions in the context of SF centers, while at NGO clinics the interview location only affected clients' responses regarding service quality. However, in outreach settings, clients are more likely to share bad experiences in exit interviews than in home-based interviews on objectively asked questions (service quality). Our study indicates signs of courtesy bias and possibly the Hawthorne effect in exit interviews. Program implementers could opt for home-based interviews for women receiving services at NGO clinics or SF center, whereas exit interviews could be used in outreach settings.

Does courtesy bias affect how clients report on objective and subjective measures of family planning service quality? A comparison between facility- and home-based interviews

PubMed Central

Hameed, Waqas; Ishaque, Muhammad; Gul, Xaher; Siddiqui, Junaid-ur-Rehman; Hussain, Sharmeen; Hussain, Wajahat; Ahmed, Aftab; Balal, Asma

2017-01-01

Purpose Despite a general understanding that exit interviews being conducted at service providers’ facilities may influence clients’ responses favorably to health professionals, there is very little evidence available that demonstrates the extent to which this problem exists. This study aimed at assessing and comparing clients’ perceptions of the quality of family planning services and their satisfaction levels between facility- and home-based interviews. Methods A cross-sectional survey was conducted among clients receiving family planning services across three service delivery channels – nongovernmental organization (NGO) clinics, social franchise (SF) centers, and outreach camps. The survey took place from December 2015 to January 2016 in 70 districts across all four provinces of Pakistan. A total of 2,807 clients were interviewed, of whom 1,404 clients were interviewed at health facilities after receiving services and 1,403 were interviewed at their homes within 3 days of method uptake. Results Overall, we found no significant differences between the characteristics of study participants interviewed at health facilities or at home. The findings suggested that experiences reported in exit surveys at facilities were strongly biased positively. This was true for both experiential (service quality) and perception-based (satisfaction) questions in the context of SF centers, while at NGO clinics the interview location only affected clients’ responses regarding service quality. However, in outreach settings, clients are more likely to share bad experiences in exit interviews than in home-based interviews on objectively asked questions (service quality). Conclusion Our study indicates signs of courtesy bias and possibly the Hawthorne effect in exit interviews. Program implementers could opt for home-based interviews for women receiving services at NGO clinics or SF center, whereas exit interviews could be used in outreach settings. PMID:29760573

A fuzzy multi-objective model for capacity allocation and pricing policy of provider in data communication service with different QoS levels

NASA Astrophysics Data System (ADS)

Pan, Wei; Wang, Xianjia; Zhong, Yong-guang; Yu, Lean; Jie, Cao; Ran, Lun; Qiao, Han; Wang, Shouyang; Xu, Xianhao

2012-06-01

Data communication service has an important influence on e-commerce. The key challenge for the users is, ultimately, to select a suitable provider. However, in this article, we do not focus on this aspect but the viewpoint and decision-making of providers for order allocation and pricing policy when orders exceed service capacity. It is a multiple criteria decision-making problem such as profit and cancellation ratio. Meanwhile, we know realistic situations in which much of the input information is uncertain. Thus, it becomes very complex in a real-life environment. In this situation, fuzzy sets theory is the best tool for solving this problem. Our fuzzy model is formulated in such a way as to simultaneously consider the imprecision of information, price sensitive demand, stochastic variables, cancellation fee and the general membership function. For solving the problem, a new fuzzy programming is developed. Finally, a numerical example is presented to illustrate the proposed method. The results show that it is effective for determining the suitable order set and pricing policy of provider in data communication service with different quality of service (QoS) levels.

41 CFR 101-5.302 - Objective.

Code of Federal Regulations, 2012 CFR

2012-07-01

... FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 5-CENTRALIZED SERVICES IN FEDERAL BUILDINGS AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.302 Objective. It is the objective of GSA to provide or arrange for appropriate health service programs in all Government-owned and leased buildings, or groups of...

41 CFR 101-5.302 - Objective.

Code of Federal Regulations, 2014 CFR

2014-07-01

... FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 5-CENTRALIZED SERVICES IN FEDERAL BUILDINGS AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.302 Objective. It is the objective of GSA to provide or arrange for appropriate health service programs in all Government-owned and leased buildings, or groups of...

41 CFR 101-5.302 - Objective.

Code of Federal Regulations, 2010 CFR

2010-07-01

... FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 5-CENTRALIZED SERVICES IN FEDERAL BUILDINGS AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.302 Objective. It is the objective of GSA to provide or arrange for appropriate health service programs in all Government-owned and leased buildings, or groups of...

41 CFR 101-5.302 - Objective.

Code of Federal Regulations, 2011 CFR

2011-07-01

... FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 5-CENTRALIZED SERVICES IN FEDERAL BUILDINGS AND COMPLEXES 5.3-Federal Employee Health Services § 101-5.302 Objective. It is the objective of GSA to provide or arrange for appropriate health service programs in all Government-owned and leased buildings, or groups of...

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

Types of strain among family members of individuals with autism spectrum disorder across the lifespan.

PubMed

Shivers, Carolyn M; Krizova, Katarina; Lee, Gloria K

2017-09-01

Although increased caregiver strain is often found among family caregivers of individuals with autism spectrum disorder, it is still unclear as to how different types of strain relate to amount and types of caregiving across the lifespan. The present study examined different types of strain (i.e. subjective internalized strain, subjective externalized strain, and objective strain) and how such strain relates to the amount of caregiving responsibilities. Data was collected via online survey from a sample of 193 family caregivers of individuals with ASD from the United States, Canada, and the Republic of Ireland. Participants completed measures of strain and caregiving responsibilities, as well as coping, demographics, and services needed and received by the individual with ASD. Caregivers reported higher levels of objective strain than subjective, and caregiving responsibility was related to objective and subjective internalized strain. Coping style was strongly correlated with all types of strain, and unmet service needs were significantly related to objective and subjective internalized strain. Caregiving behaviors were only related to objective strain. The present results indicate that, although caregiving responsibility is related to objective and subjective internalized strain, the relationship is perhaps not as strong as the relationship between coping mechanisms and strain. Future research is needed to understand different types of strain and develop strategies to help caregivers. Copyright © 2017 Elsevier Ltd. All rights reserved.

Low-cost silicon solar array project environmental hail model for assessing risk to solar collectors

NASA Technical Reports Server (NTRS)

Gonzalez, C.

1977-01-01

The probability of solar arrays being struck by hailstones of various sizes as a function of geographic location and service life was assessed. The study complements parallel studies of solar array sensitivity to hail damage, the final objective being an estimate of the most cost effective level for solar array hail protection.

GUIDANCE RESEARCH IN ACTION, GROUP COUNSELING WITH PARENTS, MONOGRAPH 2.

ERIC Educational Resources Information Center

SHAW, MERVILLE C.; TUEL, JOHN K.

THE SECOND PHASE OF A 3-YEAR STUDY TO DEFINE AN OBJECTIVE FOR GUIDANCE SERVICES IS PRIMARILY CONCERNED WITH THE INCLUSION OF TEACHERS IN GROUP COUNSELING AND THE CONTINUED DEVELOPMENT OF GROUP COUNSELING WITH PARENTS. THE 22 PARTICIPATING SCHOOLS FROM SIX SCHOOL DISTRICTS IN CALIFORNIA AND NEW MEXICO INCLUDED K-12 FROM ALL SOCIOECONOMIC LEVELS. TO…

Hospitalization Rates of Nursing Home Residents and Community-Dwelling Seniors in British Columbia

ERIC Educational Resources Information Center

Ronald, Lisa A.; McGregor, Margaret J.; McGrail, Kimberlyn M.; Tate, Robert B.; Broemling, Anne-Marie

2008-01-01

The overall use of acute care services by nursing home (NH) residents in Canada has not been well documented. Our objectives were to identify the major causes of hospitalization among NH facility residents and to compare rates to those of community-dwelling seniors. A retrospective cohort was defined using population-level health administrative…

Declining Physical Activity Levels as an Unintended Consequence of Abolishing Mandatory Campus Service Fees

ERIC Educational Resources Information Center

Jones, Sandra C.; Barrie, Lance

2011-01-01

Objective: This study investigates the effect of the introduction of voluntary student unionism and subsequent increase in campus facility fees on engagement in physical activity on campus. Participants: Participants were 1,904 students from a large regional NSW (Australia) university across 3 time periods (926 in 2005, 504 in 2006, and 474 in…

Caseworker Assessments of Risk for Recurrent Maltreatment: Association with Case-Specific Risk Factors and Re-Reports

ERIC Educational Resources Information Center

Dorsey, Shannon; Mustillo, Sarah A.; Farmer, Elizabeth M. Z.; Elbogen, Eric

2008-01-01

Objective: This article focuses on caseworkers' assessments of risk of maltreatment recurrence among families in contact with social services. Specifically, the article has two primary goals: (1) to examine the association between caseworkers' risk assessments and demographic, child, parent and family-level risk factors; and (2) to examine…

Children with Disabilities in the Child Protective Services System: An Analog Study of Investigation and Case Management

ERIC Educational Resources Information Center

Manders, Jeanette E.; Stoneman, Zolinda

2009-01-01

Objective: The study used a series of vignettes to investigate how the presence of three disabilities (cerebral palsy, intellectual disabilities, emotional/behavioral disabilities) affects the processes and outcomes of child abuse investigations at two levels of child injury severity (moderate, severe). Method: Seventy-five CPS case workers…

Independent Children's Social Work Practice Pilots: Evaluating Practitioners' Job Control and Burnout

ERIC Educational Resources Information Center

Hussein, Shereen; Manthorpe, Jill; Ridley, Julie; Austerberry, Helen; Farrelly, Nicola; Larkins, Cath; Bilson, Andy; Stanley, Nicky

2014-01-01

Objectives: To investigate whether a new model that delegates some out-of-home care services from the public to the private and not-for-profit sectors in England enhances practitioners' job control and stress levels. Methods: A 3-year longitudinal matched-control evaluation examined changes in Karasek demand-control model and Maslach burnout…

Medical and Medio-social Measures for the Health Protection of Mothers and Young Children in France.

ERIC Educational Resources Information Center

Evans, Roy; Evans, Patricia G.

1983-01-01

Provides English translation of a French study of legislation and programs providing preventive medical and social services to pregnant women and young children. Discussed are legislative objectives and organizational levels, strategies and modes of executive action, the contribution of social security to medical protection for mother and child,…

Personal goals as predictors of intended classroom goals: comparing elementary and secondary school pre-service teachers.

PubMed

Daniels, Lia M; Frenzel, Anne C; Stupnisky, Robert H; Stewart, Tara L; Perry, Raymond P

2013-09-01

The literature documents fewer classroom mastery goal structures in secondary school compared to elementary. However, little is known about how personal achievement goals may influence classroom goal structures. This is especially true at the level of pre-service teachers. Our objective was to investigate if pre-service teachers' personal goals predicted their intended classroom goal structures. Participants were 125 elementary and 175 secondary school pre-service teachers from two Western Canadian universities. Structural equation modelling was used to examine if the structural relationships and latent means of personal and intended classroom goal structures differed for elementary and secondary school pre-service teachers. The results revealed that personal goals predicted the goal structures that pre-service teachers intended to establish; however, the relationships and means differed between elementary and secondary school pre-service teachers. Specifically, personal mastery-approach goals positively predicted classroom mastery goals much more strongly at the elementary than the secondary level. Furthermore, elementary pre-service teachers had significantly higher latent mean scores on personal mastery-approach goals than their secondary counterparts. It seems possible that the currently documented differences between classroom goal structures noted for elementary compared to secondary school may be based on the personal goals endorsed as pre-service teachers. The results are further discussed in terms of alignment with research on practising teachers' personal and classroom goals and implications for teacher education. © 2012 The British Psychological Society.

From concept to application: the impact of a community-wide intervention to improve the delivery of preventive services to children.

PubMed

Margolis, P A; Stevens, R; Bordley, W C; Stuart, J; Harlan, C; Keyes-Elstein, L; Wisseh, S

2001-09-01

To improve health outcomes of children, the US Maternal and Child Health Bureau has recommended more effective organization of preventive services within primary care practices and more coordination between practices and community-based agencies. However, applying these recommendations in communities is challenging because they require both more complex systems of care delivery within organizations and more complex interactions between them. To improve the way that preventive health care services are organized and delivered in 1 community, we designed, implemented, and assessed the impact of a health care system-level approach, which involved addressing multiple care delivery processes, at multiple levels in the community, the practice, and the family. Our objective was to improve the processes of preventive services delivery to all children in a defined geographic community, with particular attention to health outcomes for low-income mothers and infants. Observational intervention study in 1 North Carolina county (population 182 000) involving low- income pregnant mothers and their infants, primary care practices, and departments of health and mental health. An interrupted time-series design was used to assess rates of preventive services in office practices before and after the intervention, and a historical cohort design was used to compare maternal and child health outcomes for women enrolled in an intensive home visiting program with women who sought prenatal care during the 9 months before the program's initiation. Outcomes were assessed when the infants reached 12 months of age. Our primary objective was to achieve changes in the process of care delivery at the level of the clinical interaction between care providers and patients that would lead to improved health and developmental outcomes for families. We selected interventions that were directed toward major risk factors (eg, poverty, ineffective care systems for preventive care in office practices) and for which there was existing evidence of efficacy. The interventions involved community-, practice-, and family-level strategies to improve processes of care delivery to families and children. The objectives of the community-level intervention were: 1) to achieve policy level changes that would result in changes in resources available at the level of clinical care, 2) to engage multiple practice organizations in the intervention to achieve an effect on most, if not all, families in the community, and 3) to enhance communication between, among, and within public and private practice organizations to improve coordination and avoid duplication of services. The objective of the practice-level interventions was to overcome specific barriers in the process of care delivery so that preventive services could be effectively delivered. To assist the health department in implementing the family-level intervention, we provided assistance in hiring and training staff and ongoing consultation on staff supervision, including the use of structured protocols for care delivery, and regular feedback data about implementation of the program. Interventions with primary care practices focused on the design of the delivery system within the office and the use of teamwork and data in an "office systems" approach to improving clinical preventive care. All practices (N = 8) that enrolled at least 5 infants/month received help in assessing performance and developing systems (eg, preventive services flow sheets) for preventive services delivery. Family-level interventions addressed the process of care delivery to high-risk pregnant women (<100% poverty) and their infants. Mothers were recruited for the home visiting intervention when they first sought prenatal care at the community health center, the county's largest provider of prenatal care to underserved women. The home visiting intervention involved teams of nurses and educators and involved 2 to 4 visits per month through the infant's first year of life to provide parental education on fetal and infant health and development, enhance parents' informal support systems, and link parents with needed health and human services. We included training in injury prevention and discipline, and home visitors assisted mothers in obtaining care from one of the primary care offices. There were high levels of participation, changes in the organization of the delivery system, and improvements in preventive health outcomes. Agencies cooperated in joint contracting, staff training, and defining program eligibility. All 8 eligible practices agreed to participate and 7/8 implemented at least 1 new office system element. Of eligible women, 89% agreed to participate, and outcome data were available on 80% (180/225). After adjusting for differences in baseline characteristics, intervention group women were significantly more likely than comparison group women to use contraceptives (69% vs 47%), not smoke tobacco (27% vs 54%) and have a safe and stimulating home environment for their children. Intervention group children were more likely to have had an appropriate number of well-child care visits (57% vs 37%) and less likely to be injured (2% vs 7%). Intervention mothers also received Aid to Families with Dependent Children for fewer months after the birth of their child (7.7 months vs 11.3 months). We observed a number of positive effects at all 3 levels of intervention. Policy-level changes at the state and community led to lasting changes in the organization and financing of care, which enabled changes in clinical services to take place. These changes have now been expanded beyond this community to other communities in the state. We were also able to engage multiple practice organizations, reduce duplication, and improve the coordination of care. Changes in the process of preventive services delivery were noted in participating practices. Finally, the outcomes of the family-level intervention were comparable in direction and magnitude to the outcomes of previous randomized trials of the intervention. All the changes were achieved over a relatively brief 3-year study period, and many have been sustained since the project was completed. Tiered, interrelated interventions directed at an entire population of mothers and children hold promise to improve the effectiveness and outcomes of health care for families and children.

Pollution monitoring using bees: a new service provided by honey bees

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

Bromenshenk, J.J.; Thomas, J.M.; Simpson, J.C.

1983-10-01

The objectives are to provide a tool for assessing pollutant distributions and the effects of pollutants on living systems. The potential of bees as pollution monitors was studied by examining bees exposed to toxic metals near a smelter in Montana and bees in the area surrounding a hazardous waste disposal site near Puget Sound, Washington. Levels of toxic metals in the bees and brood survival were examined. It was concluded bees were, indeed, suitable indicators of pollution levels. (ACR)

Cost & efficiency evaluation of a publicly financed & publicly delivered referral transport service model in three districts of Haryana State, India

PubMed Central

Prinja, Shankar; Manchanda, Neha; Aggarwal, Arun Kumar; Kaur, Manmeet; Jeet, Gursimer; Kumar, Rajesh

2013-01-01

Background & objectives: Various models of referral transport services have been introduced in different States in India with an aim to reduce maternal and infant mortality. Most of the research on referral transport has focussed on coverage, quality and timeliness of the service with not much information on cost and efficiency. This study was undertaken to analyze the cost of a publicly financed and managed referral transport service model in three districts of Haryana State, and to assess its cost and technical efficiency. Methods: Data on all resources spent for delivering referral transport service, during 2010, were collected from three districts of Haryana State. Costs incurred at State level were apportioned using appropriate methods. Data Envelopment Analysis (DEA) technique was used to assess the technical efficiency of ambulances. To estimate the efficient scale of operation for ambulance service, the average cost was regressed on kilometres travelled for each ambulance station using a quadratic regression equation. Results: The cost of referral transport per year varied from ₹5.2 million in Narnaul to ₹9.8 million in Ambala. Salaries (36-50%) constituted the major cost. Referral transport was found to be operating at an average efficiency level of 76.8 per cent. Operating an ambulance with a patient load of 137 per month was found to reduce unit costs from an average ₹ 15.5 per km to ₹ 9.57 per km. Interpretation & conclusions: Our results showed that the publicly delivered referral transport services in Haryana were operating at an efficient level. Increasing the demand for referral transport services among the target population represents an opportunity for further improving the efficiency of the underutilized ambulances. PMID:24521648

[Study on the occupational stress norm and it's application for the marketing group, public service/safety group and production laborer group].

PubMed

Yang, Xin-Wei; Wang, Zhi-Ming; Jin, Tai-Yi; Lan, Ya-Jia

2006-09-01

A study of the occupational stress norm and it's application for the marketing group, public service/safety group and production laborer group. In this study, cross-sectional study method is used, and a synthetic way of sorting and randomized sampling is adopted to deal with research targets (36 marketing group, 331 public service/safety group, 903 production laborer group). Descriptive statistics for OSI-R scale scores for the marketing group, public service/safety group and production laborer group were modulated. Scale raw score to T-score conversion tables derived from the OSI-R normative sample for marketing group public service/safety group and production laborer group were established. OSI-R profile from for marketing group, public service/safety group and production laborer group were established. For the ORQ and PSQ scales, scores at or above 70 indicate a strong levels of maladaptive stress and strain. Score in the range of 60 to 69 suggest middle levels of maladaptive stress and strain. Score in the range of 40 to 59 indicate normal levels of stress and strain. Score below 40 indicate a relative absence of occupational stress and strain. For the PRQ scales, score below 30 indicate a significant lack of coping resources. Score in the range of 30 to 39 suggest middle deficits in coping resources. Score in the range of 40 to 59 indicate average coping resources. Scores at or above 60 indicate a strong levels of coping resources. The authors combined subjective and objective environment match model of occupational stress. Different intervention measure should be take to reduce the occupational stress so as to improve the work ability.

Utilization of health services in relation to mental health problems in adolescents: A population based survey

PubMed Central

Zachrisson, Henrik D; Rödje, Kjetil; Mykletun, Arnstein

2006-01-01

Background Only a minority of adolescents reporting symptoms above case-levels on screenings for mental health seeks and receives help from specialist health services. The objective of this study was to a) examine help-seeking for symptoms of anxiety and depression in relation to symptom load dimensionally, b) identify the level of specialization in mental health among service-providers, and c) identify associations between mental health problems and contact with different types of health services. Methods This cross-sectional school-based study (response-rate 88%, n = 11154) is based on Norwegian health surveys among 15 and 16 year olds. Results We found a dose-response association between symptom-load and help seeking. Only 34% of individuals with mental symptom-load above 99th percentile reported help-seeking in the last 12 months. Forty percent of help seekers were in contact with specialists (psychiatrists or psychologists), the remaining were mainly in contact with GPs. Mental health problems increased help seeking to all twelve service providers examined. Conclusion It might not be reasonable to argue that all adolescents with case-level mental health problems are in need of treatment. However, concerning the 99th percentile, claiming treatment need is less controversial. Even in the Norwegian context where mental health services are relatively available and free of charge, help-seeking in individuals with the highest symptom-loads is still low. Most help seekers achieved contact with health care providers, half of them at a non specialized level. Our results suggest that adolescents' recognition of mental health problems or intention to seek help for these are the major "filters" restricting treatment. PMID:16480522

Association between social health insurance and choice of hospitals among internal migrants in China: a national cross-sectional study

PubMed Central

Wang, Haiqin; Zhang, Donglan; Hou, Zhiying; Yan, Fei; Hou, Zhiyuan

2018-01-01

Objectives There is a tendency to pursue higher-level hospitalisation services in China, especially for internal migrants. This study aims to investigate the choices of hospitalisation services among internal migrants, and evaluate the association between social health insurance and hospitalisation choices. Methods Data were from a 2014 nationally representative cross-sectional sample of internal migrants aged 15–59 years in China. Descriptive analyses were used to perform the distribution of healthcare facility levels for hospitalisation services, and multinomial logistic regression was applied to examine the association between social health insurance and hospitalisation choices. Results Of the 6121 inpatient care users, only 11.50% chose the primary healthcare facilities for hospitalisation services, 44.91% chose the secondary hospitals and 43.59% preferred the tertiary hospitals. The choices presented large regional variations across the country. Compared with the uninsured, social health insurance had no statistically significant effect on patient choices of healthcare facility levels among internal migrants in China, whereas socioeconomic status was positively associated with the choices. Conclusions Social health insurance had little influence on the hospital choice among the internal migrants. Thus, social health insurance should be consolidated and portable to enhance the proper incentive of health insurance on healthcare seeking behaviours. PMID:29440156

A Survey of Hospice Volunteer Coordinators: Training Methods and Objectives of Current Hospice Volunteer Training Programs.

PubMed

Brock, Cara M; Herndon, Christopher M

2017-06-01

Currently more than 5800 hospice organizations operate in the United States. 1 Hospice organizations are required by the Centers for Medicare and Medicaid Services (CMS) to use volunteers for services provided to patients. 2 Although CMS regulates the amount of hours hospice volunteers should provide, there are currently no national requirements for objectives of training. 3 The purpose of this study was to gather information from a sample of hospices regarding volunteer coordinator background, current training for volunteers, importance of training objectives, and any comments regarding additional objectives. Representative state hospice organizations were contacted by e-mail requesting their participation and distribution of the survey throughout their member hospices. The survey asked demographical questions, along with ratings of training components based on perceived level of importance and time spent on each objective. A total of 90 surveys were received, and the response rate was undeterminable. Results showed the majority of hospices were nonprofit, had less than 100 currently trained volunteers, and maintained an average daily patient census of less than 50. Questions regarding training programs indicated that most use live lecture methods of approximately 19 hours or less in duration. Overall, responding hospice organizations agreed that all objectives surveyed were important in training volunteers. The small number of respondents to this survey makes generalization nationwide difficult, however it is a strong starting point for the development of further surveys on hospice volunteer training and achieving a standardized set of training objectives and delivery methods.

7 CFR 1822.262 - Objective.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Objective. 1822.262 Section 1822.262 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE LOANS AND GRANTS...

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

PubMed

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

2015-11-01

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

Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review

PubMed Central

Hudon, Catherine; Chouinard, Maud-Christine; Lambert, Mireille; Diadiou, Fatoumata; Bouliane, Danielle; Beaudin, Jérémie

2017-01-01

Objective The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness. Design Thematic analysis review of CM studies. Methods We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004–December 2015 period, then updated to July 2017, with the keywords ‘CM’ and ‘frequent use’. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir’s implementation of health innovations framework was used to organise results into four broad levels of factors: (1) environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level. Results Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration. Conclusions CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts. PMID:29061623

Socio-Cultural and Economic Valuation of Ecosystem Services Provided by Mediterranean Mountain Agroecosystems

PubMed Central

Bernués, Alberto; Rodríguez-Ortega, Tamara; Ripoll-Bosch, Raimon; Alfnes, Frode

2014-01-01

The aim of this work was to elucidate the socio-cultural and economic value of a number of ecosystem services delivered by mountain agroecosystems (mostly grazing systems) in Euro-Mediterranean regions. We combined deliberative (focus groups) and survey-based stated-preference methods (choice modelling) to, first, identify the perceptions of farmers and other citizens on the most important ecosystem services and, second, to value these in economic terms according to the willingness to pay of the local (residents of the study area) and general (region where the study area is located) populations. Cultural services (particularly the aesthetic and recreational values of the landscape), supporting services (biodiversity maintenance) and some regulating services (particularly fire risk prevention) were clearly recognized by both farmers and citizens, with different degrees of importance according to their particular interests and objectives. The prevention of forest fires (≈50% of total willingness to pay) was valued by the general population as a key ecosystem service delivered by these agroecosystems, followed by the production of specific quality products linked to the territory (≈20%), biodiversity (≈20%) and cultural landscapes (≈10%). The value given by local residents to the last two ecosystem services differed considerably (≈10 and 25% for biodiversity and cultural landscape, respectively). The Total Economic Value of mountain agroecosystems was ≈120 € person−1 year−1, three times the current level of support of agro-environmental policies. By targeting and quantifying the environmental objectives of the European agri-environmental policy and compensating farmers for the public goods they deliver, the so-called “green” subsidies may become true Payments for Ecosystems Services. PMID:25036276

Socio-cultural and economic valuation of ecosystem services provided by Mediterranean mountain agroecosystems.

PubMed

Bernués, Alberto; Rodríguez-Ortega, Tamara; Ripoll-Bosch, Raimon; Alfnes, Frode

2014-01-01

The aim of this work was to elucidate the socio-cultural and economic value of a number of ecosystem services delivered by mountain agroecosystems (mostly grazing systems) in Euro-Mediterranean regions. We combined deliberative (focus groups) and survey-based stated-preference methods (choice modelling) to, first, identify the perceptions of farmers and other citizens on the most important ecosystem services and, second, to value these in economic terms according to the willingness to pay of the local (residents of the study area) and general (region where the study area is located) populations. Cultural services (particularly the aesthetic and recreational values of the landscape), supporting services (biodiversity maintenance) and some regulating services (particularly fire risk prevention) were clearly recognized by both farmers and citizens, with different degrees of importance according to their particular interests and objectives. The prevention of forest fires (≈50% of total willingness to pay) was valued by the general population as a key ecosystem service delivered by these agroecosystems, followed by the production of specific quality products linked to the territory (≈20%), biodiversity (≈20%) and cultural landscapes (≈10%). The value given by local residents to the last two ecosystem services differed considerably (≈10 and 25% for biodiversity and cultural landscape, respectively). The Total Economic Value of mountain agroecosystems was ≈120 € person(-1) year(-1), three times the current level of support of agro-environmental policies. By targeting and quantifying the environmental objectives of the European agri-environmental policy and compensating farmers for the public goods they deliver, the so-called "green" subsidies may become true Payments for Ecosystems Services.

The Advanced Communications Technology Satellite - Performance, Reliability and Lessons Learned

NASA Technical Reports Server (NTRS)

Krawczyk, Richard J.; Ignaczak, Louis R.

2000-01-01

The Advanced Communications Satellite (ACTS) was conceived and developed in the mid- 1980s as an experimental satellite to demonstrate unproven Ka-band technology, and potential new commercial applications and services. Since launch into geostationary orbit in September 1993. ACTS has accumulated almost seven years of essentially trouble-free operation and met all program objectives. The unique technology, service experiments. and system level demonstrations accomplished by ACTS have been reported in many forums over the past several years. As ACTS completes its final experiments activity, this paper will relate the top-level program goals that have been achieved in the design, operation, and performance of the particular satellite subsystems. Pre-launch decisions to ensure satellite reliability and the subsequent operational experiences contribute to lessons learned that may be applicable to other comsat programs.

Optimal Regulation of Virtual Power Plants

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

Dall Anese, Emiliano; Guggilam, Swaroop S.; Simonetto, Andrea

This paper develops a real-time algorithmic framework for aggregations of distributed energy resources (DERs) in distribution networks to provide regulation services in response to transmission-level requests. Leveraging online primal-dual-type methods for time-varying optimization problems and suitable linearizations of the nonlinear AC power-flow equations, we believe this work establishes the system-theoretic foundation to realize the vision of distribution-level virtual power plants. The optimization framework controls the output powers of dispatchable DERs such that, in aggregate, they respond to automatic-generation-control and/or regulation-services commands. This is achieved while concurrently regulating voltages within the feeder and maximizing customers' and utility's performance objectives. Convergence andmore » tracking capabilities are analytically established under suitable modeling assumptions. Simulations are provided to validate the proposed approach.« less

A mobile agent-based moving objects indexing algorithm in location based service

NASA Astrophysics Data System (ADS)

Fang, Zhixiang; Li, Qingquan; Xu, Hong

2006-10-01

This paper will extends the advantages of location based service, specifically using their ability to management and indexing the positions of moving object, Moreover with this objective in mind, a mobile agent-based moving objects indexing algorithm is proposed in this paper to efficiently process indexing request and acclimatize itself to limitation of location based service environment. The prominent feature of this structure is viewing moving object's behavior as the mobile agent's span, the unique mapping between the geographical position of moving objects and span point of mobile agent is built to maintain the close relationship of them, and is significant clue for mobile agent-based moving objects indexing to tracking moving objects.

Skill sharing and delegation practice in two Queensland regional allied health cancer care services: a comparison of tasks.

PubMed

Passfield, Juanine; Nielsen, Ilsa; Brebner, Neil; Johnstone, Cara

2017-07-24

Objective Delegation and skill sharing are emerging service strategies for allied health (AH) professionals working in Queensland regional cancer care services. The aim of the present study was to describe the consistency between two services for the types and frequency of tasks provided and the agreement between teams in the decision to delegate or skill share clinical tasks, thereby determining the potential applicability to other services. Methods Datasets provided by two similar services were collated. Descriptive statistical analyses were used to assess the extent of agreement. Results In all, 214 tasks were identified as being undertaken by the services (92% agreement). Across the services, 70 tasks were identified as high frequency (equal to or more frequently than weekly) and 29 as not high frequency (46% agreement). Of the 68 tasks that were risk assessed, agreement was 66% for delegation and 60% for skill sharing, with high-frequency and intervention tasks more likely to be delegated. Conclusions Strong consistency was apparent for the clinical tasks undertaken by the two cancer care AH teams, with moderate agreement for the frequency of tasks performed. The proportion of tasks considered appropriate for skill sharing and/or delegation was similar, although variation at the task level was apparent. Further research is warranted to examine the range of factors that affect the decision to skill share or delegate. What is known about the topic? There is limited research evidence regarding the use of skill sharing and delegation service models for AH in cancer care services. In particular, the extent to which decisions about task safety and appropriateness for delegation or skill sharing can be generalised across services has not been investigated. What does this paper add? This study investigated the level of clinical task consistency between two similar AH cancer care teams in regional centres. It also examined the level of agreement with regard to delegation and skill sharing to provide an indication of the level of local service influence on workforce and service model decisions. What are the implications for practitioners? Local factors have a modest influence on delegation and skill sharing decisions of AH teams. Practitioners need to be actively engaged in decision making at the local level to ensure the clinical service model meets local needs. However, teams should also capitalise on commonalities between settings to limit duplication of training and resource development through collaborative networks.

A Mobile Service Oriented Multiple Object Tracking Augmented Reality Architecture for Education and Learning Experiences

ERIC Educational Resources Information Center

Rattanarungrot, Sasithorn; White, Martin; Newbury, Paul

2014-01-01

This paper describes the design of our service-oriented architecture to support mobile multiple object tracking augmented reality applications applied to education and learning scenarios. The architecture is composed of a mobile multiple object tracking augmented reality client, a web service framework, and dynamic content providers. Tracking of…

Qualitative study to understand the barriers to recruiting young people with cancer to BRIGHTLIGHT: a national cohort study in England

PubMed Central

Kenten, Charlotte; Martins, Ana; Fern, Lorna A; Gibson, Faith; Lea, Sarah; Ngwenya, Nothando; Whelan, Jeremy S; Taylor, Rachel M

2017-01-01

Objectives BRIGHTLIGHT is a national evaluation of cancer services for teenagers and young adults in England. Following challenges with recruitment, our aim was to understand more fully healthcare professionals’ perspectives of the challenges of recruiting young people to a low-risk observational study, and to provide guidance for future recruitment processes. Design Qualitative. Setting National Health Service (NHS) hospitals in England. Methods Semistructured telephone interviews with a convenience sample of 23 healthcare professionals. Participants included principal investigators/other staff recruiting into the BRIGHTLIGHT study. Data were analysed using framework analysis. Results The emergent themes were linked to levels of research organisational management, described using the levels of social network analysis: micro-level (the individual; in this case the target population to be recruited—young people with cancer); meso-level (the organisation; refers to place of recruitment and people responsible for recruitment); and macro-level (the large-scale or global structure; refers to the wider research function of the NHS and associated policies). Study-related issues occurred across all three levels, which were influenced by the context of the study. At the meso-level, professionals’ perceptions of young people and communication between professionals generated age/cancer type silos, resulting in recruitment of either children or adults, but not both by the same team, and only in the cancer type the recruiting professional was aligned to. At the macro-level the main barrier was discordant configuration of a research service with a clinical service. Conclusions This study has identified significant barriers to recruitment mainly at the meso-level and macro-level, which are more challenging for research teams to influence. We suggest that interconnected whole-system changes are required to facilitate the success of interventions designed to improve recruitment. Interventions targeted at study design/management and the micro-level only may be less successful. We offer solutions to be considered by those involved at all levels of research for this population. PMID:29122799

The participative method of subject definition as used in the quantitative modelling of hospital laundry services.

PubMed

Hammer, K A; Janes, F R

1995-01-01

The objectives for developing the participative method of subject definition were to gain all the relevant information to a high level of fidelity in the earliest stages of the work and so be able to build a realistic model at reduced labour cost. In order to better integrate the two activities--information acquisition and mathematical modelling--a procedure was devised using the methods of interactive management to facilitate teamwork. This procedure provided the techniques to create suitable working relationships between the two groups, the informants and the modellers, so as to maximize their free and accurate intercommunication, both during the initial definition of the linen service and during the monitoring of the accuracy and reality of the draft models. The objectives of this project were met in that the final model was quickly validated and approved, at a low labour cost.

How State-Funded Home Care Programs Respond to Changes in Medicare Home Health Care: Resource Allocation Decisions on the Front Line

PubMed Central

Corazzini, Kirsten

2003-01-01

Objective To examine how case managers in a state-funded home care program allocate home care services in response to information about a client's Medicare home health care status, with particular attention to the influence of work environment. Data Sources/Study Setting Primary data collected on 355 case managers and 26 agency directors employed in June 1999 by 26 of the 27 regional agencies administering the Massachusetts Home Care Program for low-income elders. Study Design Data were collected in a cross-sectional survey study design. A case manager survey included measures of work environment, demographics, and factorial survey vignette clients (N=2,054), for which case managers assessed service eligibility levels. An agency director survey included measures of management practices. Data Collection/Extraction Methods Hierarchical linear models estimated the effects of work environment on the relationship between client receipt of Medicare home health care and care plan levels while controlling for case-mix differences in agencies' clients. Principal Findings Case managers did not supplement extant Medicare home health services, but did allocate more generous service plans to clients who have had Medicare home health care services recently terminated. This finding persisted when controlling for case mix and did not vary by work environment. Work environment affected overall care plan levels. Conclusions Study findings indicate systematic patterns of frontline resource allocation shaping the relationships among community-based long-term care payment sources. Further, results illustrate how nonuniform implementation of upper-level initiatives may be partially attributed to work environment characteristics. PMID:14596390

Assessment of antiretroviral treatment (ART) care service provision in Tigray Region health centers, North Ethiopia.

PubMed

Tessema, Shewaye Belay; Adane, Mesafint Molla

2015-09-10

Client satisfaction is a vital component and main concern intertwined with strategic decisions in service provisions. To improve efficiency of services, eliciting the opinion of users about the available services and identifying factors associated with dissatisfaction is very critical. Thus, the main objective of this study was to assess the perceived levels of clients' satisfaction with health services at ART clinic level in health centres of Tigray Region in Ethiopia. Cross sectional study was conducted from May to June 2013 in Tigray Region ART clinics. A total of 714 ART care user were included in the study using both purposive and probability sampling technique. Data was collected by using structured questionnaire and the collected data was analysed using Statistical Package for the Social Sciences (SPSS) version 16.0. Crude and Adjusted logistic regression analyses were carried out to identify the associated factors underlying perceived levels of clients' overall satisfaction. Finally, the results were presented with table as well as odds ratio (OR) and 95% confidence interval (CI). A total of 714 study participants were enrolled in this study. An overall satisfaction level of 89.6% was reported by ART care service users. Higher scores of satisfaction of services provisions were reported for courtesy and respect (95.80%) followed by privacy (93.28%). On the other hand, respondents' dissatisfaction was rated 35.32% for toilet cleanliness followed by 26.19% for availability of additional drugs. As for overall satisfaction and associated factors, adjusted logistic regression analyses showed that marital status [AOR = 2.01 (95% CI: 1.11, 3.60)], educational status [AOR = 3.13 (95% CI: 1.15, 8.53)], travel distance to reach health centre [AOR = 3.59 (95% CI: 1.23, 10.50)], toilet cleanliness [AOR = 2.22 (95% CI :1.62, 6.32)], and ART drug availability [AOR = 2.60 (95% CI :1.18, 6.52)] were found to have influence on overall ART service satisfaction status. This study revealed high level of client satisfaction rate and were associated with preventable and modifiable factors such as marital status, educational status, travel distance to reach health centre, toilet cleanliness and ART drug availability. Therefore, countermeasures such as increasing access to ART service, availing clean toilet and ART drugs may further increase client satisfaction level in the region.

Contingent Valuation and Pharmacists' Acceptable Levels of Compensation for Medication Therapy Management Services

PubMed Central

Wang, Junling; Hong, Song Hee

2012-01-01

Background Pharmacists' acceptable level of compensation for medication therapy management (MTM) services needs to be determined using various economic evaluation techniques. Objectives Using contingent valuation method, determine pharmacists' acceptable levels of compensation for MTM services. Methods A mailing survey was used to elicit Tennessee (US) pharmacists' acceptable levels of compensation for a 30-minute MTM session for a new patient with 2 medical conditions, 8 medications, and an annual drug cost of $2,000. Three versions of a series of double-bounded, closed-ended, binary discrete choice questions were asked of pharmacists for their willingness-to-accept (WTA) for an original monetary value ($30, $60, or $90) and then follow-up higher or lower value depending on their responses to the original value. A Kaplan-Meier approach was taken to analyze pharmacists' WTA, and Cox's proportional hazards model was used to examine the effects of pharmacist characteristics on their WTA. Results Three hundred and forty-eight pharmacists responded to the survey. Pharmacists' WTA for the given MTM session had a mean of $63.31 and median of $60. The proportions of pharmacists willing to accept $30, $60, and $90 for the given MTM session were 30.61%, 85.19%, and 91.01%, respectively. Pharmacists' characteristics had statistically significant association with their WTA rates. Conclusions Pharmacists' WTA for the given MTM session is higher than current Medicare MTM programs' compensation levels of $15 to $50 and patients' willingness-to-pay of less than $40. Besides advocating for higher MTM compensation levels by third-party payers, pharmacists also may need to charge patients to reach sufficient compensation levels for MTM services. PMID:22436583

Funneling Child Welfare Consumers into and through the Mental Health System: Assessment, Referral, and Quality Issues

PubMed Central

Fedoravicius, Nicole; McMillen, J. Curtis; Rowe, Jill E.; Kagotho, Njeri; Ware, Norma C.

2012-01-01

This qualitative study explores how consumers of child welfare services reach nonpsychiatric mental health providers and the perceived quality of these services. It relies on iterative interviews with individuals and groups, as well as on court observations from one metropolitan area. Results suggest that, consistent with theories of street-level bureaucracy, efficiency issues drive mental health service use, as clients are routinely subjected to psychological evaluations and funneled into mental health services as a matter of course. Referral practices are shaped by child welfare professionals' routines, discretion, and desire to meet such system objectives as providing short turnaround times for reports. The results suggest that, despite stakeholders' best intentions, maltreated children are not benefiting from thoughtful processes geared to screen for, assess, and provide targeted treatment for unmet mental health needs. PMID:22740722

SOA approach to battle command: simulation interoperability

NASA Astrophysics Data System (ADS)

Mayott, Gregory; Self, Mid; Miller, Gordon J.; McDonnell, Joseph S.

2010-04-01

NVESD is developing a Sensor Data and Management Services (SDMS) Service Oriented Architecture (SOA) that provides an innovative approach to achieve seamless application functionality across simulation and battle command systems. In 2010, CERDEC will conduct a SDMS Battle Command demonstration that will highlight the SDMS SOA capability to couple simulation applications to existing Battle Command systems. The demonstration will leverage RDECOM MATREX simulation tools and TRADOC Maneuver Support Battle Laboratory Virtual Base Defense Operations Center facilities. The battle command systems are those specific to the operation of a base defense operations center in support of force protection missions. The SDMS SOA consists of four components that will be discussed. An Asset Management Service (AMS) will automatically discover the existence, state, and interface definition required to interact with a named asset (sensor or a sensor platform, a process such as level-1 fusion, or an interface to a sensor or other network endpoint). A Streaming Video Service (SVS) will automatically discover the existence, state, and interfaces required to interact with a named video stream, and abstract the consumers of the video stream from the originating device. A Task Manager Service (TMS) will be used to automatically discover the existence of a named mission task, and will interpret, translate and transmit a mission command for the blue force unit(s) described in a mission order. JC3IEDM data objects, and software development kit (SDK), will be utilized as the basic data object definition for implemented web services.

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.

Institutional and Economic Determinants of Public Health System Performance

PubMed Central

Mays, Glen P.; McHugh, Megan C.; Shim, Kyumin; Perry, Natalie; Lenaway, Dennis; Halverson, Paul K.; Moonesinghe, Ramal

2006-01-01

Objectives. Although a growing body of evidence demonstrates that availability and quality of essential public health services vary widely across communities, relatively little is known about the factors that give rise to these variations. We examined the association of institutional, financial, and community characteristics of local public health delivery systems and the performance of essential services. Methods. Performance measures were collected from local public health systems in 7 states and combined with secondary data sources. Multivariate, linear, and nonlinear regression models were used to estimate associations between system characteristics and the performance of essential services. Results. Performance varied significantly with the size, financial resources, and organizational structure of local public health systems, with some public health services appearing more sensitive to these characteristics than others. Staffing levels and community characteristics also appeared to be related to the performance of selected services. Conclusions. Reconfiguring the organization and financing of public health systems in some communities—such as through consolidation and enhanced intergovernmental coordination—may hold promise for improving the performance of essential services. PMID:16449584

A Study of Light Level Effect on the Accuracy of Image Processing-based Tomato Grading

NASA Astrophysics Data System (ADS)

Prijatna, D.; Muhaemin, M.; Wulandari, R. P.; Herwanto, T.; Saukat, M.; Sugandi, W. K.

2018-05-01

Image processing method has been used in non-destructive tests of agricultural products. Compared to manual method, image processing method may produce more objective and consistent results. Image capturing box installed in currently used tomato grading machine (TEP-4) is equipped with four fluorescence lamps to illuminate the processed tomatoes. Since the performance of any lamp will decrease if its service time has exceeded its lifetime, it is predicted that this will affect tomato classification. The objective of this study was to determine the minimum light levels which affect classification accuracy. This study was conducted by varying light level from minimum and maximum on tomatoes in image capturing boxes and then investigates its effects on image characteristics. Research results showed that light intensity affects two variables which are important for classification, for example, area and color of captured image. Image processing program was able to determine correctly the weight and classification of tomatoes when light level was 30 lx to 140 lx.

Telecommunications forecast for ITU Region 2 to the year 1995

NASA Technical Reports Server (NTRS)

Hollansworth, J. E.; Salzman, J. A.; Ramler, J. R.

1985-01-01

Telecommunications activity was studied. The primary objective was to forecast the need for fixed service satellites (FSS) by countries within ITU Region 2 excluding the United States and Greenland. Forecasts of telecommunications equipment needs were developed as a yardstick of the relative level of telecommunications activity among developing countries within the region. A likely scenario for the implementation of domestic and regional communications satellites is forecasted to provide services to and among countries in ITU Region 2. By 1995, it is forecast that 15 fixed service satellites will be implemented. A forecast of the countries requirements indicates that, with the possible exception of Canada, this constellation of satellites will meet these countries' needs to beyond the year 2000.

Early adolescent Body Mass Index and the constructed environment.

PubMed

Jones, Randall M; Vaterlaus, J Mitchell

2014-07-01

Previous research has shown that macro-level environmental features such as access to walking trails and recreational facilities are correlated with adolescent weight. Additionally, a handful of studies have documented relationships between micro-level environmental features, such as the presence (or absence) of a television in the bedroom, and adolescent weight. In this exploratory study we focus exclusively on features of the micro-level environment by examining objects that are found within adolescent personal bedrooms in relation to the adolescent occupant's Body Mass Index score (BMI). Participants were 234 early adolescents (eighth graders and ninth graders) who lived with both biological parents and who had their own private bedroom. Discriminant analyses were used to identify the bedrooms belonging to adolescents with below and above average BMI using objects contained within the micro-level environment as discriminating variables. Bedrooms belonging to adolescents with above average BMI were more likely to contain objects associated with sedentary behavior (e.g., magazines, electronic games, dolls), whereas the bedrooms belonging to the average and below average BMI adolescents were more likely to contain objects that reflect past physical activity (e.g., trophies, souvenirs, pictures of places that they had visited). If causal connections between micro-environmental variables and adolescent BMI can be established in future longitudinal research, environmental manipulations may affect adolescent BMI. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

'It is nice to see someone coming in': exploring the social objectives of Meals-on-Wheels.

PubMed

Timonen, Virpi; O'Dwyer, Ciara

2010-09-01

Despite the fact that Meals-on-Wheels have both nutritional and social aspects, research on the social objectives of the service is lacking. This study set out to develop an understanding of the social objectives of Meals-on-Wheels and to explore the extent to which they are met by Ireland's Meals-on-Wheels services. A literature review suggested that Meals-on-Wheels services can potentially meet three social objectives: (a) providing meals recipients with social contact, (b) helping to restimulate an interest in meals and regularising mealtimes, and (c) helping to develop acceptance of the service. Interviews were conducted with 66 meals recipients to explore these themes and augment them as necessary. Study results show that meals recipients derive limited social contact from the service; regularising mealtimes was not important to most recipients; and many were reluctant to accept the service. The three objectives are therefore minimally met within the Irish system at present.

Optimization of Landscape Services under Uncoordinated Management by Multiple Landowners

PubMed Central

Porto, Miguel; Correia, Otília; Beja, Pedro

2014-01-01

Landscapes are often patchworks of private properties, where composition and configuration patterns result from cumulative effects of the actions of multiple landowners. Securing the delivery of services in such multi-ownership landscapes is challenging, because it is difficult to assure tight compliance to spatially explicit management rules at the level of individual properties, which may hinder the conservation of critical landscape features. To deal with these constraints, a multi-objective simulation-optimization procedure was developed to select non-spatial management regimes that best meet landscape-level objectives, while accounting for uncoordinated and uncertain response of individual landowners to management rules. Optimization approximates the non-dominated Pareto frontier, combining a multi-objective genetic algorithm and a simulator that forecasts trends in landscape pattern as a function of management rules implemented annually by individual landowners. The procedure was demonstrated with a case study for the optimum scheduling of fuel treatments in cork oak forest landscapes, involving six objectives related to reducing management costs (1), reducing fire risk (3), and protecting biodiversity associated with mid- and late-successional understories (2). There was a trade-off between cost, fire risk and biodiversity objectives, that could be minimized by selecting management regimes involving ca. 60% of landowners clearing the understory at short intervals (around 5 years), and the remaining managing at long intervals (ca. 75 years) or not managing. The optimal management regimes produces a mosaic landscape dominated by stands with herbaceous and low shrub understories, but also with a satisfactory representation of old understories, that was favorable in terms of both fire risk and biodiversity. The simulation-optimization procedure presented can be extended to incorporate a wide range of landscape dynamic processes, management rules and quantifiable objectives. It may thus be adapted to other socio-ecological systems, particularly where specific patterns of landscape heterogeneity are to be maintained despite imperfect management by multiple landowners. PMID:24465833

A framework for developing objective and measurable recovery criteria for threatened and endangered species.

PubMed

Himes Boor, Gina K

2014-02-01

For species listed under the U.S. Endangered Species Act (ESA), the U.S. Fish and Wildlife Service and National Marine Fisheries Service are tasked with writing recovery plans that include "objective, measurable criteria" that define when a species is no longer at risk of extinction, but neither the act itself nor agency guidelines provide an explicit definition of objective, measurable criteria. Past reviews of recovery plans, including one published in 2012, show that many criteria lack quantitative metrics with clear biological rationale and are not meeting the measureable and objective mandate. I reviewed how objective, measureable criteria have been defined implicitly and explicitly in peer-reviewed literature, the ESA, other U.S. statutes, and legal decisions. Based on a synthesis of these sources, I propose the following 6 standards be used as minimum requirements for objective, measurable criteria: contain a quantitative threshold with calculable units, stipulate a timeframe over which they must be met, explicitly define the spatial extent or population to which they apply, specify a sampling procedure that includes sample size, specify a statistical significance level, and include justification by providing scientific evidence that the criteria define a species whose extinction risk has been reduced to the desired level. To meet these 6 standards, I suggest that recovery plans be explicitly guided by and organized around a population viability modeling framework even if data or agency resources are too limited to complete a viability model. When data and resources are available, recovery criteria can be developed from the population viability model results, but when data and resources are insufficient for model implementation, extinction risk thresholds can be used as criteria. A recovery-planning approach centered on viability modeling will also yield appropriately focused data-acquisition and monitoring plans and will facilitate a seamless transition from recovery planning to delisting. © 2013 Society for Conservation Biology.

Measuring effective coverage of curative child health services in rural Burkina Faso: a cross-sectional study

PubMed Central

Koulidiati, Jean-Louis; Nesbitt, Robin C; Ouedraogo, Nobila; Hien, Hervé; Robyn, Paul Jacob; Compaoré, Philippe; Souares, Aurélia; Brenner, Stephan

2018-01-01

Objective To estimate both crude and effective curative health services coverage provided by rural health facilities to under 5-year-old (U5YO) children in Burkina Faso. Methods We surveyed 1298 child health providers and 1681 clinical cases across 494 primary-level health facilities, as well as 12 497 U5YO children across 7347households in the facilities’ catchment areas. Facilities were scored based on a set of indicators along three quality-of-care dimensions: management of common childhood diseases, management of severe childhood diseases and general service readiness. Linking service quality to service utilisation, we estimated both crude and effective coverage of U5YO children by these selected curative services. Results Measured performance quality among facilities was generally low with only 12.7% of facilities surveyed reaching our definition of high and 57.1% our definition of intermediate quality of care. The crude coverage was 69.5% while the effective coverages indicated that 5.3% and 44.6% of children reporting an illness episode received services of only high or high and intermediate quality, respectively. Conclusion Our study showed that the quality of U5YO child health services provided by primary-level health facilities in Burkina Faso was low, resulting in relatively ineffective population coverage. Poor adherence to clinical treatment guidelines combined with the lack of equipment and qualified clinical staff that performed U5YO consultations seemed to be contributors to the gap between crude and effective coverage. PMID:29858415

A Patient-Centered Framework for Evaluating Digital Maturity of Health Services: A Systematic Review

PubMed Central

Callahan, Ryan; Darzi, Ara; Mayer, Erik

2016-01-01

Background Digital maturity is the extent to which digital technologies are used as enablers to deliver a high-quality health service. Extensive literature exists about how to assess the components of digital maturity, but it has not been used to design a comprehensive framework for evaluation. Consequently, the measurement systems that do exist are limited to evaluating digital programs within one service or care setting, meaning that digital maturity evaluation is not accounting for the needs of patients across their care pathways. Objective The objective of our study was to identify the best methods and metrics for evaluating digital maturity and to create a novel, evidence-based tool for evaluating digital maturity across patient care pathways. Methods We systematically reviewed the literature to find the best methods and metrics for evaluating digital maturity. We searched the PubMed database for all papers relevant to digital maturity evaluation. Papers were selected if they provided insight into how to appraise digital systems within the health service and if they indicated the factors that constitute or facilitate digital maturity. Papers were analyzed to identify methodology for evaluating digital maturity and indicators of digitally mature systems. We then used the resulting information about methodology to design an evaluation framework. Following that, the indicators of digital maturity were extracted and grouped into increasing levels of maturity and operationalized as metrics within the evaluation framework. Results We identified 28 papers as relevant to evaluating digital maturity, from which we derived 5 themes. The first theme concerned general evaluation methodology for constructing the framework (7 papers). The following 4 themes were the increasing levels of digital maturity: resources and ability (6 papers), usage (7 papers), interoperability (3 papers), and impact (5 papers). The framework includes metrics for each of these levels at each stage of the typical patient care pathway. Conclusions The framework uses a patient-centric model that departs from traditional service-specific measurements and allows for novel insights into how digital programs benefit patients across the health system. Trial Registration N/A PMID:27080852

Access to Dental Care for Rural Children: A Survey of Nebraska General Dentists

ERIC Educational Resources Information Center

McFarland, Kimberly K.; Salama, Fouad; Yaseen, Muhammad

2011-01-01

Background: Pediatric dentists are too few in number to care for all children. Therefore, the level of pediatric dental services provided by general dentists, especially in rural areas, is crucial to improving the dental health of children. Purpose: The objectives of the study were to establish a baseline in regard to the quantity of pediatric…

Change Strategies and Disabled Persons: Postsecondary Education and Beyond. National Conference (2nd, Dayton, Ohio, October 3-6, 1978).

ERIC Educational Resources Information Center

Marx, Pat, Ed.; Hall, Perry, Ed.

The document presents proceedings on the second national conference on the physically disabled student at the postsecondary level. Specific conference objectives were: (1) to develop an understanding of the impact of attitudes on service to design and delivery and to identify effective techniques for attitude development; (2) to identify methods…

Comparing Self-Reported Versus Objectively Measured Physical Activity Behavior: A Preliminary Investigation of Older Filipino American Women

ERIC Educational Resources Information Center

Atienza, Audie A.; King, Abby C.

2005-01-01

The importance of examining health behaviors, such as physical activity, among Filipino Americans is highlighted by their higher rates of chronic disease. As physical inactivity has been linked to chronic diseases (U.S. Department of Health and Human Services, 1996), this study investigated the physical activity levels of older Filipinas. This…

Federally Funded Educational Programs for Disadvantaged Children and Youth, ESEA Title I, 1976-1977, Organized into Counties.

ERIC Educational Resources Information Center

New York State Education Dept., Albany. Div. of Federal Education Opportunity Programs.

In this report, an abbreviated descriptive summary of each Title I compensatory education project implemented by local education agencies in New York State during fiscal year 1977 is provided. Listed by county and city, each program is explained in terms of grade level, staffing, objectives, services, materials, number of pupils served and…

Targeted Support and Telecare in Staffed Housing for People with Intellectual Disabilities: Impact on Staffing Levels and Objective Lifestyle Indicators

ERIC Educational Resources Information Center

Perry, Jonathan; Firth, Caroline; Puppa, Michael; Wilson, Rick; Felce, David

2012-01-01

Background: Increased provision of out-of-family residential support is required because of demographic changes within the intellectual disabilities population. Residential support now has to be provided in a climate requiring both financial constraint and high quality service outcomes. The aim was to evaluate the quality of life consequences of…

Socioecological Influences on Community Involvement in HIV Vaccine Research

PubMed Central

Frew, Paula M.; Archibald, Matthew; Hixson, Brooke; del Rio, Carlos

2011-01-01

Objective This study investigated socioecological factors influencing HIV vaccine research participation among communities living in geographic areas with high HIV prevalence and high poverty rates. Methods We surveyed a sample of 453 adults ≥ 18 years from areas of high poverty and high HIV prevalence in metro Atlanta and differentiated the effects of individual-, social/organizational-, and community-level characteristics on participation in HIV vaccine research via multilevel modeling techniques that incorporated questionnaire, program, and census data. Results Models that adjusted for both individual-level covariates (such as race, gender, attitudes, and beliefs concerning HIV research), social/organizational- and community-level factors such as local HIV prevalence rates, revealed that the extent of HIV prevention-related programs and services in census tracts contributed to individuals’ likelihood of participation in an HIV vaccine study. Additionally, neighborhood-based organizations offering HIV medical and treatment programs, support groups, and services (e.g., food, shelter, and clothing) encourage greater HIV vaccine research participation. Conclusions The findings support the hypothesis that community-level factors facilitate participation in HIV vaccine research independent of both individual- and social/organizational-level factors. PMID:21722689

24 CFR 902.50 - Resident service and satisfaction assessment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Resident service and satisfaction... URBAN DEVELOPMENT PUBLIC HOUSING ASSESSMENT SYSTEM PHAS Indicator #4: Resident Service and Satisfaction § 902.50 Resident service and satisfaction assessment. (a) Objective. The objective of the Resident...

Simulation study to determine the impact of different design features on design efficiency in discrete choice experiments

PubMed Central

Vanniyasingam, Thuva; Cunningham, Charles E; Foster, Gary; Thabane, Lehana

2016-01-01

Objectives Discrete choice experiments (DCEs) are routinely used to elicit patient preferences to improve health outcomes and healthcare services. While many fractional factorial designs can be created, some are more statistically optimal than others. The objective of this simulation study was to investigate how varying the number of (1) attributes, (2) levels within attributes, (3) alternatives and (4) choice tasks per survey will improve or compromise the statistical efficiency of an experimental design. Design and methods A total of 3204 DCE designs were created to assess how relative design efficiency (d-efficiency) is influenced by varying the number of choice tasks (2–20), alternatives (2–5), attributes (2–20) and attribute levels (2–5) of a design. Choice tasks were created by randomly allocating attribute and attribute level combinations into alternatives. Outcome Relative d-efficiency was used to measure the optimality of each DCE design. Results DCE design complexity influenced statistical efficiency. Across all designs, relative d-efficiency decreased as the number of attributes and attribute levels increased. It increased for designs with more alternatives. Lastly, relative d-efficiency converges as the number of choice tasks increases, where convergence may not be at 100% statistical optimality. Conclusions Achieving 100% d-efficiency is heavily dependent on the number of attributes, attribute levels, choice tasks and alternatives. Further exploration of overlaps and block sizes are needed. This study's results are widely applicable for researchers interested in creating optimal DCE designs to elicit individual preferences on health services, programmes, policies and products. PMID:27436671

Quality pharmacy services and key performance indicators in Polish NICUs: a Delphi approach.

PubMed

Krzyżaniak, Natalia; Pawłowska, Iga; Bajorek, Beata

2018-03-31

Background Currently, there is no literature describing what a quality level of practice entails in Polish neonatal intensive care units (NICUs), nor are there any means of currently measuring the quality of pharmaceutical care provided to NICU patients. Objective To identify a set of essential pharmacist roles and pharmacy-relevant key performance indicators (KPI's) suitable for Polish neonatal intensive units (NICUs). Setting Polish hospital pharmacies and NICUs. Method Using a modified Delphi technique, potential KPI's structured along Donabedian's domains as well as pharmacy services were presented to an expert panel of stakeholders. Two online, consecutive Delphi rounds, were completed by panellists between August and September 2017. Main outcome measure To identify the minimum level of pharmacy services that should be consistently provided to NICU patients. Results A total of 16 panellists contributed to the expert panel. Overall, consensus of 75% was reached for 23 indicators and for 28 roles. When considering pharmacy services for the NICU, the experts were found to highly value traditional pharmacy roles, such as dispensing and extemporaneous compounding, however, they were still eager for roles in the other domains, such as educational and clinical services, to be listed as essential for NICU practice. Panellists were found to positively value the list of indicators presented, and excluded only 9 out of the total list. Conclusion There is a need for future research to establish a minimum standard of practice for Polish pharmacists to encourage the progression and standardisation of hospital pharmacy services to meet the level of practice seen in NICUs worldwide.

Impact of Referral Source and Study Applicants’ Preference for Randomly Assigned Service on Research Enrollment, Service Engagement, and Evaluative Outcomes

PubMed Central

Macias, Cathaleene; Barreira, Paul; Hargreaves, William; Bickman, Leonard; Fisher, William; Aronson, Elliot

2009-01-01

Objective The inability to blind research participants to their experimental conditions is the Achilles’ heel of mental health services research. When one experimental condition receives more disappointed participants, or more satisfied participants, research findings can be biased in spite of random assignment. The authors explored the potential for research participants’ preference for one experimental program over another to compromise the generalizability and validity of randomized controlled service evaluations as well as cross-study comparisons. Method Three Cox regression analyses measured the impact of applicants’ service assignment preference on research project enrollment, engagement in assigned services, and a service-related outcome, competitive employment. Results A stated service preference, referral by an agency with a low level of continuity in outpatient care, and willingness to switch from current services were significant positive predictors of research enrollment. Match to service assignment preference was a significant positive predictor of service engagement, and mismatch to assignment preference was a significant negative predictor of both service engagement and employment outcome. Conclusions Referral source type and service assignment preference should be routinely measured and statistically controlled for in all studies of mental health service effectiveness to provide a sound empirical base for evidence-based practice. PMID:15800153

[A Triage Scale for Mental Health, an Emerging Practice, a Value-Add for Measuring Demand for Mental Health Services].

PubMed

Boucher, Lucie

Objectives The article aims to present two studies supporting the development of l'Échelle brève de triage RIFCAS en santé mentale 0-99 ans, a measuring instrument used to determine - based on the level of customer demand, seriousness, and urgent need for intervention - the priority of a mental health service across all age groups.Methods Both versions have been subject to a measurement interjudge agreement that is compared against the judgment of professionals and other comparison tools.Results The results produced by the interjudge agreement reflect significant correlations with the priorities established by l'Échelle brève de triage RIFCAS en santé mentale 0-99 ans, the judgment of professional experts and the usual instruments used.Conclusion The final version of the triage scale provides an objective measure for the priority that should be given to all mental health service requests - these encompass all recognized and essential clinical information. Clinicians can rely on a reliable and proven instrument to prioritize service requests before placing them on the waiting list. The use of this instrument facilitates the development of a common procedure between professionals and ensures a fair and safe treatment of users.

A Study on the Development of Service Quality Index for Incheon International Airport

NASA Technical Reports Server (NTRS)

Lee, Kang Seok; Lee, Seung Chang; Hong, Soon Kil

2003-01-01

The main purpose of this study is located at developing Ominibus Monitors System(OMS) for internal management, which will enable to establish standards, finding out matters to be improved, and appreciation for its treatment in a systematic way. It is through developing subjective or objective estimation tool with use importance, perceived level, and complex index at international airport by each principal service items. The direction of this study came towards for the purpose of developing a metric analysis tool, utilizing the Quantitative Second Data, Analysing Perceived Data through airport user surveys, systemizing the data collection-input-analysis process, making data image according to graph of results, planning Service Encounter and endowing control attribution, and ensuring competitiveness at the minimal international standards. It is much important to set up a pre-investigation plan on the base of existent foreign literature and actual inspection to international airport. Two tasks have been executed together on the base of this pre-investigation; one is developing subjective estimation standards for departing party, entering party, and airport residence and the other is developing objective standards as complementary methods. The study has processed for the purpose of monitoring services at airports regularly and irregularly through developing software system for operating standards after ensuring credibility and feasibility of estimation standards with substantial and statistical way.

[The EU drinking water recommendations: objectives and perspectives].

PubMed

Blöch, H

2011-12-01

Protection of our drinking water resources and provision of safe drinking water are key requirements of modern water management and health policy. Microbiological and chemical quality standards have been established in the EU water policy since 1980, and are now complemented by a comprehensive protection of water as a resource. This contribution reflects a presentation at the scientific conference of the Federal Associations of Physicians and Dentists within the Public Health Service in May 2011 and provides an overview on objectives and challenges for drinking water protection at the European level. © Georg Thieme Verlag KG Stuttgart · New York.

Effects of Neighborhood Resources on Aggressive and Delinquent Behaviors Among Urban Youths

PubMed Central

Molnar, Beth E.; Cerda, Magdalena; Roberts, Andrea L.; Buka, Stephen L.

2008-01-01

Objectives. We sought to identify neighborhood-level resources associated with lower levels of aggression and delinquency among youths aged 9–15 years at baseline after accounting for risk factors and other types of resources. Methods. Data were derived from the Project on Human Development in Chicago Neighborhoods, which focused on 2226 ethnically diverse, urban youths, their caregivers, and the 80 neighborhoods in which they resided at baseline. Results. Living in a neighborhood with a higher concentration of organizations or services serving young people and adults was associated with lower levels of aggression (odds ratio [OR]=0.9; 95% confidence interval [CI]=0.8, 1.0); living in such a neighborhood also moderated family, peer, and mentor resources. For example, the presence of well-behaved peers was associated with lower levels of aggression among youths living in neighborhoods where the concentration of organizations and services was at least 1 standard deviation above the mean; the association was less strong among youths living in neighborhoods with organizations and services 1 standard deviation below the mean or less. Conclusions. Certain family, peer, and mentoring resources may confer benefits only in the presence of neighborhood resources. Increasing neighborhood resources should be considered in interventions designed to reduce urban youths’ involvement in violence. PMID:17901441

Standardized Curriculum for Service Station Retailing.

ERIC Educational Resources Information Center

Mississippi State Dept. of Education, Jackson. Office of Vocational, Technical and Adult Education.

This curriculum guide for service station retailing was developed by the state of Mississippi to standardize vocational education course titles and core contents. The objectives contained in this document are common to all service station retailing programs in the state. The guide contains objectives for service station retailing I and II courses.…

Trade Services System Adaptation for Sustainable Development

NASA Astrophysics Data System (ADS)

Khrichenkov, A.; Shaufler, V.; Bannikova, L.

2017-11-01

Under market conditions, the trade services system in post-Soviet Russia, being one of the most important city infrastructures, loses its systematic and hierarchic consistency hence provoking the degradation of communicating transport systems and urban planning framework. This article describes the results of the research carried out to identify objects and object parameters that influence functioning of a locally significant trade services system. Based on the revealed consumer behaviour patterns, we propose methods to determine the optimal parameters of objects inside a locally significant trade services system.

Conscientious objection and abortion: rights and duties of public sector physicians.

PubMed

Diniz, Debora

2011-10-01

The paper analyzes conscientious objection by physicians, through the concrete situation of legal abortion in Brazil. It reviews the two main ethical frameworks about conscientious objection in public health, the incompatibility thesis and the integrity thesis, to analyze the reality of legal abortion services in the referral services of the Brazilian public health care system. From these two perspectives, a third perspective is proposed - the justification thesis, to manage the right to conscientious objection among physicians in referral services. This analysis may contribute to the organization of services for legal abortion and to the education of future physicians working in emergency obstetric care.

The ADRICOSM STAR GeoPortal

NASA Astrophysics Data System (ADS)

Giorgetti, Alessandra; Cesarini, Claudia; Gambetta, Marco; Reseghetti, Franco; Vinci, Matteo

2010-05-01

From Stockholm (1972) to Rio de Janeiro (1992) and to Johannesburg (2002), environmental protection objectives are related to the principles of sustainable development. This includes the following important components: participation, information, communication, training (capacity building) and education. Better information ensure more participation from individuals, and allows citizens to take part in many different actions that can influence the policy process. Participation to political decisions need access to reliable and quality controlled information. The ADRICOSM Portal was developed in order to manage data diversity, provide access to any kind of product, provide metadata completeness and accuracy. The product, as defined in ADRICOSM, is anything that can be offered to a client and that might satisfy a want or need. This implied the implementation of services that was taking into consideration the diversity of the objects to be provided to users: observations, model outputs, maps, etc. The implementation of the portal was based on two metadata levels: 1. Directory level - consisting of broad descriptions of the contents of data sets; used to locate data sets of potential interest and 2. Data level - consisting of the actual data objects. The portal was developed as a simplified front end for the partners data management systems, giving emphasis on federated access points focused on thematic aspects. This was based on the idea that specialized customer-related access points can be better carried out by delegated teams of experts who know the needs of different customers, define the user software which is most suited to them. The data management systems provide facilities for two data tracks, one in real-time (or near-realtime) and one in delayed mode. Both tracks are based on the same data sources and transmission systems, but the data follow different routes and are processed differently depending on user requirements. The real-time data and model products are checked after first use for up-grading and additional quality control to ensure that all relevant data are preserved for final archival. In summary the ADRICOSM Geoportal has: - the objective to support data exchange in Adricosm Star and the implementation of tools to facilitate the access to data and information through thematic portals, converting individual data provider systems into a federation. - provide the necessary information to users on content of data that can be accessed in the federated systems. The portal is organised in three modules and a catalog. The module 1 has been realized by giving information on the project and objectives, data policy, reasons to provide products and services, link to the themes. Skilled people can jump to the data/products/services provider by clicking on the geographical map. Module 2 is providing more specific information on centers providing data/products/services. Module 3 is providing a direct access to partners product. It contains a short description of the products and a link. Module 4 contain the catalog for each partner product and is based on What, Where, When and How.

The Role of INSPIRE in HEP Data Preservation Efforts

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

Brooks, Travis C.; /SLAC

2010-06-11

INSPIRE is a new community resource for HEP literature and associated information. It is based on the combination of SPIRES content and features and the powerful Invenio software developed at CERN. The INSPIRE service will come online in fall of 2009, and be run by CERN, DESY, Fermilab and SLAC. Data preservation, to be successful, must not only preserve the data, but must also organize it and allow it to be found by those who would make use of it, and resources such as INSPIRE are ideally positioned and ready to provide this organization and context. In addition, INSPIRE willmore » soon be ready to provide storage of smaller datasets, such as high-level analysis objects, as stand-alone objects placed in the repository or as objects associated with an analysis paper. This small project could pave the way towards the context and organization which is one piece of the infrastructure needed for all levels of data preservation.« less

The Greek National Observatory of Forest Fires (NOFFi)

NASA Astrophysics Data System (ADS)

Tompoulidou, Maria; Stefanidou, Alexandra; Grigoriadis, Dionysios; Dragozi, Eleni; Stavrakoudis, Dimitris; Gitas, Ioannis Z.

2016-08-01

Efficient forest fire management is a key element for alleviating the catastrophic impacts of wildfires. Overall, the effective response to fire events necessitates adequate planning and preparedness before the start of the fire season, as well as quantifying the environmental impacts in case of wildfires. Moreover, the estimation of fire danger provides crucial information required for the optimal allocation and distribution of the available resources. The Greek National Observatory of Forest Fires (NOFFi)—established by the Greek Forestry Service in collaboration with the Laboratory of Forest Management and Remote Sensing of the Aristotle University of Thessaloniki and the International Balkan Center—aims to develop a series of modern products and services for supporting the efficient forest fire prevention management in Greece and the Balkan region, as well as to stimulate the development of transnational fire prevention and impacts mitigation policies. More specifically, NOFFi provides three main fire-related products and services: a) a remote sensing-based fuel type mapping methodology, b) a semi-automatic burned area mapping service, and c) a dynamically updatable fire danger index providing mid- to long-term predictions. The fuel type mapping methodology was developed and applied across the country, following an object-oriented approach and using Landsat 8 OLI satellite imagery. The results showcase the effectiveness of the generated methodology in obtaining highly accurate fuel type maps on a national level. The burned area mapping methodology was developed as a semi-automatic object-based classification process, carefully crafted to minimize user interaction and, hence, be easily applicable on a near real-time operational level as well as for mapping historical events. NOFFi's products can be visualized through the interactive Fire Forest portal, which allows the involvement and awareness of the relevant stakeholders via the Public Participation GIS (PPGIS) tool.

Introducing quality management into primary health care services in Uganda.

PubMed Central

Omaswa, F.; Burnham, G.; Baingana, G.; Mwebesa, H.; Morrow, R.

1997-01-01

In 1994, a national quality assurance programme was established in Uganda to strengthen district-level management of primary health care services. Within 18 months both objective and subjective improvements in the quality of services had been observed. In the examples documented here, there was a major reduction in maternal mortality among pregnant women referred to Jinja District Hospital, a reduction in waiting times and increased patient satisfaction at Masaka District Hospital, and a marked reduction in reported cases of measles in Arua District. Beyond these quantitative improvements, increased morale of district health team members, improved satisfaction among patients, and greater involvement of local government in the decisions of district health committees have been observed. At the central level, the increased coordination of activities has led to new guidelines for financial management and the procurement of supplies. District quality management workshops followed up by regular support visits from the Ministry of Health headquarters have led to a greater understanding by central staff of the issues faced at the district level. The quality assurance programme has also fostered improved coordination among national disease-control programmes. Difficulties encountered at the central level have included delays in carrying out district support visits and the failure to provide appropriate support. At the district level, some health teams tackled problems over which they had little control or which were overly complex; others lacked the management capacity for problem solving. PMID:9185368

Strategies for cutting hospital beds: the impact on patient service.

PubMed Central

Green, L V; Nguyen, V

2001-01-01

OBJECTIVE: To develop insights on the impact of size, average length of stay, variability, and organization of clinical services on the relationship between occupancy rates and delays for beds. DATA SOURCES: The primary data source was Beth Israel Deaconess Medical Center in Boston. Secondary data were obtained from the United Hospital Fund of New York reflecting data from about 150 hospitals. STUDY DESIGN: Data from Beth Israel Deaconess on discharges and length of stay were analyzed and fit into appropriate queueing models to generate tables and graphs illustrating the relationship between the variables mentioned above and the relationship between occupancy levels and delays. In addition, specific issues of current concern to hospital administrators were analyzed, including the impact of consolidation of clinical services and utilizing hospital beds uniformly across seven days a week rather than five. PRINCIPAL FINDINGS: Using target occupancy levels as the primary determinant of bed capacity is inadequate and may lead to excessive delays for beds. Also, attempts to reduce hospital beds by consolidation of different clinical services into single nursing units may be counterproductive. CONCLUSIONS: More sophisticated methodologies are needed to support decisions that involve bed capacity and organization in order to understand the impact on patient service. Images Figure 2 PMID:11409821

Factors Associated With Late Specialized Rehabilitation among Veterans with Lower Extremity Amputation Who Underwent Immediate Postoperative Rehabilitation

PubMed Central

Kurichi, Jibby E.; Xie, Dawei; Kwong, Pui L.; Bates, Barbara E.; Vogel, W. Bruce; Stineman, Margaret G.

2011-01-01

Objective To determine what patient- and facility-level characteristics drive late specialized rehabilitation among veterans who already received immediate postoperative services. Design Data were obtained from 8 administrative databases for 2,453 patients who underwent lower extremity amputation in Veterans Affairs Medical Centers in 2002-2004. A Cox proportional hazards model was used to determine the hazards ratios and 95% confidence intervals of the factors associated with days to readmission for late services after discharge from the surgical hospitalization. Results There were 2,304 patients who received only immediate postoperative services, while 152 also received late specialized rehabilitation. After adjustment, veterans who were less disabled physically, residing in the South Central compared to the Southeast region, and had their surgeries in CARF accredited facilities were all more likely to receive late services. The hazards ratios for type of immediate postoperative rehabilitation were not constant over time. At hospital discharge, there was no difference in receipt, however, after 3 months, those who received early specialized rehabilitation were significantly less likely to receive late services. Conclusion The factors associated with late specialized rehabilitation were due mainly to facility-level characteristics and care process variables. Knowledge of these factors may help with decision-making policies regarding CARF accredited units. PMID:21389847

Service dogs in the province of Quebec: sociodemographic profile of users and the dogs' impact on functional ability.

PubMed

Vincent, Claude; Gagnon, Dany; Routhier, François; Leblond, Jean; Boucher, Pascale; Blanchet, Marie; Martin-Lemoyne, Valérie

2015-03-01

The objectives of this study were to (1) describe the sociodemographic profile of service dog users, their physical disabilities, main occupations, living environment, and use of technical aids in daily life and (2) evaluate the impact of service dogs on wheelchair travel and picking up objects. Sociodemographic and clinical data were collected and various mobility tests were conducted in the service dog users' home environment (n = 199). The service dog users had injuries to the central or peripheral nervous system (55%), spinal cord (33%), or musculoskeletal or orthopedic system (12%). In the wheelchair travel on flat terrain test (n = 67), users travelled a longer distance in a shorter time, improving their average speed to 1.28 m/s with the service dog compared to 0.75 m/s without (p < 0.001). In a wheelchair propelling up a slope, 42% improved with the service dog (n = 60). Mounting a threshold/curb in a wheelchair, 41% improved with the service dog (n = 39). In a test where walkers and wheelchair users picked up three objects off the ground, 44% improved with the service dog (n = 164). Service dogs significantly improved wheelchair travel speed and distance on flat and ascending terrain, mounting a threshold/curb and picking up objects off the ground. Implications for Rehabilitation For people with motor impairments: Service dogs are most often used as a technical aid to pick up objects (96%), open doors (36%) and pull the wheelchair during travel (34%). Clients' performance in significant travel in a wheelchair (on flat terrain, on an upslope, mounting a threshold) improved with the service dog compared to their own performance without the dog. Clients' grasping performance (picking up three significant objects off the ground) improved with the service dog compared to their own performance without the dog.

Determining unmet, adequately met, and overly met needs for health care and services for persons living with HIV/AIDS in Mississippi.

PubMed

Krause, Denise D; May, Warren L; Butler, Kenneth R

2013-08-01

A statewide needs assessment of persons living with HIV/AIDS (PLWHA) was conducted to determine what is known about access to care, utilization of services, and perceived barriers to receiving care and services. Our objective was to determine which needs were being met or unmet among PLWHA in Mississippi to provide a better understanding of how effectively to allocate funding to provide for the needs of that group. In this cross-sectional study, a true random sample of PLWHA in Mississippi was interviewed in 2005-2006. Questions were asked to identify opinions about respondents' experiences with 23 health care services and 30 public or private assistance services. The kappa statistic was used to measure agreement between level of services needed and level of services provided. Services with the lowest kappa scores revealed which services were being either mostly unmet, or even overly met. Greatest service needs were HIV viral load test, Pap smear, CD4/T-cell count test, and medication for HIV/AIDS, which were reasonably well met. The most significantly unmet needs were dental care and dental exams, eye care and eye exams, help paying for housing, subsidized housing assistance, mental health therapy or counseling, access to emotional support groups, and job placement or employment. Overly met services included medical care at a physician's office or clinic and free condoms. This study identified needs perceived to be significantly unmet by PLWHA, as well as areas that were perceived to be adequately or overly met. This information may be used to target areas with the greatest impact for improvement and provide insight into how to effectively allocate health care resources and public/private assistance.

Disability inclusion in higher education in Uganda: Status and strategies

PubMed Central

Emong, Paul

2016-01-01

Background Uganda has embraced inclusive education and evidently committed itself to bringing about disability inclusion at every level of education. Both legal and non-legal frameworks have been adopted and arguably are in line with the intent of the Convention on the Rights of Persons with Disabilities (CRPD) on education. The CRPD, in Article 24, requires states to attain a right to education for persons with disabilities without discrimination and on the basis of equal opportunities at all levels of education. Objectives Despite Uganda’s robust disability legal and policy framework on education, there is evidence of exclusion and discrimination of students with disabilities in the higher education institutions. The main objective of this article is to explore the status of disability inclusion in higher education and strategies for its realisation, using evidence from Emong’s study, workshop proceedings where the authors facilitated and additional individual interviews with four students with disabilities by the authors. Results The results show that there are discrimination and exclusion tendencies in matters related to admissions, access to lectures, assessment and examinations, access to library services, halls of residence and other disability support services. Conclusion The article recommends that institutional policies and guidelines on support services for students with disabilities and special needs in higher education be developed, data on students with disabilities collected to help planning, collaboration between Disabled Peoples Organisations (DPO’s) strengthened to ensure disability inclusion and the establishment of disability support centres. PMID:28730044

Integration of oncology and palliative care: setting a benchmark.

PubMed

Vayne-Bossert, P; Richard, E; Good, P; Sullivan, K; Hardy, J R

2017-10-01

Integration of oncology and palliative care (PC) should be the standard model of care for patients with advanced cancer. An expert panel developed criteria that constitute integration. This study determined whether the PC service within this Health Service, which is considered to be fully "integrated", could be benchmarked against these criteria. A survey was undertaken to determine the perceived level of integration of oncology and palliative care by all health care professionals (HCPs) within our cancer centre. An objective determination of integration was obtained from chart reviews of deceased patients. Integration was defined as >70% of all respondents answered "agree" or "strongly agree" to each indicator and >70% of patient charts supported each criteria. Thirty-four HCPs participated in the survey (response rate 69%). Over 90% were aware of the outpatient PC clinic, interdisciplinary and consultation team, PC senior leadership, and the acceptance of concurrent anticancer therapy. None of the other criteria met the 70% agreement mark but many respondents lacked the necessary knowledge to respond. The chart review included 67 patients, 92% of whom were seen by the PC team prior to death. The median time from referral to death was 103 days (range 0-1347). The level of agreement across all criteria was below our predefined definition of integration. The integration criteria relating to service delivery are medically focused and do not lend themselves to interdisciplinary review. The objective criteria can be audited and serve both as a benchmark and a basis for improvement activities.

Performance evaluation of Al-Zahra academic medical center based on Iran balanced scorecard model.

PubMed

Raeisi, Ahmad Reza; Yarmohammadian, Mohammad Hossein; Bakhsh, Roghayeh Mohammadi; Gangi, Hamid

2012-01-01

Growth and development in any country's national health system, without an efficient evaluation system, lacks the basic concepts and tools necessary for fulfilling the system's goals. The balanced scorecard (BSC) is a technique widely used to measure the performance of an organization. The basic core of the BSC is guided by the organization's vision and strategies, which are the bases for the formation of four perspectives of BSC. The goal of this research is the performance evaluation of Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences, based on Iran BSC model. This is a combination (quantitative-qualitative) research which was done at Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences in 2011. The research populations were hospital managers at different levels. Sampling method was purposive sampling in which the key informed personnel participated in determining the performance indicators of hospital as the BSC team members in focused discussion groups. After determining the conceptual elements in focused discussion groups, the performance objectives (targets) and indicators of hospital were determined and sorted in perspectives by the group discussion participants. Following that, the performance indicators were calculated by the experts according to the predetermined objectives; then, the score of each indicator and the mean score of each perspective were calculated. Research findings included development of the organizational mission, vision, values, objectives, and strategies. The strategies agreed upon by the participants in the focus discussion group included five strategies, which were customer satisfaction, continuous quality improvement, development of human resources, supporting innovation, expansion of services and improving the productivity. Research participants also agreed upon four perspectives for the Al-Zahra hospital BSC. In the patients and community perspective (customer), two objectives and three indicators were agreed upon, with a mean score of 75.9%. In the internal process perspective, 4 objectives and 14 indicators were agreed upon, with a mean score of 79.37%. In the learning and growth perspective, four objectives and eight indicators were agreed upon, with a mean score of 81.11%. Finally, in the financial perspective, two objectives and five indicators were agreed upon, with a mean score of 67.15%. One way to create demand for hospital services is performance evaluation by paying close attention to all BSC perspectives, especially the non-financial perspectives such as customers and internal processes perspectives. In this study, the BSC showed the differences in performance level of the organization in different perspectives, which would assist the hospital managers improve their performance indicators. The learning and growth perspective obtained the highest score, and the financial perspective obtained the least score. Since the learning and growth perspective acts as a base for all other perspectives and they depend on it, hospitals must continuously improve the service processes and the quality of services by educating staff and updating their policies and procedures. This can increase customer satisfaction and productivity and finally improve the BSC in financial perspective.

HIV Prevention Services and Testing Utilization Behaviors among Men Who Have Sex with Men at Elevated Risk for HIV in Chongqing, China

PubMed Central

Hu, Yifei; Wu, Guohui; Jia, Yujiang; Lu, Rongrong; Xiao, Yan; Raymond, H. F.; Ruan, Yuhua; Sun, Jiangping

2014-01-01

Objective. To investigate barriers and correlates of the use of HIV prevention services and HIV testing behaviors among men who have sex with men in Chongqing. Methods. Three consecutive cross-sectional surveys provided demographic, sexual behavior, HIV/syphilis infection, HIV prevention service, and testing behavior data. Results. Of 1239 participants, 15.4% were infected with HIV, incidence was 12.3 per 100 persons/year (95% CI: 9.2–15.3), 38% of the participants reported ever having unprotected insertive anal sex, 40% ever received free condom/lubricants in the past year, and 27.7% ever obtained free sexually transmitted infection examination/treatment in the past year. Multivariable logistic regression revealed that lower levels of HIV/AIDS related stigmatizing/discriminatory attitudes, full-time jobs, and sex debut with men at a younger age were independently associated with use of free condom/lubricants. Large social networks, higher incomes, and sexual debut with men at a younger age were associated with use of any HIV prevention and HIV testing services. Lower levels of stigmatizing/discriminatory attitudes were also associated with HIV testing. Fearing needles and being unaware of the venues for testing were top barriers for testing service utilization. Conclusion. It is imperative to address HIV/AIDS related stigmatizing/discriminatory attitudes and other barriers while delivering intervention and testing services. PMID:24783195

Analysis of the Change of Health Status Among the Republic of Korea Air Force Soldiers During Military Service

PubMed Central

Yoo, Seok-Ju; Park, Won-Ju; Lee, Kwan; Lim, Hyun-Sul; Kim, Hyun-Jin; Lee, Suk-Ho

2014-01-01

Objectives: The aim of this study was to investigate whether the health status of Republic of Korea Air Force (ROKAF) soldiers changed after one year of military service. Methods: We selected 483 ROKAF soldiers from the 11 749 recruits who participated in the 2011 physical examination. The selected soldiers underwent another physical examination in 2012 for advancement to senior airman. Data from 2011 and 2012 were merged. To collect data on lifestyle, a questionnaire was sent to all included subjects via the military intranet e-mail service. Results: The percentage of recruits with an abnormal alanine transaminase level (normal range <40 IU/L) decreased from recruitment (13.7%) to the following year (2.7%). Moreover, the percentage of obese soldiers (body mass index ≥25 kg/m2) decreased from recruitment (20.5%) to the following year (10.4%). There was a significant change in mean duration of exercise carried out each day before (0.8±1.3 hours) and after (1.0±0.7 hours) joining the ROKAF service. Conclusions: These ROKAF soldiers were generally in good health before and after joining the armed service. After one year of military service, the health status of most soldiers improved, especially with respect to body mass index and alanine transaminase level. PMID:25139169

The Impact of Local Immigration Enforcement Policies on the Health of Immigrant Hispanics/Latinos in the United States

PubMed Central

Mann, Lilli; Simán, Florence M.; Song, Eunyoung; Alonzo, Jorge; Downs, Mario; Lawlor, Emma; Martinez, Omar; Sun, Christina J.; O’Brien, Mary Claire; Reboussin, Beth A.; Hall, Mark A.

2015-01-01

Objectives. We sought to understand how local immigration enforcement policies affect the utilization of health services among immigrant Hispanics/Latinos in North Carolina. Methods. In 2012, we analyzed vital records data to determine whether local implementation of section 287(g) of the Immigration and Nationality Act and the Secure Communities program, which authorizes local law enforcement agencies to enforce federal immigration laws, affected the prenatal care utilization of Hispanics/Latinas. We also conducted 6 focus groups and 17 interviews with Hispanic/Latino persons across North Carolina to explore the impact of immigration policies on their utilization of health services. Results. We found no significant differences in utilization of prenatal care before and after implementation of section 287(g), but we did find that, in individual-level analysis, Hispanic/Latina mothers sought prenatal care later and had inadequate care when compared with non-Hispanic/Latina mothers. Participants reported profound mistrust of health services, avoiding health services, and sacrificing their health and the health of their family members. Conclusions. Fear of immigration enforcement policies is generalized across counties. Interventions are needed to increase immigrant Hispanics/Latinos’ understanding of their rights and eligibility to utilize health services. Policy-level initiatives are also needed (e.g., driver’s licenses) to help undocumented persons access and utilize these services. PMID:25521886

Developing a uniformed assessment tool to evaluate care service needs for disabled persons in Japan.

PubMed

Takei, Teiji; Takahashi, Hiroshi; Nakatani, Hiroki

2008-05-01

Until recently, the care services for disabled persons have been under rigid control by public sectors in terms of provision and funding in Japan. A reform was introduced in 2003 that brought a rapid increase of utilization of services and serious shortage of financial resources. Under these circumstances, the "Services and Supports for Persons with Disabilities Act" was enacted in 2005, requiring that the care service provision process should be transparent, fair and standardized. The purpose of this study is to develop an objective tool for assessing the need for disability care. In the present study we evaluate 1423 cases of patients receiving care services in 60 municipalities, including all three categories of disabilities (physical, intellectual and mental). Using the data of the total 106 items, we conducted factor analysis and regression analysis to develop an assessment tool for people with disabilities. The data revealed that instrumental activities of daily living (IADL) played an essential role in assessing disability levels. We have developed the uniformed assessment tool that has been utilized to guide the types and quantity of care services throughout Japan.

Student and Nonstudent National Guard Service Members/Veterans and their Use of Services for Mental Health Symptoms

PubMed Central

Bonar, Erin E.; Bohnert, Kipling M.; Walters, Heather M.; Ganoczy, Dara; Valenstein, Marcia

2016-01-01

Objective To compare mental health symptoms and service utilization among returning student and nonstudent Service Members/Veterans (SM/Vs). Participants SM/Vs (N=1439) were predominately white (83%) men (92%); half were over age 30 (48%) and 24% were students. Methods SM/Vs completed surveys six months post-deployment (October 2011–July 2013). Results Students and nonstudent SM/Vs did not differ in positive screens for depression, anxiety, hazardous drinking, or Post-traumatic Stress Disorder (PTSD). Students (n=81) and nonstudents (n=265) with mental health symptoms had low levels of mental health service use (e.g., VA, civilian, or military facilities), at 47% and 57% respectively. Fewer students used VA mental health services. Common barriers to treatment-seeking included not wanting treatment on military records and embarrassment. Conclusions Like other returning SM/Vs, student SM/Vs have unmet mental health needs. The discrepancy between potential need and treatment-seeking suggests that colleges might be helpful in further facilitating mental health service use for student SM/Vs. PMID:25337770

42 CFR 423.2024 - Objections to the issues.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Objections to the issues. 423.2024 Section 423.2024 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES..., and Judicial Review § 423.2024 Objections to the issues. (a) If an enrollee objects to the issues...

Reduction of State Victim Compensation Disparities in Disadvantaged Crime Victims Through Active Outreach and Assistance: A Randomized Trial

PubMed Central

Alvidrez, Jennifer; Shumway, Martha; Boccellari, Alicia; Green, Jon Dean; Kelly, Vanessa; Merrill, Gregory

2008-01-01

Objectives. We examined whether providing active outreach and assistance to crime victims as part of comprehensive psychosocial services reduced disparities in access to state compensation funds. Methods. We analyzed data from a randomized trial of injured crime victims (N = 541) and compared outcomes from comprehensive psychosocial services with usual community care. We examined the impact of outreach and assistance on disparities in applying for victim compensation by testing for interactions between victim characteristics and treatment condition in logistic regression analyses. Results. Victims receiving comprehensive services were much more likely to apply for victim compensation than were victims receiving usual care. Comprehensive services decreased disparities associated with younger age, lower levels of education, and homelessness. Conclusions. State-level victim compensation funds are available to help individuals recover physically, psychologically, and financially from crime victimization. However, few crime victims apply for victim compensation, and there are particularly low application rates among young, male, ethnic minority, and physical assault victims. Active outreach and assistance can address disparities in access to victim compensation funds for disadvantaged populations and should be offered more widely to victims of violent crime. PMID:18382004

Rural Hospital Ownership: Medical Service Provision, Market Mix, and Spillover Effects

PubMed Central

Horwitz, Jill R; Nichols, Austin

2011-01-01

Objective To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data Sources/Study Setting Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. Study Design We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Principal Findings Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Conclusions Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. PMID:21639860

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

PubMed

Puig-Junoy, J; Pérez-Sust, P

2002-01-01

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

Instructor Guides for Training Food Service Supervisors in Long Term Care Facilities.

ERIC Educational Resources Information Center

Eastern Iowa Community Coll. District, Davenport.

This final report describes a project to develop postsecondary teacher resource guides for supervisor courses in food service management, preparation and service of modified diets, and meal service in long-term care facilities in Iowa. Introductory material includes the following: project objective, a description of how the objective was met, the…

Emotions as Proximal Causes of Word of Mouth: A Nonlinear Approach.

PubMed

Lopes, Rita Rueff; Navarro, José; Silva, Ana Junca

2018-01-01

Service research tends to operationalize word of mouth (WOM) behavior as one of the many responses to service satisfaction. In this sense, little is known about its antecedents or moderators. The objective of this study was to investigate the role of customers' emotions during service experiences on WOM, applying nonlinear techniques and exploring the moderating role of customers' propensity for emotional contagion. Using the critical incidents technique, 122 customers recalled significant service experiences and the emotions they aroused, and reported if they shared said experiences with other individuals. We found that, whereas linear methods presented non-significant results in the emotions-WOM relationship, nonlinear ones (artificial neural networks) explained 46% of variance. Negative emotions were stronger predictors of WOM and the importance of emotions for WOM was significantly higher for individuals with high propensity for emotional contagion (R^2 = .79) than for those with lower levels (R^2 = .48). Theoretical and practical implications are discussed.

A survey of recipient client physician satisfaction with teleoncology services originating from thunder bay regional health sciences centre.

PubMed

Brigden, Malcolm; Minty, Alana; Pilatzke, Susan; Della Vidova, Lori; Sherrington, Laurie; McPhail, Karen

2008-04-01

The objective of this work was to investigate end user satisfaction and perceived efficacy on the part of client physicians for teleoncology services in Northwestern Ontario. A survey of 98 referring physicians from 17 remote communities in Northwestern Ontario was undertaken primarily to determine overall client physician satisfaction with the teleoncology process. The survey also investigated perceived problems and explored potential solutions. Overall client physician satisfaction was high for the majority of response fields. However, more than 50% of surveyed physicians felt that some aspects of the teleoncology process could be improved with an emphasis on more timely communication of interview results, continuity of care, and improving patients comfort level with the technologies involved. The success of this service is evidenced by its exponential growth since the original introduction in 2001. Ninety-eight percent of referring physicians would continue to use the teleoncology service process.

High-level waste borosilicate glass: A compendium of corrosion characteristics. Volume 3

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

Cunnane, J.C.; Bates, J.K.; Bradley, C.R.

1994-03-01

The objective of this document is to summarize scientific information pertinent to evaluating the extent to which high-level waste borosilicate glass corrosion and the associated radionuclide release processes are understood for the range of environmental conditions to which waste glass may be exposed in service. Alteration processes occurring within the bulk of the glass (e.g., devitrification and radiation-induced changes) are discussed insofar as they affect glass corrosion. Volume III contains a bibliography of glass corrosion studies, including studies that are not cited in Volumes I and II.

The University of Houston Libraries' Chemistry Research Information Service: A Research Support Service Based on End-User Searching and Document Delivery. Final Report.

ERIC Educational Resources Information Center

Bailey, Charles W., Jr.

This report on a funded project that established a chemistry research information service for researchers in the University of Houston's chemistry department provides detailed descriptions of the three objectives of the project, together with an explanation of how each objective was/is to be accomplished. These objectives were/are: (1) to document…

Pre-Service and In-Service Teachers' Experiences of Learning to Program in an Object-Oriented Language

ERIC Educational Resources Information Center

Govender, I.; Grayson, D. J.

2008-01-01

This paper presents the results of an investigation into the various ways in which pre-service and in-service teachers experience learning to program in an object-oriented language. Both groups of teachers were enrolled in university courses. In most cases, the pre-service teachers were learning to program for the first time, while the in-service…

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

PubMed Central

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

2018-01-01

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

Reliability theory for repair service organization simulation and increase of innovative attraction of industrial enterprises

NASA Astrophysics Data System (ADS)

Dolzhenkova, E. V.; Iurieva, L. V.

2018-05-01

The study presents the author's algorithm for the industrial enterprise repair service organization simulation based on the reliability theory, as well as the results of its application. The monitoring of the industrial enterprise repair service organization is proposed to perform on the basis of the enterprise's state indexes for the main resources (equipment, labour, finances, repair areas), which allows quantitative evaluation of the reliability level as a resulting summary rating of the said parameters and the ensuring of an appropriate level of the operation reliability of the serviced technical objects. Under the conditions of the tough competition, the following approach is advisable: the higher efficiency of production and a repair service itself, the higher the innovative attractiveness of an industrial enterprise. The results of the calculations show that in order to prevent inefficient losses of production and to reduce the repair costs, it is advisable to apply the reliability theory. The overall reliability rating calculated on the basis of the author's algorithm has low values. The processing of the statistical data forms the reliability characteristics for the different workshops and services of an industrial enterprise, which allows one to define the failure rates of the various units of equipment and to establish the reliability indexes necessary for the subsequent mathematical simulation. The proposed simulating algorithm contributes to an increase of the efficiency of the repair service organization and improvement of the innovative attraction of an industrial enterprise.

The EPOS e-Infrastructure

NASA Astrophysics Data System (ADS)

Jeffery, Keith; Bailo, Daniele

2014-05-01

The European Plate Observing System (EPOS) is integrating geoscientific information concerning earth movements in Europe. We are approaching the end of the PP (Preparatory Project) phase and in October 2014 expect to continue with the full project within ESFRI (European Strategic Framework for Research Infrastructures). The key aspects of EPOS concern providing services to allow homogeneous access by end-users over heterogeneous data, software, facilities, equipment and services. The e-infrastructure of EPOS is the heart of the project since it integrates the work on organisational, legal, economic and scientific aspects. Following the creation of an inventory of relevant organisations, persons, facilities, equipment, services, datasets and software (RIDE) the scale of integration required became apparent. The EPOS e-infrastructure architecture has been developed systematically based on recorded primary (user) requirements and secondary (interoperation with other systems) requirements through Strawman, Woodman and Ironman phases with the specification - and developed confirmatory prototypes - becoming more precise and progressively moving from paper to implemented system. The EPOS architecture is based on global core services (Integrated Core Services - ICS) which access thematic nodes (domain-specific European-wide collections, called thematic Core Services - TCS), national nodes and specific institutional nodes. The key aspect is the metadata catalog. In one dimension this is described in 3 levels: (1) discovery metadata using well-known and commonly used standards such as DC (Dublin Core) to enable users (via an intelligent user interface) to search for objects within the EPOS environment relevant to their needs; (2) contextual metadata providing the context of the object described in the catalog to enable a user or the system to determine the relevance of the discovered object(s) to their requirement - the context includes projects, funding, organisations involved, persons involved, related publications, facilities, equipment and others, and utilises CERIF (Common European Research Information Format) standard (see www.eurocris.org); (3) detailed metadata which is specific to a domain or to a particular object and includes the schema describing the object to processing software. The other dimension of the metadata concerns the objects described. These are classified into users, services (including software), data and resources (computing, data storage, instruments and scientific equipment). An alternative architecture has been considered: using brokering. This technique has been used especially in North America geoscience projects to interoperate datasets. The technique involves writing software to interconvert between any two node datasets. Given n nodes this implies writing n*(n-1) convertors. EPOS Working Group 7 (e-infrastructures and virtual community) which deals with the design and implementation of a prototype of the EPOS services, chose to use an approach which endows the system with an extreme flexibility and sustainability. It is called the Metadata Catalogue approach. With the use of the catalogue the EPOS system can: 1. interoperate with software, services, users, organisations, facilities, equipment etc. as well as datasets; 2. avoid to write n*(n-1) software convertors and generate as much as possible, through the information contained in the catalogue only n convertors. This is a huge saving - especially in maintenance as the datasets (or other node resources) evolve. We are working on (semi-) automation of convertor generation by metadata mapping - this is leading-edge computer science research; 3. make large use of contextual metadata which enable a user or a machine to: (i) improve discovery of resources at nodes; (ii) improve precision and recall in search; (iii) drive the systems for identification, authentication, authorisation, security and privacy recording the relevant attributes of the node resources and of the user; (iv) manage provenance and long-term digital preservation; The linkage between the Integrated Services, which provide the integration of data and services, with the diverse Thematic Services Nodes is provided by means of a compatibility layer, which includes the aforementioned metadata catalogue. This layer provides 'connectors' to make local data, software and services available through the EPOS Integrated Services layer. In conclusion, we believe the EPOS e-infrastructure architecture is fit for purpose including long-term sustainability and pan-European access to data and services.

Occupation is related to Weight and Lifestyle Factors among Employees at Worksites Involved in a Weight Gain Prevention Study

PubMed Central

Gans, Kim M.; Salkeld, Judith; Risica, Patricia Markham; Lenz, Erin; Burton, Deborah; Mello, Jennifer; Bell, Johanna P.

2015-01-01

Objective To examine the relationship between job type, weight status and lifestyle factors that are potential contributors to obesity including, diet, physical activity and perceived stress among employees enrolled in the Working on Wellness (WOW) project. Methods Randomly selected employees at 24 worksites completed a baseline survey (n=1700); some also an in-person survey and anthropometric measures (n=1568). Employees were classified by US Labor standards as: white collar (n=1297), blue collar (n=303), or service worker (n=92), 8 unknown. Associations were analyzed using Chi-Square, GLM procedures, and adjusted for demographics using Logistic Regression. Results In unadjusted models, BMI of service workers was higher than white collar workers; F&V intake was higher for service and blue collar than white collar; white collar workers reported highest stress levels in job and life. However, in models adjusted for demographics, the only significant difference was to physical activity (i.e., MET/min per week), with blue collar workers reporting higher levels of physical activity than service workers, who reported higher levels than the white collar workers. Conclusions Future research should further examine the relationship between health and job status to corroborate the results of the current study and to consider designing future worksite health promotion interventions that are tailored by job category. PMID:26461872

Predictors of utilisation of dental care services in a nationally representative sample of adults.

PubMed

Guiney, H; Woods, N; Whelton, H; Morgan, K

2011-12-01

The objective of this study was to identify the predictors of utilisation of dental care services in Ireland. The 2007 Irish Survey of Lifestyle, Attitudes and Nutrition is a cross-sectional study, conducted in 2006/2007 (n = 10,364), by interviews at home to a representative sample of adults aged 18 years or over. Multivariate logistic regression was used to investigate the influence of socioeconomic, predisposing and enabling factors on the odds of males and females having a dental visit in the past year. The significant predictors of visiting the dentist in the past year were for males: having 3rd level education, employment status, earning 50,000 euros or more, location of residence, use of a car, brushing frequently, and dentition status. For females, the predictors were being between 25-34 or 55-64 years-old, education level, earning 50,000 euros or more, location of residence, use of a car, brushing frequently and dentition status. Predictors of the use of dental services vary by gender. Predictors common to both genders were education level, higher income, location of residence, use of a car, brushing frequently and dentition status. Many of the predictors of dental visiting in the past year are also related to social inequalities in health. These predictors may be useful markers of impact for policies designed to address inequalities in access to oral health services.

“You Know You Are Sick, Why Do You Carry A Pregnancy Again?” Applying the Socio-Ecological Model to Understand Barriers to PMTCT Service Utilization in Western Kenya

PubMed Central

Onono, Maricianah; Kwena, Zachary; Turan, Janet; Bukusi, Elizabeth A; Cohen, Craig R; Gray, Glenda E

2015-01-01

Objective Throughout most of sub-Saharan Africa (SSA), prevention of mother-to-child transmission (PMTCT) services are readily available. However, PMTCT programs in SSA have had suboptimal performance compared to other regions of the world. The main objective of this study is to explore the socio-ecological and individual factors influencing the utilization of PMTCT services among HIV-positive pregnant women in western Kenya using a social ecological model as our analytical lens. Methods Data were collected using in-depth interviews with 33 HIV-infected women attending government health facilities in rural western Kenya. Women with HIV-infected infants aged between 6 weeks to 6 months with a definitive diagnosis of HIV in the infant, as well as those with an HIV-negative test result in the infant were interviewed between November 2012 and June 2013. Coding and analysis of the transcripts followed grounded theory tenets. Coding reports were discussed in a series of meetings held among the authors. We then employed constant comparative analysis to discover dominant individual, family, society and structural determinants of PMTCT use. Results Barriers to women’s utilization of PMTCT services fell within the broad constructs of the socio-ecological model of individual, family, society and structural determinants. Several themes cut across the different steps of PMTCT cascade and relate to different constructs of the socio-ecological model. These themes include: self-motivation, confidence and resilience, family support, absence or reduced stigma, right provider attitude and quality of health services provided. We also found out that these factors ensured enhanced maternal health and HIV negative children. Conclusion The findings of this study suggest that a woman’s social environment is an important determinant of MTCT. PMTCT Interventions must comprehensively address multiple factors across the different ecological levels. More research is however required for the development of multi-component interventions that combine strategies at different ecological levels. PMID:26457229

Improvement Instruction and Services for Socially Maladjusted and Emotionally Disturbed Children, 1972-1973. Final Report.

ERIC Educational Resources Information Center

Teaching and Learning Research Corp., New York, NY.

The objectives of this program, funded under Title I of the 1965 ESEA, were as follows: (1) to raise the achievement levels in reading for children in the special schools who were retarded in reading two or more years. Each of the 28 special schools selected a target group of children for whom intensive remediation was provided; (2) to develop…

Protecting Children from Violence and Maltreatment: A Qualitative Comparative Analysis Assessing the Implementation of U.N. CRC Article 19

ERIC Educational Resources Information Center

Svevo-Cianci, Kimberly A.; Hart, Stuart N.; Rubinson, Claude

2010-01-01

Objectives: (1) To identify which United Nations Convention on the Rights of the Child (CRC) recommended child protection (CP) measures, such as policy, reporting systems, and services for child abuse and neglect (CAN) victims, individually or in combination, were most important in establishing a basic level of child protection in 42 countries;…

Object/Shape Recognition Technology: An Assessment of the Feasibility of Implementation at Defense Logistics Agency Disposition Services

DTIC Science & Technology

2015-02-25

provide efficiency and effectively manufacture or inventory items. The industries that benefit from Cognex technology are automotive, food and beverage ...recognition tedmology, Tedmology Readiness Level, PAGES Cost Benefit Analysis, Tedmology Commercialization, Technology Transition 139 16. PRICE CODE 17...Technology Development & Transition Strategy Guidebook xvii UD Ultimate Disposal U.S. United States USAF United States Air Force xviii THIS

A Resource Package Training Framework for Producing Quality Graduates to Work in Rural, Regional and Remote Australia: A Global Perspective

ERIC Educational Resources Information Center

Lynch, Timothy

2014-01-01

The purpose of this paper is to advocate the resource package for producing quality graduates to work in rural, regional and remote Australia (TERRR Network), using a global perspective. This paper argues that the resource package achieves more than the objectives of the original project; "Developing Strategies at the Pre-service Level to…

Poverty, Sprawl, and Restaurant Types Influence Body Mass Index of Residents in California Counties

PubMed Central

Gregson, Jennifer

2011-01-01

Objectives. This article examines the relationships between structural poverty (the proportion of people in a county living at ≤130% of the federal poverty level [FPL]), urban sprawl, and three types of restaurants (grouped as fast food, chain full service, and independent full service) in explaining body mass index (BMI) of individuals. Methods. Relationships were tested with two-tiered hierarchical models. Individual-level data, including the outcome variable of calculated BMI, were from the 2005, 2006, and 2007 California Behavioral Risk Factor Surveillance Survey (n=14,205). County-level data (n=33) were compiled from three sources. The 2000 U.S. Census provided the proportion of county residents living at ≤130% of FPL and county demographic descriptors. The sprawl index used came from the Smart Growth America Project. Fast-food, full-service chain, and full-service independently owned restaurants as proportions of the total retail food environment were constructed from a commercially available market research database from 2004. Results. In the analysis, county-level demographic characteristics lost significance and poverty had a consistent, robust association on BMI (p<0.001). Sprawl demonstrated an additional, complementary association to county poverty (p<0.001). Independent restaurants had a large, negative association to BMI (p<0.001). The coefficients for chain and fast-food restaurants were large and positive (p≤0.001), indicating that as the proportion of these restaurants in a county increases, so does BMI. Conclusions. This study demonstrates the important role of county poverty and urban sprawl toward understanding environmental influences on BMI. Using three categories of restaurants demonstrates different associations of full-service chain and independent restaurants, which are often combined in other research. PMID:21563722

Interpretation of medical imaging data with a mobile application: a mobile digital imaging processing environment.

PubMed

Lin, Meng Kuan; Nicolini, Oliver; Waxenegger, Harald; Galloway, Graham J; Ullmann, Jeremy F P; Janke, Andrew L

2013-01-01

Digital Imaging Processing (DIP) requires data extraction and output from a visualization tool to be consistent. Data handling and transmission between the server and a user is a systematic process in service interpretation. The use of integrated medical services for management and viewing of imaging data in combination with a mobile visualization tool can be greatly facilitated by data analysis and interpretation. This paper presents an integrated mobile application and DIP service, called M-DIP. The objective of the system is to (1) automate the direct data tiling, conversion, pre-tiling of brain images from Medical Imaging NetCDF (MINC), Neuroimaging Informatics Technology Initiative (NIFTI) to RAW formats; (2) speed up querying of imaging measurement; and (3) display high-level of images with three dimensions in real world coordinates. In addition, M-DIP provides the ability to work on a mobile or tablet device without any software installation using web-based protocols. M-DIP implements three levels of architecture with a relational middle-layer database, a stand-alone DIP server, and a mobile application logic middle level realizing user interpretation for direct querying and communication. This imaging software has the ability to display biological imaging data at multiple zoom levels and to increase its quality to meet users' expectations. Interpretation of bioimaging data is facilitated by an interface analogous to online mapping services using real world coordinate browsing. This allows mobile devices to display multiple datasets simultaneously from a remote site. M-DIP can be used as a measurement repository that can be accessed by any network environment, such as a portable mobile or tablet device. In addition, this system and combination with mobile applications are establishing a virtualization tool in the neuroinformatics field to speed interpretation services.

Interpretation of Medical Imaging Data with a Mobile Application: A Mobile Digital Imaging Processing Environment

PubMed Central

Lin, Meng Kuan; Nicolini, Oliver; Waxenegger, Harald; Galloway, Graham J.; Ullmann, Jeremy F. P.; Janke, Andrew L.

2013-01-01

Digital Imaging Processing (DIP) requires data extraction and output from a visualization tool to be consistent. Data handling and transmission between the server and a user is a systematic process in service interpretation. The use of integrated medical services for management and viewing of imaging data in combination with a mobile visualization tool can be greatly facilitated by data analysis and interpretation. This paper presents an integrated mobile application and DIP service, called M-DIP. The objective of the system is to (1) automate the direct data tiling, conversion, pre-tiling of brain images from Medical Imaging NetCDF (MINC), Neuroimaging Informatics Technology Initiative (NIFTI) to RAW formats; (2) speed up querying of imaging measurement; and (3) display high-level of images with three dimensions in real world coordinates. In addition, M-DIP provides the ability to work on a mobile or tablet device without any software installation using web-based protocols. M-DIP implements three levels of architecture with a relational middle-layer database, a stand-alone DIP server, and a mobile application logic middle level realizing user interpretation for direct querying and communication. This imaging software has the ability to display biological imaging data at multiple zoom levels and to increase its quality to meet users’ expectations. Interpretation of bioimaging data is facilitated by an interface analogous to online mapping services using real world coordinate browsing. This allows mobile devices to display multiple datasets simultaneously from a remote site. M-DIP can be used as a measurement repository that can be accessed by any network environment, such as a portable mobile or tablet device. In addition, this system and combination with mobile applications are establishing a virtualization tool in the neuroinformatics field to speed interpretation services. PMID:23847587

Coping with a MEDLIB-L service outage

PubMed Central

Brown, Christine D.; MacCall, Steven

2001-01-01

Objective: The study assessed the coping strategies of MEDLIB-L subscribers during an unexpected disruption in the list's service. Methods: An online survey of MEDLIB-L subscribers was performed following a six-day service outage in August 1999. Results: Respondents' information needs resulted in two distinct coping strategies. Subscribers without a recognized information need or an information need determined to be not pressing coped by waiting out the interruption. Subscribers with pressing information needs turned to alternative methods of resolving these needs. Conclusions: While most respondents missed the list and the assistance that it provided, many did not feel that the outage required significant coping strategies. The outage was viewed as a “minor stressor” and did not require secondary-level assessment of the availability and suitability of alternative resources. PMID:11837260

An Integer Programming Model For Solving Heterogeneous Vehicle Routing Problem With Hard Time Window considering Service Choice

NASA Astrophysics Data System (ADS)

Susilawati, Enny; Mawengkang, Herman; Efendi, Syahril

2018-01-01

Generally a Vehicle Routing Problem with time windows (VRPTW) can be defined as a problem to determine the optimal set of routes used by a fleet of vehicles to serve a given set of customers with service time restrictions; the objective is to minimize the total travel cost (related to the travel times or distances) and operational cost (related to the number of vehicles used). In this paper we address a variant of the VRPTW in which the fleet of vehicle is heterogenic due to the different size of demand from customers. The problem, called Heterogeneous VRP (HVRP) also includes service levels. We use integer programming model to describe the problem. A feasible neighbourhood approach is proposed to solve the model.

[Research on tumor information grid framework].

PubMed

Zhang, Haowei; Qin, Zhu; Liu, Ying; Tan, Jianghao; Cao, Haitao; Chen, Youping; Zhang, Ke; Ding, Yuqing

2013-10-01

In order to realize tumor disease information sharing and unified management, we utilized grid technology to make the data and software resources which distributed in various medical institutions for effective integration so that we could make the heterogeneous resources consistent and interoperable in both semantics and syntax aspects. This article describes the tumor grid framework, the type of the service being packaged in Web Service Description Language (WSDL) and extensible markup language schemas definition (XSD), the client use the serialized document to operate the distributed resources. The service objects could be built by Unified Modeling Language (UML) as middle ware to create application programming interface. All of the grid resources are registered in the index and released in the form of Web Services based on Web Services Resource Framework (WSRF). Using the system we can build a multi-center, large sample and networking tumor disease resource sharing framework to improve the level of development in medical scientific research institutions and the patient's quality of life.

Satellite provided customer premise services: A forecast of potential domestic demand through the year 2000. Volume 2: Technical report

NASA Technical Reports Server (NTRS)

Kratochvil, D.; Bowyer, J.; Bhushan, C.; Steinnagel, K.; Al-Kinani, G.

1983-01-01

The potential United States domestic telecommunications demand for satellite provided customer premises voice, data and video services through the year 2000 were forecast, so that this information on service demand would be available to aid in NASA program planning. To accomplish this overall purpose the following objectives were achieved: development of a forecast of the total domestic telecommunications demand, identification of that portion of the telecommunications demand suitable for transmission by satellite systems, identification of that portion of the satellite market addressable by Computer premises services systems, identification of that portion of the satellite market addressabble by Ka-band CPS system, and postulation of a Ka-band CPS network on a nationwide and local level. The approach employed included the use of a variety of forecasting models, a market distribution model and a network optimization model. Forecasts were developed for; 1980, 1990, and 2000; voice, data and video services; terrestrial and satellite delivery modes; and C, Ku and Ka-bands.

Franchising Reproductive Health Services

PubMed Central

Stephenson, Rob; Tsui, Amy Ong; Sulzbach, Sara; Bardsley, Phil; Bekele, Getachew; Giday, Tilahun; Ahmed, Rehana; Gopalkrishnan, Gopi; Feyesitan, Bamikale

2004-01-01

Objectives Networks of franchised health establishments, providing a standardized set of services, are being implemented in developing countries. This article examines associations between franchise membership and family planning and reproductive health outcomes for both the member provider and the client. Methods Regression models are fitted examining associations between franchise membership and family planning and reproductive health outcomes at the service provider and client levels in three settings. Results Franchising has a positive association with both general and family planning client volumes, and the number of family planning brands available. Similar associations with franchise membership are not found for reproductive health service outcomes. In some settings, client satisfaction is higher at franchised than other types of health establishments, although the association between franchise membership and client outcomes varies across the settings. Conclusions Franchise membership has apparent benefits for both the provider and the client, providing an opportunity to expand access to reproductive health services, although greater attention is needed to shift the focus from family planning to a broader reproductive health context. PMID:15544644

Determinants of expenditure variation in health care and care of the elderly among Finnish municipalities.

PubMed

Häkkinen, U; Luoma, K

1995-01-01

In Finland, municipal health care expenditure varies from FIM 3 800 per capita to FIM 7 800 per capita. The objective of this study was to estimate the impact of different economic, structural and demographic factors on the per capita costs of health services and care of the elderly. Using regression analysis we attempted to explain observed differences in expenditure by determining separately the effects of allocative and productive inefficiency and the effects of factors influencing the demand for services. We found income level of local population, generosity of central government matching grant, allocative efficiency (the mix of care between institutional and non-institutional care), productive efficiency of service providers, and factors associated with the need of services (age structure, morbidity) to be the most important determinants of health care expenditure. Our results reveal that municipalities have the means at their disposal (by shifting resources to outpatient care and increasing productivity) to significantly reduce expenditure on health services and care of the elderly.

Satellite provided customer premise services: A forecast of potential domestic demand through the year 2000. Volume 2: Technical report

NASA Astrophysics Data System (ADS)

Kratochvil, D.; Bowyer, J.; Bhushan, C.; Steinnagel, K.; Al-Kinani, G.

1983-08-01

The potential United States domestic telecommunications demand for satellite provided customer premises voice, data and video services through the year 2000 were forecast, so that this information on service demand would be available to aid in NASA program planning. To accomplish this overall purpose the following objectives were achieved: development of a forecast of the total domestic telecommunications demand, identification of that portion of the telecommunications demand suitable for transmission by satellite systems, identification of that portion of the satellite market addressable by Computer premises services systems, identification of that portion of the satellite market addressabble by Ka-band CPS system, and postulation of a Ka-band CPS network on a nationwide and local level. The approach employed included the use of a variety of forecasting models, a market distribution model and a network optimization model. Forecasts were developed for; 1980, 1990, and 2000; voice, data and video services; terrestrial and satellite delivery modes; and C, Ku and Ka-bands.

76 FR 53255 - Responsibility of Applicants for Promoting Objectivity in Research for which Public Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-25

... Part 50 45 CFR Part 94 Responsibility of Applicants for Promoting Objectivity in Research for Which...-AA53 Responsibility of Applicants for Promoting Objectivity in Research for which Public Health Service... of Applicants for Promoting Objectivity in Research for which Public Health Service Funding is Sought...

Maternal willingness to pay for infant and young child nutrition counseling services in Vietnam

PubMed Central

Nguyen, Phuong H.; Hoang, Minh V.; Hajeebhoy, Nemat; Tran, Lan M.; Le, Chung H.; Menon, Purnima; Rawat, Rahul

2015-01-01

Background Alive & Thrive Vietnam, a 6-year initiative (2009–2014), has developed and incorporated elements of social franchising into government health services to provide high-quality nutrition counseling services to improve infant and young child feeding practices. One element of franchising that has not yet been implemented is fee for service, which is a potential financing mechanism for sustaining services in the long run. Objective This research aims to estimate maternal willingness to pay (WTP) for nutrition counseling services and to examine potential factors associated with their WTP. Design and methods Data were drawn from an impact evaluation survey of 2,511 women with a child <2 years old from four provinces in Vietnam. An iterative bidding technique was employed to explore individual WTP. The first bid was defined as VND 20,000 (~US$ 1), which was approximately the level of the actual service cost. Depending on the participant response, the bid increased or decreased. Finally, the respondents were asked about the highest price they would be willing to pay for the service. Results Overall, 92.6% of clients reported a need for nutrition counseling services for children <2 years. The WTP rates at bid levels of VND 5,000, 10,000, 20,000, 40,000, and 100,000 were 95.2, 94.4, 90.7, 68.9, and 33.4%, respectively. The mean and median of the maximum WTP were VND 58,500 and 50,000, respectively. In multiple regression models, WTP rates were higher among younger women, the Kinh majority group, and better educated and wealthier women. Conclusion A high demand for nutrition counseling coupled with a WTP by almost all segments of society would potentially cover costs of delivery for nutrition counseling services in Vietnam. PMID:26328947

Decentralization and equity of resource allocation: evidence from Colombia and Chile.

PubMed Central

Bossert, Thomas J.; Larrañaga, Osvaldo; Giedion, Ursula; Arbelaez, José Jesus; Bowser, Diana M.

2003-01-01

OBJECTIVE: To investigate the relation between decentralization and equity of resource allocation in Colombia and Chile. METHODS: The "decision space" approach and analysis of expenditures and utilization rates were used to provide a comparative analysis of decentralization of the health systems of Colombia and Chile. FINDINGS: Evidence from Colombia and Chile suggests that decentralization, under certain conditions and with some specific policy mechanisms, can improve equity of resource allocation. In these countries, equitable levels of per capita financial allocations at the municipal level were achieved through different forms of decentralization--the use of allocation formulae, adequate local funding choices and horizontal equity funds. Findings on equity of utilization of services were less consistent, but they did show that increased levels of funding were associated with increased utilization. This suggests that improved equity of funding over time might reduce inequities of service utilization. CONCLUSION: Decentralization can contribute to, or at least maintain, equitable allocation of health resources among municipalities of different incomes. PMID:12751417

[Assessment levels of the user's satisfaction in a private hospital].

PubMed

da Cruz, Wilma Batista Souza; Melleiro, Marta Maria

2010-03-01

The objective of this study was to analyze the satisfaction of the users of a private hospital in terms of a number of attributes of the services in units. This exploratory, descriptive study used a quantitative approach and was developed in a private hospital in the city of São Paulo. The casuistry consisted of 71 users and data collection was performed during the period from March to August 2007, using a derivative of the scale model of the Service Quality (SERVQUAL) of the evaluative model of Parasuraman et al. The level of overall satisfaction ranged around 95%. The assurance (96%) and reliability (96%) were considered the most important dimensions of quality, followed by empathy (95%), responsiveness (93%) and tangibility (88%). Medical and nursing staffs introduced high levels of satisfaction. 91% has intention to recommend the hospital. This research provided the knowledge of the attributes most important in terms of satisfaction and contributed to confirming or reshaping assistance and management processes.

The impact of contracting-out on health system performance: a conceptual framework.

PubMed

Liu, Xingzhu; Hotchkiss, David R; Bose, Sujata

2007-07-01

Despite the increased popularity of contracting-out of health services in developing countries, its effectiveness on overall health system performance is not yet conclusive. Except for substantial evidence of contracting-out's positive effect on access to health services and some evidence on improved equity in access, there is little evidence of contracting-out's impact on quality and efficiency. Most studies on the subject evaluate specific contracting-out projects against narrowly specified project objectives, not against more broadly defined health system goals. For this reason, conclusions of positive effects pertaining to project level may not hold at system level. This paper presents a conceptual framework that is expected to facilitate comprehensive, rigorous, and standardized evaluation of contracting-out at health system level. Specifically, this framework supports: full and standardized description of contracting-out interventions, study of the determinants of effectiveness, examination of provider and purchaser responses, assessment of the impact of contracting-out on all dimensions of health system performance, and cross-project analyses.

Maintenance and Exchange of Learning Objects in a Web Services Based e-Learning System

ERIC Educational Resources Information Center

Vossen, Gottfried; Westerkamp, Peter

2004-01-01

"Web services" enable partners to exploit applications via the Internet. Individual services can be composed to build new and more complex ones with additional and more comprehensive functionality. In this paper, we apply the Web service paradigm to electronic learning, and show how to exchange and maintain learning objects is a…

An Evaluation of an Occupational Health Advice Service

ERIC Educational Resources Information Center

Shearn, P.; Ford, Norma J.; Murphy, R. G.

2010-01-01

Objective: The objective of this article is to identify the profile of service users of an occupational health (OH) support service and establish areas of need, and to gather client feedback on the experience of participating in the support service and perceived outcomes and the impact of the advice received. Design and Setting: We carried out…

Disparities in treatment for substance use disorders and co-occurring disorders for ethnic/racial minority youth

PubMed Central

Alegria, Margarita; Carson, Nicholas J.; Goncalves, Marta; Keefe, Kristen

2012-01-01

Objective To review the literature on racial and ethnic disparities in behavioral health services and present recent data, focusing on services for substance use disorders (SUD) and comorbid mental health disorders for children and adolescents. Method A literature review was conducted of behavioral health services for minority youth. Papers were included if specific comparisons in receipt of SUD services for youth were made by race or ethnicity. The review was organized following the Sociocultural Framework. Results Compared to non-Latino Whites with SUD, Black adolescents with SUD report receiving less specialty and informal care, while Latinos with SUD report less informal services. Potential mechanisms of racial and ethnic disparities were identified in: federal and economic health care policies and regulations; the operation of the health care system and provider organization; provider level factors; the environmental context; the operation of the community system; and patient level factors. Significant disparities reductions could be achieved by adoption of certain state policies and regulations that increase eligibility in public insurance. There is also a need to study how the organization of treatment services might lead to service disparities, particularly problems in treatment completion. Institutional and family characteristics linked to better quality of care should be explored. Since treatments appear to work well independent of race/ethnicity, translational research to bring evidence based care in diverse communities can bolster their effectiveness. Conclusions Our review suggests promising venues to reduce ethnic and racial disparities in behavioral health services for ethnic and racial minority youth. PMID:21156267

Women's persistent depressive and perinatal grief symptoms following a miscarriage: the role of childlessness and satisfaction with healthcare services.

PubMed

deMontigny, Francine; Verdon, Chantal; Meunier, Sophie; Dubeau, Diane

2017-10-01

The objectives of this cross-sectional study were to determine whether depressive and perinatal grief symptoms vary according to time since miscarriage and to test whether childlessness and satisfaction with healthcare services influence symptom duration. A total of 245 women who had experienced a miscarriage answered a self-report questionnaire, indicating the date of their miscarriage and assessing their present level of depressive and perinatal grief symptoms. They also provided sociodemographic characteristics and indicated their level of satisfaction with healthcare services. One-way analyses of variance indicated that women who had miscarried within the past 6 months reported higher scores for depressive symptoms than did women who had miscarried between 7 and 12 months ago and more than 2 years ago. However, when controlling for childlessness and satisfaction with healthcare services, those differences became respectively marginal and non-significant, indicating that depressive symptoms are similar across time for more than 2 years after the loss. Regarding perinatal grief, results revealed that symptoms significantly decreased across time only for women with children and women who were satisfied with healthcare services. For childless women and those dissatisfied with healthcare services, perinatal grief symptoms did not vary according to time since miscarriage. Results suggest that, particularly for women who are childless and/or dissatisfied with healthcare services, depressive and perinatal grief symptoms persist long after a miscarriage. These results highlight the importance of paying particular attention to more vulnerable women and of improving healthcare services post-miscarriage.

Practical Strategies for Integrating Final Ecosystem Goods and ...

EPA Pesticide Factsheets

The concept of Final Ecosystem Goods and Services (FEGS) explicitly connects ecosystem services to the people that benefit from them. This report presents a number of practical strategies for incorporating FEGS, and more broadly ecosystem services, into the decision-making process. Whether a decision process is in early or late stages, or whether a process includes informal or formal decision analysis, there are multiple points where ecosystem services concepts can be integrated. This report uses Structured Decision Making (SDM) as an organizing framework to illustrate the role ecosystem services can play in a values-focused decision-process, including: • Clarifying the decision context: Ecosystem services can help clarify the potential impacts of an issue on natural resources together with their spatial and temporal extent based on supply and delivery of those services, and help identify beneficiaries for inclusion as stakeholders in the deliberative process. • Defining objectives and performance measures: Ecosystem services may directly represent stakeholder objectives, or may be means toward achieving other objectives. • Creating alternatives: Ecosystem services can bring to light creative alternatives for achieving other social, economic, health, or general well-being objectives. • Estimating consequences: Ecosystem services assessments can implement ecological production functions (EPFs) and ecological benefits functions (EBFs) to link decision alt

NASE 2015: Implementation of a Management Quality System

NASA Astrophysics Data System (ADS)

Ros, Rosa Maria; García, Beatriz; Santa Maria, Delia

2015-08-01

ISO 29990:2010, Learning services for non-formal education and training - Basic requirements for service providers, proposes enhance transparency and allow comparison on a worldwide basis of learning services, offering a single alternative backed by international consensus to the huge variety of national service and management standards which now exists in the field of non-formal learning. The objective of ISO 29990:2010 is to provide a generic model for quality professional practice and performance, and a common reference for learning service providers and their clients in the design, development and delivery of non-formal education, training and development.NASE project, which was born as a consequence of the implementation of IAU-10 Years Strategic Plan and it is in agreement with the proposal to increase the interest and efforts of IAU on schools before the university and constitutes good objective for the implementation of ISO 29990-2010.Taking into account the main objectives of the Strategic Plan, it is possible to remark that NASE acts on all the education levels, and had, during the past 5 years a big impact because Ministries of Education, Universities and Planetariums are involved. After 5 years NASE organized more than 60 courses in about 20 countries distributed in America, Africa, Asia and Europe. In many countries local governments changed their curriculum according NASE course contents (i.e. Nicaragua, Argentina and Honduras).The knowledge obtained by teachers is evaluated by the department of education of the local government or universities who participated. NASE acts as part of the Professional formation of Professors in Science and in this sense is a Program directed to the Tertiary and University Education.After 5 years of development, we present the implementation of a Quality Management System, according to ISO 29990:2010, devoted to Learning services for non-formal education and training. Basic requirements for service providers, and show that an Educational Program as NASE can also rich the international management standard levels’, demonstrating that knowledge is a factor of economic growing in the World.

CCSDS Spacecraft Monitor and Control Mission Operations Interoperability Prototype

NASA Technical Reports Server (NTRS)

Lucord, Steve; Martinez, Lindolfo

2009-01-01

We are entering a new era in space exploration. Reduced operating budgets require innovative solutions to leverage existing systems to implement the capabilities of future missions. Custom solutions to fulfill mission objectives are no longer viable. Can NASA adopt international standards to reduce costs and increase interoperability with other space agencies? Can legacy systems be leveraged in a service oriented architecture (SOA) to further reduce operations costs? The Operations Technology Facility (OTF) at the Johnson Space Center (JSC) is collaborating with Deutsches Zentrum fur Luft- und Raumfahrt (DLR) to answer these very questions. The Mission Operations and Information Management Services Area (MOIMS) Spacecraft Monitor and Control (SM&C) Working Group within the Consultative Committee for Space Data Systems (CCSDS) is developing the Mission Operations standards to address this problem space. The set of proposed standards presents a service oriented architecture to increase the level of interoperability among space agencies. The OTF and DLR are developing independent implementations of the standards as part of an interoperability prototype. This prototype will address three key components: validation of the SM&C Mission Operations protocol, exploration of the Object Management Group (OMG) Data Distribution Service (DDS), and the incorporation of legacy systems in a SOA. The OTF will implement the service providers described in the SM&C Mission Operation standards to create a portal for interaction with a spacecraft simulator. DLR will implement the service consumers to perform the monitor and control of the spacecraft. The specifications insulate the applications from the underlying transport layer. We will gain experience with a DDS transport layer as we delegate responsibility to the middleware and explore transport bridges to connect disparate middleware products. A SOA facilitates the reuse of software components. The prototype will leverage the capabilities of existing legacy systems. Various custom applications and middleware solutions will be combined into one system providing the illusion of a set of homogenous services. This paper will document our journey as we implement the interoperability prototype. The team consists of software engineers with experience on the current command, telemetry and messaging systems that support the International Space Station (ISS) and Space Shuttle programs. Emphasis will be on the objectives, results and potential cost saving benefits.

Improving client-centred care and services: the role of front/back-office configurations.

PubMed

Broekhuis, Manda; de Blok, Carolien; Meijboom, Bert

2009-05-01

This paper is a report of a study conducted to explore the application of designing front- and back-office work resulting in efficient client-centred care in healthcare organizations that supply home care, welfare and domestic services. Front/back-office configurations reflect a neglected domain of design decisions in the development of more client-centred processes and structures without incurring major cost increases. Based on a literature search, a framework of four front/back-office configurations was constructed. To illustrate the usefulness of this framework, a single, longitudinal case study was performed in a large organization, which provides home care, welfare and domestic services for a sustained period (2005-2006). The case study illustrates how front/back-office design decisions are related to the complexity of the clients' demands and the strategic objectives of an organization. The constructed framework guides the practical development of front/back-office designs, and shows how each design contributes differently to such performance objectives as quality, speed and efficiency. The front/back-office configurations presented comprise an important first step in elaborating client-centred care and service provision to the operational level. It helps healthcare organizations to become more responsive and to provide efficient client-centred care and services when approaching demand in a well-tuned manner. In addition to its applicability in home care, we believe that a deliberate front/back-office configuration also has potential in other fields of health care.

OpenID Connect as a security service in cloud-based medical imaging systems.

PubMed

Ma, Weina; Sartipi, Kamran; Sharghigoorabi, Hassan; Koff, David; Bak, Peter

2016-04-01

The evolution of cloud computing is driving the next generation of medical imaging systems. However, privacy and security concerns have been consistently regarded as the major obstacles for adoption of cloud computing by healthcare domains. OpenID Connect, combining OpenID and OAuth together, is an emerging representational state transfer-based federated identity solution. It is one of the most adopted open standards to potentially become the de facto standard for securing cloud computing and mobile applications, which is also regarded as "Kerberos of cloud." We introduce OpenID Connect as an authentication and authorization service in cloud-based diagnostic imaging (DI) systems, and propose enhancements that allow for incorporating this technology within distributed enterprise environments. The objective of this study is to offer solutions for secure sharing of medical images among diagnostic imaging repository (DI-r) and heterogeneous picture archiving and communication systems (PACS) as well as Web-based and mobile clients in the cloud ecosystem. The main objective is to use OpenID Connect open-source single sign-on and authorization service and in a user-centric manner, while deploying DI-r and PACS to private or community clouds should provide equivalent security levels to traditional computing model.

Community pharmacists and mental illness: a survey of service provision, stigma, attitudes and beliefs.

PubMed

Giannetti, Vincent; Caley, Charles F; Kamal, Khalid M; Covvey, Jordan R; McKee, Jerry; Wells, Barbara G; Najarian, Dean M; Dunn, Tyler J; Vadagam, Pratyusha

2018-06-04

Background Half of Americans experience mental illness during their lifetime. Significant opportunity exists for community pharmacists to deliver services to these patients; however, personal and practice-related barriers may prevent full engagement. Objective To assess the demographics, practice characteristics, service provision, stigma, attitudes and beliefs of a national sample of community pharmacists towards individuals with mental illness. Setting National random sample of 3008 community pharmacists in the USA. Method 101-item cross-sectional mailed survey questionnaire on: (1) demographics, (2) knowledge and practice characteristics, (3) provision of clinical pharmacy services, and (4) comparative opinions. Main outcome measure Scaled measures of service provision (comfort, confidence, willingness and interest) and comparative opinions (stigma, attitudes and beliefs) of mental illness, four linear regression models to predict service provision. Results A total of 239 responses were received (response rate 7.95%). Across pharmacy services, ratings for willingness/interest were higher than those for comfort/confidence. Pharmacists who reported providing medication therapy management (MTM) services for patients reported higher comfort (18.36 vs. 17.46, p < 0.05), confidence (17.73 vs. 16.01, p < 0.05), willingness (20.0 vs. 18.62, p < 0.05) and interest (19.13 vs. 17.66, p < 0.05). Pharmacists with personal experience with mental illness also resulted in higher scores across all four domains of service provision, lower levels of stigma (18.28 vs. 20.76, p < 0.05) and more positive attitudes (52.24 vs. 50.53, p < 0.01). Regression analyses demonstrated increased frequency of MTM service delivery and more positive attitudes as significantly predictive across all four models for comfort, confidence, willingness and interest. Increased delivery of pharmacy services was significantly associated with both willingness and interest to provide mental illness-specific services. Conclusion Despite willingness/interest to provide services to patients with mental illness, decreased levels of comfort/confidence remain service-related barriers for community pharmacists.

Overview of the Acoustic Testing of the European Service Module Structural Test Article (E-STA)

NASA Technical Reports Server (NTRS)

Hughes, William; Fogt, Vince; Le Plenier, Cyprien; Duval, Francois; Durand, Jean-Francois; Staab, Lucas D.; Hozman, Aron; Mcnelis, Anne; Bittinger, Samantha; Thirkettle, Anthony;

Overview of the Acoustic Testing of the European Service Module Structural Test Article (E-STA)

NASA Technical Reports Server (NTRS)

Hughes, William; Le Plenier, Cyprien; Duval, Francois; Staab, Lucas; Hozman, Aron; Thirkettle, Anthony; Fogt, Vincent; Durand, Jean-Francois; McNelis, Anne; Bittinger, Samantha;

Efficacy of a Process Improvement Intervention on Delivery of HIV Services to Offenders: A Multisite Trial

PubMed Central

Shafer, Michael S.; Dembo, Richard; del Mar Vega-Debién, Graciela; Pankow, Jennifer; Duvall, Jamieson L.; Belenko, Steven; Frisman, Linda K.; Visher, Christy A.; Pich, Michele; Patterson, Yvonne

2014-01-01

Objectives. We tested a modified Network for the Improvement of Addiction Treatment (NIATx) process improvement model to implement improved HIV services (prevention, testing, and linkage to treatment) for offenders under correctional supervision. Methods. As part of the Criminal Justice Drug Abuse Treatment Studies, Phase 2, the HIV Services and Treatment Implementation in Corrections study conducted 14 cluster-randomized trials in 2011 to 2013 at 9 US sites, where one correctional facility received training in HIV services and coaching in a modified NIATx model and the other received only HIV training. The outcome measure was the odds of successful delivery of an HIV service. Results. The results were significant at the .05 level, and the point estimate for the odds ratio was 2.14. Although overall the results were heterogeneous, the experiments that focused on implementing HIV prevention interventions had a 95% confidence interval that exceeded the no-difference point. Conclusions. Our results demonstrate that a modified NIATx process improvement model can effectively implement improved rates of delivery of some types of HIV services in correctional environments. PMID:25322311

GUEST EDITORS' INTRODUCTION: Guest Editors' introduction

NASA Astrophysics Data System (ADS)

Guerraoui, Rachid; Vinoski, Steve

1997-09-01

The organization of a distributed system can have a tremendous impact on its capabilities, its performance, and its ability to evolve to meet changing requirements. For example, the client - server organization model has proven to be adequate for organizing a distributed system as a number of distributed servers that offer various functions to client processes across the network. However, it lacks peer-to-peer capabilities, and experience with the model has been predominantly in the context of local networks. To achieve peer-to-peer cooperation in a more global context, systems issues of scale, heterogeneity, configuration management, accounting and sharing are crucial, and the complexity of migrating from locally distributed to more global systems demands new tools and techniques. An emphasis on interfaces and modules leads to the modelling of a complex distributed system as a collection of interacting objects that communicate with each other only using requests sent to well defined interfaces. Although object granularity typically varies at different levels of a system architecture, the same object abstraction can be applied to various levels of a computing architecture. Since 1989, the Object Management Group (OMG), an international software consortium, has been defining an architecture for distributed object systems called the Object Management Architecture (OMA). At the core of the OMA is a `software bus' called an Object Request Broker (ORB), which is specified by the OMG Common Object Request Broker Architecture (CORBA) specification. The OMA distributed object model fits the structure of heterogeneous distributed applications, and is applied in all layers of the OMA. For example, each of the OMG Object Services, such as the OMG Naming Service, is structured as a set of distributed objects that communicate using the ORB. Similarly, higher-level OMA components such as Common Facilities and Domain Interfaces are also organized as distributed objects that can be layered over both Object Services and the ORB. The OMG creates specifications, not code, but the interfaces it standardizes are always derived from demonstrated technology submitted by member companies. The specified interfaces are written in a neutral Interface Definition Language (IDL) that defines contractual interfaces with potential clients. Interfaces written in IDL can be translated to a number of programming languages via OMG standard language mappings so that they can be used to develop components. The resulting components can transparently communicate with other components written in different languages and running on different operating systems and machine types. The ORB is responsible for providing the illusion of `virtual homogeneity' regardless of the programming languages, tools, operating systems and networks used to realize and support these components. With the adoption of the CORBA 2.0 specification in 1995, these components are able to interoperate across multi-vendor CORBA-based products. More than 700 member companies have joined the OMG, including Hewlett-Packard, Digital, Siemens, IONA Technologies, Netscape, Sun Microsystems, Microsoft and IBM, which makes it the largest standards body in existence. These companies continue to work together within the OMG to refine and enhance the OMA and its components. This special issue of Distributed Systems Engineering publishes five papers that were originally presented at the `Distributed Object-Based Platforms' track of the 30th Hawaii International Conference on System Sciences (HICSS), which was held in Wailea on Maui on 6 - 10 January 1997. The papers, which were selected based on their quality and the range of topics they cover, address different aspects of CORBA, including advanced aspects such as fault tolerance and transactions. These papers discuss the use of CORBA and evaluate CORBA-based development for different types of distributed object systems and architectures. The first paper, by S Rahkila and S Stenberg, discusses the application of CORBA to telecommunication management networks. In the second paper, P Narasimhan, L E Moser and P M Melliar-Smith present a fault-tolerant extension of an ORB. The third paper, by J Liang, S Sédillot and B Traverson, provides an overview of the CORBA Transaction Service and its integration with the ISO Distributed Transaction Processing protocol. In the fourth paper, D Sherer, T Murer and A Würtz discuss the evolution of a cooperative software engineering infrastructure to a CORBA-based framework. The fifth paper, by R Fatoohi, evaluates the communication performance of a commercially-available Object Request Broker (Orbix from IONA Technologies) on several networks, and compares the performance with that of more traditional communication primitives (e.g., BSD UNIX sockets and PVM). We wish to thank both the referees and the authors of these papers, as their cooperation was fundamental in ensuring timely publication.

China launched a pilot project to improve its rare disease healthcare levels.

PubMed

Cui, Yazhou; Zhou, Xiaoyan; Han, Jinxiang

2014-01-27

China is facing the great challenge of serving the world's largest rare disease population. It is necessary to develop a specific medical plan to increase the levels of optimal prevention, diagnosis and treatment of rare diseases under the existing clinical service structures in China. In 2013, China launched its first pilot project focused on 20 representative rare diseases. A national network including approximately 100 provincial or municipal medical centers has been established to enable collaboration on rare diseases across China. The main objectives for this project are to develop and apply medical guidelines and clinical pathways for rare diseases, to establish a rare disease patient registry and data repository system, and to promote molecular testing for rare genetic disorders. This project also emphasizes building close links among the collaborative network, clinicians on the frontlines in basic medical services institutions and rare disease patient organizations. Primarily, this project expects to develop an actionable medical services plan to increase the delivery of quality healthcare for individuals and families living with rare diseases in China within five years.

The importance of measuring unmet healthcare needs.

PubMed

Gauld, Robin; Raymont, Antony; Bagshaw, Philip F; Nicholls, M Gary; Frampton, Christopher M

2014-10-17

Major restructuring of the health sector has been undertaken in many countries, including New Zealand and England, yet objective assessment of the outcomes has rarely been recorded. In the absence of comprehensive objective data, the success or otherwise of health reforms has been inferred from narrowly-focussed data or anecdotal accounts. A recent example relates to a buoyant King's Fund report on the quest for integrated health and social care in Canterbury, New Zealand which prompted an equally supportive editorial article in the British Medical Journal (BMJ) suggesting it may contain lessons for England's National Health Service. At the same time, a report published in the New Zealand Medical Journal expressed concerns at the level of unmet healthcare needs in Canterbury. Neither report provided objective information about changes over time in the level of unmet healthcare needs in Canterbury. We propose that the performance of healthcare systems should be measured regularly, objectively and comprehensively through documentation of unmet healthcare needs as perceived by representative segments of the population at formal interview. Thereby the success or otherwise of organisational changes to a health system and its adequacy as demographics of the population evolve, even in the absence of major restructuring of the health sector, can be better documented.

Differentiated strategies for improving streaming service quality

NASA Astrophysics Data System (ADS)

An, Hui; Chen, Xin-Meng

2005-02-01

With the explosive growth of streaming services, users are becoming more and more sensitive to its quality of service. To handle these problems, the research community focuses of the application of caching and replication techniques. But most approaches try to find specific strategies of caching of replication that suit for streaming service characteristics and to design some kind of universal policy to deal with all streaming objects. This paper explores the combination of caching and replication for improving streaming service quality and demonstrates that it makes sense to incorporate two technologies. It provides a system model and discusses some related issues of how to determining a refreshable streaming object and which refreshment policies a refreshable object should use.

Athletic Trainer Services in Public and Private Secondary Schools

PubMed Central

Pike, Alicia M.; Pryor, Riana R.; Vandermark, Lesley W.; Mazerolle, Stephanie M.; Casa, Douglas J.

2017-01-01

Context: The presence of athletic trainers (ATs) in secondary schools to provide medical care is crucial, especially with the rise in sports participation and resulting high volume of injuries. Previous authors have investigated the level of AT services offered, but the differences in medical care offered between the public and private sectors have not been explored. Objective: To compare the level of AT services in public and private secondary schools. Design: Concurrent mixed-methods study. Setting: Public and private secondary schools in the United States. Patients or Other Participants: A total of 10 553 secondary schools responded to the survey (8509 public, 2044 private). Main Outcome Measure(s): School administrators responded to the survey via telephone or e-mail. Descriptive statistics depict national data. Open-ended questions were evaluated through content analysis. Results: A greater percentage of public secondary schools than private secondary schools hired ATs. Public secondary schools provided a higher percentage of full-time, part-time, and clinic AT services than private secondary schools. Only per diem AT services were more frequent in the private sector. Regardless of the extent of services, reasons for not employing an AT were similar between sectors. Common barriers were budget, school size, and lack of awareness of the role of an AT. Unique to the public sector, remote location was identified as a challenge faced by some administrators. Conclusions: Both public and private secondary schools lacked ATs, but higher percentages of total AT services and full-time services were available in the public sector. Despite differences in AT services, both settings provided a similar number of student-athletes with access to medical care. Barriers to hiring ATs were comparable between public and private secondary schools; however, remote location was a unique challenge for the public sector. PMID:28157403

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

PubMed

Okpani, Arnold I; Abimbola, Seye

2016-01-01

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

Who is a community health worker? – a systematic review of definitions

PubMed Central

Olaniran, Abimbola; Smith, Helen; Unkels, Regine; Bar-Zeev, Sarah; van den Broek, Nynke

2017-01-01

ABSTRACT Background: Community health workers (CHWs) can play vital roles in increasing coverage of basic health services. However, there is a need for a systematic categorisation of CHWs that will aid common understanding among policy makers, programme planners, and researchers. Objective: To identify the common themes in the definitions and descriptions of CHWs that will aid delineation within this cadre and distinguish CHWs from other healthcare providers. Design: A systematic review of peer-reviewed papers and grey literature. Results: We identified 119 papers that provided definitions of CHWs in 25 countries across 7 regions. The review shows CHWs as paraprofessionals or lay individuals with an in-depth understanding of the community culture and language, have received standardised job-related training of a shorter duration than health professionals, and their primary goal is to provide culturally appropriate health services to the community. CHWs can be categorised into three groups by education and pre-service training. These are lay health workers (individuals with little or no formal education who undergo a few days to a few weeks of informal training), level 1 paraprofessionals (individuals with some form of secondary education and subsequent informal training), and level 2 paraprofessionals (individuals with some form of secondary education and subsequent formal training lasting a few months to more than a year). Lay health workers tend to provide basic health services as unpaid volunteers while level 1 paraprofessionals often receive an allowance and level 2 paraprofessionals tend to be salaried. Conclusions: This review provides a categorisation of CHWs that may be useful for health policy formulation, programme planning, and research. PMID:28222653

Early outreach to survivors of the shootings in Norway on the 22nd of July 2011

PubMed Central

Dyb, Grete; Jensen, Tine; Glad, Kristin Alve; Nygaard, Egil; Thoresen, Siri

2014-01-01

Background Under-treatment and unmet needs among survivors have been documented years after terror attacks. Improved early and proactive outreach strategies, including targeted interventions for individuals in need, are required. After the terrorist attacks in Norway on 22 July 2011, a national, proactive outreach strategy was developed and implemented to help those who were directly affected. Objectives The aims of this study were threefold: (1) to investigate whether the survivors at the island of Utøya had received proactive outreach from the municipalities, (2) to examine the relationships between received health services and the survivors’ level of exposure and post-trauma health problems, and (3) to explore the level of unmet needs among survivors 5 months post-terror. Methods Three hundred and twenty five survivors (M age=19.4, SD=4.6, 47.1% females, response rate 66%) of the 2011 massacre on Utøya Island, Norway, were interviewed face-to-face 4–5 months post-terror. The survivors were asked if they had received proactive outreach from their municipality, and what type of health services they had received. Survivors’ level of peri-trauma exposure, loss and injury, posttraumatic stress reactions, symptoms of anxiety and depression, somatic health problems, and sick leave, were assessed. Results Most participants (87%) reported that they had received early and proactive outreach, and most (84%) had a contact person. In addition a majority of the survivors has received support from their general practitioner (63%), or other municipal help services (66%). Specialized mental health services by psychiatrists or psychologists had been provided to 73.1% of the survivors. Survivors who had been referred to specialized mental health services reported higher levels of exposure to trauma, posttraumatic stress reactions, depression and anxiety, and somatic health problems, compared to non-receivers of such services. Forty-three survivors (14%) reported unmet needs for services. Conclusion In accordance with the national strategy, the vast majority of the participants in this study had received an early and proactive outreach and targeted responses from specialized mental health services had been provided to survivors in need of more extensive help. However, an important minority of the participants had not been reached as planned. The knowledge from this study may guide professionals and decision makers in planning for future disasters and improve the levels of care. PMID:25018858

Home Management and Human Service Competencies.

ERIC Educational Resources Information Center

Regional Learning Service of Central New York, Syracuse.

Faculty representatives from five postsecondary institutions having human service/human ecology programs and two members of the Regional Learning Service staff comprised a task force whose objectives were to identify competencies acquired through home management which relate to undergraduate course objectives, to recommend ways to assess these,…

Factors Associated With Emergency Department Visits: A Multistate Analysis of Adult Fee-for-Service Medicaid Beneficiaries.

PubMed

Agarwal, Parul; Bias, Thomas K; Madhavan, Suresh; Sambamoorthi, Nethra; Frisbee, Stephanie; Sambamoorthi, Usha

2016-04-27

The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47), Hispanics (IRR = 1.63), polypharmacy (IRR = 1.89), and tobacco use (IRR = 2.23). Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33). The county-level factors associated with ED visits were unemployment rate (IRR = 0.94) and number of urgent care clinics (IRR = 0.96). Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options.

An international, multidisciplinary, service-learning program: an option in the dental school curriculum.

PubMed

Martinez-Mier, Esperanza A; Soto-Rojas, Armando E; Stelzner, Sarah M; Lorant, Diane E; Riner, Mary E; Yoder, Karen M

2011-04-01

Many health professions students who treat Spanish-speaking patients in the United States have little concept of their culture and health related traditions. The lack of understanding of these concepts may constitute major barriers to healthcare for these patients. International service-learning experiences allow students to work directly in communities from which patients immigrate and, as a result, students gain a better understanding of these barriers. This article describes the implementation of an international, multidisciplinary, service-learning program in a dental school in the United States. The Indiana University International Service-Learning program in Hidalgo, Mexico began in 1999 as an alternative spring break travel and clinical experience for medical students, focusing on the treatment of acute health problems. Travel-related preparatory sessions were offered, and no learning or service objectives had been developed. The program has evolved to include a multidisciplinary team of dental, medical, nursing, public health and social work students and faculty. The experience is now integrated into a curriculum based on the service-learning model that allows students to use their clinical skills in real-life situations and provides structured time for reflection. The program aims to enhance teaching and foster civic responsibility in explicit partnership with the community. Preparatory sessions have evolved into a multidisciplinary graduate level course with defined learning and service objectives. PROGRAM EVALUATION METHODS: In order to assess the program's operation as perceived by students and faculty and to evaluate student's perceptions of learning outcomes, evaluation tools were developed. These tools included student and faculty evaluation questionnaires, experiential learning journals, and a strengths, weaknesses, opportunities and threats analysis. Evaluation data show that after program participation, students perceived an increase in their cultural awareness, cross-cultural communication skills and understanding of barriers and disparities faced by Latinos in the United States. Faculty evaluations offer insights into the lessons learned through the implementation process. The development of a service-learning based curriculum has posed challenges but has enriched international service experiences.

[Accesibility and effectivity in Mexico].

PubMed

García-Peña, Carmen; González-González, César

2011-01-01

This is an analysis of two of the dimensions of a health system: accessibility and effectiveness, taking account the objectives of a health system (improving the health of the population, provide appropriate treatment for users of health services and ensure financial security for health) cannot be achieved exclusively by a well-functioning health system and the provision of medical services, being that the health status is explained by many factors and social determinants that deal with the conditions of people and their health behaviors and the level of individual co-responsibility. Despite the advances in the Mexican health system which has greatly improved the health conditions of the population, there is a lag in investment in health, with the major investment challenges as such, coordination between all levels, distribution of human, technological and financial resources, the autonomy of professional practice, the innovation of attention schemes, and modernization of trade unions.

What systems participants know about access and service entry and why managers should listen.

PubMed

Duncombe, Rohena

2017-08-01

Objective The present study looked at the views of people directly involved in the entry process for community health counselling using the frame of the health access literature. The concurrence of system participants' views with the access literature highlights access issues, particularly for people who are vulnerable or disadvantaged. The paper privileges the voices of the system participants, inviting local health services to consider using participatory design to improve access at the entry point. Methods People involved in the entry process for community health counselling explored the question, 'What, for you, are the features of a good intake system?' They also commented on themes identified during pilot interviews. These were thematically analysed for each participant group by the researcher to develop a voice for each stakeholder group. Results People accessing the service could be vulnerable and the entry process failed to take that into account. People directly involved in the counselling service entry system, system participants, consisted of: professionals referring in, people seeking services and reception staff taking first enquiries. They shared substantially the same concerns as each other. The responses from these system participants are consistent with the international literature on access and entry into health services. Conclusion Participatory service design could improve primary healthcare service entry at the local level. Canvassing the experiences of system participants is important for delivering services to those who have the least access and, in that way, could contribute to health equity. What is known about the topic? People with the highest health needs receive the fewest services. Health inequality is increasing. What does this paper add? System participants can provide advice consistent with the academic research literature that is useful for improving service entry at the local level. What are the implications for practitioners? Participatory design can inform policy makers and service providers. Entry systems could acknowledge the potential vulnerability or disadvantage of people approaching the service.

Active Duty- U.S. Army Noise-Induced Hearing Injury Quarterly Surveillance: Q1 2010 Thru Q2 2012

DTIC Science & Technology

2014-06-10

threshold shift, tinnitus , and Noise-Induced Hearing Loss. RECOMMENDATIONS: Commanders and Preventive Medicine assets at multiple levels should use...Humes LE, Jollenbeck LM, Durch JS: Noise and military service: Implications for hearing loss and tinnitus . Washington, DC: National Academy Press...NONSPECIFIC ABNORMAL AUDITORY FUNCTION STUDIES TINN Tinnitus 38830 TINNITUS UNSPECIFIED TINN Tinnitus 38831 SUBJECTIVE TINNITUS TINN Tinnitus 38832 OBJECTIVE

Measures of Social Deprivation That Predict Health Care Access and Need within a Rational Area of Primary Care Service Delivery

PubMed Central

Butler, Danielle C; Petterson, Stephen; Phillips, Robert L; Bazemore, Andrew W

2013-01-01

Objective To develop a measure of social deprivation that is associated with health care access and health outcomes at a novel geographic level, primary care service area. Data Sources/Study Setting Secondary analysis of data from the Dartmouth Atlas, AMA Masterfile, National Provider Identifier data, Small Area Health Insurance Estimates, American Community Survey, Area Resource File, and Behavioural Risk Factor Surveillance System. Data were aggregated to primary care service areas (PCSAs). Study Design Social deprivation variables were selected from literature review and international examples. Factor analysis was used. Correlation and multivariate analyses were conducted between index, health outcomes, and measures of health care access. The derived index was compared with poverty as a predictor of health outcomes. Data Collection/Extraction Methods Variables not available at the PCSA level were estimated at block level, then aggregated to PCSA level. Principal Findings Our social deprivation index is positively associated with poor access and poor health outcomes. This pattern holds in multivariate analyses controlling for other measures of access. A multidimensional measure of deprivation is more strongly associated with health outcomes than a measure of poverty alone. Conclusions This geographic index has utility for identifying areas in need of assistance and is timely for revision of 35-year-old provider shortage and geographic underservice designation criteria used to allocate federal resources. PMID:22816561

[Financing of regional occupational health service centers: structure and financial criteria in years 2000-2001].

PubMed

Rydlewska-Liszkowska, Izabela

2003-01-01

The rational planning and financing of occupational health services at the national level have to be based on an appropriate system of information about individual units and their financial status that could illustrate their financial administration. This is required not only in view of the internal needs of public money management, but also in view of the national health accounts. The major task in this regard is to assess the level and structure of financing to individual units and to check the soundness of criteria used in the process of supplying financial means. The results of such an analysis can be a valuable source of information for planning carried out also by the institutions which provide funds to cover the cost of tasks performed by individual units. The aim of the project implemented by the Nofer Institute of Occupational Medicine was to collect, process and analyze data on the level and structure of financing of provincial occupational medicine centers. In this paper, the objectives, methodology and analytical tools are discussed. The results and structural data on the level and structure of financing of regional occupational health services centers covering a two-year period are presented. At the same time, the criteria for allocating funds were identified, which made it possible to evaluate the situation and to propose new solutions.

Organizational Stress Moderates the Relationship between Mental Health Provider Adaptability and Organizational Commitment

PubMed Central

Green, Amy E.; Dishop, Christopher; Aarons, Gregory A

2016-01-01

Objective Community mental health providers often operate within stressful work environments and are at high risk for emotional exhaustion, which can negatively affect job performance and client satisfaction with services. This cross-sectional study examines the relationships between organizational stress, provider adaptability, and organizational commitment. Methods Variables were analyzed using moderated multi-level regression in a sample of 311 mental health providers from 49 community mental health programs. Results Stressful organizational climate, characterized by high levels of emotional exhaustion, role conflict, and role overload, was negatively related to organizational commitment. Organizational stress moderated the relationship between provider adaptability and organizational commitment, such that those who were more adaptable had greater levels of organizational commitment when organizational stress was low, but were less committed than those who were less adaptable when organizational stress was high. Conclusions In the current study, providers higher in adaptability may perceive their organization as a greater fit when characterized by lower levels of stressfulness; however, highly adaptable providers may also exercise choice that manifests in lower commitment to staying in an overly stressful work environment. Service systems and organizational contexts are becoming increasingly demanding and stressful for direct mental health service providers. Therefore, community mental health organizations should assess and understand their organizational climate and intervene with empirically based organizational strategies when necessary to reduce stressful climates and maintain desirable employees. PMID:27301760

A Study of Self-Concept and Interest in Teaching of Pre-Service Teachers of Secondary Level

NASA Astrophysics Data System (ADS)

Mishra, Shri Krishna; Yadav, Badri

2012-12-01

The present research paper is devoted to provide a summary of the entire study, which includes a SKITT out line of the major objective. Methodology and procedure followed in different phase of study. This study was undertaken to know the Self-concept and interest in teaching of pre-service teachers of middle level Shri Kanwartara institute for treacherís training Mandleshwar Dist-Khargone (M.P.) efforts was made to find out the difference and relationship between the above two variables.The physical self-image is usually formed first and is related to the student physical appearance, psychological self-image is based on thoughtsfeelings and emotions. They consist of the qualities such as courage, honesty, independence, self-confidence, aspiration and abilities of various kinds.A manís day-to-day life is shaped by his interest and attitudes. His day-to-day relations with other member of the society, his educational and vocational adjustment, his attitudes and values depend upon his interest. There are various objects in this universe. Those which are pleasant and appealing to our instincts and sense become the centre of our Curiosity. interest differs from individual to individual and as such they are quite subjective.

A scoping review of appropriateness of care research activity in Canada from a health system-level perspective.

PubMed

Brien, Susan; Gheihman, Galina; Tse, Yi Ki Yvonne; Byrnes, Mary; Harrison, Sophia; Dobrow, Mark J

2014-05-01

Jurisdictions are increasingly focusing on appropriate use of healthcare services and interventions as a means to improve health system performance. Our objectives were to conduct a scoping review to (a) map Canadian research and related activity on system-level appropriateness of care and (b) create a resource database that could be used to inform evidence-based decision-making and future research priorities in this area. We searched Medline, EMBASE and CINAHL databases between 2003-2013 using terms including "appropriate," "inappropriate," "health technology assessment" and "cost-effectiveness." Articles were included if they were Canadian-based and relevant to our definition. The database search was complemented by a website search of relevant Canadian organizations. 4,979 articles were identified through the literature search, and 103 articles relevant to system-level appropriateness of care across Canada were charted. Of these, 64 contained an evaluation of appropriateness, 30 used a method of cost-effectiveness or total cost impact analysis and 9 involved another methodology. The most common health service categories included drug therapy (n=40) and health service utilization (n=33). Fifty-eight websites were summarized containing material relevant to system-level appropriateness of care. Our review identifies Canadian research and related activity pertaining to appropriateness of healthcare from a system-level perspective and provides a useful resource both to support evidence-based decision-making and to guide future appropriateness research. Copyright © 2014 Longwoods Publishing.

Improving cancer control through a community-based cancer awareness initiative☆

PubMed Central

Smith, Samuel G.; Rendell, Helen; George, Helen; Power, Emily

2014-01-01

Objective To assess the impact of the Cancer Research UK Cancer Awareness Roadshow on intentions to change health behaviours and use local health services related to cancer. Method Feedback forms from visitors to three Roadshows collected data on anticipated lifestyle changes and health service use following their visit to the Roadshow. Demographic predictors of intentions were investigated. Results A total of 6009 individuals completed a feedback form. On average, respondents intended to make between two and three (2.55; SD = 1.77) lifestyle changes, and use between none and one (0.59; SD = 0.77) local health services following their visit. Multivariable analysis showed that age (p = 0.001), ethnicity (p = 0.006), and occupation (p = 0.043) were significant predictors of anticipated lifestyle changes. Anticipated health service use was higher among men (p = 0.001), younger groups (p < 0.001), and smokers (p < 0.001). Overall effects of ethnicity (p = 0.001) and occupation (p < 0.001) on anticipated health service use were also observed. Post-hoc analyses indicated stronger effects of the Roadshow among disadvantaged groups. Conclusion High levels of anticipated health behaviour change and health service use were observed among Roadshow visitors. Disadvantaged groups such as lower socioeconomic groups, ethnic minorities, and smokers showed particularly high levels of intention. A more in-depth evaluation of the Roadshow is warranted. PMID:24239683

Curriculum Providing Cognitive Knowledge and Problem-Solving Skills for Anesthesia Systems-Based Practice

PubMed Central

Wachtel, Ruth E.; Dexter, Franklin

2010-01-01

Background Residency programs accredited by the ACGME are required to teach core competencies, including systems-based practice (SBP). Projects are important for satisfying this competency, but the level of knowledge and problem-solving skills required presupposes a basic understanding of the field. The responsibilities of anesthesiologists include the coordination of patient flow in the surgical suite. Familiarity with this topic is crucial for many improvement projects. Intervention A course in operations research for surgical services was originally developed for hospital administration students. It satisfies 2 of the Institute of Medicine's core competencies for health professionals: evidence-based practice and work in interdisciplinary teams. The course lasts 3.5 days (eg, 2 weekends) and consists of 45 cognitive objectives taught using 7 published articles, 10 lectures, and 156 computer-assisted problem-solving exercises based on 17 case studies. We tested the hypothesis that the cognitive objectives of the curriculum provide the knowledge and problem-solving skills necessary to perform projects that satisfy the SBP competency. Standardized terminology was used to define each component of the SBP competency for the minimum level of knowledge needed. The 8 components of the competency were examined independently. Findings Most cognitive objectives contributed to at least 4 of the 8 core components of the SBP competency. Each component of SBP is addressed at the minimum requirement level of exemplify by at least 6 objectives. There is at least 1 cognitive objective at the level of summarize for each SBP component. Conclusions A curriculum in operating room management can provide the knowledge and problem-solving skills anesthesiologists need for participation in projects that satisfy the SBP competency. PMID:22132289

Local health care expenditure plans and their opportunity costs.

PubMed

Karlsberg Schaffer, Sarah; Sussex, Jon; Devlin, Nancy; Walker, Andrew

2015-09-01

In the UK, approval decisions by Health Technology Assessment bodies are made using a cost per quality-adjusted life year (QALY) threshold, the value of which is based on little empirical evidence. We test the feasibility of estimating the "true" value of the threshold in NHS Scotland using information on marginal services (those planned to receive significant (dis)investment). We also explore how the NHS makes spending decisions and the role of cost per QALY evidence in this process. We identify marginal services using NHS Board-level responses to the 2012/13 Budget Scrutiny issued by the Scottish Government, supplemented with information on prioritisation processes derived from interviews with Finance Directors. We search the literature for cost-effectiveness evidence relating to marginal services. The cost-effectiveness estimates of marginal services vary hugely and thus it was not possible to obtain a reliable estimate of the threshold. This is unsurprising given the finding that cost-effectiveness evidence is rarely used to justify expenditure plans, which are driven by a range of other factors. Our results highlight the differences in objectives between HTA bodies and local health service decision makers. We also demonstrate that, even if it were desirable, the use of cost-effectiveness evidence at local level would be highly challenging without extensive investment in health economics resources. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Estimating Demand for and Supply of Pediatric Preventive Dental Care for Children and Identifying Dental Care Shortage Areas, Georgia, 2015.

PubMed

Cao, Shanshan; Gentili, Monica; Griffin, Paul M; Griffin, Susan O; Harati, Pravara; Johnson, Ben; Serban, Nicoleta; Tomar, Scott

Demand for dental care is expected to outpace supply through 2025. The objectives of this study were to determine the extent of pediatric dental care shortages in Georgia and to develop a general method for estimation that can be applied to other states. We estimated supply and demand for pediatric preventive dental care for the 159 counties in Georgia in 2015. We compared pediatric preventive dental care shortage areas (where demand exceeded twice the supply) designated by our methods with dental health professional shortage areas designated by the Health Resources & Services Administration. We estimated caries risk from a multivariate analysis of National Health and Nutrition Examination Survey data and national census data. We estimated county-level demand based on the time needed to perform preventive dental care services and the proportion of time that dentists spend on pediatric preventive dental care services from the Medical Expenditure Panel Survey. Pediatric preventive dental care supply exceeded demand in Georgia in 75 counties: the average annual county-level pediatric preventive dental care demand was 16 866 hours, and the supply was 32 969 hours. We identified 41 counties as pediatric dental care shortage areas, 14 of which had not been designated by the Health Resources & Services Administration. Age- and service-specific information on dental care shortage areas could result in more efficient provider staffing and geographic targeting.

Linking Ecosystem Services and Human Health: The Eco-Health Relationship Browser (paper)

EPA Science Inventory

Objectives Ecosystems provide multiple services of benefit to society. Many of these ecosystem services have been linked to a range of positive health outcomes. The objectives of this review were to identify the set of literature related to this research topic and to subsequentl...

Association between perceived stress, multimorbidity and primary care health services: a Danish population-based cohort study

PubMed Central

Vestergaard, Mogens; Larsen, Karen Kjær; Fenger-Grøn, Morten

2018-01-01

Objectives Mental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental–physical multimorbidity. Design Population-based cohort study. Setting Primary healthcare in Denmark. Participants 118 410 participants from the Danish National Health Survey 2010 followed for 1 year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers. Outcome measures General daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers. Results Perceived stress levels were associated with primary care activity in a dose–response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95% CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95% CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95% CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95% CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95% CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services. Conclusion Persons with high stress levels generally had higher use of primary healthcare, 4–6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services. PMID:29478014

The care and course of diabetes: differences according to level of education.

PubMed

van der Meer, J B; Mackenbach, J P

1999-01-01

The objective of this study was to describe socioeconomic differences in the utilisation of health services among persons with diabetes and to link these differences with socioeconomic differences in the course of diabetes. A 2-year follow-up study (1991-1993) was done with data from a population-based survey in The Netherlands (city of Eindhoven and surroundings). Those reporting diabetes who also reported treatment with a diet, oral antidiabetics or insulin and who completed questionnaires in the years 1991 and 1993 (n = 173) were included in the analysis. Main outcome measures were: (1) the odds ratios according to level of education of utilisation of 11 types of service or medical checks in 1991, relevant for diabetes; and (2) odds ratios according to level of education of the difference between 1991 and 1993 in the prevalence of symptoms of diabetic complications. Controlling for severity of diabetes, contact rates with the general practitioner were significantly (P < 0.05) higher among those with primary education, compared to those with an educational level of intermediate vocational training or higher. Rates of checks by a specialist, influenza vaccination and many other checks were statistically significantly lower among those with a low educational level, although the group with the lowest educational level did not always show the lowest rates. Of symptoms indicating diabetes complications, the prevalence of pain in the legs and visual impairments developed more unfavourably among those with primary education. The prevalence of all symptoms together developed more unfavourably among those with primary education. A direct contribution of uptake of checks and services to the differential course of diabetes by education could not be demonstrated. People with diabetes with a low level of education have lower utilisation rates of checks and services relevant for diabetes care, and a worse outcome in terms of complications.

Service Quality Of Diagnostic Fine Needle Aspiration Cytology In A Tertiary Care Hospital Of Lahore (Process Measure As Patient's Perspective).

PubMed

Rizvi, Zainab; Usmani, Rabia Arshed; Rizvi, Amna; Wazir, Salim; Zahra, Taskeen; Rasool, Hafza

2017-01-01

Quality of any service is the most important aspect for the manufacturer as well as the consumer. The primary objective of any nation's health system is to provide supreme quality health care services to its patients. The objective of this study was to assess the quality of diagnostic fine needle aspiration cytology service in a tertiary care hospital. As Patient's perspectives provide valuable information on quality of process, therefore, patient's perception in terms of satisfaction with the service was measured. In this cross sectional analytical study, 291 patients undergoing fine needle aspiration cytology in Mayo Hospital were selected by systematic sampling technique. Information regarding satisfaction of patients with four dimensions of service quality process, namely "procedure, sterilization, conduct and competency of doctor" was collected through interview on questionnaire. The questionnaire was developed on SERVQUAL model, a measurement tool, for quality assessment of services provided to patients. All items were assessed on 2- point likert scale (0=dissatisfied, 1=satisfied). Frequencies and percentages of satisfied and dissatisfied patients were recorded for each item and all items in each dimension were scored. If the percentage of sum of all item scores of a dimension was ≥60, the dimension was 'good quality'. Whereas <60% was 'poor quality' dimension. Data was analysed using epi-info-3.5.1. Fisher test was applied to check statistical significance. (p-value <0.05). Out of the 4 dimensions of service quality process, Procedure (48.8%), Sterilization (51.5%) and practitioner conduct (50.9%) were perceived as 'poor' by the patients. Only practitioner competency (67.4%) was perceived as 'good'. Comparison of dimensions of service quality scoring with overall level of patient satisfaction revealed that all 4 dimensions were significantly related to patient dissatisfaction (p<.05). The study suggests that service quality of therapeutic and diagnostic procedures in public hospitals should be routinely monitored from the patients' point of view as most aspects of service quality in public hospitals of Pakistan, require improvements. In this manner patient's satisfaction regarding use of services in public hospitals can be made better.

How to Allow Conscientious Objection in Medicine While Protecting Patient Rights.

PubMed

Ancell, Aaron; Sinnott-Armstrong, Walter

2017-01-01

Paradigmatic cases of conscientious objection in medicine are those in which a physician refuses to provide a medical service or good because doing so would conflict with that physician's personal moral or religious beliefs. Should such refusals be allowed in medicine? We argue that (1) many conscientious objections to providing certain services must be allowed because they fall within the range of freedom that physicians have to determine which services to offer in their practices; (2) at least some conscientious objections to serving particular groups of patients should be allowed because they are not invidiously discriminatory; and (3) even in cases of invidiously discriminatory conscientious objections, legally prohibiting individual physicians from refusing to serve patients on the basis of such objections is not always the best solution.

Assessment of the implementation of the primary health care package at selected sites in South Africa.

PubMed

Heunis, J C; van Rensburg, H C J; Claassens, D L

2006-11-01

A major objective of public health policy in South Africa is to develop a district-based health service focused on the delivery of primary health care. The primary health care package has been developed to promote the delivery of a number of services at the primary level. This paper assesses the implementation of the package in eight historically disadvantaged urban renewal nodes singled out for accelerated development through the government's urban renewal strategy. Data were gathered by way of interviews with primary health care facility managers and programme co-ordinators and through physical observations at facilities. The findings show that while some facilities were able to offer clients most of the services specified by the package, many others were unable do so. The urban renewal nodes differed noticeably in this respect.

WE-E-16A-01: Medical Physics Economics Update

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

Goodwin, J; Dirksen, B; White, G

Radiology and Medical Physics reimbursement for Medicare services is constantly changing. In this presentation we will review the proposed reimbursement rules and levels for 2015 and compare them with those currently in effect for 2014. In addition, we will discuss the challenges that may lie ahead for the medical physics profession as the Centers for Medicare and Medicaid Services (CMS) moves away from a fee for service payment model and towards one of prospective payment. Learning Objectives: Understand the differences in the Medicare reimbursement systems for outpatient departments as opposed to physicians and free standing centers. Learn the proposed Medicaremore » rules for 2015 and how they may affect Radiology and Medical Physics revenues. Be aware of possible long term changes in reimbursement and how they may affect our employers, our pocket books and our profession.« less

Spending on social and public health services and its association with homicide in the USA: an ecological study

PubMed Central

Sipsma, Heather L; Canavan, Maureen E; Rogan, Erika; Taylor, Lauren A; Talbert-Slagle, Kristina M; Bradley, Elizabeth H

2017-01-01

Objective To examine whether state-level spending on social and public health services is associated with lower rates of homicide in the USA. Design Ecological study. Setting USA. Participants All states in the USA and the District of Columbia for which data were available (n=42). Primary outcome measure Homicide rates for each state were abstracted from the US Department of Justice Federal Bureau of Investigation’s Uniform Crime Reporting. Results After adjusting for potential confounding variables, we found that every $10 000 increase in spending per person living in poverty was associated with 0.87 fewer homicides per 100 000 population or approximately a 16% decrease in the average homicide rate (estimate=−0.87, SE=0.15, p<0.001). Furthermore, there was no significant effect in the quartile of states with the highest percentages of individuals living in poverty but significant effects in the quartiles of states with lower percentages of individuals living in poverty. Conclusions Based on our findings, spending on social and public health services is associated with significantly lower homicide rates at the state level. Although we cannot infer causality from this research, such spending may provide promising avenues for homicide reduction in the USA, particularly among states with lower levels of poverty. PMID:29025831

Audiometric profile of civilian pilots according to noise exposure

PubMed Central

Falcão, Taiana Pacheco; Luiz, Ronir Raggio; Schütz, Gabriel Eduardo; Mello, Márcia Gomide da Silva; Câmara, Volney de Magalhães

2014-01-01

OBJECTIVE To evaluate the audiometric profile of civilian pilots according to the noise exposure level. METHODS This observational cross-sectional study evaluated 3,130 male civilian pilots aged between 17 and 59 years. These pilots were subjected to audiometric examinations for obtaining or revalidating the functional capacity certificate in 2011. The degree of hearing loss was classified as normal, suspected noise-induced hearing loss, and no suspected hearing loss with other associated complications. Pure-tone air-conduction audiometry was performed using supra-aural headphones and acoustic stimulus of the pure-tone type, containing tone thresholds of frequencies between 250 Hz and 6,000 Hz. The independent variables were professional categories, length of service, hours of flight, and right or left ear. The dependent variable was pilots with suspected noise-induced hearing loss. The noise exposure level was considered low/medium or high, and the latter involved periods > 5,000 flight hours and > 10 years of flight service. RESULTS A total of 29.3% pilots had suspected noise-induced hearing loss, which was bilateral in 12.8% and predominant in the left ear (23.7%). The number of pilots with suspected hearing loss increased as the noise exposure level increased. CONCLUSIONS Hearing loss in civilian pilots may be associated with noise exposure during the period of service and hours of flight. PMID:25372170

Availability and Quality of Family Planning Services in the Democratic Republic of the Congo: High Potential for Improvement

PubMed Central

Mpunga, Dieudonné; Lumbayi, JP; Dikamba, Nelly; Mwembo, Albert; Ali Mapatano, Mala; Wembodinga, Gilbert

2017-01-01

Objective: To determine the availability and quality of family planning services within health facilities throughout the Democratic Republic of the Congo (DRC). Methods: Data were collected for the cross-sectional study from April 2014 to June 2014 by the Ministry of Public Health. A total of 1,568 health facilities that reported data to the National Health Information System were selected by multistage random sampling in the 11 provinces of the DRC existing at that time. Data were collected through interviews, document review, and direct observation. Two dependent variables were measured: availability of family planning services (consisting of a room for services, staff assigned to family planning, and evidence of client use of family planning) and quality of family planning services (assessed as “high” if the facility had at least 1 trained staff member, family planning service delivery guidelines, at least 3 types of methods, and a sphygmomanometer, or “low” if the facility did not meet any of these 4 criteria). Pearson's chi-square test and odds ratios (ORs) were used to test for significant associations, using the alpha significance level of .05. Results: We successfully surveyed 1,555 facilities (99.2%) of those included in the sample. One in every 3 facilities (33%) offered family planning services as assessed by the index of availability, of which 20% met all 4 criteria for providing high-quality services. Availability was greatest at the highest level of the health system (hospitals) and decreased incrementally with each health system level, with disparities between provinces and urban and rural areas. Facilities in urban areas were more likely than in rural areas to meet the standard for high-quality services (P<.001). Public facilities were less likely than private facilities to have high-quality services (P=.02). Among all 1,555 facilities surveyed, 14% had at least 3 types of methods available at the time of the survey; the most widely available methods were male condoms, combined oral contraceptive pills, and progestin-only injectable contraceptives. Conclusion: Availability and quality of family planning services in health facilities in the DRC remain low, with inequitable distribution of services throughout the country. To improve access to and use of family planning, efforts should focus on improving availability and quality at lower health system levels and in rural areas where the majority of the population lives. PMID:28588047

75 FR 2140 - Clean Air Act Operating Permit Program; Petition for Objection to Federal Operating Permit for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-14

... Objection to Federal Operating Permit for American Electric Power Service Corporation, Southwest Electric... object to the American Electric Power Service Corporation, Southwest Electric Power Company (AEP... Permits Section, Multimedia Planning and Permitting Division, EPA Region 6, 1445 Ross Avenue, Dallas...

Evaluation of Patient Satisfaction with Tuberculosis Services in Southern Nigeria

PubMed Central

Onyeonoro, Ugochukwu U; Chukwu, Joseph N; Nwafor, Charles C; Meka, Anthony O; Omotowo, Babatunde I; Madichie, Nelson O; Ogbudebe, Chidubem; Ikebudu, Joy N; Oshi, Daniel C; Ekeke, Ngozi; Paul, Nsirimobu I; Duru, Chukwuma B

2015-01-01

OBJECTIVE Knowing tuberculosis (TB) patients’ satisfaction enables TB program managers to identify gaps in service delivery and institute measures to address them. This study is aimed at evaluating patients’ satisfaction with TB services in southern Nigeria. MATERIALS AND METHODS A total of 378 patients accessing TB care were studied using a validated Patient Satisfaction (PS-38) questionnaire on various aspects of TB services. Factor analysis was used to identify eight factors related to TB patient satisfaction. Test of association was used to study the relation between patient satisfaction scores and patient and health facility characteristics, while multilinear regression analysis was used to identify predictors of patient satisfaction. RESULTS Highest satisfaction was reported for adherence counseling and access to care. Patient characteristics were associated with overall satisfaction, registration, adherence counseling, access to care, amenities, and staff attitude, while health system factors were associated with staff attitude, amenities, and health education. Predictors of satisfaction with TB services included gender, educational status, if tested for HIV, distance, payment for TB services, and level and type of health-care facility. CONCLUSION Patient- and health system–related factors were found to influence patient satisfaction and, hence, should be taken into consideration in TB service programing. PMID:26508872

Evaluating health service quality: using importance performance analysis.

PubMed

Izadi, Azar; Jahani, Younes; Rafiei, Sima; Masoud, Ali; Vali, Leila

2017-08-14

Purpose Measuring healthcare service quality provides an objective guide for managers and policy makers to improve their services and patient satisfaction. Consequently, the purpose of this paper is to measure service quality provided to surgical and medical inpatients at Kerman Medical Sciences University (KUMS) in 2015. Design/methodology/approach A descriptive-analytic study, using a cross-sectional method in the KUMS training hospitals, was implemented between October 2 and March 15, 2015. Using stratified random sampling, 268 patients were selected. Data were collected using an importance-performance analysis (IPA) questionnaire, which measures current performance and determines each item's importance from the patients' perspectives. These data indicate overall satisfaction and appropriate practical strategies for managers to plan accordingly. Findings Findings revealed a significant gap between service importance and performance. From the patients' viewpoint, tangibility was the highest priority (mean=3.54), while reliability was given the highest performance (mean=3.02). The least important and lowest performance level was social accountability (mean=1.91 and 1.98, respectively). Practical implications Healthcare managers should focus on patient viewpoints and apply patient comments to solve problems, improve service quality and patient satisfaction. Originality/value The authors applied an IPA questionnaire to measure service quality provided to surgical and medical ward patients. This method identifies and corrects service quality shortcomings and improving service recipient perceptions.

Robotics and Automation for Flight Deck Aircraft Servicing

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

Chesser, J.B.; Draper, J.V.; Pin, F.G.

1999-03-01

One of the missions of the Future Aircraft Carriers Program is to investigate methods that would improve aircraft turnaround servicing activities on carrier decks. The major objectives and criteria for evaluating alternative aircraft servicing methods are to reduce workload requirements, turnaround times (TAT), and life-cycle costs (LCC). Technologies in the field of Robotics and Automation (R and A) have the potential to significantly contribute to these objectives. The objective of this study was to investigate aircraft servicing functions on carrier decks which would offer the potentially most significant payoff if improved by various R and A technologies. Improvement in thismore » case means reducing workload, time and LCC. This objective was accomplished using a ''bottom-up'' formalized approach as described in the following.« less

Performance evaluation of Al-Zahra academic medical center based on Iran balanced scorecard model

PubMed Central

Raeisi, Ahmad Reza; Yarmohammadian, Mohammad Hossein; Bakhsh, Roghayeh Mohammadi; Gangi, Hamid

2012-01-01

Background: Growth and development in any country's national health system, without an efficient evaluation system, lacks the basic concepts and tools necessary for fulfilling the system's goals. The balanced scorecard (BSC) is a technique widely used to measure the performance of an organization. The basic core of the BSC is guided by the organization's vision and strategies, which are the bases for the formation of four perspectives of BSC. The goal of this research is the performance evaluation of Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences, based on Iran BSC model. Materials and Methods: This is a combination (quantitative–qualitative) research which was done at Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences in 2011. The research populations were hospital managers at different levels. Sampling method was purposive sampling in which the key informed personnel participated in determining the performance indicators of hospital as the BSC team members in focused discussion groups. After determining the conceptual elements in focused discussion groups, the performance objectives (targets) and indicators of hospital were determined and sorted in perspectives by the group discussion participants. Following that, the performance indicators were calculated by the experts according to the predetermined objectives; then, the score of each indicator and the mean score of each perspective were calculated. Results: Research findings included development of the organizational mission, vision, values, objectives, and strategies. The strategies agreed upon by the participants in the focus discussion group included five strategies, which were customer satisfaction, continuous quality improvement, development of human resources, supporting innovation, expansion of services and improving the productivity. Research participants also agreed upon four perspectives for the Al-Zahra hospital BSC. In the patients and community perspective (customer), two objectives and three indicators were agreed upon, with a mean score of 75.9%. In the internal process perspective, 4 objectives and 14 indicators were agreed upon, with a mean score of 79.37%. In the learning and growth perspective, four objectives and eight indicators were agreed upon, with a mean score of 81.11%. Finally, in the financial perspective, two objectives and five indicators were agreed upon, with a mean score of 67.15%. Conclusion: One way to create demand for hospital services is performance evaluation by paying close attention to all BSC perspectives, especially the non-financial perspectives such as customers and internal processes perspectives. In this study, the BSC showed the differences in performance level of the organization in different perspectives, which would assist the hospital managers improve their performance indicators. The learning and growth perspective obtained the highest score, and the financial perspective obtained the least score. Since the learning and growth perspective acts as a base for all other perspectives and they depend on it, hospitals must continuously improve the service processes and the quality of services by educating staff and updating their policies and procedures. This can increase customer satisfaction and productivity and finally improve the BSC in financial perspective. PMID:23555104

Investigation into the impact of agility on conceptual fighter design

NASA Technical Reports Server (NTRS)

Engelbeck, R. M.

1995-01-01

The Agility Design Study was performed by the Boeing Defense and Space Group for the NASA Langley Research Center. The objective of the study was to assess the impact of agility requirements on new fighter configurations. Global trade issues investigated were the level of agility, the mission role of the aircraft (air-to-ground, multi-role, or air-to-air), and whether the customer is Air force, Navy, or joint service. Mission profiles and design objectives were supplied by NASA. An extensive technology assessment was conducted to establish the available technologies to industry for the aircraft. Conceptual level methodology is presented to assess the five NASA-supplied agility metrics. Twelve configurations were developed to address the global trade issues. Three-view drawings, inboard profiles, and performance estimates were made and are included in the report. A critical assessment and lessons learned from the study are also presented.

NASCOM network ground communications availability report

NASA Technical Reports Server (NTRS)

1983-01-01

A performance analysis of NASCOM Network circuits is presented. An objective of 99.80 percent availability has been established for all network circuits and an acceptable level of 99.50. A network narrative summary for the current month includes changes in network configurations, current month's totals for modes of service and trouble category losses, a discussion of trends, and significant losses that affected the performance indexes of individual or groups of circuits. A table and narrative summary of those circuits that failed to meet the objective of 99.80% availability for all network circuits and an acceptable level of 99.50. Lost time and interruption tables showing all circuits affected by outages, by trouble category, with their total time and events, scheduled operating hours, and individual availability indexes also are included. Selected circuits whose availabilities have or continue to affect the overall network availability are also analyzed.

Higher haemoglobin levels and dedicated trauma admission are associated with survival after severe traumatic brain injury.

PubMed

Baltazar, Gerard Anthony; Pate, Amy J; Panigrahi, Benita; Sharp, Audrey; Smith, Michael; Chendrasekhar, Akella

2015-01-01

Prevention of secondary brain injury is a key component of acute management of patients with severe traumatic brain injury (TBI). Haemoglobin concentration may have an impact on optimization of cerebral oxygenation. Patients with TBI may best be served by an organized trauma service. The objective is to determine if haemoglobin concentration or dedicated trauma admission has an impact on outcomes after severe TBI. This study retrospectively analysed consecutive patients with severe TBI admitted to a level-I trauma centre over 3 years. Patients <16 years-old and with length of stay (LOS) <24 hours were excluded. Data were collected on demographics; injury severity; LOS; admission service; survival to discharge; and haemoglobin levels from hospital days 1-7. Data were also collected on number of transfusions of packed red blood cells. The sample was stratified based on admission service and survival to discharge. Of 147 patients (age = 54.1 ± 3.7 years), overall mortality rate was 15.4% (n = 23). Overall, non-survivors had lower daily and 7-day mean haemoglobin levels (10.7 ± 0.9 vs. 12.9 ± 0.4 g dL(-1), p < 0.001). Non-surgical admissions had lower haemoglobin levels and a higher mortality rate (28.9% vs. 12.2%, p < 0.001) compared to dedicated trauma admissions. Among patients with severe TBI, higher haemoglobin levels and maintenance as a dedicated trauma admission are associated with higher survival to discharge.

The Data Base of the International Geodynamics and Earth Tide Service (IGETS)

NASA Astrophysics Data System (ADS)

Voigt, Christian; Förste, Christoph; Wziontek, Hartmut; Crossley, David; Meurers, Bruno; Pálinkáš, Vojtech; Hinderer, Jacques; Boy, Jean-Paul; Barriot, Jean-Pierre; Sun, Heping

2017-04-01

The International Geodynamics and Earth Tide Service (IGETS) was established in 2015 by the International Association of Geodesy (IAG). IGETS continues the activities of the Global Geodynamics Project (GGP, 1997-2015) to provide support to geodetic and geophysical research activities using superconducting gravimeter data within the context of an international network. The primary objective of IGETS is to provide a service for continuous ground based measurements to monitor temporal variations of the Earth's gravity field and deformation of the Earth's surface by long term records from ground gravimeters, tiltmeters, strainmeters and other geodynamic sensors. IGETS also continues the activities of the International Center for Earth Tides (ICET), in particular, in collecting, archiving and distributing Earth tide records from long series of the various geodynamic sensors. This presentation introduces the IGETS data base hosted by GFZ and accessible via http://igets.gfz-potsdam.de to the geodetic and geodynamics community as well as to all other interested data producers and users. At present, records from superconducting gravimeters at 34 stations worldwide are available. Level 1 products are raw gravity and local pressure records decimated at 1 minute samples. As a new feature, records with 1 or 2 seconds samples are already provided for a few stations. Level 2 products consist of gravity and pressure data corrected for instrumental perturbations and ready for tidal analysis, which are derived from Level 1 datasets and computed by the University of French Polynesia (Tahiti, French Polynesia). Gravity residuals after particular geophysical corrections (including solid Earth tides, polar motion, tidal and non-tidal loading effects) considered as Level 3 products are derived from Level 2 datasets and computed by EOST (Ecole et Observatoire des Sciences de la Terre, Strasbourg, France). The IGETS data sets are stored by GFZ on a FTP server and are freely available after a compulsory user registration. A major benefit of IGETS is the provision of digital object identifiers (DOI) by the research repository of GFZ Data Services for the data sets of every station. This ensures a long term storage and an increased visibility as part of an international network but also a proper data citation. At present, the IGETS data base is supported by 24 data producers providing records to almost 100 registered users. All relevant information on the data base, i.e., data availability and access, stations and sensors, conventional data formats, etc. are compiled in a specific scientific technical report (see http://doi.org/10.2312/GFZ.b103-16087). As IGETS is seeking for providing all kinds of long-term geodynamic time series, interested station operators are cordially invited to provide their data sets to the IGETS data base and, in return, benefit from being part of the IAG service IGETS.

Virtual Workshop Environment (VWE): A Taxonomy and Service Oriented Architecture (SOA) Framework for Modularized Virtual Learning Environments (VLE)--Applying the Learning Object Concept to the VLE

ERIC Educational Resources Information Center

Paulsson, Fredrik; Naeve, Ambjorn

2006-01-01

Based on existing Learning Object taxonomies, this article suggests an alternative Learning Object taxonomy, combined with a general Service Oriented Architecture (SOA) framework, aiming to transfer the modularized concept of Learning Objects to modularized Virtual Learning Environments. The taxonomy and SOA-framework exposes a need for a clearer…

Using modular psychotherapy in school mental health: Provider perspectives on intervention-setting fit

PubMed Central

Lyon, Aaron R.; Ludwig, Kristy; Romano, Evalynn; Koltracht, Jane; Stoep, Ann Vander; McCauley, Elizabeth

2013-01-01

Objective The “fit” or appropriateness of well-researched interventions within usual care contexts is among the most commonly-cited, but infrequently researched, factors in the successful implementation of new practices. The current study was initiated to address two exploratory research questions: (1) How do clinicians describe their current school mental health service delivery context? and (2) How do clinicians describe the fit between modular psychotherapy and multiple levels of the school mental health service delivery context? Method Following a year-long training and consultation program in an evidence-based, modular approach to psychotherapy, semi-structured qualitative interviews were conducted with seventeen school-based mental health providers to evaluate their perspectives on the appropriateness of implementing the approach within a system of school-based health centers. Interviews were transcribed and coded for themes using conventional and directed content analysis. Results Findings identified key elements of the school mental health context including characteristics of the clinicians, their practices, the school context, and the service recipients. Specific evaluation of intervention-setting appropriateness elicited many comments about both practical and value-based (e.g., cultural considerations) aspects at the clinician and client levels, but fewer comments at the school or organizational levels. Conclusions Results suggest that a modular approach may fit well with the school mental health service context, especially along practical aspects of appropriateness. Future research focused on the development of methods for routinely assessing appropriateness at different stages of the implementation process is recommended. PMID:24134063

Internet Services for Communicating With the General Practice: Barely Noticed and Used by Patients

PubMed Central

Vermeulen, Joan; Friele, Roland D; van Schayck, Onno CP; de Jong, Judith D; de Witte, Luc P

2015-01-01

Background The Netherlands is one of the frontrunners of eHealth in Europe. Many general practices offer Internet services, which can be used by patients to communicate with their general practice. In promoting and implementing such services, it is important to gain insight into patients’ actual use and intention toward using. Objective The objective of the study is to investigate the actual use and intention toward using Internet services to communicate with the general practice by the general practice population. The secondary objective is to study the factors and characteristics that influence their intention to use such services. Methods There were 1500 members of the Dutch Health Care Consumer Panel, age over 18 years, that were invited to participate in this cross-sectional study. People who had contacted their general practitioner at least once in the past year were included. Participants were asked to fill out a questionnaire about the following services: Internet appointment planning, asking questions on the Internet, email reminders about appointments, Internet prescription refill requests, Internet access to medical data, and Internet video consultation. Participants indicated whether they had used these services in the past year, they would like to use them, and whether they thought their general practice had these services. For the first two services, participants rated items based on the unified theory of acceptance and use of technology complemented with additional constructs. These items were divided into six subscales: effort expectancy, performance expectancy, trust, attitude, facilitating conditions, and social influence. Results There were 546 participants that were included in the analyses out of 593 who met the inclusion criteria. The participants had a mean age of 53 years (SD 15.4), 43.6% (n=238) were male, and 66.8% (n=365) had at least one chronic illness. Actual use of the services varied between 0% (n=0, video consultation) and 10.4% (n=57, requesting prescription refill by Internet). The proportion of participants with a positive intention to use the service varied between 14.7% (n=80, video consultation) and 48.7% (n=266, Internet access to medical data). For each service, approximately half indicated that they did not know whether the service was available. Univariate logistic regression analyses revealed that all the constructs as well as age, level of education, and Internet usage had a significant association with intention toward using Internet appointment planning and asking questions by Internet. Conclusions Internet communication services to contact the general practice are not yet frequently used by this population. Although a substantial number of persons have a positive intention toward using such services, not all people who receive primary care seem willing to use them. The lack of awareness of the availability and functionality of such services might play an important role. PMID:26601596

Perspectives of Nurses Toward Telehealth Efficacy and Quality of Health Care: Pilot Study

PubMed Central

Bastola, Dhundy R

2018-01-01

Background Telehealth nursing, or the delivery, management, and coordination of nursing care services provided via telecommunications technology, is one of the methods of delivering health care to patients in the United States. It is important to assess the service quality of the involved health professionals as well as the telehealth nursing process. The focus of this study is the innovative model of telehealth care delivery by nurses for managing patients with chronic disease while they are living in their own residence. Objective The primary objective of this pilot study was to examine whether telehealth technology impacts the perceived level of internal service quality delivered by nurses within a telehealth organization. To address this research goal, the notion of telehealth nursing service quality (TNSQ) is empirically tested and validated with a survey instrument. Methods Data were collected from nurses belonging to a home care agency based on interview questions inquiring about facilitators and inhibitors to TNSQ. A survey to measure TNSQ based on the SERVQUAL instrument was completed by adjusting descriptions of the original instrument to suit the context. Follow-up interviews were conducted to validate questions on the revised instrument. Results The findings of this survey research were positive, based on mean differences between expectations and perceptions of TNSQ. This indicates satisfaction with TNSQ and shows that the quality of the service is higher than what the respondents expect. The Wilcoxon signed-rank test using the P value for the test, which is .35, did not show a statistically significant change between the median differences of perception and expectation. The total number of respondents was 13. Results indicate that overall perceived service quality is a positive value (0.05332). This means the perceptions of the level of service are slightly higher than what they expect, indicating there is satisfaction with TNSQ. Conclusions The responses to the interview questions and data gathered from the survey showed overall satisfaction with TNSQ. The SERVQUAL instrument was a good framework to assess TNSQ. In a nutshell, the study highlighted how the telehealth process provides daily monitoring of patient health, leading to the benefits of immediate feedback for patients, family, and caregivers as well as convenience of scheduling. PMID:29802089

[Use of customer relationship management to improve healthcare for citizens. The 24h Andalusian Health Service: Healthline].

PubMed

Quero, Manuel; Ramos, María Belén; López, Wilfredo; Cubillas, Juan José; González, José María; Castillo, José Luis

2016-01-01

Salud Responde (in English: Healthline) is a Health Service and Information Centre of the taxpayer-funded Andalusian Health System (AHS) that offers a Telephone Health Advisory Service called SA24h, among other services. The main objective of SA24h is to inform and advise citizens on health issues and the available health resources of the AHS. SA24h has a Customer Relationship Management information technology tool that organises information at various levels of specialization. Depending on the difficulty of the query, the citizen is attended by professionals with distinct profiles, providing a consensual response within the professionals working within Salud Responde or within other healthcare levels of the AHS. SA24h provided responses to 757,168 patient queries from late 2008 to the end of 01/12/2015. A total of 9.38% of the consultations were resolved by the non-health professionals working at Salud Responde. The remaining 84.07% were resolved by health staff. A total of 6.5% of users were referred to accident and emergency facilities while 88.77% did not need to attend their general practitioner within the next 24hours, thus avoiding unnecessary visits to health care facilities. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

The school bus routing and scheduling problem with transfers

PubMed Central

Doerner, Karl F.; Parragh, Sophie N.

2015-01-01

In this article, we study the school bus routing and scheduling problem with transfers arising in the field of nonperiodic public transportation systems. It deals with the transportation of pupils from home to their school in the morning taking the possibility that pupils may change buses into account. Allowing transfers has several consequences. On the one hand, it allows more flexibility in the bus network structure and can, therefore, help to reduce operating costs. On the other hand, transfers have an impact on the service level: the perceived service quality is lower due to the existence of transfers; however, at the same time, user ride times may be reduced and, thus, transfers may also have a positive impact on service quality. The main objective is the minimization of the total operating costs. We develop a heuristic solution framework to solve this problem and compare it with two solution concepts that do not consider transfers. The impact of transfers on the service level in terms of time loss (or user ride time) and the number of transfers is analyzed. Our results show that allowing transfers reduces total operating costs significantly while average and maximum user ride times are comparable to solutions without transfers. © 2015 Wiley Periodicals, Inc. NETWORKS, Vol. 65(2), 180–203 2015 PMID:28163329

Ethical Challenges of Randomized Violence Intervention Trials: Examining the SHARE intervention in Rakai, Uganda

PubMed Central

Wagman, Jennifer A.; Paul, Amy; Namatovu, Fredinah; Ssekubugu, Robert; Nalugoda, Fred

2016-01-01

Objective We identify complexities encountered, including unanticipated crossover between trial arms and inadequate ‘standard of care’ violence services, during a cluster randomized trial (CRT) of a community-level intimate partner violence (IPV) and HIV prevention intervention in Uganda. Methods Concepts in public health ethics - beneficence, social value of research, fairness, standard of care, and researcher responsibilities for post-trial benefits - are used to critically reflect on lessons learned and guide discussion on practical and ethical challenges of violence intervention CRTs. Results Existing ethical guidelines provide incomplete guidance for responding to unexpected crossover in CRTs providing IPV services. We struggled to balance duty of care with upholding trial integrity, and identifying and providing appropriate standard of care. While we ultimately offered short-term IPV services to controls, we faced additional challenges related to sustaining services beyond the ‘short-term’ and post-trial. Conclusion Studies evaluating community-level violence interventions, including those combined with HIV reduction strategies, are limited yet critical for developing evidence-based approaches for effectively preventing IPV. Although CRTs are a promising design, further guidance is needed to implement trials that avoid introducing tensions between validity of findings, researchers’ responsibilities to protect participants, and equitable distribution of CRT benefits. PMID:27453794

SLA-aware differentiated QoS in elastic optical networks

NASA Astrophysics Data System (ADS)

Agrawal, Anuj; Vyas, Upama; Bhatia, Vimal; Prakash, Shashi

2017-07-01

The quality of service (QoS) offered by optical networks can be improved by accurate provisioning of service level specifications (SLSs) included in the service level agreement (SLA). A large number of users coexisting in the network require different services. Thus, a pragmatic network needs to offer a differentiated QoS to a variety of users according to the SLA contracted for different services at varying costs. In conventional wavelength division multiplexed (WDM) optical networks, service differentiation is feasible only for a limited number of users because of its fixed-grid structure. Newly introduced flex-grid based elastic optical networks (EONs) are more adaptive to traffic requirements as compared to the WDM networks because of the flexibility in their grid structure. Thus, we propose an efficient SLA provisioning algorithm with improved QoS for these flex-grid EONs empowered by optical orthogonal frequency division multiplexing (O-OFDM). The proposed algorithm, called SLA-aware differentiated QoS (SADQ), employs differentiation at the level of routing, spectrum allocation, and connection survivability. The proposed SADQ aims to accurately provision the SLA using such multilevel differentiation with an objective to improve the spectrum utilization from the network operator's perspective. SADQ is evaluated for three different CoSs under various traffic demand patterns and for different ratios of the number of requests belonging to the three considered CoSs. We propose two new SLA metrics for the improvement of functional QoS requirements, namely, security, confidentiality and survivability of high class of service (CoS) traffic. Since, to the best of our knowledge, the proposed SADQ is the first scheme in optical networks to employ exhaustive differentiation at the levels of routing, spectrum allocation, and survivability in a single algorithm, we first compare the performance of SADQ in EON and currently deployed WDM networks to assess the differentiation capability of EON and WDM networks under such differentiated service environment. The proposed SADQ is then compared with two existing benchmark routing and spectrum allocation (RSA) schemes that are also designed under EONs. Simulations indicate that the performance of SADQ is distinctly better in EON than in WDM network under differentiated QoS scenario. The comparative analysis of the proposed SADQ with the considered benchmark RSA strategies designed under EON shows the improved performance of SADQ in EON paradigm for offering differentiated services as per the SLA.

Does integration of HIV and SRH services achieve economies of scale and scope in practice? A cost function analysis of the Integra Initiative

PubMed Central

Obure, Carol Dayo; Guinness, Lorna; Sweeney, Sedona; Initiative, Integra; Vassall, Anna

2016-01-01

Objective Policy-makers have long argued about the potential efficiency gains and cost savings from integrating HIV and sexual reproductive health (SRH) services, particularly in resource-constrained settings with generalised HIV epidemics. However, until now, little empirical evidence exists on whether the hypothesised efficiency gains associated with such integration can be achieved in practice. Methods We estimated a quadratic cost function using data obtained from 40 health facilities, over a 2-year-period, in Kenya and Swaziland. The quadratic specification enables us to determine the existence of economies of scale and scope. Findings The empirical results reveal that at the current output levels, only HIV counselling and testing services are characterised by service-specific economies of scale. However, no overall economies of scale exist as all outputs are increased. The results also indicate cost complementarities between cervical cancer screening and HIV care; post-natal care and HIV care and family planning and sexually transmitted infection treatment combinations only. Conclusions The results from this analysis reveal that contrary to expectation, efficiency gains from the integration of HIV and SRH services, if any, are likely to be modest. Efficiency gains are likely to be most achievable in settings that are currently delivering HIV and SRH services at a low scale with high levels of fixed costs. The presence of cost complementarities for only three service combinations implies that careful consideration of setting-specific clinical practices and the extent to which they can be combined should be made when deciding which services to integrate. Trial registration number NCT01694862. PMID:26438349

Public-private implementation of integrated emergency response services: Case study of GVK Emergency Management and Research Institute in Karnataka, India.

PubMed

Sriram, Veena M; Gururaj, Gopalkrishna; Hyder, Adnan A

2017-12-01

Emergency medical services are important to the functioning of health systems, but these services tend to be neglected in low- and middle-income countries, such as India. In recent years, several models of pre-hospital emergency medical services have emerged in India. Research on these models holds important lessons for existing and future emergency medical service programs in low- and middle-income countries. Our objective was to provide a comprehensive description of the organizational structure and service delivery model of a public-private partnership in the southern Indian state of Karnataka, GVK Emergency Management and Research Institute, with a particular focus on its operations in Bengaluru. A case study methodology was used to explore systematically the organizational model of GVK Emergency Management and Research Institute in Karnataka. Qualitative data were collected through an in-person site visit to GVK Emergency Management and Research Institute headquarters in Bengaluru in July 2013. Three sources were used: in-depth, semistructured interviews, document review, and nonparticipant observation. Data were analyzed according to the health system "building blocks" proposed by the World Health Organization. The organization follows a standardized model across the states and union territories where they have contractual arrangements, including Karnataka. Processes for fleet maintenance, information systems/information technology and training, and deployment were well structured at the organizational level. The public-private partnership appears pro-poor in orientation; however, further demand-side research is required on the perspective of patients. Our study reveals a functional structure at the organizational level, which provides a key service at no cost to users. Detailed analyses of this nature can help inform global efforts for the development and strengthening of emergency medical services systems. Copyright © 2017 Elsevier Inc. All rights reserved.

20 CFR 638.508 - Sale of services or objects.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Sale of services or objects. 638.508 Section 638.508 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR JOB CORPS PROGRAM UNDER TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.508 Sale of services...

[PUBLIC ADMINISTRATION OF PERSONNEL POLICY IN REFORMING OF UKRAINIAN HEALTH CARE SYSTEM USING THE EXAMPLE OF DERMATOVENEREOLOGICAL SERVICE].

PubMed

Korolenko, V V; Dykun, O P; Isayenko, R M; Remennyk, O I; Avramenko, T P; Stepanenko, V I; Petrova, K I; Volosovets, O P; Lazoryshynets, V V

2014-01-01

The health care system, its modernization and optimization are among the most important functions of the modern Ukrainian state. The main goal of the reforms in the field of healthcare is to improve the health of the population, equal and fair access for all to health services of adequate quality. Important place in the health sector reform belongs to optimizing the structure and function of dermatovenereological service. The aim of this work is to address the issue of human resources management of dermatovenereological services during health sector reform in Ukraine, taking into account the real possibility of disengagement dermatovenereological providing care between providers of primary medical care level (general practitioners) and providers of secondary (specialized) and tertiary (high-specialized) medical care (dermatovenerologists and pediatrician dermatovenerologists), and coordinating interaction between these levels. During research has been found, that the major problems of human resources of dermatovenereological service are insufficient staffing and provision of health-care providers;,growth in the number of health workers of retirement age; sectoral and regional disparity of staffing; the problem of improving the skills of medical personnel; regulatory support personnel policy areas and create incentives for staff motivation; problems of rational use of human resources for health care; problems of personnel training for dermatovenereological service. Currently reforming health sector should primarily serve the needs of the population in a fairly effective medical care at all levels, to ensure that there must be sufficient qualitatively trained and motivated health workers. To achieve this goal directed overall work of the Ministry of Health of Uktaine, the National Academy of Medical Sciences of Ukraine, medical universities, regional health authorities, professional medical associations. Therefore Ukrainian dermatovenereological care, in particular fixed, needs a deep and objective medical and social audit. A necessary condition for the harmonious development of dermatovenereological service is adequate staffing to ensure it to reflect changes in the structure of the provision of the assistance at various levels, as well as their effective coordination throughout the natient's medical route.

Multilevel analysis of sports video sequences

NASA Astrophysics Data System (ADS)

Han, Jungong; Farin, Dirk; de With, Peter H. N.

2006-01-01

We propose a fully automatic and flexible framework for analysis and summarization of tennis broadcast video sequences, using visual features and specific game-context knowledge. Our framework can analyze a tennis video sequence at three levels, which provides a broad range of different analysis results. The proposed framework includes novel pixel-level and object-level tennis video processing algorithms, such as a moving-player detection taking both the color and the court (playing-field) information into account, and a player-position tracking algorithm based on a 3-D camera model. Additionally, we employ scene-level models for detecting events, like service, base-line rally and net-approach, based on a number real-world visual features. The system can summarize three forms of information: (1) all court-view playing frames in a game, (2) the moving trajectory and real-speed of each player, as well as relative position between the player and the court, (3) the semantic event segments in a game. The proposed framework is flexible in choosing the level of analysis that is desired. It is effective because the framework makes use of several visual cues obtained from the real-world domain to model important events like service, thereby increasing the accuracy of the scene-level analysis. The paper presents attractive experimental results highlighting the system efficiency and analysis capabilities.

Contribution of village cooperation unit in improving farmers incomes

NASA Astrophysics Data System (ADS)

Sibuea, M. B.; Sibuea, F. A.

2018-02-01

One of the government and private efforts to improve people’s welfare particularly to improve farmer’s income is to activate the Village Cooperation Unit (KUD). The objective of research was to know the efficiency level of farming organized by farmers together with cooperative. Theoretically some social economic variables have been known influences the rate of farmer’s income, therefore three social variables, such us the level of cooperation services, members participation and friendship among farmers with cooperation were studied. List of questions divided into forty family’s leader members of KUD which become samples. Analysis models were used production function of Cob-Douglass and Output Input Ratio models. It was concluded that level of participation and friendship partially were significantly to the income’s rate meanwhile variable of cooperation services level were not significant. Simultaneously, three factors gave very significant contribution, where R-square was 0.97 so that very significant. It’s also concluded that the biggest contribution given by the friendship level. Efficiency level or farming efforts of the farmers is very well and feasible with the average of OIR rate 19.23. This research recommended that this effort could be improved from friendship process among institution since the contribution was significantly improving the farmer’s income.

Clients' satisfaction with HIV treatment services in Bamenda, Cameroon: a cross-sectional study.

PubMed

Wung, Buh Amos; Peter, Nde Fon; Atashili, Julius

2016-07-19

Clients have explicit desires or requests for services when visiting hospitals; inadequate discovery of their needs may result in dissatisfaction. Patient satisfaction influences retention in HIV care, adherence to HAART and serves as determinant to HIV suppression. This study's objectives were to quantify clients' satisfaction with HIV services in Bamenda and determine relationship between satisfaction and clients' socio-demographic/structural characteristics. A cross-sectional study was conducted on HIV-positive patients followed-up, on treatment and who consulted in the Bamenda Regional Hospital treatment centre between July and August 2014. Participants consent was sought and data collected on client's level of satisfaction to staff-patient-communication, staff attitudes, privacy and confidentiality and staffing and amenities situations in the hospital. Data was collected using a structured questionnaire interviewer-administered by investigator and trained health personnel. Collected data was analyzed using Epi Info version 3.5.4 and clients' satisfaction measured using frequencies and percentages. A total of 384 participants took part in this study and their median age was 37 years (IQR: 29-46). Two hundred and seventy-four (71.4 %) participants were females. Overall satisfaction with HIV services was 91.2 % and participants reported less satisfaction with overall staffing and amenities situation of the centre (3.6 %). In the multivariate analysis, only being female, employed and perceiving high number of nurses working at the treatment centre remained significant predictors of overall satisfaction with HIV services. A high proportion of participants expressed satisfaction with HIV services. However, some dissatisfaction is masked in this high satisfaction level. This dissatisfaction underscores need to improve staff attitudes, staff-patient-communication, employ more staff and build better patient facilities. Future studies need to focus on assessing long-term progression of satisfaction levels with services and determinants of satisfaction involving larger samples in many treatment centres.

Building effective service linkages in primary mental health care: a narrative review part 2

PubMed Central

2011-01-01

Background Primary care services have not generally been effective in meeting mental health care needs. There is evidence that collaboration between primary care and specialist mental health services can improve clinical and organisational outcomes. It is not clear however what factors enable or hinder effective collaboration. The objective of this study was to examine the factors that enable effective collaboration between specialist mental health services and primary mental health care. Methods A narrative and thematic review of English language papers published between 1998 and 2009. An expert reference group helped formulate strategies for policy makers. Studies of descriptive and qualitative design from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted on factors reported as enablers or barriers to development of service linkages. These were tabulated by theme at clinical and organisational levels and the inter-relationship between themes was explored. Results A thematic analysis of 30 papers found the most frequently cited group of factors was "partnership formation", specifically role clarity between health care workers. Other factor groups supporting clinical partnership formation were staff support, clinician attributes, clinic physical features and evaluation and feedback. At the organisational level a supportive institutional environment of leadership and change management was important. The expert reference group then proposed strategies for collaboration that would be seen as important, acceptable and feasible. Because of the variability of study types we did not exclude on quality and findings are weighted by the number of studies. Variability in local service contexts limits the generalisation of findings. Conclusion The findings provide a framework for health planners to develop effective service linkages in primary mental health care. Our expert reference group proposed five areas of strategy for policy makers that address organisational level support, joint clinical problem solving, local joint care guidelines, staff training and supervision and feedback. PMID:21435273

The psychological and social characteristics of patients referred for NHS cosmetic surgery: quantifying clinical need.

PubMed

Cook, Sharon A; Rosser, Robert; Toone, Helen; James, M Ian; Salmon, Peter

2006-01-01

Elective cosmetic surgery is expanding in the UK in both the public and private sectors. Because resources are constrained, many cosmetic procedures are being excluded within the National Health Service. If guidelines on who can receive such surgery are to be evidence-based, information is needed about the level of dysfunction in patients referred for elective surgery and whether this is related to their degree of physical abnormality. Consecutive patients referred to a regional plastic surgery and burns unit for assessment for elective cosmetic surgery completed standardised measures of physical and psychosocial dysfunction, and indicated their perception of the degree of their abnormality and their preoccupation with it. We distinguished between patients referred for physical reasons or appearance reasons only, and compared levels of physical and psychosocial dysfunction in each with published values for community and clinical samples. Surgeons indicated patients' degree of objective abnormality, and we identified the relationship of dysfunction with perceived and objective abnormality and preoccupation. Whether patients sought surgery for physical or appearance reasons, physical function was normal. Those seeking surgery for appearance reasons only had moderate psychosocial dysfunction, but were not as impaired as clinical groups with psychological problems. Patients seeking the correction of minor skin lesions for purely appearance reasons reported excellent physical and psychosocial function. Level of function was related (negatively) to patients' preoccupation with abnormality rather than to their perceived or objective abnormality. In general, patients referred for elective cosmetic surgery did not present with significant levels of dysfunction. Moreover, levels of functioning were related to preoccupation rather than to objective abnormality. Therefore, for most patients, whether surgical treatment is generally appropriate is questionable. Future guidelines must seek to identify the small minority who do have a clinical need for surgery.

Information persistence services designed to support home care.

PubMed

Rocha, Nelson Pacheco; Queirós, Alexandra; Augusto, Filipe; Rodríguez, Yosvany Llerena; Cardoso, Carlos; Grade, José Miguel; Quintas, João

2015-03-10

Due to the challenges faced by health and social care systems, in particular those related to actual demographic trends, home care emerges as a potentially cost-effective solution to answer the needs of citizens, and to allow the reallocation of resources to alternatives to hospitalization or institutionalization. Home care services require cooperation between different actors, including health and social caregivers, care receivers, and their informal caregivers (eg, relatives or friends), across time, space, and organizational boundaries. Therefore, it is foreseeable that eHealth services can contribute to their improvement. The aim of this study is to evaluate information persistence services based on the Reference Information Model (RIM) of the Health Level Seven (HL7) version 3 to support formal caregivers, both health and social care providers, and informal caregivers in the context of home care services. A pilot study was set up involving two Portuguese institutions that provide home care services for the elderly. Defining of information requirements was performed according to a comprehensive process. This included a review of the literature, observations of work activities, interviews with caregivers, care receivers and their relatives, analysis of paper documentation related to care receivers' histories, health conditions and care plans, and brainstorming groups involving specialized professionals. Following this, information objects were implemented and validated. The methodological approach, as well as the information persistence services, proved to be robust and adequate to specify, implement, and validate different types of information objects related to home care services for the elderly. This study also reinforces the application of the RIM of the HL7 version 3 beyond the strict scope of health care, allowing the persistence of not only health care information, but also information related to social assistance activities. This study contributes to the ongoing efforts related to the development of eHealth applications to improve the cooperation among formal health care and social caregivers, as well as care receivers and their informal caregivers.

Implementing a continuum of evidence-based psychosocial interventions for people with severe mental illness: part 1-review of major initiatives and implementation strategies.

PubMed

Menear, Matthew; Briand, Catherine

2014-04-01

Providing comprehensive care to people with severe mental illness (SMI) involves moving beyond pharmacological treatment and ensuring access to a wide range of evidence-based psychosocial services. Numerous initiatives carried out in North America and internationally have promoted the widespread adoption of such services. Objectives of this rapid review were 3-fold: to identify these implementation initiatives, to describe the implementation strategies used to promote the uptake of psychosocial services, and to identify key issues related to the implementation of a broad range of services. Part 1 presents findings for objectives 1 and 2 of the review. Searches were carried out in MEDLINE and PsycINFO for reports published between 1990 and 2012 using key words related to SMI, psychosocial practices, and implementation. Contacts with experts and reference list and reverse citation searches were also conducted. Fifty-five articles were retained that identified more than a dozen major North American and international implementation initiatives. Initiative leaders employed diverse strategies at the planning, execution, and evaluation stages of the implementation process. Stakeholder meetings, training, ongoing consultation, and quality or fidelity monitoring were strategies consistently adopted across most initiatives, whereas theory-based approaches and organizational- and system-level strategies were less frequently described. Insights from the initiatives identified in this review can help guide future efforts to implement a broad range of psychosocial services for people with SMI. However, such efforts will also need to be informed by more rigorous, theory-based studies of implementation processes and outcomes.

DoD Role in Counterdrug Operations - Can We Achieve Better Results?

DTIC Science & Technology

1999-04-01

drug detection 34 requirement. Tests showed fully loaded containers can be effectively screened for narcotics with high energy X - ray technologies...The DOD and the U.S. Customs Service are procuring X - ray systems with higher energy level, mobile X - ray systems, and even more advanced handheld...reduction in domestic marijuana cultivation and methamphetamine production by the year 2002. Long term objectives include a 30 percent reduction in the flow

Iran: Regional Stability

DTIC Science & Technology

1975-04-01

Iranian plan to specify the underlying development strategy , the overall development objectives, 7 and some sectoral growth targets. Iran’s Fourth Plan...current prices was estimated at 4.42 billion dollars; at the end of the decade it had more than tripled to reach a level of about 14.9 billion dollars...Military Service- 2 years. Total armed forces- 112,500. Army: 100,000. 2 amoured divisions, each of 2 armd bdes and 1 mech bde. 3 infantry divisions

Custodial Services and Building Maint: Performance Objectives.

ERIC Educational Resources Information Center

Downing, Charles; And Others

Several intermediate performance objectives and corresponding criterion measures are listed for each of 14 terminal objectives for high school custodial service and building maintenance course (the third year of a 3-year program). The materials were developed for a 36-week course (3 hours daily) designed to prepare 12th graders with entry level…

42 CFR 405.1024 - Objections to the issues.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Objections to the issues. 405.1024 Section 405.1024 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE... issues. (a) If a party objects to the issues described in the notice of hearing, he or she must notify...

Involving older people in intermediate care.

PubMed

Andrews, JoyAnn; Manthorpe, Jill; Watson, Roger

2004-05-01

Intermediate care has become a crucial part of the United Kingdom government's programme for improving services for older people. Older people comprise a substantial part of the user base for these services, and it is increasingly recognized that there is a need for greater user involvement in service development for intermediate care. National initiatives undertaken in intermediate care have sought to widen and deepen the remit of such services, and in this way promote greater independence and improved quality of care for older people. In particular, the government has set out clear plans for reshaping services for older people in the National Health Service Plan and the rationale for greater involvement of older people in service development. This article considers ways in which these national and local objectives may be achieved and considers some of the implications for nursing. This paper aims to explore the concept of intermediate care and to identify trends and existing evidence of user involvement in care. In this way it charts a possible way forward for the development of a more 'user sensitive' approach. The following databases were searched: Medline, Cochrane Library, the Social Science Citation Index and CINAHL. Key words were 'intermediate care', 'older people', 'formal care', 'primary care', 'social services' and 'geriatrics', used in combination. The findings from this study indicate that there is considerable scope for increased user involvement in service development for intermediate care. Such challenges may be more effectively met through greater clarity of the concept of intermediate care, and a bridging of user involvement at the practice and policy levels. Nurses are key providers of intermediate care in the community. The involvement of older people in intermediate care service development must be premised on a shared comprehension of the purpose and function of intermediate care. Nurses must be involved in shifting intermediate care from being service-focused to patient-centred. Effective participation eschews the application of global constructs for older people, while supporting greater participation at all levels and robust implementation processes.

Implications of external price referencing of pharmaceuticals in Middle East countries.

PubMed

Kaló, Zoltán; Alabbadi, Ibrahim; Al Ahdab, Ola Ghaleb; Alowayesh, Maryam; Elmahdawy, Mahmoud; Al-Saggabi, Abdulaziz H; Tanzi, Vito Luigi; Al-Badriyeh, Daoud; Alsultan, Hamad S; Ali, Faleh Mohamed Hussain; Elsisi, Gihan H; Akhras, Kasem S; Vokó, Zoltán; Kanavos, Panos

2015-01-01

External price referencing (EPR) is applied frequently to control pharmaceutical prices. Our objective was to analyse how EPR is used in Middle Eastern (ME) countries and to compare the price corridor for original pharmaceuticals to non-pharmaceutical services not subjected to EPR. We conducted a survey on EPR regulations and collected prices of 16 patented pharmaceuticals and 14 non-pharmaceutical services in seven Middle Eastern (ME) countries. Maximum and minimum prices of each pharmaceutical and non-pharmaceutical technology were compared to mean prices in the countries studied by using market exchange rates. Influencing factors of pharmaceutical prices were assessed by multivariate linear regression analysis. The average price corridor is narrower for pharmaceuticals (-39.8%; +35.9%) than for outpatient and hospital services (-81.7%; +96.3%). Our analysis revealed the importance of population size and EPR implementation on drug price levels; however, EPR results in higher pharmaceutical prices in lower-income countries compared to non-pharmaceutical services.

The role of service areas in the optimization of FSS orbital and frequency assignments

NASA Technical Reports Server (NTRS)

Levis, C. A.; Wang, C.-W.; Yamamura, Y.; Reilly, C. H.; Gonsalvez, D. J.

1986-01-01

An implicit relationship is derived which relates the topocentric separation of two satellites required for a given level of single-entry protection to the separation and orientation of their service areas. The results are presented explicitly for circular beams and topocentric angles. A computational approach is given for elliptical beams and for use with longitude and latitude variables. It is found that the geocentric separation depends primarily on the service area separation, secondarily on a parameter which characterizes the electrical design, and only slightly on the mean orbital position of the satellites. Both linear programming and mixed integer programming algorithms are implemented. Possible objective function choices are discussed, and explicit formulations are presented for the choice of the sum of the absolute deviations of the orbital locations from some prescribed 'ideal' location set. A test problem involving six service areas is examined with results that are encouraging with respect to applying the linear programming procedure to larger scenarios.

Patterns of Service Use in Two Types of Managed Behavioral Health Care Plan

PubMed Central

Merrick, Elizabeth Levy; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M.; Azzone, Vanessa; McCann, Bernard; Ritter, Grant; Zolotusky, Galina; McGuire, Thomas G.; Reif, Sharon

2009-01-01

Objective To describe service use patterns by level of care in two managed care products: employee assistance program (EAP) combined with behavioral health benefits, and standard behavioral health benefits. Methods This is a cross-sectional analysis of administrative data for 2004 from a national managed behavioral health care organization (MBHO). Utilization of 11 specific service categories was compared across products. The weighted sample reflected exact matching on sociodemographics (N= 710,014 unweighted; 286,750 weighted). Results In the EAP/behavioral health product,, the proportion of enrollees with outpatient mental health and substance abuse office visits (including EAP) was higher (p<.01), as was substance abuse day treatment/intensive outpatient care (p<.05). Use of residential substance abuse rehabilitation was lower (p<.05). Other differences were also found. Conclusion EAP/behavioral health and standard behavioral health care products had distinct utilization patterns in this large MBHO. In particular, greater use of certain outpatient services was observed within the EAP/behavioral health product. PMID:20044425

Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies.

PubMed

Schuklenk, Udo; Smalling, Ricardo

2017-04-01

We describe a number of conscientious objection cases in a liberal Western democracy. These cases strongly suggest that the typical conscientious objector does not object to unreasonable, controversial professional services-involving torture, for instance-but to the provision of professional services that are both uncontroversially legal and that patients are entitled to receive. We analyse the conflict between these patients' access rights and the conscientious objection accommodation demanded by monopoly providers of such healthcare services. It is implausible that professionals who voluntarily join a profession should be endowed with a legal claim not to provide services that are within the scope of the profession's practice and that society expects them to provide. We discuss common counterarguments to this view and reject all of them. 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/.

BioServices: a common Python package to access biological Web Services programmatically.

PubMed

Cokelaer, Thomas; Pultz, Dennis; Harder, Lea M; Serra-Musach, Jordi; Saez-Rodriguez, Julio

2013-12-15

Web interfaces provide access to numerous biological databases. Many can be accessed to in a programmatic way thanks to Web Services. Building applications that combine several of them would benefit from a single framework. BioServices is a comprehensive Python framework that provides programmatic access to major bioinformatics Web Services (e.g. KEGG, UniProt, BioModels, ChEMBLdb). Wrapping additional Web Services based either on Representational State Transfer or Simple Object Access Protocol/Web Services Description Language technologies is eased by the usage of object-oriented programming. BioServices releases and documentation are available at http://pypi.python.org/pypi/bioservices under a GPL-v3 license.

Satellite provided customer promises services, a forecast of potential domestic demand through the year 2000. Volume 4: Sensitivity analysis

NASA Technical Reports Server (NTRS)

Kratochvil, D.; Bowyer, J.; Bhushan, C.; Steinnagel, K.; Kaushal, D.; Al-Kinani, G.

1984-01-01

The overall purpose was to forecast the potential United States domestic telecommunications demand for satellite provided customer promises voice, data and video services through the year 2000, so that this information on service demand would be available to aid in NASA program planning. To accomplish this overall purpose the following objectives were achieved: (1) development of a forecast of the total domestic telecommunications demand; (2) identification of that portion of the telecommunications demand suitable for transmission by satellite systems; (3) identification of that portion of the satellite market addressable by consumer promises service (CPS) systems; (4) identification of that portion of the satellite market addressable by Ka-band CPS system; and (5) postulation of a Ka-band CPS network on a nationwide and local level. The approach employed included the use of a variety of forecasting models, a parametric cost model, a market distribution model and a network optimization model. Forecasts were developed for: 1980, 1990, and 2000; voice, data and video services; terrestrial and satellite delivery modes; and C, Ku and Ka-bands.

[Some aspects regarding occupational health in small and middle enterprises].

PubMed

Bîclea, Carmen; Silion, I

2010-01-01

The objective of the study was to assess occupational health services in small and medium enterprises (SME's) in Bacău, between 2007 and 2008, in order to increase the quality of services' management. Five hundred seventy nine SME's with 21,815 employees have been studied, with a number of employees varying from ten to 250 per enterprise. About 4478 employees, out of which 587 with different occupational exposures, have no occupational health services provided on a contract basis. The high number of occupational diseases and work related accidents in SME's show a low level of concern for occupational health and safety matters, compared to big enterprises. The employees' opinions showed that the role of occupational health is not known, there is no concern for the medical adaptation of new employees or old employees rehired after a long break, the employees do not consult occupational health services on their own accord. The occupational services do not fully satisfy the need. The study offers useful data to physicians and SME's management in order to improve the occupational health management.

Satellite provided customer promises services, a forecast of potential domestic demand through the year 2000. Volume 4: Sensitivity analysis

NASA Astrophysics Data System (ADS)

Kratochvil, D.; Bowyer, J.; Bhushan, C.; Steinnagel, K.; Kaushal, D.; Al-Kinani, G.

1984-03-01

The overall purpose was to forecast the potential United States domestic telecommunications demand for satellite provided customer promises voice, data and video services through the year 2000, so that this information on service demand would be available to aid in NASA program planning. To accomplish this overall purpose the following objectives were achieved: (1) development of a forecast of the total domestic telecommunications demand; (2) identification of that portion of the telecommunications demand suitable for transmission by satellite systems; (3) identification of that portion of the satellite market addressable by consumer promises service (CPS) systems; (4) identification of that portion of the satellite market addressable by Ka-band CPS system; and (5) postulation of a Ka-band CPS network on a nationwide and local level. The approach employed included the use of a variety of forecasting models, a parametric cost model, a market distribution model and a network optimization model. Forecasts were developed for: 1980, 1990, and 2000; voice, data and video services; terrestrial and satellite delivery modes; and C, Ku and Ka-bands.

The costs of scaling up HIV prevention for high risk groups: lessons learned from the Avahan Programme in India.

PubMed

Chandrashekar, Sudhashree; Guinness, Lorna; Pickles, Michael; Shetty, Govindraj Y; Alary, Michel; Vickerman, Peter; Vassall, Anna

2014-01-01

The study objective is to measure, analyse costs of scaling up HIV prevention for high-risk groups in India, in order to assist the design of future HIV prevention programmes in South Asia and beyond. Prospective costing study. This study is one of the most comprehensive studies of the costs of HIV prevention for high-risk groups to date in both its scope and size. HIV prevention included outreach, sexually transmitted infections (STI) services, condom provision, expertise enhancement, community mobilisation and enabling environment activities. Economic costs were collected from 138 non-government organisations (NGOs) in 64 districts, four state level lead implementing partners (SLPs), and the national programme level (Bill and Melinda Gates Foundation (BMGF)) office over four years using a top down costing approach, presented in US$ 2011. Mean total unit costs (2004-08) per person reached at least once a year and per monthly contact were US$ 235(56-1864) and US$ 82(12-969) respectively. 35% of the cost was incurred by NGOs, 30% at the state level SLP and 35% at the national programme level. The proportion of total costs by activity were 34% for expertise enhancement, 37% for programme management (including support and supervision), 22% for core HIV prevention activities (outreach and STI services) and 7% for community mobilisation and enabling environment activities. Total unit cost per person reached fell sharply as the programme expanded due to declining unit costs above the service level (from US$ 477 per person reached in 2004 to US$ 145 per person reached in 2008). At the service level also unit costs decreased slightly over time from US$ 68 to US$ 64 per person reached. Scaling up HIV prevention for high risk groups requires significant investment in expertise enhancement and programme administration. However, unit costs decreased with programme expansion in spite of an increase in the scope of activities.

Distributive Effects of Forest Service Attempts to Maintain Community Stability

Treesearch

Steven E. Daniels; William F. Hyde; David N. Wear

1991-01-01

Community stability is an objective of USDA Forest Service timber sales. This paper examines that objective, and the success the Forest Service can have in attaining it, through its intended maintenance of a constant volume timber harvest schedule. We apply a three-factor, two-sector modified general equilibrium model with empirical evidence from the timber-based...

Problems and Expectations of University Students Attending Higher Education in Turkey: Orientation Services

ERIC Educational Resources Information Center

Kutlu, Mustafa

2005-01-01

The objective of this research is to find out the problems and expectations of the students in Inonu University (in Malatya, a city in east Turkey) concerning the orientation services. An additional objective is to ascertain whether students' expectations with regard to orientation services differ according to their sex, their place of origin, and…

The association between attributions of responsibility for motor vehicle accidents and patient satisfaction: a study within a no-fault injury compensation system.

PubMed

Thompson, Jason; Berk, Michael; O'Donnell, Meaghan; Stafford, Lesley; Nordfjaern, Trond

2015-05-01

This study set out to test the relationship between attributions of responsibility for motor vehicle accidents and satisfaction with personal injury compensation systems. The study analysed survey data from 1394 people injured in a motor vehicle accident who were compensated under a no-fault personal injury compensation system. Patients' ratings of satisfaction with the compensation system across five domains (resolves your issues, keeps you up-to-date, treats you as an individual, cares about you, and overall satisfaction) were analysed alongside patient attributions of responsibility for their accident (not responsible, partly responsible, totally responsible). Postaccident physical and mental health status, age, gender, and duration of compensation claim were controlled for in the analysis. A multivariate analysis of covariance indicated attributions of responsibility for accidents were significantly associated with levels of patient satisfaction across all five domains under study (F (10, 2084) = 3.7, p<0.001, η(2)  =0.02). Despite access to virtually indistinguishable services, patients who attributed responsibility for their accidents to others were significantly less satisfied with the injury compensation system than those who attributed responsibility to themselves. Satisfaction with no-fault motor vehicle injury compensation services are associated with patients' attributions of responsibility for their accident. Compensation systems and other rehabilitation services monitoring patient satisfaction should adjust for attributions of responsibility when assessing levels of patient satisfaction between time periods, services, or injured populations. Differences in levels of patient satisfaction observed between compensation or rehabilitation populations may reflect differences in attributions of responsibility for accidents rather than objective service quality. © The Author(s) 2014.

Performance-based financing to increase utilization of maternal health services: Evidence from Burkina Faso.

PubMed

Steenland, Maria; Robyn, Paul Jacob; Compaore, Philippe; Kabore, Moussa; Tapsoba, Boukary; Zongo, Aloys; Haidara, Ousmane Diadie; Fink, Günther

2017-12-01

Performance-based financing (PBF) programs are increasingly implemented in low and middle-income countries to improve health service quality and utilization. In April 2011, a PBF pilot program was launched in Boulsa, Leo and Titao districts in Burkina Faso with the objective of increasing the provision and quality of maternal health services. We evaluate the impact of this program using facility-level administrative data from the national health management information system (HMIS). Primary outcomes were the number of antenatal care visits, the proportion of antenatal care visits that occurred during the first trimester of pregnancy, the number of institutional deliveries and the number of postnatal care visits. To assess program impact we use a difference-in-differences approach, comparing changes in health service provision post-introduction with changes in matched comparison areas. All models were estimated using ordinary least squares (OLS) regression models with standard errors clustered at the facility level. On average, PBF facilities had 2.3 more antenatal care visits (95% CI [0.446-4.225]), 2.1 more deliveries (95% CI [0.034-4.069]) and 9.5 more postnatal care visits (95% CI [6.099, 12.903]) each month after the introduction of PBF. Compared to the service provision levels prior to the interventions, this implies a relative increase of 27.7 percent for ANC, of 9.2 percent for deliveries, and of 118.7 percent for postnatal care. Given the positive results observed during the pre-pilot period and the limited resources available in the health sector, the PBF program in Burkina Faso may be a low-cost, high impact intervention to improve maternal and child health.

Determining the impacts of hospital cost-sharing on the uninsured near-poor households in Vietnam

PubMed Central

2014-01-01

Objectives The study objective was to identify the size of different hospital financing sources for different hospital services and their impact on the uninsured. Methods A panel dataset of 84 public general hospitals (2005–2008) with cross-section data on hospital activity and hospital revenue was created and used to calculate unit costs of different hospital services by applying multiple regression models. The resulting risk of catastrophic health expenditure (CHE) was estimated based on official income statistics. Results Average user fees (UF) for outpatient visits and inpatient bed days were US$4.13 and US$20.27, while actual full costs (AFC) were US$8.41 and US$36.66, respectively. These unit costs were 2.5 times higher in hospitals at the central versus the provincial level. UF for surgical inpatient bed days were 3.6 times that of non-surgical treatments (US$47.50 vs. 12.87) and AFC 5.0 times (US$101.72 vs. 20.08). UF accounted for 44.6%-77.9% of the AFC, the rest (22.1%-55.4%) was provided by direct government support (DGS). One surgical inpatient treatment at either central or provincial hospital level and one non-surgical inpatient treatment at central hospital level, immediately pushed uninsured near-poor households at risk of CHE. Conclusions Around 45% of hospital AFC was paid by DGS, the larger rest by UF. UF have become a great financial burden on the uninsured near-poor households, who have to pay for these out-of-pocket and therefore may not utilize even necessary services. If the rate of DGS were reduced, this would have the effect of increasing UF, but the savings to Government could be spent on subsidizing insurance to ensure that a larger part of the population can cover UF through insurance, especially the near-poor households. PMID:24885268

OpenID Connect as a security service in cloud-based medical imaging systems

PubMed Central

Ma, Weina; Sartipi, Kamran; Sharghigoorabi, Hassan; Koff, David; Bak, Peter

2016-01-01

Abstract. The evolution of cloud computing is driving the next generation of medical imaging systems. However, privacy and security concerns have been consistently regarded as the major obstacles for adoption of cloud computing by healthcare domains. OpenID Connect, combining OpenID and OAuth together, is an emerging representational state transfer-based federated identity solution. It is one of the most adopted open standards to potentially become the de facto standard for securing cloud computing and mobile applications, which is also regarded as “Kerberos of cloud.” We introduce OpenID Connect as an authentication and authorization service in cloud-based diagnostic imaging (DI) systems, and propose enhancements that allow for incorporating this technology within distributed enterprise environments. The objective of this study is to offer solutions for secure sharing of medical images among diagnostic imaging repository (DI-r) and heterogeneous picture archiving and communication systems (PACS) as well as Web-based and mobile clients in the cloud ecosystem. The main objective is to use OpenID Connect open-source single sign-on and authorization service and in a user-centric manner, while deploying DI-r and PACS to private or community clouds should provide equivalent security levels to traditional computing model. PMID:27340682

Self-adaptive Fault-Tolerance of HLA-Based Simulations in the Grid Environment

NASA Astrophysics Data System (ADS)

Huang, Jijie; Chai, Xudong; Zhang, Lin; Li, Bo Hu

The objects of a HLA-based simulation can access model services to update their attributes. However, the grid server may be overloaded and refuse the model service to handle objects accesses. Because these objects have been accessed this model service during last simulation loop and their medium state are stored in this server, this may terminate the simulation. A fault-tolerance mechanism must be introduced into simulations. But the traditional fault-tolerance methods cannot meet the above needs because the transmission latency between a federate and the RTI in grid environment varies from several hundred milliseconds to several seconds. By adding model service URLs to the OMT and expanding the HLA services and model services with some interfaces, this paper proposes a self-adaptive fault-tolerance mechanism of simulations according to the characteristics of federates accessing model services. Benchmark experiments indicate that the expanded HLA/RTI can make simulations self-adaptively run in the grid environment.

A component-based, distributed object services architecture for a clinical workstation.

PubMed

Chueh, H C; Raila, W F; Pappas, J J; Ford, M; Zatsman, P; Tu, J; Barnett, G O

1996-01-01

Attention to an architectural framework in the development of clinical applications can promote reusability of both legacy systems as well as newly designed software. We describe one approach to an architecture for a clinical workstation application which is based on a critical middle tier of distributed object-oriented services. This tier of network-based services provides flexibility in the creation of both the user interface and the database tiers. We developed a clinical workstation for ambulatory care using this architecture, defining a number of core services including those for vocabulary, patient index, documents, charting, security, and encounter management. These services can be implemented through proprietary or more standard distributed object interfaces such as CORBA and OLE. Services are accessed over the network by a collection of user interface components which can be mixed and matched to form a variety of interface styles. These services have also been reused with several applications based on World Wide Web browser interfaces.

A component-based, distributed object services architecture for a clinical workstation.

PubMed Central

Chueh, H. C.; Raila, W. F.; Pappas, J. J.; Ford, M.; Zatsman, P.; Tu, J.; Barnett, G. O.

1996-01-01

Attention to an architectural framework in the development of clinical applications can promote reusability of both legacy systems as well as newly designed software. We describe one approach to an architecture for a clinical workstation application which is based on a critical middle tier of distributed object-oriented services. This tier of network-based services provides flexibility in the creation of both the user interface and the database tiers. We developed a clinical workstation for ambulatory care using this architecture, defining a number of core services including those for vocabulary, patient index, documents, charting, security, and encounter management. These services can be implemented through proprietary or more standard distributed object interfaces such as CORBA and OLE. Services are accessed over the network by a collection of user interface components which can be mixed and matched to form a variety of interface styles. These services have also been reused with several applications based on World Wide Web browser interfaces. PMID:8947744

A periodic review integrated inventory model with controllable setup cost, imperfect items, and inspection errors under service level constraint

NASA Astrophysics Data System (ADS)

Saga, R. S.; Jauhari, W. A.; Laksono, P. W.

2017-11-01

This paper presents an integrated inventory model which consists of single vendor and buyer. The buyer managed its inventory periodically and orders products from the vendor to satisfy the end customer’s demand, where the annual demand and the ordering cost were in the fuzzy environment. The buyer used a service level constraint instead of the stock-out cost term, so that the stock-out level per cycle was bounded. Then, the vendor produced and delivered products to the buyer. The vendor had a choice to commit an investment to reduce the setup cost. However, the vendor’s production process was imperfect, thus the lot delivered contained some defective products. Moreover, the buyer’s inspection process was not error-free since the inspector could be mistaken in categorizing the product’s quality. The objective was to find the optimum value for the review period, the setup cost, and the number of deliveries in one production cycle which might minimize the joint total cost. Furthermore, the algorithm and numerical example were provided to illustrate the application of the model.

Diabetes Outcomes in the Indian Health System During the Era of the Special Diabetes Program for Indians and the Government Performance and Results Act

PubMed Central

Wilson, Charlton; Gilliland, Susan; Cullen, Theresa; Moore, Kelly; Roubideaux, Yvette; Valdez, Lorraine; Vanderwagen, William; Acton, Kelly

2005-01-01

Objectives. We reviewed changes in blood glucose, blood pressure, and cholesterol levels among American Indians and Alaska Natives between 1995 and 2001 to estimate the quality of diabetes care in the Indian Health Service (IHS) health care delivery system. Methods. We conducted a cross-sectional analysis of data from the Indian Health Service Diabetes Care and Outcomes Audit. Results. Adjusted mean Hemoglobin A1c (HbA1c) levels (7.9% vs 8.9%) and mean diastolic blood pressure levels (76 vs 79 mm Hg) were lower in 2001 than in 1995, respectively. A similar pattern was observed for mean total cholesterol (193 vs 208 mg/dL) and triglyceride (235 vs 257 mg/dL) levels in 2001 and 1995, respectively. Conclusions. We identified changes in intermediate clinical outcomes over the period from 1995 to 2001 that may reflect the global impact of increased resource allocation and improvements in processes on the quality of diabetes care, and we describe the results that may be achieved when community, health program, and congressional initiatives focus on common goals. PMID:16051933

Assessment of an Innovative Voluntary Substance Abuse Treatment Program Designed to Replace Compulsory Drug Detention Centers in Malaysia

PubMed Central

Khan, Farrah; Krishnan, Archana; Ghani, Mansur A.; Wickersham, Jeffrey A.; Fu, Jeannia J.; Lim, Sin How; Dhaliwal, Sangeeth Kaur; Kamarulzaman, Adeeba; Altice, Frederick L.

2017-01-01

Background As part of an ongoing initiative by the Malaysian government to implement alternative approaches to involuntary detention of people who use drugs, the National Anti-Drug Agency has created new voluntary drug treatment programs known as Cure and Care (C&C) Centers that provide free access to addiction treatment services, including methadone maintenance therapy, integrated with social and health services. Objectives We evaluated early treatment outcomes and client satisfaction among patients accessing C&C treatment and ancillary services at Malaysia’s second C&C Center located in Kota Bharu, Kelantan. Methods In June–July 2012, a cross-sectional convenience survey of 96 C&C inpatients and outpatients who entered treatment >30 days previously was conducted to assess drug use, criminal justice experience, medical co-morbidities, motivation for seeking treatment, and attitudes towards the C&C. Drug use was compared for the 30-day-period before C&C entry and the 30-day-period before the interview. Results Self-reported drug use levels decreased significantly among both inpatient and outpatient clients after enrolling in C&C treatment. Higher levels of past drug use, lower levels of social support, and more severe mental health issues were reported by participants who were previously imprisoned. Self-reported satisfaction with C&C treatment services was high. Conclusions/Importance Preliminary evidence of reduced drug use and high levels of client satisfaction among C&C clients provide support for Malaysia’s ongoing transition from compulsory drug detention centers (CDDCs) to these voluntary drug treatment centers. If C&C centers are successful, Malaysia plans to gradually transition away from CDDCs entirely. PMID:28635521

Strengthening professionals: a chapter-level formative evaluation of the Medical Library Association mentoring initiative.

PubMed

Kwasik, Hanna; Fulda, Pauline O

2006-01-01

The main objective was to determine to what extent the Medical Library Association (MLA) mentoring initiative was implemented in the South Central Chapter of the Medical Library Association (SCC/ MLA) and to identify the needs, improvements, and adjustments in mentoring services for the future to improve the practice of librarianship. The data were collected by administering an anonymous structured survey designed by the authors. The survey was mailed to all 335 chapter members. The authors elicited responses to determine the chapter members' mentoring needs, awareness of available resources, satisfaction with existing services and resources, needs for the future, and suggestions to meet those needs. Of the 335 delivered surveys, 184 were returned, yielding a return rate of 55%. Eighty percent had a mentor or mentors in their careers, and 74% were either very satisfied or satisfied with the relationship. The majority considered having a mentor a critical part of the professional experience. The mentoring activity chosen by respondents as the most important was improvement of job performance through skills development. Over 50% were aware of SCC/MLA's mentoring activities, and less than 50% were aware of MLA's mentoring Website. The rate of response and the wealth of comments provided by respondents document the high level of interest in mentoring by medical librarians in the region. The following mentoring services were equally important to SCC/MLA members and were recommended for improvement or development at the regional level: a formalized mentoring program in the region, Web-based mentoring resources on the SCC/MLA Website, and a continuing education course for mentors. Members are aware of mentoring activities in the region; however, participation levels need to be increased in activities that SCC/MLA and MLA provide. Mentoring continues to evolve as a service in the profession.

An Interative Grahical User Interface for Maritime Security Services

NASA Astrophysics Data System (ADS)

Reize, T.; Müller, R.; Kiefl, R.

2013-10-01

In order to analyse optical satellite images for maritime security issues in Near-Real-Time (NRT) an interactive graphical user interface (GUI) based on NASA World Wind was developed and is presented in this article. Targets or activities can be detected, measured and classified with this tool simply and quickly. The service uses optical satellite images, currently taken from 6 sensors: Worldview-1 and Worldview-2, Ikonos, Quickbird, GeoEye-1 and EROS-B. The GUI can also handle SAR-images, air-borne images or UAV images. Software configurations are provided in a job-order file and thus all preparation tasks, such as image installation are performed fully automatically. The imagery can be overlaid with vessels derived by an automatic detection processor. These potential vessel layers can be zoomed in by a single click and sorted with an adapted method. Further object properties, such as vessel type or confidence level of identification, can be added by the operator manually. The heading angle can be refined by dragging the vessel's head or switching it to 180° with a single click. Further vessels or other relevant objects can be added. The objects length, width, heading and position are calculated automatically from three clicks on top, bottom and an arbitrary point at one of the object's longer side. In case of an Activity Detection, the detected objects can be grouped in area of interests (AOI) and classified, according to the ordered activities. All relevant information is finally written to an exchange file, after quality control and necessary correction procedures are performed. If required, image thumbnails can be cut around objects or around whole areas of interest and saved as separated, geo-referenced images.

Common object request broker architecture (CORBA)-based security services for the virtual radiology environment.

PubMed

Martinez, R; Cole, C; Rozenblit, J; Cook, J F; Chacko, A K

2000-05-01

The US Army Great Plains Regional Medical Command (GPRMC) has a requirement to conform to Department of Defense (DoD) and Army security policies for the Virtual Radiology Environment (VRE) Project. Within the DoD, security policy is defined as the set of laws, rules, and practices that regulate how an organization manages, protects, and distributes sensitive information. Security policy in the DoD is described by the Trusted Computer System Evaluation Criteria (TCSEC), Army Regulation (AR) 380-19, Defense Information Infrastructure Common Operating Environment (DII COE), Military Health Services System Automated Information Systems Security Policy Manual, and National Computer Security Center-TG-005, "Trusted Network Interpretation." These documents were used to develop a security policy that defines information protection requirements that are made with respect to those laws, rules, and practices that are required to protect the information stored and processed in the VRE Project. The goal of the security policy is to provide for a C2-level of information protection while also satisfying the functional needs of the GPRMC's user community. This report summarizes the security policy for the VRE and defines the CORBA security services that satisfy the policy. In the VRE, the information to be protected is embedded into three major information components: (1) Patient information consists of Digital Imaging and Communications in Medicine (DICOM)-formatted fields. The patient information resides in the digital imaging network picture archiving and communication system (DIN-PACS) networks in the database archive systems and includes (a) patient demographics; (b) patient images from x-ray, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US); and (c) prior patient images and related patient history. (2) Meta-Manager information to be protected consists of several data objects. This information is distributed to the Meta-Manager nodes and includes (a) radiologist schedules; (b) modality worklists; (c) routed case information; (d) DIN-PACS and Composite Health Care system (CHCS) messages, and Meta-Manager administrative and security information; and (e) patient case information. (3) Access control and communications security is required in the VRE to control who uses the VRE and Meta-Manager facilities and to secure the messages between VRE components. The CORBA Security Service Specification version 1.5 is designed to allow up to TCSEC's B2-level security for distributed objects. The CORBA Security Service Specification defines the functionality of several security features: identification and authentication, authorization and access control, security auditing, communication security, nonrepudiation, and security administration. This report describes the enhanced security features for the VRE and their implementation using commercial CORBA Security Service software products.

Home Economics. Exploration of Clothing Management, Production and Service Occupations. Performance Objectives. Criterion Measures.

ERIC Educational Resources Information Center

Duval County School Board, Jacksonville, FL.

Several intermediate performance objectives and corresponding criterion measures are presented for each of five terminal objectives for a 12- to 18-week course designed to provide students in grades 8 or 9 with opportunities to explore a broad range of clothing management, production, and service occupations. The course was designed to provide…

78 FR 6817 - Clean Air Act Operating Permit Program; Petition for Objection to State Operating Permit for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-31

... Objection to State Operating Permit for Wisconsin Public Service Corporation--JP Pulliam Plant AGENCY... McGillivray Westerberg and Bender, LLC, on behalf of the Sierra Club, to object to the operating permit for Wisconsin Public Service Corporation--JP Pulliam Plant. Pursuant to section 505(b)(2) of the Act, a...

A fuzzy MCDM model with objective and subjective weights for evaluating service quality in hotel industries

NASA Astrophysics Data System (ADS)

Zoraghi, Nima; Amiri, Maghsoud; Talebi, Golnaz; Zowghi, Mahdi

2013-12-01

This paper presents a fuzzy multi-criteria decision-making (FMCDM) model by integrating both subjective and objective weights for ranking and evaluating the service quality in hotels. The objective method selects weights of criteria through mathematical calculation, while the subjective method uses judgments of decision makers. In this paper, we use a combination of weights obtained by both approaches in evaluating service quality in hotel industries. A real case study that considered ranking five hotels is illustrated. Examples are shown to indicate capabilities of the proposed method.

Strategic planning for clinical services: St. Joseph Hospital and Health Care Center.

PubMed

Linggi, A; Pelham, L D

1986-09-01

A pharmacy department at a 340-bed community hospital based its strategic plan for developing patient-oriented services on a sound drug distribution system, a credible work-measurement program, and fiscal responsibility. In 1982 the department of pharmacy and i.v. therapy implemented a strategic plan for improving pharmaceutical services. The plan involved developing goals and objectives for the department; marketing the department's services and fiscal management to hospital administrators, medical staff, and nursing staff; building teamwork among the pharmacy staff; and improving the drug distribution system before instituting clinical services. Hiring of additional pharmacy staff was justified on the basis of work-measurement data. By adjusting staffing levels every two weeks based on work-measurement data, the department increased the efficiency of drug distribution activities; the pharmacy also implemented cost-saving programs like selection of therapeutic alternates and formulary restrictions. The savings were then reinvested in labor-intensive patient-oriented pharmaceutical services. A staff development program using staff pharmacists as preceptors expanded the breadth and depth of pharmacists' clinical skills. The planning efforts were successful because the needs of hospital administrators, the pharmacy department, and staff members were addressed.

Incarcerated Veterans Outreach Program.

PubMed

Schaffer, Bradley J

2016-01-01

The objective of this study is to identify and facilitate re-entry services for military veterans in the Criminal Justice System through the Incarcerated Veteran Outreach Program. Veterans are explored as a subgroup of the general inmate jail populations in southern Ohio based upon veteran's status, military discharges, service-related injuries, treatment needs, pre-release planning, and re-entry services. Veterans reported having psycho-social problems, diverse levels of criminality, criminogenic needs, and significant episodes of homelessness. A sample of 399 incarcerated veterans in state prison, county jails, and community corrections setting were identified and completed the psycho-social pre-release assessment. Their average age was 44.6; they were more likely to be White males, divorced, most honorably discharged, and were represented in the following eras: 34% Vietnam, 35% post-Vietnam, 26% Persian Gulf War, and 5% Operation Iraqi Freedom/Operation Enduring Freedom. The findings encourage the development of a re-entry outreach model and strategies to prevent episodes of criminal recidivism.

The Missing Link: Improving Quality With a Chronic Disease Management Intervention for the Primary Care Office

PubMed Central

Zweifler, John

2007-01-01

Bold steps are necessary to improve quality of care for patients with chronic diseases and increase satisfaction of both primary care physicians and patients. Office-based chronic disease management (CDM) workers can achieve these objectives by offering self-management support, maintaining disease registries, and monitoring compliance from the point of care. CDM workers can provide the missing link by connecting patients, primary care physicans, and CDM services sponsored by health plans or in the community. CDM workers should be supported financially by Medicare, Medicaid, and commercial health plans through reimbursements to physicians for units of service, analogous to California’s Comprehensive Perinatal Services Program. Care provided by CDM workers should be standardized, and training requirements should be sufficiently flexible to ensure wide dissemination. CDM workers can potentially improve quality while reducing costs for preventable hospitalizations and emergency department visits, but evaluation at multiple levels is recommended. PMID:17893388

Energy Efficiency and Renewable Energy Network (EREN) customer satisfaction survey, 1997. Final report

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

Anderson, A.V.; Henderson, D.P.

the EREN Customer Satisfaction Survey 1997 was designed to follow up the results of the 1995-96 Surveys, enabling comparison to the 1995- 96 baseline, and to provide additional qualitative feedback about EREN. Both the 1995-96 and 1997 Surveys had these objectives: Identify and define actual EREN users; Determine the value or benefits derived from the use of EREN; Determine the kind and quality of services that users want; Determine the users` levels of satisfaction with existing services; Determine users` preferences in both the sources of service and means of delivery; and Establish continuous quality improvement measures. This report presents themore » methodology used, scope and limitations of the study, description of the survey instrument, and findings regarding demographics, technical capabilities, usage patterns, general use, importance of and satisfaction with resources, and additional information and comments.« less

Smart Objects, Dumb Archives: A User-Centric, Layered Digital Library Framework

NASA Technical Reports Server (NTRS)

Maly, Kurt; Nelson, Michael L.; Zubair, Mohammad

1999-01-01

Currently, there exist a large number of superb digital libraries, all of which are, unfortunately, vertically integrated and all presenting a monolithic interface to their users. Ideally, a user would want to locate resources from a variety of digital libraries dealing only with one interface. A number of approaches exist to this interoperability issue exist including: defining a universal protocol for all libraries to adhere to; or developing mechanisms to translate between protocols. The approach we illustrate in this paper is to push down the level of universal protocols to one for digital object communication and for communication for simple archives. This approach creates the opportunity for digital library service providers to create digital libraries tailored to the needs of user communities drawing from available archives and individual publishers who adhere to this standard. We have created a reference implementation based on the hyper text transfer protocol (http) with the protocols being derived from the Dienst protocol. We have created a special class of digital objects called buckets and a number of archives based on a NASA collection and NSF funded projects. Starting from NCSTRL we have developed a set of digital library services called NCSTRL+ and have created digital libraries for researchers, educators and students that can each draw on all the archives and individually created buckets.

Enhancing Outcomes for Outpatient Percutaneous Coronary Interventions

PubMed Central

Spruce, Kevin; Butler, Chondra

2017-01-01

Purpose and Objectives: A quality improvement project was conducted to create a sustainable continuum of care for increased volumes of outpatients receiving percutaneous coronary interventions. Dramatic growth exposed system vulnerabilities and left staff overwhelmed. Four postinterventional project objectives included reducing preprocedural preparation times, reducing bleeding complications, reducing hospital length of stay, and collectively increasing patient satisfaction. Description of the Project: Amidst creating a specialized postintervention coronary recovery area and acquiring and training existing preregistration and recovery nurses, a fragmented system of care was united. The clinical nurse specialist–led project used a systematic and evidence-based implementation process to harmoniously acclimate perioperative staff. An evaluation process further defined new opportunities to support a growing service line. Outcomes: Postimplementation data were collected over a 3-month period. An overall improvement was found in all targeted objectives, despite an upsurge in case volumes. A moderately significant correlation (r [105] = 0.424, P < .001) was found between bleeding occurrences and hospital length of stay. Conclusion: The synergy between interdepartmental collaboration and strategic staffing reallocation was shown to be invaluable to alleviate procedural areas of service, such as the cardiac catheterization laboratory. As a project champion, the clinical nurse specialist is an essential catalyst to identify and creatively surmount system-level challenges. PMID:28991015

Evaluation of bull fertility in dairy and beef cattle using cow field data.

PubMed

Berry, D P; Evans, R D; Mc Parland, S

2011-01-01

A successful outcome to a given service is a combination of both male and female fertility. Despite this, most national evaluations for fertility are generally confined to female fertility with evaluations for male fertility commonly undertaken by individual breeding organisations and generally not made public. The objective of this study was to define a pertinent male fertility trait for seasonal calving production systems, and to develop a multiple regression mixed model that may be used to evaluate male fertility at a national level. The data included in the study after editing consisted of 361,412 artificial inseminations from 206,683 cow-lactations (134,911 cows) in 2,843 commercial dairy and beef herds. Fixed effects associated with whether a successful pregnancy ensued (pregnant = 1) or not (pregnant = 0) from a given service were year by month of service, day of the week, days since calving, cow parity, level of calving difficulty experienced, whether or not the previous calving was associated with perinatal mortality, and age of the service bull at the date of insemination. Non-additive genetic effects such as heterosis and recombination loss as well as inbreeding level of the service bull, dam or mating were not associated with a successful pregnancy; there was no difference in pregnancy rate between fresh or frozen semen. Random effects included in the model were the additive genetic effect of the cow, as well as a within lactation and across lactation permanent environmental effect of the cow; pedigree group effects based on cow breed were also included via the relationship matrix. Temporal differences in the AI technician and service bull were also included as random effects. A difference in five percentage units in male fertility was evident between the average effects of different dairy and beef breeds. The correlation between raw pregnancy rates for bulls with more than 100 services (n = 431) and service bull solutions from the mixed model analysis was 0.66. The correlation between the raw pregnancy rates of 288 technicians with more than 100 services and their respective solutions from the mixed model was 0.35. These low to moderate correlations suggest considerable re-ranking among both service bulls and technicians and suggest possibly a benefit of using a statistical model to better estimate the performance of both service bulls and technicians. Copyright © 2011 Elsevier Inc. All rights reserved.

Primary Care Performance Measurement and Reporting at a Regional Level: Could a Matrix Approach Provide Actionable Information for Policy Makers and Clinicians?

PubMed

Langton, Julia M; Wong, Sabrina T; Johnston, Sharon; Abelson, Julia; Ammi, Mehdi; Burge, Fred; Campbell, John; Haggerty, Jeannie; Hogg, William; Wodchis, Walter P; McGrail, Kimberlyn

2016-11-01

Primary care services form the foundation of modern healthcare systems, yet the breadth and complexity of services and diversity of patient populations may present challenges for creating comprehensive primary care information systems. Our objective is to develop regional-level information on the performance of primary care in Canada. A scoping review was conducted to identify existing initiatives in primary care performance measurement and reporting across 11 countries. The results of this review were used by our international team of primary care researchers and clinicians to propose an approach for regional-level primary care reporting. We found a gap between conceptual primary care performance measurement frameworks in the peer-reviewed literature and real-world primary care performance measurement and reporting activities. We did not find a conceptual framework or analytic approach that could readily form the foundation of a regional-level primary care information system. Therefore, we propose an approach to reporting comprehensive and actionable performance information according to widely accepted core domains of primary care as well as different patient population groups. An approach that bridges the gap between conceptual frameworks and real-world performance measurement and reporting initiatives could address some of the potential pitfalls of existing ways of presenting performance information (i.e., by single diseases or by age). This approach could produce meaningful and actionable information on the quality of primary care services. Copyright © 2016 Longwoods Publishing.

Invisible Care: Friend and Partner Care Among Older Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults

PubMed Central

Shiu, Chengshi; Muraco, Anna; Fredriksen-Goldsen, Karen

2016-01-01

Objective Lesbian, gay, bisexual, and transgender (LGBT) older adult caregivers may encounter obstacles in obtaining health and aging services due to discrimination in service and legal systems. The caregiving relationships in LGBT communities also differ from the general population in that friends are providing a large portion of informal care. This article examines how the relational context of caregiving relates to caregiving demands and resources, which in turn, influence perceived stress and depressive symptomatology among older LGBT caregivers. Method Using data from the National Health, Aging, and Sexuality Study: Caring and Aging with Pride, this study examines 451 participants who are providing caregiving to partners and friends. Structural equation modeling was applied to estimate the associations among the caregiver–care recipient relationship and caregiving demands, resources, perceived stress, and depressive symptomatology. Results On average, as compared with those caring for partners, those who provided care to friends reported experiencing lower levels of caregiving demands and lower levels of social support. The lower caregiving demands correlated positively with both lower perceived stress and less severe depressive symptomatology; however, the lower levels of social support were related to higher perceived stress and higher depressive symptomatology. Conclusions Caregiving provided by friends, which has long been under recognized, plays an important role in the LGBT community. Because lower levels of caregiving demands are offset by less social support, LGBT friend-caregivers experience similar levels of perceived stress and depressive symptomatology to those providing care to spouses and partners. Policy and service reforms are needed to better acknowledge the continuum of informal caregiving relationships. PMID:28367277

Availability and distribution of safe abortion services in rural areas: a facility assessment study in Madhya Pradesh, India

PubMed Central

Chaturvedi, Sarika; Ali, Sayyed; Randive, Bharat; Sabde, Yogesh; Diwan, Vishal; De Costa, Ayesha

2015-01-01

Background Unsafe abortion contributes to a significant portion of maternal mortality in India. Access to safe abortion care is known to reduce maternal mortality. Availability and distribution of abortion care facilities can influence women's access to these services, especially in rural areas. Objectives To assess the availability and distribution of abortion care at facilities providing childbirth care in three districts of Madhya Pradesh (MP) province of India. Design Three socio demographically heterogeneous districts of MP were selected for this study. Facilities conducting at least 10 deliveries a month were surveyed to assess availability and provision of abortion services using UN signal functions for emergency obstetric care. Geographical Information System was used for visualisation of the distribution of facilities. Results The three districts had 99 facilities that conducted >10 deliveries a month: 74 in public and 25 in private sector. Overall, 48% of facilities reported an ability to provide safe surgical abortion service. Of public centres, 32% reported the ability compared to 100% among private centres while 18% of public centres and 77% of private centres had performed an abortion in the last 3 months. The availability of abortion services was higher at higher facility levels with better equipped and skilled personnel availability, in urban areas and in private sector facilities. Conclusions Findings showed that availability of safe abortion care is limited especially in rural areas. More emphasis on providing safe abortion services, particularly at primary care level, is important to more significantly dent maternal mortality in India. PMID:25797220

How much does it cost to achieve coverage targets for primary healthcare services? A costing model from Aceh, Indonesia.

PubMed

Abdullah, Asnawi; Hort, Krishna; Abidin, Azwar Zaenal; Amin, Fadilah M

2012-01-01

Despite significant investment in improving service infrastructure and training of staff, public primary healthcare services in low-income and middle-income countries tend to perform poorly in reaching coverage targets. One of the factors identified in Aceh, Indonesia was the lack of operational funds for service provision. The objective of this study was to develop a simple and transparent costing tool that enables health planners to calculate the unit costs of providing basic health services to estimate additional budgets required to deliver services in accordance with national targets. The tool was developed using a standard economic approach that linked the input activities to achieving six national priority programs at primary healthcare level: health promotion, sanitation and environment health, maternal and child health and family planning, nutrition, immunization and communicable diseases control, and treatment of common illness. Costing was focused on costs of delivery of the programs that need to be funded by local government budgets. The costing tool consisting of 16 linked Microsoft Excel worksheets was developed and tested in several districts enabled the calculation of the unit costs of delivering of the six national priority programs per coverage target of each program (such as unit costs of delivering of maternal and child health program per pregnant mother). This costing tool can be used by health planners to estimate additional money required to achieve a certain level of coverage of programs, and it can be adjusted for different costs and program delivery parameters in different settings. Copyright © 2012 John Wiley & Sons, Ltd.

Effectiveness of the Smart Care Service for Diabetes Management

PubMed Central

Chung, Young-Soon; Lee, Chang Hee

2014-01-01

Objectives The aim of this study was to assess the effectiveness of the Smart Care service for the diabetes management. Methods Fifty-six patients with diabetes mellitus were recruited in Daegu, Korea. All participants completed a diabetes management education course (diet, exercise, and complications) for their self-care and received access to a care management website through a netbook and smartphone. The website accepts uploads of glucose level, body weight, HbA1c, low-density lipoprotein cholesterol level, and blood pressure. Participants communicated with the care manager through the internal management system of the website. The intervention was applied for 6 months. Results Participants receiving the Smart Care service had lower blood glucose and HbA1c during 6 months follow-up when 1-month values (p < 0.001) were compared. There was no significant difference in body weight and body mass index between 1 month and 6 months. The average number of remote consultation with the Smart Care service per person was 10.4 by nurses, 3.0 by nutritionists, and 1.6 by sports curers. Regression analysis indicated that the number of times counseling was offered by nurses influences body weight and that the number of minutes of telephone counseling influences both body weight and body mass index. Conclusions We have confirmed that the Smart Care service might be an effective system for reduction in blood glucose and HbA1c. We expect that the Smart Care service will contribute to delaying diabetes complications and improving the quality of life of patients with diabetes. PMID:25405065

Bio-inspired Autonomic Structures: a middleware for Telecommunications Ecosystems

NASA Astrophysics Data System (ADS)

Manzalini, Antonio; Minerva, Roberto; Moiso, Corrado

Today, people are making use of several devices for communications, for accessing multi-media content services, for data/information retrieving, for processing, computing, etc.: examples are laptops, PDAs, mobile phones, digital cameras, mp3 players, smart cards and smart appliances. One of the most attracting service scenarios for future Telecommunications and Internet is the one where people will be able to browse any object in the environment they live: communications, sensing and processing of data and services will be highly pervasive. In this vision, people, machines, artifacts and the surrounding space will create a kind of computational environment and, at the same time, the interfaces to the network resources. A challenging technological issue will be interconnection and management of heterogeneous systems and a huge amount of small devices tied together in networks of networks. Moreover, future network and service infrastructures should be able to provide Users and Application Developers (at different levels, e.g., residential Users but also SMEs, LEs, ASPs/Web2.0 Service roviders, ISPs, Content Providers, etc.) with the most appropriate "environment" according to their context and specific needs. Operators must be ready to manage such level of complication enabling their latforms with technological advanced allowing network and services self-supervision and self-adaptation capabilities. Autonomic software solutions, enhanced with innovative bio-inspired mechanisms and algorithms, are promising areas of long term research to face such challenges. This chapter proposes a bio-inspired autonomic middleware capable of leveraging the assets of the underlying network infrastructure whilst, at the same time, supporting the development of future Telecommunications and Internet Ecosystems.

Evaluating the uptake, acceptability, and effectiveness of Uliza! clinicians' HIV hotline: a telephone consultation service in Kenya.

PubMed

Karari, Charles; Tittle, Robin; Penner, Jeremy; Kulzer, Jayne; Bukusi, Elizabeth A; Marima, Reson; Cohen, Craig R

2011-01-01

Many clinical sites that serve patients who are HIV positive face challenges of insufficient staffing levels and staff training and have limited access to consultation resources including specialists on site. Uliza! (Swahili for "ask") Clinicians' HIV Hotline was launched in April 2006 in Nyanza province in Kenya as a HIV telephone consultation service for healthcare providers. Hotline users called an Uliza! consultant who discussed the patients' problems and helped the caller work through a solution, as well as reinforced national guidelines. This objective of this study was to evaluate the uptake, acceptability, and effectiveness of Uliza! Consultants completed a form with details of each call, and healthcare workers completed satisfaction surveys during site visits. All available medical records were audited to determine whether the advice given by the consultant was implemented. After a year of service, Uliza! responded to 296 calls. Clinical officers (64%) followed by nurses (21%) most frequently used the service. Most callers had questions regarding antiretroviral therapy (36%) or tuberculosis (18%). Thirty-six percent of all consults were pediatric questions. Ninety-four percent of users rated the service as useful. Advice given to providers was implemented and documented in the medical records in 72% of the charts audited. Healthcare providers in HIV clinics will use a telephone consultation service when easily accessible. Clinicians using Uliza! found it useful, and advice given was usually implemented. Uliza! increased access to current information for quality care in a rural and resource limited setting and has potential for scale-up to a national level.

Implementation of Evidence-Based Employment Services in Specialty Mental Health

PubMed Central

Hamilton, Alison B; Cohen, Amy N; Glover, Dawn L; Whelan, Fiona; Chemerinski, Eran; McNagny, Kirk P; Mullins, Deborah; Reist, Christopher; Schubert, Max; Young, Alexander S

2013-01-01

Objective. Study a quality improvement approach for implementing evidence-based employment services at specialty mental health clinics. Data Sources/Study Setting. Semistructured interviews with clinicians and administrators before, during, and after implementation. Qualitative field notes, structured baseline and follow-up interviews with patients, semistructured interviews with patients after implementation, and administrative data. Study Design. Site-level controlled trial at four implementation and four control sites. Hybrid implementation–effectiveness study with mixed methods intervention evaluation design. Data Collection/Extraction Methods. Site visits, in-person and telephone interviews, patient surveys, patient self-assessment. A total of 801 patients completed baseline surveys and 53 clinicians and other clinical key stakeholders completed longitudinal qualitative interviews. Principal Findings. At baseline, sites varied in the availability, utilization, and quality of supported employment. Each site needed quality improvement for this service, though for differing reasons, with some needing development of the service itself and others needing increased service capacity. Improvements in knowledge, attitudes, beliefs, and referral behaviors were evident in mid- and postimplementation interviews, though some barriers persisted. Half of patients expressed an interest in working at baseline. Patients at implementation sites were 2.3 times more likely to receive employment services during the study year. Those who had a service visit were more likely to be employed at follow-up than those who did not. Conclusions. Studies of implementation and effectiveness require mixed methods to both enhance implementation in real time and provide context for interpretation of complex results. In this study, a quality improvement approach resulted in superior patient-level outcomes and improved clinician knowledge, attitudes, and behaviors, in the context of substantial variation among sites. PMID:24138608

Service Utilization for Lifetime Mental Disorders in U.S. Adolescents: Results of the National Comorbidity Survey-Adolescent Supplement (NCS-A)

ERIC Educational Resources Information Center

Merikangas, Kathleen Ries; He, Jian-ping; Burstein, Marcy; Swendsen, Joel; Avenevoli, Shelli; Case, Brady; Georgiades, Katholiki; Heaton, Leanne; Swanson, Sonja; Olfson, Mark

2011-01-01

Objective: Mental health policy for youth has been constrained by a paucity of nationally representative data concerning patterns and correlates of mental health service utilization in this segment of the population. The objectives of this investigation were to examine the rates and sociodemographic correlates of lifetime mental health service use…

People Management. Final Report of the People Management Committee

DTIC Science & Technology

1975-04-25

Objective Memorandum Planning, Programming, C Budgeting System Personnel Priority Model Projected Requisitioning Authority Prior ServIce Quality ...April 1975 PREPARED FOR - G THE DEPARTMENT OF ARMY OFFICE OF THE DEPUTY CHIEF OF STAFF FOR PERSONNEL NATIONAL TECHNICAL INFORMATION SERVICE US... service accessions and reenllstees. (3) Manage the DEP. (4) Bolster systems discipline. d. RecommendetIons; (1) That manpower objectives

Cancer Preventive Services, Socioeconomic Status and the Affordable Care Act

PubMed Central

Cooper, Gregory S; Kou, Tzuyung Doug; Dor, Avi; Koroukian, Siran M; Schluchter, Mark D

2016-01-01

Background Out of pocket expenditures are thought to be an important barrier to receipt of cancer preventive services, especially among lower socioeconomic status (SES). The Affordable Care Act (ACA) eliminated out-of-pocket expenditures for recommended services, including mammography and colonoscopy. Our objective was to determine changes in uptake of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after ACA implementation. Methods Using Medicare claims data, we identified women ≥ 70 without mammography in the previous 2 years, and men and women ≥ 70 at increased risk for colorectal cancer without colonoscopy in the past 5 years. We identified procedure receipt in the two-year period prior to ACA implementation (2009-2010) and after implementation (2011-September 2012). Multivariable generalized estimating equation models determine the independent association of and county-level quartile of median income and education with receipt of testing. Results For mammography, lower SES quartile was associated with less uptake but the post-ACA disparities were smaller compared to the pre-ACA period. In addition, mammography rates increased from pre- to post-ACA in all SES quartiles. For colonoscopy, in both the pre- and post-ACA periods, there was an association between uptake and educational level and to some extent, income. However, there were no appreciable changes with colonoscopy and SES following the ACA. Conclusions Removal of out-of-pocket expenditures may overcome a barrier to receipt of recommended preventive services but for colonoscopy, other procedural factors may remain as deterrents. PMID:28067955

Patient satisfaction with primary health care rendered by community midwives in the area of Poznań.

PubMed

Niewiadomski, Tomasz; Biskupska, Maria; Wysocki, Jacek

2014-01-01

The main objective of this study was to examine the level of patient satisfaction with the care rendered by community midwives in the area of Poznań. A patient survey was distributed using face-to-face recruitment and with mail collection. Eight hundred new mothers were asked to participate in the study by filling out the questionnaire after eight weeks of the postpartum period. One hundred seventy seven (22.12%) returned completed questionnaires which were then analyzed. This paper provides information on the high level of patient satisfaction with the services provided by community midwives and the important role community midwives play in caring for and supporting women in the post partum period. The results of this study indicate that women in the area of Poznań, are satisfied with the care they receive from midwives. They also indicate a lack of association of patient satisfaction scores between groups of patients based on demographic data and reason for using community midwife services. It was also found that the overall patient satisfaction score depends most heavily on the time frame of receiving community midwife services.

Informal Caregiving of Hospice Patients

PubMed Central

Pottie, Colin G.; Burch, Karen A.; Irwin, Scott A.

2014-01-01

Abstract Background: Informal caregivers play a critical role in the provision of care to hospice patients. The care they provide often impacts their physical and psychological well-being. Objective: This study synthesized 58 articles pertaining to informal hospice caregiving, focusing on caregivers' satisfaction with hospice services, the physical and psychological well-being of caregivers, the predictors of caregivers' well-being, the direct impact of hospice services on caregivers, and the effectiveness of targeted interventions for hospice caregivers. Method: A systematic literature review of journal articles published between 1985 and 2012 was conducted. Results: The studies reviewed found hospice caregivers to experience clinically significant levels of anxiety, depression, and stress; however, results for caregiver burden and quality of life were mixed. Caregivers' perceptions regarding the meaningfulness of care as well as their levels of social support were associated with enhanced psychological outcomes. Conclusions: Beyond satisfaction with hospice services, the direct impact of standard hospice care on caregivers remains uncertain. Caregiver intervention studies have demonstrated promising outcomes signifying a need for additional investigations into hospice-specific interventions that improve caregiver outcomes. Additional research and resources are needed to assist hospice caregivers, with the ultimate goal of minimizing their psychiatric and physical morbidity and enhancing their caregiving and subsequent bereavement processes. PMID:24992371

Implementation and Integration of Regional Health Care Data Networks in the Hellenic National Health Service

PubMed Central

Vidalis, Ioannis; Papanikolaou, Christos; Vagelatos, Aristides

2002-01-01

Background Modern health care is provided with close cooperation among many different institutions and professionals, using their specialized expertise in a common effort to deliver best-quality and, at the same time, cost-effective services. Within this context of the growing need for information exchange, the demand for realization of data networks interconnecting various health care institutions at a regional level, as well as a national level, has become a practical necessity. Objectives To present the technical solution that is under consideration for implementing and interconnecting regional health care data networks in the Hellenic National Health System. Methods The most critical requirements for deploying such a regional health care data network were identified as: fast implementation, security, quality of service, availability, performance, and technical support. Results The solution proposed is the use of proper virtual private network technologies for implementing functionally-interconnected regional health care data networks. Conclusions The regional health care data network is considered to be a critical infrastructure for further development and penetration of information and communication technologies in the Hellenic National Health System. Therefore, a technical approach was planned, in order to have a fast cost-effective implementation, conforming to certain specifications. PMID:12554551

An Analysis of Factors Related to Retirement Intentions of Upper Level Civil Service Employees in the Air Force.

DTIC Science & Technology

1986-09-01

workforce that is incapable of performing organizational objectives (Humple and Lyons , 1983; Tucker, 1985). . Research into retirement within the federal...organization (Donnelly, Gibson, Ivancevich ; 1984). The present study focuses on civilian middle managers, GM13 to GMI5, within technical career fields...Masson, Demestree, and Lyon ; 1979). The second study performed a factorial analysis on data from 457 respondents between the ages of 25 to 64 that worked

[The subjective quality of life of patients with schizophrenia: influence of psychopathology and patients' expectations. A comparative study].

PubMed

Salomé, F; Petitjean, F; Germain, C; Demant, J-C

2004-01-01

Most studies on the quality of life (Qol) of patients with schizophrenia deal with objective living conditions and how they are perceived by hospitalized patients. The few studies that compare Qol for patients treated in part time services with the Qol of ambulatory patients do not show any significant difference in terms of subjective Qol. Some stu-dies evaluate the influence of psychopathology and needs (or expectations) on the subjective Qol in these groups of patients. Available data indicate that the general well-being is influenced by psychopathology (positive, negative or depressive symptoms) and unmet needs in ambulatory patients. They also show that subjective Qol in certain life domains (social relations, family relations, leisure, health, law and security) is influenced by negative symptoms, anxiety and depression in patients treated in part-time services. The aim of this study is to compare the objective and subjective Qol of patients with schizophrenia treated in part time services (day hospital and day care center) to the Qol of out-patients treated on a purely ambulatory basis (out patient clinic). We studied the Qol of 2 groups of 30 patients with schizophrenia (ICD 10 criteria) treated in various centers. The first group was made of ambulatory patients, the second one was constituted of patients treated in a day hospital or a day care center. Patients were matched for age, duration of illness, number of hospitalizations. The instruments used for rating were the following: Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), Positive And Negative Symptoms Scale (PANSS), Drug Attitude Inventory (DAI-10). The Qol was measured with a french version of the Lancashire Quality Of Life Profile (LQOLP) (Salomé, Germain, Petitjean, Demant and Boyer, 2000). This instrument measures the objective Qol as well as the subjective Qol. It does possess satisfying psychometric properties and offers the possibility to establish Qol profiles. All Qol ratings were carried out by a clinician who was not involved in the treatment of the patients. When the 2 groups are compared our results indicate that ambulatory patients are less symptomatic, have a better level of functioning and a better objective Qol in such domains as: finances, living situation, family relations and health. There is no significant difference in terms of anxiety and depression as measured by the respective items of the PANSS. Patients treated in part-time services present higher scores of positive symptoms. Our results indicate that there is no significant difference for subjective Qol variables between the two groups, except for general well-being, that tends to be higher in ambulatory patients. When exploring the influence of clinical data on the Qol in each group, we find negative correlations in ambulatory patients between various domains of subjective Qol and illness severity (law and security, family relations, social relations, general well-being), global functioning (family relations, social relation, health) and positive symptoms (living conditions, law and security, family relations, social relations, health). In this same group, the subjective Qol for family relations is significantly correlated with several expectations in terms of Qol improvement (leisure, social relations, family relations, transport, work). In these patients, the subjective Qol for social relations is also significantly correlated with their expectations in terms of Qol improvement (work, money, lodging, affective relations, transport). There is no significant correlation between subjective Qol and expectations in patients treated in part-time services. Our results indicate that part time services treat schizophrenic patients with a lower level of global functioning and a higher level of symptom severity compared with ambulatory patients. These results confirm other studies that show no significant difference between these 2 groups in terms of subjective Qol. The subjective Qol in the field of relations (family and social) in ambulatory patients seems particularly sensitive to illness severity, positive symptoms and global functioning level. This has also been reported by other studies. In patients treated in part-time services, the subjective Qol, particularly for living conditions and security, seems sensitive to anxiety and depression. This has also been shown by other studies. Finally, our results underline the importance of patients' expectations in terms of subjective Qol, particularly in the field of relations (family and social) for ambulatory patients.

Development and evaluation of an intermediate-level elective course on medical Spanish for pharmacy students.

PubMed

Mueller, Robert

The Spanish-speaking population in the United States is increasing rapidly, and there is a need for additional educational efforts, beyond teaching basic medical Spanish terminology, to increase the number of Spanish-speaking pharmacists able to provide culturally appropriate care to this patient population. This article describes the development and evaluation of an intermediate-level elective course where students integrated pharmacy practice skills with Spanish-language skills and cultural competency. Educational Activity and Setting: Medical Spanish for Pharmacists was developed as a two-credit elective course for pharmacy students in their third-professional-year who possessed a certain level of Spanish language competence. The course was designed so that students would combine patient care skills such as obtaining a medication list and providing patient education, and pharmacotherapy knowledge previously learned in the curriculum, along with Spanish-language skills, and apply them to simulated Spanish-speaking patients. Elements to promote cultural competency were integrated throughout the course through a variety of methods, including a service learning activity. Successful attainment of course goals and objectives were demonstrated through quizzes, assignments, examinations, and an objective structured clinical examination (OSCE). Based on these course assessments, students performed well during both offerings of the course. While the class cohort size was small in the two offerings of the course, the Medical Spanish for Pharmacists elective may still serve as an example for other pharmacy programs as an innovative approach in combining Spanish language, specific pharmacy skills, cultural competency, and service learning. Copyright © 2017 Elsevier Inc. All rights reserved.

Stormwater Management Effects on Ecosystem Services: A Literature Review

NASA Astrophysics Data System (ADS)

Prudencio, L.; Null, S. E.

2016-12-01

Managing stormwater provides benefits for enhancing water supplies while reducing urban runoff. Yet, there has been little research focused on understanding how stormwater management affects ecosystem services, the benefits that ecosystems provide to humans. Garnering more knowledge of the changes to ecosystem services from stormwater management will ultimately improve management and decision-making. The objective of this research is to review and synthesize published literature on 1) ecosystem services and stormwater management and 2) changes in ecosystem services from anthropogenic impacts and climate warming, to establish a foundation for research at the intersection of ecosystems services, stormwater management, and global environmental change. We outline four research areas for ecosystem services and stormwater management that should be further explored. These four areas, named after the four types of ecosystem services, highlight context-specific research questions and human and climate change effects. We conclude that effective and sustainable stormwater management requires incorporating engineering, social, and environmental criteria to quantify benefits of provisioning, regulating, cultural, and supporting ecosystem services. Lastly, improved current and potential stormwater management policy may better support sustainable stormwater methods at the institutional level. Stormwater quality and monitoring could be improved through the use of the Clean Water Act (e.g. Total Maximum Daily Loads), the Endangered Species Act, and public health measures. Additional policies regulating groundwater quantity and quality have been and may continue to be implemented by states, encouraging sustainable and cleaner stormwater practices.

Exploring pre-service science teachers' pedagogical capacity for formative assessment through analyses of student answers

NASA Astrophysics Data System (ADS)

Aydeniz, Mehmet; Dogan, Alev

2016-05-01

Background: There has been an increasing emphasis on empowering pre-service and in-service science teachers to attend student reasoning and use formative assessments to guide student learning in recent years. Purpose: The purpose of this study was to explore pre-service science teachers' pedagogical capacity for formative assessment. Sample: This study took place in Turkey. The participants include 53 pre-service science teachers in their final year of schooling. All but two of the participants are female. Design and methods: We used a mixed-methods methodology in pursing this inquiry. Participants analyzed 28 responses to seven two-tiered questions given by four students of different ability levels. We explored their ability to identify the strengths and weaknesses in students' answers. We paid particular attention to the things that the pre-service science teachers noticed in students' explanations, the types of inferences they made about students' conceptual understanding, and the affordances of pedagogical decisions they made. Results: The results show that the majority of participants made an evaluative judgment (i.e. the answer is correct or incorrect) in their analyses of students' answers. Similarly, the majority of the participants recognized the type of mistake that the students made. However, they failed to successfully elaborate on fallacies, limitations, or strengths in student reasoning. We also asked the participants to make pedagogical decisions related to what needs to be done next in order to help the students to achieve academic objectives. Results show that 8% of the recommended instructional strategies were of no affordance, 64% of low-affordance, and 28% were of high affordance in terms of helping students achieve the academic objectives. Conclusion: If our goal is to improve pre-service science teachers' noticing skills, and the affordance of feedback that they provide, engaging them in activities that asks them to attend to students' ideas and reasoning may be useful.

Multi-objective optimization to evaluate tradeoffs among forest ecosystem services following fire hazard reduction in the Deschutes National Forest, USA

Treesearch

Svetlana A. (Kushch) Schroder; Sandor F. Toth; Robert L. Deal; Gregory J. Ettl

2016-01-01

Forest owners worldwide are increasingly interested in managing forests to provide a broad suite of Ecosystem services, balancing multiple objectives and evaluating management activities in terms of Potential tradeoffs. We describe a multi-objective mathematical programming model to quantify tradeoffs in expected sediment delivery and the preservation of Northern...

An Analysis on Usage Preferences of Learning Objects and Learning Object Repositories among Pre-Service Teachers

ERIC Educational Resources Information Center

Yeni, Sabiha; Ozdener, Nesrin

2014-01-01

The purpose of the study is to investigate how pre-service teachers benefit from learning objects repositories while preparing course content. Qualitative and quantitative data collection methods were used in a mixed methods approach. This study was carried out with 74 teachers from the Faculty of Education. In the first phase of the study,…

Planning for people? An evaluation of objectives for managing visitors at wildlife refuges in the United States

Treesearch

Jeffrey J. Brooks; Robert Massengale

2011-01-01

This study evaluates the quality of planning objectives for visitor services as written in Comprehensive Conservation Plans for the National Wildlife Refuge System of the United States. Planners in the U.S. Fish and Wildlife Service are predominantly writing public use objectives that address wildlife recreation and education. Results indicate that planners are writing...

An Innovative Community-Based Model for Improving Preventive Care in Rural Counties

PubMed Central

Scheid, Dewey; Zhao, Daniel; Mishra, Bhawani; Greever-Rice, Tracy

2017-01-01

Objectives This quasi-experimental pilot study aimed to implement and evaluate a sustainable, rural community-based patient outreach model for preventive care provided through primary care practices located in a rural county in Oklahoma. A Wellness Coordinator (WC) working with primary care practices (PCPs), the county health department, the county hospital, and a health information exchange (HIE) organization helped county residents receive evidence-based preventive services. Methods The WC used a community wellness registry connected to electronic medical records via HIE and called patients at the county level based on PCP-prioritized and tailored protocols. The registry flagged patient-level preventive care gaps, tracked outreach efforts, and documented the delivery of preventive services throughout the community. Return on investment (ROI) for prioritized preventive services was estimated in participating organizations. Results Six of the seven primary care practices in the county expressed interest in the project. Three of these practices fully implemented the 1-year outreach program starting in mid-2015. The regional HIE supplied periodic data updates for 9,138 county residents to help the coordinators address care gaps using the community registry. A total of 5,034 outreach calls were made by the WC in the first year and 7,776 prioritized recommendations were offered when care gaps were detected. Of the 5,034 distinct patients who received a call, 1146 (22%) were up-to-date on all prioritized services, while 3,888 (78%) were due for at least one of the selected services. Healthcare organizations in the county significantly improved the delivery of selected preventive services (mean increase: 35% across 10 services; p= 0.004; range: 3% to 215%) and realized a mean ROI of 80% for these services (range: 32% to 122%). The health system that employed the WC earned an estimated revenue of $52,000 realizing a 40% ROI for the coordinator position. Conclusions Although more research is needed, our pilot study suggests that it may be feasible and cost-effective to implement an innovative, county-level patient outreach program for improving preventive care in rural settings. PMID:28923810

Measuring Software Product Quality: The ISO 25000 Series and CMMI

DTIC Science & Technology

2004-06-14

performance objectives” covers objectives and requirements for product quality, service quality , and process performance. Process performance objectives...such that product quality, service quality , and process performance attributes are measurable and controlled throughout the project (internal and

Requirements for Flight Testing Automated Terminal Service

DOT National Transportation Integrated Search

1977-05-01

This report describes requirements for the flight tests of the baseline Automated Terminals Service (ATS) system. The overall objective of the flight test program is to evaluate the feasibility of the ATS concept. Within this objective there are two ...

Service management: New Zealand's model of resource management.

PubMed

Malcolm, L

1990-12-01

The health system in New Zealand, which in many respects is similar to that of the United Kingdom NHS, is currently undergoing massive change. In 1989 fourteen area health boards were formed, each board being accountable to the minister of health for achieving health goals and providing comprehensive health services for its defined population. This process has been assisted by the promulgation of a set of national health goals and a national health charter. Within area health boards the principle of general management is being implemented. Organisational structures are moving away from hospitals to services in a process which is being called service management which may be defined as the decentralisation of general management to the clinical workface. Similar in many respects to the resource management initiatives in the NHS it brings together medical, nursing and business management at the operational level with one person being accountable for the achievement of quality of care objectives within a budgetary framework. Budgetary restraints in excess of 10% have been achieved in the last 12 months partly through the service management process. Service management is seen to be a major paradigm shift in health services organisation and could be of international significance in its potential for achieving medical accountability for cost containment and quality assurance, and for coordinating care across agency and disciplinary boundaries.

Auditing a court assessment and advice service for defendants with mental health difficulties: utilizing electronic patient records.

PubMed

Gough, Karen; Magness, Laura; Winstanley, Julia

2012-07-01

This study is an audit of the Somerset Court Advice and Assessment Service (CAAS) throughout its first year of implementation. It reports that the service successfully met the six desired objectives as set out in its Service Level Agreement. Further to this, it reports that the use of National Health Service electronic patient records within a court setting facilitated the provision of apposite and timely information to the court. Specific findings were that deliberate self-harm/suicidal ideation and mood disorders were the primary reasons for a person requiring CAAS involvement. Violence against the person, breach of orders and theft were the most prevalent categories of offending within this referred group. The prevalence of previous psychiatric history was significantly higher than found in comparable audits. It is likely that this is due to the efficacy of proactive and in vivo utilization of electronic patient records. Conclusions include the need to work in partnership with drug and alcohol agencies and the importance of recognizing that these services have significant clinical benefits for defendants with mental health problems, and the court system in terms of financial savings. We suggest ongoing audit is necessary to guide the development of other schemes in this pioneering service area.

Demonstration and evaluation of gas turbine transit buses

NASA Technical Reports Server (NTRS)

1983-01-01

The Gas Turbine Transit Bus Demonstration Program was designed to demonstrate and evaluate the operation of gas turbine engines in transit coaches in revenue service compared with diesel powered coaches. The main objective of the program was to accelerate development and commercialization of automotive gas turbines. The benefits from the installation of this engine in a transit coach were expected to be reduced weight, cleaner exhaust emissions, lower noise levels, reduced engine vibration and maintenance requirements, improved reliability and vehicle performance, greater engine braking capability, and superior cold weather starting. Four RTS-II advanced design transit coaches were converted to gas turbine power using engines and transmissions. Development, acceptance, performance and systems tests were performed on the coaches prior to the revenue service demonstration.

Final Report for the Advanced Concept Studies for Supersonic Commercial Transports Entering Service in the 2030 to 2035 Period, N+3 Supersonic Program

NASA Technical Reports Server (NTRS)

Morgenstern, John; Norstrud, Nicole; Stelmack, Marc; Skoch, Craig

2010-01-01

The N+3 Final Report documents the work and progress made by Lockheed Martin Aeronautics in response to the NASA sponsored program "N+3 NRA Advanced Concept Studies for Supersonic Commercial Transports Entering Service in the 2030 to 2035 Period." The key technical objective of this effort was to generate promising supersonic concepts for the 2030 to 2035 timeframe and to develop plans for maturing the technologies required to make those concepts a reality. The N+3 program is aligned with NASA's Supersonic Project and is focused on providing alternative system-level solutions capable of overcoming the efficiency, environmental, and performance barriers to practical supersonic flight

[Evaluation of healthcare quality for acute cerebrovascular disease in the context of the service level agreement].

PubMed

Millán, Eduardo; Olascoaga Arrate, Adela; Garai, Idoia

2009-04-01

The service level agreement establishes the quality requirements for those services contracted by the Basque Government Health Department from Osakidetza-Servicio Vasco de Salud. Acute cerebrovascular disease (ACVD) is one of the care processes with quality specifications. To outline the procedure adopted to evaluate ACVD care and the results obtained in four hospitals in Vizcaya between 2003 and 2007. In 2003, a work group consisting of clinicians, hospital and quality assurance managers, and experts from the Regional Health Board chose a series of indicators which would be measured by an external auditor. This group reviews the results annually and sets objectives for the following financial year. The improvement in almost all the indicators has been significant, and those with high ratings from the beginning have maintained their level. The percentage of patients who had a CAT scan in the first six hours after arriving at hospital increased from 57% to 85%, and the administration of anticoagulants within 12 hours increased from 70% of cases to 90%. The fibrinolysis rate was 3.8% in two hospitals. The percentage of patients who began rehabilitation whilst admitted was less than 3%. After operating for five years, the procedure adopted, which involves collaboration between clinical, management and planning staff, has been shown to be viable and effective in improving the quality of ACVD care.

Assessment of palliative care services in western Kenya.

PubMed

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

2017-04-01

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

Using Habitat Equivalency Analysis to Assess the Cost Effectiveness of Restoration Outcomes in Four Institutional Contexts

NASA Astrophysics Data System (ADS)

Scemama, Pierre; Levrel, Harold

2016-01-01

At the national level, with a fixed amount of resources available for public investment in the restoration of biodiversity, it is difficult to prioritize alternative restoration projects. One way to do this is to assess the level of ecosystem services delivered by these projects and to compare them with their costs. The challenge is to derive a common unit of measurement for ecosystem services in order to compare projects which are carried out in different institutional contexts having different goals (application of environmental laws, management of natural reserves, etc.). This paper assesses the use of habitat equivalency analysis (HEA) as a tool to evaluate ecosystem services provided by restoration projects developed in different institutional contexts. This tool was initially developed to quantify the level of ecosystem services required to compensate for non-market impacts coming from accidental pollution in the US. In this paper, HEA is used to assess the cost effectiveness of several restoration projects in relation to different environmental policies, using case studies based in France. Four case studies were used: the creation of a market for wetlands, public acceptance of a port development project, the rehabilitation of marshes to mitigate nitrate loading to the sea, and the restoration of streams in a protected area. Our main conclusion is that HEA can provide a simple tool to clarify the objectives of restoration projects, to compare the cost and effectiveness of these projects, and to carry out trade-offs, without requiring significant amounts of human or technical resources.

Using Habitat Equivalency Analysis to Assess the Cost Effectiveness of Restoration Outcomes in Four Institutional Contexts.

PubMed

Scemama, Pierre; Levrel, Harold

2016-01-01

At the national level, with a fixed amount of resources available for public investment in the restoration of biodiversity, it is difficult to prioritize alternative restoration projects. One way to do this is to assess the level of ecosystem services delivered by these projects and to compare them with their costs. The challenge is to derive a common unit of measurement for ecosystem services in order to compare projects which are carried out in different institutional contexts having different goals (application of environmental laws, management of natural reserves, etc.). This paper assesses the use of habitat equivalency analysis (HEA) as a tool to evaluate ecosystem services provided by restoration projects developed in different institutional contexts. This tool was initially developed to quantify the level of ecosystem services required to compensate for non-market impacts coming from accidental pollution in the US. In this paper, HEA is used to assess the cost effectiveness of several restoration projects in relation to different environmental policies, using case studies based in France. Four case studies were used: the creation of a market for wetlands, public acceptance of a port development project, the rehabilitation of marshes to mitigate nitrate loading to the sea, and the restoration of streams in a protected area. Our main conclusion is that HEA can provide a simple tool to clarify the objectives of restoration projects, to compare the cost and effectiveness of these projects, and to carry out trade-offs, without requiring significant amounts of human or technical resources.

A microprocessor card software server to support the Quebec health microprocessor card project.

PubMed

Durant, P; Bérubé, J; Lavoie, G; Gamache, A; Ardouin, P; Papillon, M J; Fortin, J P

1995-01-01

The Quebec Health Smart Card Project is advocating the use of a memory card software server[1] (SCAM) to implement a portable medical record (PMR) on a smart card. The PMR is viewed as an object that can be manipulated by SCAM's services. In fact, we can talk about a pseudo-object-oriented approach. This software architecture provides a flexible and evolutive way to manage and optimize the PMR. SCAM is a generic software server; it can manage smart cards as well as optical (laser) cards or other types of memory cards. But, in the specific case of the Quebec Health Card Project, SCAM is used to provide services between physicians' or pharmacists' software and IBM smart card technology. We propose to expose the concepts and techniques used to provide a generic environment to deal with smart cards (and more generally with memory cards), to obtain a dynamic an evolutive PMR, to raise the system global security level and the data integrity, to optimize significantly the management of the PMR, and to provide statistic information about the use of the PMR.

[Security of the medicinal therapy: Cartography of risks a priori within service of orthopaedic surgery].

PubMed

Razurel, A; Bertrand, É; Deranlot, J; Benhamou, F; Tritz, T; Le Mercier, F; Hardy, P

2015-11-01

Security and quality of the Medicinal Therapy are one of the most important objectives of the April 6th, 2011 order. The objective is to realize this study of the risks incurred by patients related to management and security of medicinal therapy in order to establish a plan to reduce the risks of drug's dispensation. The method of the Preliminary Risk Analysis (PRA) has been implemented by a multidisciplinary group in a hospital service of orthopaedic surgery. The study focused on the dispensation phase of medicinal circuit. This analysis revealed 148 scenarii, 35 were criticality unacceptable. Fifty-four initial risk control actions were proposed and their stress levels to put them in place were evaluated. The main measures of risk management are: training, information, communication, computerization, automation, dual control, updating the documentation system, drug reconciliation and respect for Best Practices Hospitallers (BPH). Risk management requires a significant human and financial investment as well as, material resources and multidisciplinary expertise in order to offer the best solutions. Copyright © 2015 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Wide-area mapping of small-scale features in agricultural landscapes using airborne remote sensing

NASA Astrophysics Data System (ADS)

O'Connell, Jerome; Bradter, Ute; Benton, Tim G.

2015-11-01

Natural and semi-natural habitats in agricultural landscapes are likely to come under increasing pressure with the global population set to exceed 9 billion by 2050. These non-cropped habitats are primarily made up of trees, hedgerows and grassy margins and their amount, quality and spatial configuration can have strong implications for the delivery and sustainability of various ecosystem services. In this study high spatial resolution (0.5 m) colour infrared aerial photography (CIR) was used in object based image analysis for the classification of non-cropped habitat in a 10,029 ha area of southeast England. Three classification scenarios were devised using 4 and 9 class scenarios. The machine learning algorithm Random Forest (RF) was used to reduce the number of variables used for each classification scenario by 25.5 % ± 2.7%. Proportion of votes from the 4 class hierarchy was made available to the 9 class scenarios and where the highest ranked variables in all cases. This approach allowed for misclassified parent objects to be correctly classified at a lower level. A single object hierarchy with 4 class proportion of votes produced the best result (kappa 0.909). Validation of the optimum training sample size in RF showed no significant difference between mean internal out-of-bag error and external validation. As an example of the utility of this data, we assessed habitat suitability for a declining farmland bird, the yellowhammer (Emberiza citronella), which requires hedgerows associated with grassy margins. We found that ˜22% of hedgerows were within 200 m of margins with an area >183.31 m2. The results from this analysis can form a key information source at the environmental and policy level in landscape optimisation for food production and ecosystem service sustainability.

Wide-area mapping of small-scale features in agricultural landscapes using airborne remote sensing.

PubMed

O'Connell, Jerome; Bradter, Ute; Benton, Tim G

2015-11-01

Natural and semi-natural habitats in agricultural landscapes are likely to come under increasing pressure with the global population set to exceed 9 billion by 2050. These non-cropped habitats are primarily made up of trees, hedgerows and grassy margins and their amount, quality and spatial configuration can have strong implications for the delivery and sustainability of various ecosystem services. In this study high spatial resolution (0.5 m) colour infrared aerial photography (CIR) was used in object based image analysis for the classification of non-cropped habitat in a 10,029 ha area of southeast England. Three classification scenarios were devised using 4 and 9 class scenarios. The machine learning algorithm Random Forest (RF) was used to reduce the number of variables used for each classification scenario by 25.5 % ± 2.7%. Proportion of votes from the 4 class hierarchy was made available to the 9 class scenarios and where the highest ranked variables in all cases. This approach allowed for misclassified parent objects to be correctly classified at a lower level. A single object hierarchy with 4 class proportion of votes produced the best result (kappa 0.909). Validation of the optimum training sample size in RF showed no significant difference between mean internal out-of-bag error and external validation. As an example of the utility of this data, we assessed habitat suitability for a declining farmland bird, the yellowhammer ( Emberiza citronella ), which requires hedgerows associated with grassy margins. We found that ∼22% of hedgerows were within 200 m of margins with an area >183.31 m 2 . The results from this analysis can form a key information source at the environmental and policy level in landscape optimisation for food production and ecosystem service sustainability.

Racial and Ethnic Differences in Substance Abuse Service Needs, Utilization, and Outcomes in California

PubMed Central

Niv, Noosha; Pham, Rhoda; Hser, Yih-Ing

2010-01-01

Objective This study examined differences in service needs and treatment utilization, retention, and outcomes between African-American, Hispanic, and white substance abusers in community-based treatment programs. Methods Data were collected from 2,401 African Americans, 3,222 Hispanics, and 7,980 whites who were admitted to 43 drug treatment programs across California from 2000 to 2001. The Addiction Severity Index (ASI) was administered at intake to assess clients’ problem severity in a number of domains (alcohol use, drug use, employment, family and social relationships, legal, medical, and psychological), and treatment retention and arrest data were obtained from administrative records. A subsample was followed up at three months to assess service utilization (N=2,145) and again at nine months to readminister the ASI (N=2,566). Results All three groups had similar severity levels of drug and legal problems upon treatment entry. Upon entry to treatment, white clients had the highest severity levels of alcohol, family, and psychiatric problems and African Americans had the highest severity levels of employment problems compared with the other two groups. Treatment retention did not differ between the three groups, but whites received a greater number of alcohol treatment services than did African Americans or Hispanics, and African Americans received a greater number of employment services than did Hispanic and white clients. All three groups showed significant improvement in all outcome domains except for medical outcomes. At the nine-month follow-up, whites had worse outcomes in the alcohol domain compared with the other two groups, and whites had worse outcomes in the legal domain compared with Hispanics. Compared with whites, African Americans were significantly less likely to be charged with driving under the influence in the year after treatment admission. Conclusions All three groups improved after treatment, although benefits from treatment can be further enhanced if services underscore different facets of the psychosocial problems of each racial and ethnic group. PMID:19797375

The relationship between patient object relations and the therapeutic alliance in a naturalistic psychotherapy sample.

PubMed

Errázuriz, Paula; Constantino, Michael J; Calvo, Esteban

2015-09-01

This study examined the relationship between patients' object relations and interpersonal process in psychotherapy. Namely, we tested the hypothesis that the quality of patients' object relations is positively associated with both patient- and therapist-rated alliance quality. Psychotherapy was administered naturalistically, with quantitative data collection before and during treatment. Participants included 73 adult outpatients and 23 therapists at two mental health clinics. Using the Bell Object Relations and Reality Testing Inventory, we measured four dimensions of patients' object relations at baseline-alienation, insecure attachment, egocentricity, and social incompetence. Using the Working Alliance Inventory, we measured alliance from patient and therapist perspectives. Control variables included time, patient demographics, symptom severity, and clinic. We employed hierarchical linear modelling to analyse data with a nested structure, with 138 sessions at Level 1, 73 patients at Level 2, and 23 therapists at Level 3. Patient alienation and insecure attachment were associated with lower patient-rated alliance, while egocentricity was associated with higher patient-rated alliance. Patients' object relations were not significantly associated with therapist-rated alliance. On average, patients perceived the alliance more positively than their therapists, with a weak positive correlation between the alliance perspectives. The results suggest that object relation dimensions may be important patient characteristics for forecasting therapeutic relationship quality. They also call for more attention to differences between alliance rating perspectives. Treatment may benefit from more attention to the quality of patients' object relations. If patients present with high levels of alienation and insecure attachment, therapists may need to pay especially close attention to the therapeutic alliance, and prudently address any ruptures in its quality. When monitoring the alliance quality, it is important to consider that patients and therapists may have different perspectives. Therapists relying solely on their own perceptions are at risk of missing alliance difficulties, and patients' object relations may be uniquely predictive of their own sense of the alliance. Therefore, it may be helpful to ask patients in session and through standardized measures for feedback on how they perceive the goals and tasks of treatment and the emotional bond with their therapist. Again, any alliance tensions could then be addressed directly as a means to maintaining engagement in the service of better outcome. © 2014 The British Psychological Society.

Design for the Evaluation of the San Francisco Home Health Services. Emergency Family Care Services Program.

ERIC Educational Resources Information Center

Remy, Linda L.

This is a design for the evaluation of emergency family care programs of the San Francisco, California Home Health Services administration. The design objectives are qiven as the promotion of the health and welfare of the family unit and the reduction of the number of out-of-home placements of children and subsequent crises. The objectives of the…

Reference Model for Project Support Environments Version 1.0

DTIC Science & Technology

1993-02-28

relationship with the framework’s Process Support services and with the Lifecycle Process Engineering services. Examples: "* ORCA (Object-based...Design services. Examples: "* ORCA (Object-based Requirements Capture and Analysis). "* RETRAC (REquirements TRACeability). 4.3 Life-Cycle Process...34traditional" computer tools. Operations: Examples of audio and video processing operations include: "* Create, modify, and delete sound and video data

Part 1 : heavy axle load revenue service mega site testing 2005-2012.

DOT National Transportation Integrated Search

2014-06-01

Since 2005, the Federal Railroad Administration : and the Association of American Railroads have : jointly funded a heavy axle load (HAL) revenue : service testing program with several objectives. : One objective is to determine the effects of HAL : ...

Part 2 : heavy axle load revenue service mega site testing 2005-2012.

DOT National Transportation Integrated Search

2014-06-01

Since 2005, the Federal Railroad Administration : and the Association of American Railroads have : jointly funded a heavy axle load (HAL) revenue : service testing program, with several objectives. : One objective is to determine the effects of HAL :...

An objective method for a video quality evaluation in a 3DTV service

NASA Astrophysics Data System (ADS)

Wilczewski, Grzegorz

2015-09-01

The following article describes proposed objective method for a 3DTV video quality evaluation, a Compressed Average Image Intensity (CAII) method. Identification of the 3DTV service's content chain nodes enables to design a versatile, objective video quality metric. It is based on an advanced approach to the stereoscopic videostream analysis. Insights towards designed metric mechanisms, as well as the evaluation of performance of the designed video quality metric, in the face of the simulated environmental conditions are herein discussed. As a result, created CAII metric might be effectively used in a variety of service quality assessment applications.

A Comparative Analysis of Perceptions of Pharmacy Students’ Stress and Stressors across Two Multicampus Universities

PubMed Central

Gaither, Caroline A.; Crawford, Stephanie Y.; Tieman, Jami

2016-01-01

Objective. To compare perceived levels of stress, stressors, and academic self-efficacy among students at two multicampus colleges of pharmacy. Methods. A survey instrument using previously validated items was developed and administered to first-year, second-year, and third-year pharmacy students at two universities with multiple campuses in spring 2013. Results. Eight hundred twenty students out of 1115 responded (73.5% response rate). Institutional differences were found in perceived student stress levels, self-efficacy, and stress-related causes. An interaction effect was demonstrated between institution and campus type (main or branch) for perceived stress and self-efficacy although campus type alone did not demonstrate a direct effect. Institutional and campus differences existed in awareness of campus counseling services, as did a few differences in coping methods. Conclusion. Stress measures were similar for pharmacy students at main or branch campuses. Institutional differences in student stress might be explained by instructional methods, campus support services, institutional climate, and nonuniversity factors. PMID:27402985

A Comparative Analysis of Perceptions of Pharmacy Students' Stress and Stressors across Two Multicampus Universities.

PubMed

Awé, Clara; Gaither, Caroline A; Crawford, Stephanie Y; Tieman, Jami

2016-06-25

Objective. To compare perceived levels of stress, stressors, and academic self-efficacy among students at two multicampus colleges of pharmacy. Methods. A survey instrument using previously validated items was developed and administered to first-year, second-year, and third-year pharmacy students at two universities with multiple campuses in spring 2013. Results. Eight hundred twenty students out of 1115 responded (73.5% response rate). Institutional differences were found in perceived student stress levels, self-efficacy, and stress-related causes. An interaction effect was demonstrated between institution and campus type (main or branch) for perceived stress and self-efficacy although campus type alone did not demonstrate a direct effect. Institutional and campus differences existed in awareness of campus counseling services, as did a few differences in coping methods. Conclusion. Stress measures were similar for pharmacy students at main or branch campuses. Institutional differences in student stress might be explained by instructional methods, campus support services, institutional climate, and nonuniversity factors.

Micro-Credit and Community Wildlife Management: Complementary Strategies to Improve Conservation Outcomes in Serengeti National Park, Tanzania

NASA Astrophysics Data System (ADS)

Kaaya, Emmanuel; Chapman, Margaret

2017-09-01

Community wildlife management programs in African protected areas aim to deliver livelihood and social benefits to local communities in order to bolster support for their conservation objectives. Most of these benefits are delivered at the community level. However, many local people are also seeking more individual or household-level livelihood benefits from community wildlife management programs because it is at this level that many of the costs of protected area conservation are borne. Because community wildlife management delivers few benefits at this level, support for their conservation objectives amongst local people often declines. The study investigated the implications of this for reducing poaching in Serengeti National Park, Tanzania. Three community wildlife management initiatives undertaken by Park management were compared with regard to their capacity to deliver the individual and household-level benefits sought by local people: community conservation services, wildlife management areas and community conservation banks. Interviews were carried out with poachers and local people from four villages in the Western Serengeti including members of village conservation banks, as well as a number of key informants. The results suggest that community conservation banks could, as a complementary strategy to existing community wildlife management programs, potentially provide a more effective means of reducing poaching in African protected areas than community wildlife management programs alone.

Multi-objective spatial tools to inform maritime spatial planning in the Adriatic Sea.

PubMed

Depellegrin, Daniel; Menegon, Stefano; Farella, Giulio; Ghezzo, Michol; Gissi, Elena; Sarretta, Alessandro; Venier, Chiara; Barbanti, Andrea

2017-12-31

This research presents a set of multi-objective spatial tools for sea planning and environmental management in the Adriatic Sea Basin. The tools address four objectives: 1) assessment of cumulative impacts from anthropogenic sea uses on environmental components of marine areas; 2) analysis of sea use conflicts; 3) 3-D hydrodynamic modelling of nutrient dispersion (nitrogen and phosphorus) from riverine sources in the Adriatic Sea Basin and 4) marine ecosystem services capacity assessment from seabed habitats based on an ES matrix approach. Geospatial modelling results were illustrated, analysed and compared on country level and for three biogeographic subdivisions, Northern-Central-Southern Adriatic Sea. The paper discusses model results for their spatial implications, relevance for sea planning, limitations and concludes with an outlook towards the need for more integrated, multi-functional tools development for sea planning. Copyright © 2017. Published by Elsevier B.V.

Athletic Trainer Services in US Private Secondary Schools

PubMed Central

Pike, Alicia; Pryor, Riana R.; Mazerolle, Stephanie M.; Stearns, Rebecca L.; Casa, Douglas J.

2016-01-01

Context: Availability of athletic trainer (AT) services in US secondary schools has recently been reported to be as high as 70%, but this only describes the public sector. The extent of AT coverage in private secondary school settings has yet to be investigated and may differ from the public secondary school setting for several reasons, including differences in funding sources. Objective: To determine the level of AT services in US private secondary schools and identify the reasons why some schools did not employ ATs. Design: Concurrent mixed-methods study. Setting: Private secondary schools in the United States. Patients or Other Participants: Of 5414 private secondary schools, 2044 (38%) responded to the survey. Main Outcome Measure(s): School administrators responded to the survey via telephone or e-mail. This instrument was previously used in a study examining AT services among public secondary schools. Descriptive statistics provided national data. Open-ended questions were evaluated through content analysis. Results: Of the 2044 schools that responded, 58% (1176/2044) offered AT services, including 28% (574/2040) full time, 25% (501/2042) part time, 4% (78/1918) per diem, and 20% (409/2042) from a hospital or clinic. A total of 84% (281 285/336 165) of athletes had access to AT services. Larger private secondary schools were more likely to have AT services available. Barriers to providing AT services in the private sector were budgetary constraints, school size and sports, and lack of awareness of the role of an AT. Conclusions: More than half of the surveyed private secondary schools in the United States had AT services available; however, only 28% had a full-time AT. This demonstrates the need for increased medical coverage to provide athletes in this setting the appropriate level of care. Budgetary concerns, size of the school and sport offerings, and lack of awareness of the role of the AT continued to be barriers in the secondary school setting. PMID:27749083

Examining Inequities in Incidence of Catastrophic Health Expenditures on Different Healthcare Services and Health Facilities in Nigeria

PubMed Central

Onwujekwe, Obinna; Hanson, Kara; Uzochukwu, Benjamin

2012-01-01

Objective There is limited evidence about levels of socio-economic and other differences in catastrophic health spending in Nigeria and in many sub-Saharan African countries. The study estimated the level of catastrophic healthcare expenditures for different healthcare services and facilities and their distribution across socioeconomic status (SES) groups. Methods The study took place in four Local Government Areas in southeast Nigeria. Data were collected using interviewer-administered questionnaires administered to 4873 households. Catastrophic health expenditures (CHE) were measured using a threshold of 40% of monthly non-food expenditure. We examined both total monthly health expenditure and disaggregated expenditure by source and type of care. Results The average total household health expenditure per month was 2354 Naira ($19.6). For outpatient services, average monthly expenditure was 1809 Naira ($15.1), whilst for inpatient services it was 610 Naira ($5.1). Higher health expenditures were incurred by urban residents and the better-off SES groups. Overall, 27% of households incurred CHE, higher for poorer socioeconomic groups and for rural residents. Only 1.0% of households had a member that was enrolled in a health insurance scheme. Conclusion The worse-off households (the poorest SES and rural dwellers) experienced the highest burden of health expenditure. There was almost a complete lack of financial risk protection. Health reform mechanisms are needed to ensure universal coverage with financial risk protection mechanisms. PMID:22815828

A Qualitative Study of US Clinical Ethics Services: Objectives and Outcomes.

PubMed

McClimans, Leah; Pressgrove, Geah; Rhea, James

2016-01-01

The quality of clinical ethics services in health care organizations is increasingly seen as an important aspect of the overall quality of care. But measuring this quality is difficult because there is a lack of clarity and consensus regarding the objectives of clinical ethics and the best outcome domains to measure. The aim of this qualitative study is to explore the views of experts about the objectives and outcomes of clinical ethics services in the US. We interviewed 19 experts in clinical ethics, focusing on the appropriate objectives and outcomes of a clinical ethics service (CES). Participants were selected using a purposive snowball sampling strategy. The development of the interview protocol was informed by the clinical ethics literature as well as by research and theories that inform clinical ethics practice. Interviews were conducted by phone, recorded, and transcribed for individual analysis. Analysis proceeded through the development of a codebook of categories using QDA Miner software. Our experts identified 12 objectives and nine outcomes. Some of these identifications were familiar (e.g., mediation and satisfaction) and some were novel (e.g., be of service and transformation). We found that experts are divided in their emphasis on the kinds of objectives that are most important. In terms of outcomes, our experts were concerned with the appropriateness of different proxy and direct measures. This study provides the perspectives of a select group of experts on the objectives and outcomes appropriate for a CES in the United States. The themes identified will be used in future research to inform a Delphi study to refine and obtain expert consensus.

Comprehensive Evaluation of Electronic Medical Record System Use and User Satisfaction at Five Low-Resource Setting Hospitals in Ethiopia

PubMed Central

Fritz, Fleur

2015-01-01

Background Electronic medical record (EMR) systems are increasingly being implemented in hospitals of developing countries to improve patient care and clinical service. However, only limited evaluation studies are available concerning the level of adoption and determinant factors of success in those settings. Objective The objective of this study was to assess the usage pattern, user satisfaction level, and determinants of health professional’s satisfaction towards a comprehensive EMR system implemented in Ethiopia where parallel documentation using the EMR and the paper-based medical records is in practice. Methods A quantitative, cross-sectional study design was used to assess the usage pattern, user satisfaction level, and determinant factors of an EMR system implemented in Ethiopia based on the DeLone and McLean model of information system success. Descriptive statistical methods were applied to analyze the data and a binary logistic regression model was used to identify determinant factors. Results Health professionals (N=422) from five hospitals were approached and 406 responded to the survey (96.2% response rate). Out of the respondents, 76.1% (309/406) started to use the system immediately after implementation and user training, but only 31.7% (98/309) of the professionals reported using the EMR during the study (after 3 years of implementation). Of the 12 core EMR functions, 3 were never used by most respondents, and they were also unaware of 4 of the core EMR functions. It was found that 61.4% (190/309) of the health professionals reported over all dissatisfaction with the EMR (median=4, interquartile range (IQR)=1) on a 5-level Likert scale. Physicians were more dissatisfied (median=5, IQR=1) when compared to nurses (median=4, IQR=1) and the health management information system (HMIS) staff (median=2, IQR=1). Of all the participants, 64.4% (199/309) believed that the EMR had no positive impact on the quality of care. The participants indicated an agreement with the system and information quality (median=2, IQR=0.5) but strongly disagreed with the service quality (median=5, IQR=1). The logistic regression showed a strong correlation between system use and dissatisfaction (OR 7.99, 95% CI 5.62-9.10) and service quality and satisfaction (OR 8.23, 95% CI 3.23-17.01). Conclusions Health professionals’ use of the EMR is low and they are generally dissatisfied with the service of the implemented system. The results of this study show that this dissatisfaction is caused mainly and strongly by the poor service quality, the current practice of double documentation (EMR and paper-based), and partial departmental use of the system in the hospitals. Thus, future interventions to improve the current use or future deployment projects should focus on improving the service quality such as power infrastructure, user support, trainings, and more computers in the wards. After service quality improvement, other departments (especially inter-dependent departments) should be motivated and supported to use the EMR to avoid the dependency deadlock. PMID:26007237

Remote information service access system based on a client-server-service model

DOEpatents

Konrad, Allan M.

1996-01-01

A local host computing system, a remote host computing system as connected by a network, and service functionalities: a human interface service functionality, a starter service functionality, and a desired utility service functionality, and a Client-Server-Service (CSS) model is imposed on each service functionality. In one embodiment, this results in nine logical components and three physical components (a local host, a remote host, and an intervening network), where two of the logical components are integrated into one Remote Object Client component, and that Remote Object Client component and the other seven logical components are deployed among the local host and remote host in a manner which eases compatibility and upgrade problems, and provides an illusion to a user that a desired utility service supported on a remote host resides locally on the user's local host, thereby providing ease of use and minimal software maintenance for users of that remote service.

Remote information service access system based on a client-server-service model

DOEpatents

Konrad, A.M.

1997-12-09

A local host computing system, a remote host computing system as connected by a network, and service functionalities: a human interface service functionality, a starter service functionality, and a desired utility service functionality, and a Client-Server-Service (CSS) model is imposed on each service functionality. In one embodiment, this results in nine logical components and three physical components (a local host, a remote host, and an intervening network), where two of the logical components are integrated into one Remote Object Client component, and that Remote Object Client component and the other seven logical components are deployed among the local host and remote host in a manner which eases compatibility and upgrade problems, and provides an illusion to a user that a desired utility service supported on a remote host resides locally on the user`s local host, thereby providing ease of use and minimal software maintenance for users of that remote service. 16 figs.

Remote information service access system based on a client-server-service model

DOEpatents

Konrad, Allan M.

1999-01-01

A local host computing system, a remote host computing system as connected by a network, and service functionalities: a human interface service functionality, a starter service functionality, and a desired utility service functionality, and a Client-Server-Service (CSS) model is imposed on each service functionality. In one embodiment, this results in nine logical components and three physical components (a local host, a remote host, and an intervening network), where two of the logical components are integrated into one Remote Object Client component, and that Remote Object Client component and the other seven logical components are deployed among the local host and remote host in a manner which eases compatibility and upgrade problems, and provides an illusion to a user that a desired utility service supported on a remote host resides locally on the user's local host, thereby providing ease of use and minimal software maintenance for users of that remote service.

Remote information service access system based on a client-server-service model

DOEpatents

Konrad, A.M.

1996-08-06

A local host computing system, a remote host computing system as connected by a network, and service functionalities: a human interface service functionality, a starter service functionality, and a desired utility service functionality, and a Client-Server-Service (CSS) model is imposed on each service functionality. In one embodiment, this results in nine logical components and three physical components (a local host, a remote host, and an intervening network), where two of the logical components are integrated into one Remote Object Client component, and that Remote Object Client component and the other seven logical components are deployed among the local host and remote host in a manner which eases compatibility and upgrade problems, and provides an illusion to a user that a desired utility service supported on a remote host resides locally on the user`s local host, thereby providing ease of use and minimal software maintenance for users of that remote service. 16 figs.

Remote information service access system based on a client-server-service model

DOEpatents

Konrad, Allan M.

1997-01-01

A local host computing system, a remote host computing system as connected by a network, and service functionalities: a human interface service functionality, a starter service functionality, and a desired utility service functionality, and a Client-Server-Service (CSS) model is imposed on each service functionality. In one embodiment, this results in nine logical components and three physical components (a local host, a remote host, and an intervening network), where two of the logical components are integrated into one Remote Object Client component, and that Remote Object Client component and the other seven logical components are deployed among the local host and remote host in a manner which eases compatibility and upgrade problems, and provides an illusion to a user that a desired utility service supported on a remote host resides locally on the user's local host, thereby providing ease of use and minimal software maintenance for users of that remote service.

Factors mediating HIV risk among female sex workers in Europe: a systematic review and ecological analysis

PubMed Central

Platt, Lucy; Jolley, Emma; Rhodes, Tim; Hope, Vivian; Latypov, Alisher; Reynolds, Lucy; Wilson, David

2013-01-01

Objectives We reviewed the epidemiology of HIV and selected sexually transmitted infections (STIs) among female sex workers (FSWs) in WHO-defined Europe. There were three objectives: (1) to assess the prevalence of HIV and STIs (chlamydia, syphilis and gonorrhoea); (2) to describe structural and individual-level risk factors associated with prevalence and (3) to examine the relationship between structural-level factors and national estimates of HIV prevalence among FSWs. Design A systematic search of published and unpublished literature measuring HIV/STIs and risk factors among FSWs, identified through electronic databases published since 2005. ‘Best’ estimates of HIV prevalence were calculated from the systematic review to provide national level estimates of HIV. Associations between HIV prevalence and selected structural-level indicators were assessed using linear regression models. Studies reviewed Of the 1993 papers identified in the search, 73 peer-reviewed and grey literature documents were identified as meeting our criteria of which 63 papers provided unique estimates of HIV and STI prevalence and nine reported multivariate risk factors for HIV/STI among FSWs. Results HIV in Europe remains low among FSWs who do not inject drugs (<1%), but STIs are high, particularly syphilis in the East and gonorrhoea. FSWs experience high levels of violence and structural risk factors associated with HIV, including lack of access to services and working on the street. Linear regression models showed HIV among FSWs to link with injecting drug use and imprisonment. Conclusions Findings show that HIV prevention interventions should be nested inside strategies that address the social welfare of sex workers, highlighting in turn the need to target the social determinants of health and inequality, including regarding access to services, experience of violence and migration. Future epidemiological and intervention studies of HIV among vulnerable populations need to better systematically delineate how microenvironmental and macroenvironmental factors combine to increase or reduce HIV/STI risk. PMID:23883879

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.

An innovative partnership in service.

PubMed

Lazarus, Cathy J; Krane, N Kevin; Bowdish, Bruce

2002-07-01

Stimulated by the need for better alignment of educational content and goals with evolving societal needs, practice patterns, and scientific developments, many medical schools are implementing new and creative educational experiences for students. Tulane University School of Medicine and Apple Computers have established an innovative partnership in which Apple laptop computers support and enhance students' service learning projects. The partnership also provides a unique opportunity to meet the Medical School Objectives Project (MSOP) objectives in Medical Informatics and Population Health, as outlined in Report II.(1) Apple Computers has a commitment to the New Orleans community as part of its corporate strategic plan to support educational programs at all levels; Tulane has a longstanding commitment to and experience with student-led service learning as part of the Foundations in Medicine Course.(2) Senior administrative personnel from Tulane and Apple discussed these common interests, resulting in a partnership to enhance the potential impact on the community served. Apple agreed to donate 20 G3 Powerbooks and a complete set of the Apple Learning series of software to support new and ongoing service-learning projects. A committee of Tulane faculty and students, information technology staff, and an Apple representative developed the project. To maximize students' access to the laptops while managing the administration's liability, the laptops were identically configured with standardized software packages (database development and maintenance, Web access, word processing, presentation development and execution, automated backup, and individual project access to protected server space). To maximize the use of the laptops, students from the service-learning organizations can check out the laptops on a just-in-time basis, because the projects have different needs over time. Student-service leaders are currently defining and developing the exact uses for the laptops. We anticipate that this project will enhance the administrative management of service-learning programs (e.g., schedules, directions to sites), the presentation of educational programs (e.g., teaching in schools), the creation of new media to support programs (e.g., our restaurant choking program has a partnership with the American Heart Association to create a video and training manual to be used nationwide), and data tracking (e.g., sites and clients served, outcomes achieved). Students' use of the laptops should support the achievement of several of the MSOP Report II Medical Informatics objectives. To assess that, all first-year medical students are completing a pre- and post-project survey based on those objectives. The availability of laptops and software should significantly enhance the service-learning programs. The students participating should gain important skills in the use of computer technology related to their roles as lifelong learners, educators and communicators, researchers, and managers.(1) We plan to report the results of the pre- and post-project surveys once they have been completed. Students' feedback on the project has been very positive, and we hope it can serve as a model for other medical school, corporate, and community partnerships.

Variability in the performance of preventive services and in the degree of control of identified health problems: A primary care study protocol

PubMed Central

Bolíbar, Bonaventura; Pareja, Clara; Astier-Peña, M Pilar; Morán, Julio; Rodríguez-Blanco, Teresa; Rosell-Murphy, Magdalena; Iglesias, Manuel; Juncosa, Sebastián; Mascort, Juanjo; Violan, Concepció; Magallón, Rosa; Apezteguia, Javier

2008-01-01

Background Preventive activities carried out in primary care have important variability that makes necessary to know which factors have an impact in order to establish future strategies for improvement. The present study has three objectives: 1) To describe the variability in the implementation of 7 preventive services (screening for smoking status, alcohol abuse, hypertension, hypercholesterolemia, obesity, influenza and tetanus immunization) and to determine their related factors; 2) To describe the degree of control of 5 identified health problems (smoking, alcohol abuse, hypertension, hypercholesterolemia and obesity); 3) To calculate intraclass correlation coefficients. Design Multi-centered cross-sectional study of a randomised sample of primary health care teams from 3 regions of Spain designed to analyse variability and related factors of 7 selected preventive services in years 2006 and 2007. At the end of 2008, we will perform a cross-sectional study of a cohort of patients attended in 2006 or 2007 to asses the degree of control of 5 identified health problems. All subjects older than16 years assigned to a randomised sample of 22 computerized primary health care teams and attended during the study period are included in each region providing a sample with more than 850.000 subjects. The main outcome measures will be implementation of 7 preventive services and control of 5 identified health problems. Furthermore, there will be 3 levels of data collection: 1) Patient level (age, gender, morbidity, preventive services, attendance); 2) Health-care professional level (professional characteristics, years working at the team, workload); 3) Team level (characteristics, electronic clinical record system). Data will be transferred from electronic clinical records to a central database with prior encryption and dissociation of subject, professional and team identity. Global and regional analysis will be performed including standard analysis for primary health care teams and health-care professional level. Linear and logistic regression multilevel analysis adjusted for individual and cluster variables will also be performed. Variability in the number of preventive services implemented will be calculated with Poisson multilevel models. Team and health-care professional will be considered random effects. Intraclass correlation coefficients, standard error and variance components for the different outcome measures will be calculated. PMID:18691407

Modeling and optimization of the multiobjective stochastic joint replenishment and delivery problem under supply chain environment.

PubMed

Wang, Lin; Qu, Hui; Liu, Shan; Dun, Cai-xia

2013-01-01

As a practical inventory and transportation problem, it is important to synthesize several objectives for the joint replenishment and delivery (JRD) decision. In this paper, a new multiobjective stochastic JRD (MSJRD) of the one-warehouse and n-retailer systems considering the balance of service level and total cost simultaneously is proposed. The goal of this problem is to decide the reasonable replenishment interval, safety stock factor, and traveling routing. Secondly, two approaches are designed to handle this complex multi-objective optimization problem. Linear programming (LP) approach converts the multi-objective to single objective, while a multi-objective evolution algorithm (MOEA) solves a multi-objective problem directly. Thirdly, three intelligent optimization algorithms, differential evolution algorithm (DE), hybrid DE (HDE), and genetic algorithm (GA), are utilized in LP-based and MOEA-based approaches. Results of the MSJRD with LP-based and MOEA-based approaches are compared by a contrastive numerical example. To analyses the nondominated solution of MOEA, a metric is also used to measure the distribution of the last generation solution. Results show that HDE outperforms DE and GA whenever LP or MOEA is adopted.

Modeling and Optimization of the Multiobjective Stochastic Joint Replenishment and Delivery Problem under Supply Chain Environment

PubMed Central

Dun, Cai-xia

2013-01-01

As a practical inventory and transportation problem, it is important to synthesize several objectives for the joint replenishment and delivery (JRD) decision. In this paper, a new multiobjective stochastic JRD (MSJRD) of the one-warehouse and n-retailer systems considering the balance of service level and total cost simultaneously is proposed. The goal of this problem is to decide the reasonable replenishment interval, safety stock factor, and traveling routing. Secondly, two approaches are designed to handle this complex multi-objective optimization problem. Linear programming (LP) approach converts the multi-objective to single objective, while a multi-objective evolution algorithm (MOEA) solves a multi-objective problem directly. Thirdly, three intelligent optimization algorithms, differential evolution algorithm (DE), hybrid DE (HDE), and genetic algorithm (GA), are utilized in LP-based and MOEA-based approaches. Results of the MSJRD with LP-based and MOEA-based approaches are compared by a contrastive numerical example. To analyses the nondominated solution of MOEA, a metric is also used to measure the distribution of the last generation solution. Results show that HDE outperforms DE and GA whenever LP or MOEA is adopted. PMID:24302880

Optimizing Wind And Hydropower Generation Within Realistic Reservoir Operating Policy

NASA Astrophysics Data System (ADS)

Magee, T. M.; Clement, M. A.; Zagona, E. A.

2012-12-01

Previous studies have evaluated the benefits of utilizing the flexibility of hydropower systems to balance the variability and uncertainty of wind generation. However, previous hydropower and wind coordination studies have simplified non-power constraints on reservoir systems. For example, some studies have only included hydropower constraints on minimum and maximum storage volumes and minimum and maximum plant discharges. The methodology presented here utilizes the pre-emptive linear goal programming optimization solver in RiverWare to model hydropower operations with a set of prioritized policy constraints and objectives based on realistic policies that govern the operation of actual hydropower systems, including licensing constraints, environmental constraints, water management and power objectives. This approach accounts for the fact that not all policy constraints are of equal importance. For example target environmental flow levels may not be satisfied if it would require violating license minimum or maximum storages (pool elevations), but environmental flow constraints will be satisfied before optimizing power generation. Additionally, this work not only models the economic value of energy from the combined hydropower and wind system, it also captures the economic value of ancillary services provided by the hydropower resources. It is recognized that the increased variability and uncertainty inherent with increased wind penetration levels requires an increase in ancillary services. In regions with liberalized markets for ancillary services, a significant portion of hydropower revenue can result from providing ancillary services. Thus, ancillary services should be accounted for when determining the total value of a hydropower system integrated with wind generation. This research shows that the end value of integrated hydropower and wind generation is dependent on a number of factors that can vary by location. Wind factors include wind penetration level, variability due to geographic distribution of wind resources, and forecast error. Electric power system factors include the mix of thermal generation resources, available transmission, demand patterns, and market structures. Hydropower factors include relative storage capacity, reservoir operating policies and hydrologic conditions. In addition, the wind, power system, and hydropower factors are often interrelated because stochastic weather patterns can simultaneously influence wind generation, power demand, and hydrologic inflows. One of the central findings is that the sensitivity of the model to changes cannot be performed one factor at a time because the impact of the factors is highly interdependent. For example, the net value of wind generation may be very sensitive to changes in transmission capacity under some hydrologic conditions, but not at all under others.

Evaluating the operations capability of Freedom's Data Management System

NASA Technical Reports Server (NTRS)

Sowizral, Henry A.

1990-01-01

Three areas of Data Management System (DMS) performance are examined: raw processor speed, the subjective speed of the Lynx OS X-Window system, and the operational capacity of the Runtime Object Database (RODB). It is concluded that the proposed processor will operate at its specified rate of speed and that the X-Window system operates within users' subjective needs. It is also concluded that the RODB cannot provide the required level of service, even with a two-order of magnitude (100 fold) improvement in speed.

Communications satellite system for Africa

NASA Astrophysics Data System (ADS)

Kriegl, W.; Laufenberg, W.

1980-09-01

Earlier established requirement estimations were improved upon by contacting African administrations and organizations. An enormous demand is shown to exist for telephony and teletype services in rural areas. It is shown that educational television broadcasting should be realized in the current African transport and communications decade (1978-1987). Radio broadcasting is proposed in order to overcome illiteracy and to improve educational levels. The technical and commercial feasibility of the system is provided by computer simulations which demonstrate how the required objectives can be fulfilled in conjunction with ground networks.

Determinants of Services Sourcing Performance

DTIC Science & Technology

2010-12-16

resources toward those factors that have the greatest impact on performance and avoid the inefficient use of resources on those factors that have...little or no impact . C. RESEARCH OBJECTIVES The objective of this research is to address existing gaps in the literature and to offer service contract...Research Question 2: Which determinant(s) have the greatest impact on the key contract outcomes of service quality and regulatory and statutory compliance

Preliminary Guidelines for Installation Product Line Land Management Suite (LMS) Product Developers

DTIC Science & Technology

2005-01-01

land use patterns might call a storm simulation model available as a CDF service to evaluate the ability of the pattern to maintain water quality ...Analysis GIS data Server Internal DIAS objects External DIAS objects External CDF services Fort Future DIAS Model GUI Figure 10. A Fort Future DIAS...31 iv ERDC/CERL TR-05-1 Are Programs that Analyze Data Being Developed as CDF Services

Conscientious objection in healthcare, referral and the military analogy.

PubMed

Clarke, Steve

2017-04-01

An analogy is sometimes drawn between the proper treatment of conscientious objectors in healthcare and in military contexts. In this paper, I consider an aspect of this analogy that has not, to my knowledge, been considered in debates about conscientious objection in healthcare. In the USA and elsewhere, tribunals have been tasked with the responsibility of recommending particular forms of alternative service for conscientious objectors. Military conscripts who have a conscientious objection to active military service, and whose objections are deemed acceptable, are required either to serve the military in a non-combat role, or assigned some form of community service that does not contribute to the effectiveness of the military. I argue that consideration of the role that military tribunals have played in determining the appropriate form of alternative service for conscripts who are conscientious objectors can help us to understand how conscientious objectors in healthcare ought to be treated. Additionally, I show that it helps us to address the vexed issue of whether or not conscientious objectors who refuse to provide a service requested by a patient should be required to refer that patient to another healthcare professional. 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/.

[Use of services and treatment adequacy of major depressive episodes in France].

PubMed

Briffault, X; Morvan, Y; Rouillon, F; Dardennes, R; Lamboy, B

2010-06-01

Though depressive disorders are major problems of public health, general population data about use of services and treatment adequacy are scarce in France. The literature suggests that the percentage of people suffering from mental disorders who are adequately treated is low. The objective of this study was to estimate the 12-month use of services in the French general population suffering from major depressive episodes (MDE) and levels of treatment adequacy. This analysis was conducted on data from the Health barometer 2005, an epidemiological survey concerning several health topics. Thirty thousand five hundred and fourteen individuals from 12 to 75 years old were interviewed by telephone from October 2004 to February 2005. Depressive disorders were assessed by a standardized tool, the CIDI-SF, according to DSM-IV classification. The mental health questions were answered by 16,883 individuals; i.e. by 60% of individuals aged 15 or older. One year prevalence of MDE was 7.8%. In this group, 58.2% used services in a 12-month period, though only 21% of the service users received adequate treatment. Amongst those who used services, 2/3 consulted health care professionals (i.e. 1/3 of people presenting a MDE). The remaining percentage - 21.4% - of people presenting a MDE used psychotropic drugs without mentioning any use of services for mental health problems. The vast majority of individuals with MDE who used services (34.6% of those with MDE) consulted a professional trained to treat depression (general practitioner, psychiatrist, psychologist and psychotherapist). Only a small proportion (19.9%) of those consulting a professional went to a non-specialist professional as well; and even less (6%) consulted only a non-specialist professional. Amongst trained professionals, most consultations (61%, or 21.1% of the MDE group) concern general practitioners; another 38.4% (13.3% of the MDE group) involved psychiatrists; and 27.8% (9.6% of the MDE group) went to psychologists or psychotherapists. Amongst the psychologists and psychotherapists, most consultations were with psychologists (74.1%). The proportion with adequate treatment differed according to the type of professional. Consulting a general practitioner is associated with the lowest levels of adequate treatment (37.2%, and for general practitioners only, 21.5%). Consulting a psychiatrist is associated with higher proportions of adequate treatment (65.1%, and for consulting a psychiatrist only, 60.7%). Consulting both a general practitioner and a psychiatrist is associated with the highest levels of adequate treatment (79.7%). Antidepressants (ATD) are used far more frequently than psychotherapy (PT): 33.4% of individuals with MDE used ATD, and among the latter, 58.4% had also used anxiolytic drugs (AXL). Finally, 26.9% of the MDE group used AXL, 7.5% without any use of ATD. For PT, 10.8% used PT, and 8.1% used PT and ATD. Improving use of professionals and treatment adequacy are two primary objectives from a public health perspective. Since most adequately treated people used an antidepressant therapy (90%), and only 30% a PT, use of psychotherapeutic approaches might be improved. Moreover, levels of treatment adequacy are very low in people presenting an MDE who did not consult for "mental health reasons". Improving the recognition of symptoms of depression might contribute to better treatment adequacy. Copyright (c) 2009 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Payments for Ecosystem Services for watershed water resource allocations

NASA Astrophysics Data System (ADS)

Fu, Yicheng; Zhang, Jian; Zhang, Chunling; Zang, Wenbin; Guo, Wenxian; Qian, Zhan; Liu, Laisheng; Zhao, Jinyong; Feng, Jian

2018-01-01

Watershed water resource allocation focuses on concrete aspects of the sustainable management of Ecosystem Services (ES) that are related to water and examines the possibility of implementing Payment for Ecosystem Services (PES) for water ES. PES can be executed to satisfy both economic and environmental objectives and demands. Considering the importance of calculating PES schemes at the social equity and cooperative game (CG) levels, to quantitatively solve multi-objective problems, a water resources allocation model and multi-objective optimization are provided. The model consists of three modules that address the following processes: ① social equity mechanisms used to study water consumer associations, ② an optimal decision-making process based on variable intervals and CG theory, and ③ the use of Shapley values of CGs for profit maximization. The effectiveness of the proposed methodology for realizing sustainable development was examined. First, an optimization model with water allocation objective was developed based on sustainable water resources allocation framework that maximizes the net benefit of water use. Then, to meet water quality requirements, PES cost was estimated using trade-off curves among different pollution emission concentration permissions. Finally, to achieve equity and supply sufficient incentives for water resources protection, CG theory approaches were utilized to reallocate PES benefits. The potential of the developed model was examined by its application to a case study in the Yongding River watershed of China. Approximately 128 Mm3 of water flowed from the upper reach (Shanxi and Hebei Provinces) sections of the Yongding River to the lower reach (Beijing) in 2013. According to the calculated results, Beijing should pay USD6.31 M (¥39.03 M) for water-related ES to Shanxi and Hebei Provinces. The results reveal that the proposed methodology is an available tool that can be used for sustainable development with resolving PES amounts among different regions under social and environmental constraints by considering the characteristics of social equity and CGs.

Early experiences with e-health services (1999-2002): promise, reality, and implications.

PubMed

Fung, Vicki; Ortiz, Eduardo; Huang, Jie; Fireman, Bruce; Miller, Robert; Selby, Joseph V; Hsu, John

2006-05-01

E-health services may improve the quality and efficiency of care; however, there is little quantitative data on e-health use. The objective of this study was to examine trends in e-health use and user characteristics. This was a longitudinal study of e-health use (1999-2002) within an integrated delivery system (IDS). We classified 4 e-health services into transactional (drug refills and appointment scheduling) and care-related (medical and medication advice) services. Approximately 3.3 million members of a large, prepaid IDS. Amount and frequency of e-health use over time and characteristics of users. The number of members registered for access to e-health increased from 20,617 (0.7% of all members) in Q1 1999 to 270,987 (8.6%) in Q3 2002. Between Q1 and Q3 2002, 42,845 members (1.3%) used the drug refill service and 55,901 (1.7%) used the appointment scheduling service compared with 10,756 members (0.3%) who used the medical advice service and 3069 (0.1%) who used the medication advice service. Over the same period, transactional service users averaged 3.5 uses/user versus 1.6 uses/user among care-related service users. Members most likely to use e-health services had a high level of clinical need, a regular primary care provider, were 30 to 64 years old, female, white, and lived in a nonlow socioeconomic status neighborhood. These findings were consistent across e-health service types. Although use of all e-health services grew rapidly, use of care-related services lagged significantly behind use of transactional services. Subjects with greater clinical need and better ties to the health system were more likely to use both types of e-health services.