Gay with a Disability: A College Student's Multiple Cultural Journey

ERIC Educational Resources Information Center

Henry, Wilma J.; Fuerth, Katherine; Figliozzi, Jennifer

2010-01-01

Traditionally, student issues regarding disability and sexuality have been viewed and addressed in isolation on college campuses. However, students with multiple minority identities are in need of services and personnel that are responsive to their unique needs as members of two historically oppressed minority groups. This qualitative exploration…

Accomplishing Multiple Goals through Community Connections

ERIC Educational Resources Information Center

Stone, Jody

2007-01-01

With schools being asked to accomplish more and more, it is increasingly important to, whenever possible, address multiple goals in teaching. Educating the whole child dictates that we find ways to ensure our graduates are well-rounded, independent thinkers capable of becoming well-adjusted, contributing adults. Thus community service has become a…

Ready, set, go: a cross-sectional survey to understand priorities and preferences for multiple health behaviour change in a highly disadvantaged group.

PubMed

Noble, Natasha; Paul, Christine; Sanson-Fisher, Robert; Turon, Heidi; Turner, Nicole; Conigrave, Katherine

2016-09-13

Socially disadvantaged groups, such as Aboriginal Australians, tend to have a high prevalence of multiple lifestyle risk factors, increasing the risk of disease and underscoring the need for services to address multiple health behaviours. The aims of this study were to explore, among a socially disadvantaged group of people attending an Aboriginal Community Controlled Health Service (ACCHS): a) readiness to change health behaviours; b) acceptability of addressing multiple risk factors sequentially or simultaneously; and c) preferred types of support services. People attending an ACCHS in regional New South Wales (NSW) completed a touchscreen survey while waiting for their appointment. The survey assessed participant health risk status, which health risks they would like to change, whether they preferred multiple health changes to be made together or separately, and the types of support they would use. Of the 211 participants who completed the survey, 94 % reported multiple (two or more) health risks. There was a high willingness to change, with 69 % of current smokers wanting to cut down or quit, 51 % of overweight or obese participants wanting to lose weight and 44 % of those using drugs in the last 12 months wanting to stop or cut down. Of participants who wanted to make more than one health change, over half would be willing to make simultaneous or over-lapping health changes. The most popular types of support were help from a doctor or Health Worker and seeing a specialist, with less than a quarter of participants preferring telephone or electronic (internet or smart phone) forms of assistance. The importance of involving family members was also identified. Strategies addressing multiple health behaviour changes are likely to be acceptable for people attending an ACCHS, but may need to allow flexibility in the choice of initial target behaviour, timing of changes, and the format of support provided.

Arts across the Disciplines: Using the Voices of the Oppressed and Vulnerable to Inspire Analytical Thinking in the Human Services Curricula

ERIC Educational Resources Information Center

Peters, Ardith A.; McClatchey, Irene S.

2017-01-01

This paper addresses how professors in a Social Work and Human Services Program in the Southeastern United States include voices of the oppressed and vulnerable through art forms to develop analytical thinking to prepare human service practitioners. This pedagogical practice is based on Gardner's discussion of Multiple Intelligences. The authors…

Food Service Supervisor. Dietetic Support Personnel Achievement Test.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater.

This guide contains a series of multiple-choice items and guidelines to assist instructors in composing criterion-referenced tests for use in the food service supervisor component of Oklahoma's Dietetic Support Personnel training program. Test items addressing each of the following occupational duty areas are provided: human relations; nutrient…

Food Service Worker. Dietetic Support Personnel Achievement Test.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater.

This guide contains a series of multiple-choice items and guidelines to assist instructors in composing criterion-referenced tests for use in the food service worker component of Oklahoma's Dietetic Support Personnel training program. Test items addressing each of the following occupational duty areas are provided: human relations; personal…

Conducting an audit to improve the facilitation of emergency maternal and newborn referral in northern Ghana.

PubMed

Awoonor-Williams, John Koku; Bailey, Patricia E; Yeji, Francis; Adongo, Ayire Emmanuel; Baffoe, Peter; Williams, Afua; Mercer, Sarah

2015-10-01

Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; district management addressed the costliness and lack of transport and increased midwives' ability to communicate with pregnant women and drivers; and that facility staff increasingly adhered to guidelines and facilitating mechanisms. By conducting an audit of maternal and newborn referrals, the Ghana Health Service identified areas for improvement that service providers and management at multiple levels addressed, demonstrating a platform for problem solving that could be a model elsewhere.

Developing effective interuniversity partnerships and community-based research to address health disparities.

PubMed

Carey, Timothy S; Howard, Daniel L; Goldmon, Moses; Roberson, James T; Godley, Paul A; Ammerman, Alice

2005-11-01

Health disparities are an enormous challenge to American society. Addressing these disparities is a priority for U.S. society and especially for institutions of higher learning, with their threefold mission of education, service, and research. Collaboration across multiple intellectual disciplines will be critical as universities address health disparities. In addition, universities must collaborate with communities, with state partners, and with each other. Development of these collaborations must be sensitive to the history and unique characteristics of each academic institution and population. The authors describe the challenges of all three types of collaboration, but primarily focus on collaboration between research-intensive universities and historically black colleges and universities. The authors describe a four-year collaboration between Shaw University and the University of North Carolina at Chapel Hill (UNC-CH). These universities strategically developed multiple research initiatives to address health disparities, building on modest early success and personal relationships. These activities included participation by Shaw faculty in faculty development activities, multiple collaborative pilot studies, and joint participation in securing grants from the Agency for Health care Research and Quality of the federal Department of Health and Human Services and the National Institutes of Health, including a P-60 Project EXPORT center grant. These multiple activities were sometimes led by UNC-CH, sometimes by Shaw University. Open discussion of problems as they arose, realistic expectations, and mutual recognition of the strengths of each institution and its faculty have been critical in achieving successful collaboration to date.

Developing Effective Interuniversity Partnerships and Community-Based Research to Address Health Disparities

PubMed Central

Carey, Timothy S.; Howard, Daniel L.; Goldmon, Moses; Roberson, James T.; Godley, Paul A.; Ammerman, Alice

2009-01-01

Health disparities are an enormous challenge to American society. Addressing these disparities is a priority for U.S. society and especially for institutions of higher learning, with their threefold mission of education, service, and research. Collaboration across multiple intellectual disciplines will be critical as universities address health disparities. In addition, universities must collaborate with communities, with state partners, and with each other. Development of these collaborations must be sensitive to the history and unique characteristics of each academic institution and population. The authors describe the challenges of all three types of collaboration, but primarily focus on collaboration between research-intensive universities and historically black colleges and universities. The authors describe a four-year collaboration between Shaw University and the University of North Carolina at Chapel Hill (UNC-CH). These universities strategically developed multiple research initiatives to address health disparities, building on modest early success and personal relationships. These activities included participation by Shaw faculty in faculty development activities, multiple collaborative pilot studies, and joint participation in securing grants from the Agency for Health care Research and Quality of the federal Department of Health and Human Services and the National Institutes of Health, including a P-60 Project EXPORT center grant. These multiple activities were sometimes led by UNC-CH, sometimes by Shaw University. Open discussion of problems as they arose, realistic expectations, and mutual recognition of the strengths of each institution and its faculty have been critical in achieving successful collaboration to date. PMID:16249303

The potential benefit of a home fire safety intervention during emergency medical services calls.

PubMed

Pirrallo, R G; Rubin, J M; Murawsky, G A

1998-03-01

To determine how often house fires occur at 1- and 2-family dwellings visited previously by emergency medical services (EMS) personnel and whether these visits were missed opportunities for a point-of-contact home fire safety intervention. A retrospective, consecutive, case series analysis of all Milwaukee Fire Department alarm responses during 1994 was performed. Measurements included date of service, type of response, property type, dollar loss estimate, number of injuries and fatalities, cause of alarm, and presence of an operational smoke detector. Descriptive, chi2, and relative risk statistics were used to describe the relationship between EMS responses and fire responses at 1- and 2-family dwellings. The Milwaukee Fire Department dispatched 94,378 requests for service to 43,556 addresses. 16,150 addresses generated multiple requests; 7.2% (1,162/16,150) were for an "alarm of fire" response [relative risk 1.83 (95% CI: 1.69-1.99) for addresses with multiple requests vs those with a single request for service]. Most [62% (721/1,162)] of the addresses were visited by EMS personnel prior to the alarm; 28% (205/721) were 1- and 2-family dwellings. A mean of 1.8 (376/205) EMS responses occurred prior to the "alarm of fire" response; 121 addresses received 1 response, 46 received 2, 18 received 3, and 20 received > or = 4 responses. Of 169 addresses with complete data, there was a total fire dollar loss of $1,963,020 (1994) along with 32 injuries and 0 fatalities. While 47% (80/169) of the 1- and 2-family dwellings had a smoke detector present, only 17% (29/169) of the dwellings had an operational smoke detector. A point-of-contact home fire safety intervention appears of potential benefit for frequent users of EMS care. Determination of the presence of an operational smoke detector in 1- and 2-family dwellings may be a useful injury prevention act during such EMS calls.

Innovative Approaches Address Aging and Mental Health Needs in LGBTQ Communities.

PubMed

Hoy-Ellis, Charles P; Ator, Michael; Kerr, Christopher; Milford, Jessica

2016-01-01

LGBTQ older adults have higher levels of psychological distress as compared to older adults in general. They also experience multiple barriers to accessing equitable, culturally competent mental health and aging services because of their distinct histories and particular social contexts. This article discusses this lack of access to services, and highlights an innovative way mental health services are being delivered in LGBTQ communities.

A primary care-public health partnership addressing homelessness, serious mental illness, and health disparities.

PubMed

Weinstein, Lara Carson; Lanoue, Marianna D; Plumb, James D; King, Hannah; Stein, Brianna; Tsemberis, Sam

2013-01-01

People with histories of homelessness and serious mental illness experience profound health disparities. Housing First is an evidenced-based practice that is working to end homelessness for these individuals through a combination of permanent housing and community-based supports. The Jefferson Department of Family and Community Medicine and a Housing First agency, Pathways to Housing-PA, has formed a partnership to address multiple levels of health care needs for this group. We present a preliminary program evaluation of this partnership using the framework of the patient-centered medical home and the "10 Essential Public Health Services." Preliminary program evaluation results suggest that this partnership is evolving to function as an integrated person-centered health home and an effective local public health monitoring system. The Pathways to Housing-PA/Jefferson Department of Family and Community Medicine partnership represents a community of solution, and multiple measures provide preliminary evidence that this model is feasible and can address the "grand challenges" of integrated community health services.

Finding Resources to Support Workforce Development Services for Youth

ERIC Educational Resources Information Center

Relave, Nanette

2006-01-01

Funding for youth employment and training has been scaled back during the past few decades. In addition, funding for workforce development services is spread among multiple programs and agencies, resulting in a fragmented funding environment. To address this issue, the youth provisions of the Workforce Investment Act (WIA) aimed to move this…

The Effects of Organizational Culture on Mental Health Service Engagement of Transition Age Youth.

PubMed

Kim, HyunSoo; Tracy, Elizabeth M; Biegel, David E; Min, Meeyoung O; Munson, Michelle R

2015-10-01

Nationwide, there is a growing concern in understanding mental health service engagement among transition age youth. The ecological perspective suggests that there are multiple barriers to service engagement which exist on varying levels of the ecosystem. Based on the socio-technical theory and organizational culture theory, this study examined the impact of organization-level characteristics on perceived service engagement and the moderating role of organizational culture on practitioner-level characteristics affecting youth service engagement. A cross-sectional survey research design was used to address the research questions. The data were collected from 279 practitioners from 27 mental health service organizations representing three major metropolitan areas in Ohio. Hierarchical linear modeling was used to address a nested structure. Findings revealed that location of organization, service setting, and organizational culture had significant effects on the continuation of services. In addition, the relationship between service coordination and resource knowledge and service engagement was moderated by organizational culture.

Adapting to Sydney's local government boundaries changes: a population health perspective.

PubMed

Assareh, Hassan; Achat, Helen M; Bag, Shopna; Moerkerken, Leendert; Gabriel, Salwa

2018-06-14

The territory of a Local Health District (LHD) comprises multiple local government areas (LGAs). The recent amalgamation of several LGAs in metropolitan Sydney has resulted in two new LGAs being expanded across multiple LHDs, resulting in nonconcordance of boundaries. Here, we discuss the implications for planning health activities and service delivery, and ways to address them.

Innovative Approaches Address Aging and Mental Health Needs in LGBTQ Communities

PubMed Central

Hoy-Ellis, Charles P.; Ator, Michael; Kerr, Christopher; Milford, Jessica

2016-01-01

LGBTQ older adults have higher levels of psychological distress as compared to older adults in general. They also experience multiple barriers to accessing equitable, culturally competent mental health and aging services because of their distinct histories and particular social contexts. This article discusses this lack of access to services, and highlights an innovative way mental health services are being delivered in LGBTQ communities. PMID:28366982

Using structured and unstructured data to identify patients' need for services that address the social determinants of health.

PubMed

Vest, Joshua R; Grannis, Shaun J; Haut, Dawn P; Halverson, Paul K; Menachemi, Nir

2017-11-01

Increasingly, health care providers are adopting population health management approaches that address the social determinants of health (SDH). However, effectively identifying patients needing services that address a SDH in primary care settings is challenging. The purpose of the current study is to explore how various data sources can identify adult primary care patients that are in need of services that address SDH. A cross-sectional study described patients in need of SDH services offered by a safety-net hospital's federally qualified health center clinics. SDH services of social work, behavioral health, nutrition counseling, respiratory therapy, financial planning, medical-legal partnership assistance, patient navigation, and pharmacist consultation were offered on a co-located basis and were identified using structured billing and scheduling data, and unstructured electronic health record data. We report the prevalence of the eight different SDH service needs and the patient characteristics associated with service need. Moreover, characteristics of patients with SDH services need documented in structured data sources were compared with those documented by unstructured data sources. More than half (53%) of patients needed SDH services. Those in need of such services tended to be female, older, more medically complex, and higher utilizers of services. Structured and unstructured data sources exhibited poor agreement on patient SDH services need. Patients with SDH services need documented by unstructured data tended to be more complex. The need for SDH services among a safety-net population is high. Identifying patients in need of such services requires multiple data sources with structured and unstructured data. Copyright © 2017. Published by Elsevier B.V.

An innovative Oklahoma program to coordinate interdisciplinary and interagency services for children with special healthcare needs at a county level.

PubMed

Wolraich, Mark; Lockhart, Jennifer; Worley, Louis

2013-03-01

Children and youth with special health care needs (CYSHCN) and their families often require multiple services from multiple providers in order to meet their needs. The Sooner SUCCESS (State Unified Children's Comprehensive Exemplary Services for Special Needs), was developed based on a complex adaptive systems approach allowing local coalitions to address their unique needs. Sooner SUCCESS provides support to families and service providers at the community level including a broad range of supports from simply helping a family identify and access a service that already exists to innovatively marshaling generic resources to meet a unique need. The program uses these family support activities coupled with the Community Needs Assessment to identify local service needs encouraging community capacity building by coordinating the efforts of the health, mental health, social and education systems to identify service gaps and develop community-based strategies to fill those gaps.

Defining an economics research program to describe and evaluate ecosystem services.

Treesearch

Jeffrey D. Kline

2007-01-01

Balancing society’s multiple and sometimes competing objectives regarding forests calls for information describing the direct and indirect benefits resulting from forest policy and management, whether to address wildfire, loss of open space, unmanaged recreation, ecosystem restoration, or other objectives. The USDA Forest Service recently has proposed the concept of...

A Different Web-Based Geocoding Service Using Fuzzy Techniques

NASA Astrophysics Data System (ADS)

Pahlavani, P.; Abbaspour, R. A.; Zare Zadiny, A.

2015-12-01

Geocoding - the process of finding position based on descriptive data such as address or postal code - is considered as one of the most commonly used spatial analyses. Many online map providers such as Google Maps, Bing Maps and Yahoo Maps present geocoding as one of their basic capabilities. Despite the diversity of geocoding services, users usually face some limitations when they use available online geocoding services. In existing geocoding services, proximity and nearness concept is not modelled appropriately as well as these services search address only by address matching based on descriptive data. In addition there are also some limitations in display searching results. Resolving these limitations can enhance efficiency of the existing geocoding services. This paper proposes the idea of integrating fuzzy technique with geocoding process to resolve these limitations. In order to implement the proposed method, a web-based system is designed. In proposed method, nearness to places is defined by fuzzy membership functions and multiple fuzzy distance maps are created. Then these fuzzy distance maps are integrated using fuzzy overlay technique for obtain the results. Proposed methods provides different capabilities for users such as ability to search multi-part addresses, searching places based on their location, non-point representation of results as well as displaying search results based on their priority.

"Who has ever loved a drug addict? It's a lie. They think a 'teja' is as bad person": multiple stigmas faced by women who inject drugs in coastal Kenya.

PubMed

Mburu, Gitau; Ayon, Sylvia; Tsai, Alexander C; Ndimbii, James; Wang, Bangyuan; Strathdee, Steffanie; Seeley, Janet

2018-05-25

A tenth of all people who inject drugs in Kenya are women, yet their social contexts and experiences remain poorly understood. This paper reports how multiple forms of stigma are experienced by women who inject drugs in coastal Kenya and the impact that they have on their ability to access essential health services. In 2015, in-depth interviews and focus group discussions were held with 45 women who inject drugs in two coastal towns. These data were supplemented with in-depth interviews with five individual stakeholders involved in service provision to this population. Data were analyzed thematically using NVivo. Women who inject drugs experience multiple stigmas, often simultaneously. These included the external stigma and self-stigma of injection drug use, external gender-related stigma of being a female injecting drug user, and the external stigma of being HIV positive (i.e., among those living with HIV). Stigma led to rejection, social exclusion, low self-esteem, and delay or denial of services at health facilities. HIV and harm reduction programs should incorporate interventions that address different forms of stigma among women who inject drugs in coastal Kenya. Addressing stigma will require a combination of individual, social, and structural interventions, such as collective empowerment of injecting drug users, training of healthcare providers on issues and needs of women who inject drugs, peer accompaniment to health facilities, addressing wider social determinants of stigma and discrimination, and expansion of harm reduction interventions to change perceptions of communities towards women who inject drugs.

MABEL at IPAC: managing address books and email lists at the Infrared Processing and Analysis Center

NASA Astrophysics Data System (ADS)

Crane, Megan; Brinkworth, Carolyn; Gelino, Dawn; O'Leary, Ellen

2012-09-01

The Infrared Processing and Analysis Center (IPAC), located on the campus of the California Institute of Technology, is NASA's multi-mission data center for infrared astrophysics. Some of IPAC's services include administering data analysis funding awards to the astronomical community, organizing conferences and workshops, and soliciting and selecting fellowship and observing proposals. As most of these services are repeated annually or biannually, it becomes necessary to maintain multiple lists of email contacts associated with each service. MABEL is a PHP/MySQL web database application designed to facilitate this process. It serves as an address book containing up-to-date contact information for thousands of recipients. Recipients may be assigned to any number of email lists categorized by IPAC project and team. Lists may be public (viewable by all project members) or private (viewable only by team members). MABEL can also be used to send HTML or plain-text emails to multiple lists at once and prevents duplicate emails to a single recipient. This work was performed at the California Institute of Technology under contract to the National Aeronautics and Space Administration.

A Review of Empirical Analyses of Disinvestment Initiatives.

PubMed

Chambers, James D; Salem, Mark N; D'Cruz, Brittany N; Subedi, Prasun; Kamal-Bahl, Sachin J; Neumann, Peter J

Disinvesting in low-value health care services provides opportunities for investment in higher value care and thus an increase in health care efficiency. To identify international experience with disinvestment initiatives and to review empirical analyses of disinvestment initiatives. We performed a literature search using the PubMed database to identify international experience with disinvestment initiatives. We also reviewed empirical analyses of disinvestment initiatives. We identified 26 unique disinvestment initiatives implemented across 11 countries. Nineteen addressed multiple intervention types, six addressed only drugs, and one addressed only devices. We reviewed 18 empirical analyses of disinvestment initiatives: 7 reported that the initiative was successful, 8 reported that the initiative was unsuccessful, and 3 reported that findings were mixed; that is, the study considered multiple services and reported a decrease in the use of some but not others. Thirty-seven low-value services were evaluated across the 18 empirical analyses, for 14 (38%) of which the disinvestment initiative led to a decline in use. Six of the seven studies that reported the disinvestment initiative to be successful included an attempt to promote the disinvestment initiative among participating clinicians. The success of disinvestment initiatives has been mixed, with fewer than half the identified empirical studies reporting that use of the low-value service was reduced. Our findings suggest that promotion of the disinvestment initiative among clinicians is a key component to the success of the disinvestment initiative. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Outcomes of a care coordinated service model for persons with severe and persistent mental illness: A qualitative study.

PubMed

Isaacs, Anton N; Sutton, Keith; Dalziel, Kim; Maybery, Darryl

2017-02-01

Owing to difficulties faced by individuals with severe and persistent mental illness (SPMI) in accessing multiple services, the Australian Government trialed a care coordinated service model called the Partners in Recovery (PIR) initiative. A total of 45 stakeholders in Gippsland were asked what difference the initiative had made. The PIR initiative benefited not only clients and carers but also service providers. It addressed an unmet need in service delivery for individuals with SPMI. The PIR initiative has filled a gap in delivery of care for individuals with SPMI in Gippsland.

Disclosing Sex Trading Histories to Providers: Barriers and Facilitators to Navigation of Social Services Among Women Impacted by Commercial Sexual Exploitation.

PubMed

Gerassi, Lara; Edmond, Tonya E; Fabbre, Vanessa; Howard, Abby; Nichols, Andrea J

2017-12-01

Sex trafficking and commercial sexual exploitation (CSE) can lead to devastating health and mental health consequences for women, such as elevated rates of substance use, trauma, posttraumatic stress disorder, depression, sexually transmitted infections (STIs), and HIV. Consequently, engagement with services that address addiction, mental health, and housing, and provide general advocacy is critically important to women's increased safety, stabilization, and quality of life. The purpose of this study is to identify perceived barriers and facilitators to service access and engagement with social services among women involved in CSE. Drawing from a larger grounded theory study that partnered with an anti-trafficking coalition and a substance use treatment center for women, in-depth, semistructured interviews were conducted with 30 adult women who traded sex as adults and 20 service providers who come into contact with this population. Women engaging in services were sampled through maximum variation sampling ( n = 24) and women not engaged with services ( n = 6) were recruited through snowball sampling. Providers were recruited through purposive sampling through the coalition ( n = 10) and nominations sampling ( n = 10). Open and focused coding were conducted. Multiple enhancements to methodological and analytic rigor were taken, including collaboration with multiple key stakeholders, use of nonstigmatizing language, self-reflexivity processes, analytic memo-writing, and member checking. Findings suggest that women experienced judgment when disclosing sex trading in social service intakes, and individual and group sessions from providers and other women in the groups. Although some women saw disclosure as helpful in addressing the complex feelings stemming from sex trading, as well as the desire to help or relate to other women in similar situations, they also identified risk of harm and multiple barriers to disclosing during intake meetings and individual sessions with providers as well as group sessions with providers and other clients. Implications for individual and group practice are discussed.

Cloud E-Learning Service Strategies for Improving E-Learning Innovation Performance in a Fuzzy Environment by Using a New Hybrid Fuzzy Multiple Attribute Decision-Making Model

ERIC Educational Resources Information Center

Su, Chiu Hung; Tzeng, Gwo-Hshiung; Hu, Shu-Kung

2016-01-01

The purpose of this study was to address this problem by applying a new hybrid fuzzy multiple criteria decision-making model including (a) using the fuzzy decision-making trial and evaluation laboratory (DEMATEL) technique to construct the fuzzy scope influential network relationship map (FSINRM) and determine the fuzzy influential weights of the…

47 CFR 101.1309 - Regulatory status.

Code of Federal Regulations, 2010 CFR

2010-10-01

... party may challenge the regulatory status granted an MAS licensee. System License Requirements ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Regulatory status. 101.1309 Section 101.1309... SERVICES Multiple Address Systems General Provisions § 101.1309 Regulatory status. (a) The Commission will...

47 CFR 101.1325 - Construction requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 5 2012-10-01 2012-10-01 false Construction requirements. 101.1325 Section 101... FIXED MICROWAVE SERVICES Multiple Address Systems System Requirements § 101.1325 Construction requirements. (a) Incumbent and site-based licenses are subject to the construction requirements set forth in...

47 CFR 101.1325 - Construction requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Construction requirements. 101.1325 Section 101... FIXED MICROWAVE SERVICES Multiple Address Systems System Requirements § 101.1325 Construction requirements. (a) Incumbent and site-based licenses are subject to the construction requirements set forth in...

Combining qualitative and quantitative operational research methods to inform quality improvement in pathways that span multiple settings

PubMed Central

Crowe, Sonya; Brown, Katherine; Tregay, Jenifer; Wray, Jo; Knowles, Rachel; Ridout, Deborah A; Bull, Catherine; Utley, Martin

2017-01-01

Background Improving integration and continuity of care across sectors within resource constraints is a priority in many health systems. Qualitative operational research methods of problem structuring have been used to address quality improvement in services involving multiple sectors but not in combination with quantitative operational research methods that enable targeting of interventions according to patient risk. We aimed to combine these methods to augment and inform an improvement initiative concerning infants with congenital heart disease (CHD) whose complex care pathway spans multiple sectors. Methods Soft systems methodology was used to consider systematically changes to services from the perspectives of community, primary, secondary and tertiary care professionals and a patient group, incorporating relevant evidence. Classification and regression tree (CART) analysis of national audit datasets was conducted along with data visualisation designed to inform service improvement within the context of limited resources. Results A ‘Rich Picture’ was developed capturing the main features of services for infants with CHD pertinent to service improvement. This was used, along with a graphical summary of the CART analysis, to guide discussions about targeting interventions at specific patient risk groups. Agreement was reached across representatives of relevant health professions and patients on a coherent set of targeted recommendations for quality improvement. These fed into national decisions about service provision and commissioning. Conclusions When tackling complex problems in service provision across multiple settings, it is important to acknowledge and work with multiple perspectives systematically and to consider targeting service improvements in response to confined resources. Our research demonstrates that applying a combination of qualitative and quantitative operational research methods is one approach to doing so that warrants further consideration. PMID:28062603

Proceedings of the Mobile Satellite System Architectures and Multiple Access Techniques Workshop

NASA Technical Reports Server (NTRS)

Dessouky, Khaled

1989-01-01

The Mobile Satellite System Architectures and Multiple Access Techniques Workshop served as a forum for the debate of system and network architecture issues. Particular emphasis was on those issues relating to the choice of multiple access technique(s) for the Mobile Satellite Service (MSS). These proceedings contain articles that expand upon the 12 presentations given in the workshop. Contrasting views on Frequency Division Multiple Access (FDMA), Code Division Multiple Access (CDMA), and Time Division Multiple Access (TDMA)-based architectures are presented, and system issues relating to signaling, spacecraft design, and network management constraints are addressed. An overview article that summarizes the issues raised in the numerous discussion periods of the workshop is also included.

47 CFR 101.1331 - Treatment of incumbents.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Treatment of incumbents. 101.1331 Section 101... FIXED MICROWAVE SERVICES Multiple Address Systems System Requirements § 101.1331 Treatment of incumbents... associated with incumbent authorizations in the 928/959 MHz bands that have cancelled automatically or...

Multiple Voices for Ethnically Diverse Exceptional Learners, 1995.

ERIC Educational Resources Information Center

Ford, Bridgie Alexis, Ed.

1995-01-01

This first serial issue addresses topics and issues impacting educational services for culturally and linguistically diverse (CLD) learners. The issue contains three research-into-practice articles, an interview section called "In the Oral Tradition," and three teacher-generated articles which delineate learner-enhancing practices for…

Service models and realization of differentiated services networks

NASA Astrophysics Data System (ADS)

Elizondo, Antonio J.; Garcia Osma, Maria L.; Einsiedler, Hans J.; Roth, Rudolf; Smirnov, Michael I.; Bartoli, Maurizio; Castelli, Paolo; Varga, Balazs; Krampell, Magnus

2001-07-01

Internet Service Providers need to offer Quality of Service (QoS) to fulfil the requirements of applications of their customers. Moreover, in a competitive market environment costs must be low. The selected service model must be effective and low in complexity, but it should still provide high quality and service differentiation, that the current Internet is not yet capable to support. The Differentiated Services (DiffServ) Architecture has been proposed for enabling a range of different Classes of Service (CoS). In the EURESCOM project P1006 several European service providers co-operated to examine various aspects involved in the introduction of service differentiation using the DiffServ approach. The project explored a set of service models for Expedited Forwarding (EF) and Assured Forwarding (AF) and identified requirements for network nodes. Besides, we addressed also measurement issues, charging and accounting issues. Special attention has been devoted to requirements of elastic traffic that adapts its sending rate to congestion state and available bandwidth. QoS mechanisms must prove Transmission Control Protocol (TCP) friendliness. TCP performance degrades under multiple losses. Since RED based queue management may still cause multiple discards, a modified marking scheme called Capped Leaky Bucket is proposed to improve the performance of elastic applications.

Assessing and Managing Multiple Risks in a Changing World ...

EPA Pesticide Factsheets

Roskilde University hosted a November 2015 workshop on “Environmental Risk – Assessing and Managing Multiple Risks in a Changing World”. Thirty attendees from 9 countries developed consensus recommendations regarding: implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process involving both universal and site-, region-, or problem-specific protection goals; addressing societal issues; risk management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. We encourage both cross- and inter-disciplinary approaches to address 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and non-chemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk assessment process; 4) fully integrate risk assessors and communities of interest into the risk management process; 5) consider socio-economics and increase transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference con

77 FR 47875 - National Register of Historic Places Request for Comments on Identifying, Evaluating and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-10

... Cultural Properties and Native American Landscapes AGENCY: National Park Service, Interior. ACTION: Request... landscapes. DATES: Submit comments through October 31, 2012. ADDRESSES: NPS requests that all comments and... traditional community Multiple lines of documentary evidence Broad ethnographic landscapes Property boundaries...

A service brokering and recommendation mechanism for better selecting cloud services.

PubMed

Gui, Zhipeng; Yang, Chaowei; Xia, Jizhe; Huang, Qunying; Liu, Kai; Li, Zhenlong; Yu, Manzhu; Sun, Min; Zhou, Nanyin; Jin, Baoxuan

2014-01-01

Cloud computing is becoming the new generation computing infrastructure, and many cloud vendors provide different types of cloud services. How to choose the best cloud services for specific applications is very challenging. Addressing this challenge requires balancing multiple factors, such as business demands, technologies, policies and preferences in addition to the computing requirements. This paper recommends a mechanism for selecting the best public cloud service at the levels of Infrastructure as a Service (IaaS) and Platform as a Service (PaaS). A systematic framework and associated workflow include cloud service filtration, solution generation, evaluation, and selection of public cloud services. Specifically, we propose the following: a hierarchical information model for integrating heterogeneous cloud information from different providers and a corresponding cloud information collecting mechanism; a cloud service classification model for categorizing and filtering cloud services and an application requirement schema for providing rules for creating application-specific configuration solutions; and a preference-aware solution evaluation mode for evaluating and recommending solutions according to the preferences of application providers. To test the proposed framework and methodologies, a cloud service advisory tool prototype was developed after which relevant experiments were conducted. The results show that the proposed system collects/updates/records the cloud information from multiple mainstream public cloud services in real-time, generates feasible cloud configuration solutions according to user specifications and acceptable cost predication, assesses solutions from multiple aspects (e.g., computing capability, potential cost and Service Level Agreement, SLA) and offers rational recommendations based on user preferences and practical cloud provisioning; and visually presents and compares solutions through an interactive web Graphical User Interface (GUI).

Conjoint Behavioral Consultation: Community-School Collaboration and Behavioral Outcomes Using Multiple Baseline

ERIC Educational Resources Information Center

Bellinger, Skylar A.; Lee, Steven W.; Jamison, T. Rene; Reese, R. Matthew

2016-01-01

A plethora of literature suggests that collaborative partnerships among families, educators, and outside service providers are necessary and beneficial to address behavior problems, but there continues to be a lack of coordination among these stakeholders. The current study used conjoint behavioral consultation (CBC) to facilitate the development…

Faculty Sufficiency and AACSB Accreditation Compliance within a Global University: A Mathematical Modeling Approach

ERIC Educational Resources Information Center

Boronico, Jess; Murdy, Jim; Kong, Xinlu

2014-01-01

This manuscript proposes a mathematical model to address faculty sufficiency requirements towards assuring overall high quality management education at a global university. Constraining elements include full-time faculty coverage by discipline, location, and program, across multiple campus locations subject to stated service quality standards of…

36 CFR 1192.35 - Public information system.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Public information system... Buses, Vans and Systems § 1192.35 Public information system. (a) Vehicles in excess of 22 feet in length, used in multiple-stop, fixed-route service, shall be equipped with a public address system permitting...

Identity and Access Management: Technological Implementation of Policy

ERIC Educational Resources Information Center

von Munkwitz-Smith, Jeff; West, Ann

2004-01-01

Navigating the multiple processes for accessing ever-multiplying campus information systems can be a daunting task for students, faculty, and staff. This article provides a brief overview of Identity and Access Management Services. The authors review key characteristics and components of this new information architecture and address the issue of…

A keyword approach to finding common ground in community-based definitions of human well-being

EPA Science Inventory

Ecosystem-based management involves the integration of ecosystem services and their human beneficiaries into decision making. This can occur at multiple scales; addressing global issues such as climate change down to local problems such as flood protection and maintaining water q...

Building Sustainable Health and Education Partnerships: Stories from Local Communities

ERIC Educational Resources Information Center

Blank, Martin J.

2015-01-01

Background: Growing health disparities have a negative impact on young people's educational achievement. Community schools that involve deep relationships with partners across multiple domains address these disparities by providing opportunities and services that promote healthy development of young people, and enable them to graduate from high…

Comparative effectiveness of mailed reminder letters on mammography screening compliance.

PubMed

Romaire, Melissa A; Bowles, Erin J Aiello; Anderson, Melissa L; Buist, Diana S M

2012-08-01

Reminder letters are effective at prompting women to schedule mammograms. Less well studied are reminders addressing multiple preventive service recommendations. We compared the effectiveness of a mammogram-specific reminder sent when a woman was due for a mammogram to a reminder letter addressing multiple preventive services and sent on a woman's birthday on mammography receipt. The study included 48,583 women 52-74 years enrolled in Group Health Cooperative, a health plan in Washington State. From 2005 to 2009, women were mailed 88,605 mammogram-specific or birthday letters. In this one group pretest-posttest study, we modeled the odds of obtaining a screening mammogram after receiving a letter by reminder type using logistic regression, controlling for demographic and healthcare use characteristics and stratifying by whether women were overdue or up-to-date with mammography at the mailing. Among women up-to-date with screening, birthday letters were negatively associated with mammography receipt compared to mammogram-specific letters (birthday letters with 1-2 recommendations: OR=0.73; 95% CI:0.68-0.79; 3 recommendations: OR=0.74; 95% CI:0.69-0.78; 4-8 recommendations: OR=0.62 95% CI:0.55-0.68) after. Among overdue women, birthday letters with 4-8 recommendations were negatively associated with mammography receipt. Transitioning from mammogram-specific reminder letters to multiple preventive service birthday letters was associated with decreased mammography receipt. Copyright © 2012 Elsevier Inc. All rights reserved.

Health impact of US military service in a large population-based military cohort: findings of the Millennium Cohort Study, 2001-2008

PubMed Central

2011-01-01

Background Combat-intense, lengthy, and multiple deployments in Iraq and Afghanistan have characterized the new millennium. The US military's all-volunteer force has never been better trained and technologically equipped to engage enemy combatants in multiple theaters of operations. Nonetheless, concerns over potential lasting effects of deployment on long-term health continue to mount and are yet to be elucidated. This report outlines how findings from the first 7 years of the Millennium Cohort Study have helped to address health concerns related to military service including deployments. Methods The Millennium Cohort Study was designed in the late 1990s to address veteran and public concerns for the first time using prospectively collected health and behavioral data. Results Over 150 000 active-duty, reserve, and National Guard personnel from all service branches have enrolled, and more than 70% of the first 2 enrollment panels submitted at least 1 follow-up survey. Approximately half of the Cohort has deployed in support of operations in Iraq and Afghanistan. Conclusion The Millennium Cohort Study is providing prospective data that will guide public health policymakers for years to come by exploring associations between military exposures and important health outcomes. Strategic studies aim to identify, reduce, and prevent adverse health outcomes that may be associated with military service, including those related to deployment. PMID:21281496

The joint venture alternative to mergers.

PubMed

Enders, R J

1995-02-01

However, while a joint venture may be "safe" from antitrust challenge, it is not without some practical difficulties, especially with respect to consolidating services at one location or jointly offering services provided at multiple facilities. These practical concerns include: 1. Who will exercise operational management of the joint venture? 2. How will the joint venture deal with different pricing for services that will be provided at multiple locations? 3. What criteria will be used to decide the location at which consolidated tertiary services will be offered? 4. In what circumstances can the joint venture be unwound, either in its entirety or as to discrete functions? When clinical services have been consolidated at one location, there is an appropriate concern by the other hospital that it will be unable to provide or re-enter the market for those services if the joint venture dissolves. These operational concerns, of course, are not addressed in the Consent Decree. Thus, even if a joint venture relationship survives antitrust scrutiny, the parties must still negotiate and resolve these operational issues in order for the joint venture to be viable.

Dual diagnosis capability in mental health and addiction treatment services: An assessment of programs across multiple state systems

PubMed Central

McGovern, Mark P.; Lambert-Harris, Chantal; Gotham, Heather J.; Claus, Ronald E.; Xie, Haiyi

2012-01-01

Despite increased awareness of the benefits of integrated services for persons with co-occurring substance use and psychiatric disorders, estimates of the availability of integrated services vary widely. The present study utilized standardized measures of program capacity to address co-occurring disorders, the Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) indexes, and sampled 256 programs across the United States. Approximately 18% of addiction treatment and 9% of mental health programs met criteria for dual diagnosis capable services. This is the first report on public access to integrated services using objective measures. PMID:23183873

Combining qualitative and quantitative operational research methods to inform quality improvement in pathways that span multiple settings.

PubMed

Crowe, Sonya; Brown, Katherine; Tregay, Jenifer; Wray, Jo; Knowles, Rachel; Ridout, Deborah A; Bull, Catherine; Utley, Martin

2017-08-01

Improving integration and continuity of care across sectors within resource constraints is a priority in many health systems. Qualitative operational research methods of problem structuring have been used to address quality improvement in services involving multiple sectors but not in combination with quantitative operational research methods that enable targeting of interventions according to patient risk. We aimed to combine these methods to augment and inform an improvement initiative concerning infants with congenital heart disease (CHD) whose complex care pathway spans multiple sectors. Soft systems methodology was used to consider systematically changes to services from the perspectives of community, primary, secondary and tertiary care professionals and a patient group, incorporating relevant evidence. Classification and regression tree (CART) analysis of national audit datasets was conducted along with data visualisation designed to inform service improvement within the context of limited resources. A 'Rich Picture' was developed capturing the main features of services for infants with CHD pertinent to service improvement. This was used, along with a graphical summary of the CART analysis, to guide discussions about targeting interventions at specific patient risk groups. Agreement was reached across representatives of relevant health professions and patients on a coherent set of targeted recommendations for quality improvement. These fed into national decisions about service provision and commissioning. When tackling complex problems in service provision across multiple settings, it is important to acknowledge and work with multiple perspectives systematically and to consider targeting service improvements in response to confined resources. Our research demonstrates that applying a combination of qualitative and quantitative operational research methods is one approach to doing so that warrants further consideration. 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/.

Standards for vision science libraries: 2014 revision.

PubMed

Motte, Kristin; Caldwell, C Brooke; Lamson, Karen S; Ferimer, Suzanne; Nims, J Chris

2014-10-01

This Association of Vision Science Librarians revision of the "Standards for Vision Science Libraries" aspires to provide benchmarks to address the needs for the services and resources of modern vision science libraries (academic, medical or hospital, pharmaceutical, and so on), which share a core mission, are varied by type, and are located throughout the world. Through multiple meeting discussions, member surveys, and a collaborative revision process, the standards have been updated for the first time in over a decade. While the range of types of libraries supporting vision science services, education, and research is wide, all libraries, regardless of type, share core attributes, which the standards address. The current standards can and should be used to help develop new vision science libraries or to expand the growth of existing libraries, as well as to support vision science librarians in their work to better provide services and resources to their respective users.

Standards for vision science libraries: 2014 revision

PubMed Central

Motte, Kristin; Caldwell, C. Brooke; Lamson, Karen S.; Ferimer, Suzanne; Nims, J. Chris

2014-01-01

Objective: This Association of Vision Science Librarians revision of the “Standards for Vision Science Libraries” aspires to provide benchmarks to address the needs for the services and resources of modern vision science libraries (academic, medical or hospital, pharmaceutical, and so on), which share a core mission, are varied by type, and are located throughout the world. Methods: Through multiple meeting discussions, member surveys, and a collaborative revision process, the standards have been updated for the first time in over a decade. Results: While the range of types of libraries supporting vision science services, education, and research is wide, all libraries, regardless of type, share core attributes, which the standards address. Conclusions: The current standards can and should be used to help develop new vision science libraries or to expand the growth of existing libraries, as well as to support vision science librarians in their work to better provide services and resources to their respective users. PMID:25349547

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

PubMed Central

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

2012-01-01

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

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

PubMed

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

2012-11-06

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

A Service Brokering and Recommendation Mechanism for Better Selecting Cloud Services

PubMed Central

Gui, Zhipeng; Yang, Chaowei; Xia, Jizhe; Huang, Qunying; Liu, Kai; Li, Zhenlong; Yu, Manzhu; Sun, Min; Zhou, Nanyin; Jin, Baoxuan

2014-01-01

Cloud computing is becoming the new generation computing infrastructure, and many cloud vendors provide different types of cloud services. How to choose the best cloud services for specific applications is very challenging. Addressing this challenge requires balancing multiple factors, such as business demands, technologies, policies and preferences in addition to the computing requirements. This paper recommends a mechanism for selecting the best public cloud service at the levels of Infrastructure as a Service (IaaS) and Platform as a Service (PaaS). A systematic framework and associated workflow include cloud service filtration, solution generation, evaluation, and selection of public cloud services. Specifically, we propose the following: a hierarchical information model for integrating heterogeneous cloud information from different providers and a corresponding cloud information collecting mechanism; a cloud service classification model for categorizing and filtering cloud services and an application requirement schema for providing rules for creating application-specific configuration solutions; and a preference-aware solution evaluation mode for evaluating and recommending solutions according to the preferences of application providers. To test the proposed framework and methodologies, a cloud service advisory tool prototype was developed after which relevant experiments were conducted. The results show that the proposed system collects/updates/records the cloud information from multiple mainstream public cloud services in real-time, generates feasible cloud configuration solutions according to user specifications and acceptable cost predication, assesses solutions from multiple aspects (e.g., computing capability, potential cost and Service Level Agreement, SLA) and offers rational recommendations based on user preferences and practical cloud provisioning; and visually presents and compares solutions through an interactive web Graphical User Interface (GUI). PMID:25170937

An evolutionary communications scenario for Mars exploration

NASA Technical Reports Server (NTRS)

Stevenson, Steven M.

1987-01-01

As Mars exploration grows in complexity with time, the corresponding communication needs will grow in variety and complexity also. From initial Earth/Mars links, further needs will arise for complete surface connectivity for the provision of navigation, position location, and voice, data, and video communications services among multiple Mars bases and remote exploration sites. This paper addresses the likely required communication functions over the first few decades of Martian exploration and postulates systems for providing these services. Required technologies are identified and development requirements indicated.

Development and Psychometric Evaluation of the Autism Stigma and Knowledge Questionnaire (ASK-Q)

ERIC Educational Resources Information Center

Harrison, Ashley J.; Bradshaw, Laine P.; Naqvi, Nilofer C.; Paff, Madison L.; Campbell, Jonathan M.

2017-01-01

ASD knowledge deficits contribute to disparities in the timing and quality of ASD services. To address the limitations with existing measures of ASD knowledge, we developed and examined the Autism Stigma and Knowledge Questionnaire (ASK-Q), which comprehensively assesses multiple subdomains of ASD knowledge while maintaining strong psychometric…

Addressing Pediatric Health Concerns through School-Based Consultation

ERIC Educational Resources Information Center

Truscott, Stephen D.; Albritton, Kizzy

2011-01-01

In schools, the term "consultation" has multiple meanings. Often it is used to describe a quick, informal process of advice giving between teachers and/or school specialists. As a formal discipline, School-Based Consultation (SBC) is an indirect service delivery model that involves two or more parties working together to benefit students. Most…

Barriers to the Accessibility and Continuity of Health-Care Services in People with Multiple Sclerosis

PubMed Central

Bishop, Malachy; Pionke, J.J.; Strauser, David; Santens, Ryan L.

2017-01-01

Background: Individuals with multiple sclerosis (MS) face a range of barriers to accessing and using health-care services. The aim of this review was to identify specific barriers to accessing and using health-care services based on a continuum of the health-care delivery system. Methods: Literature searches were conducted in the PubMed, PsycINFO, CINAHL, and Web of Science databases. The following terms were searched as subject headings, key words, or abstracts: health care, access, barriers, physical disability, and multiple sclerosis. The literature search produced 361 potentially relevant citations. After screening titles, abstracts, and citations, eight citations were selected for full-text review. Results: Health-care barriers were divided into three continuous phases of receiving health care. In the before-visit phase, the most commonly identified barrier was transportation. In the during-visit phase, communication quality was the major concern. In the after-visit phase, discontinued referral was the major barrier encountered. Conclusions: There are multiple interrelated barriers to accessing and using health-care services along the health-care delivery continuum for people with MS and its associated physical disabilities, ranging from complex and long-recognized barriers that will likely require extended advocacy to create policy changes to issues that can and should be addressed through relatively minor changes in health-care delivery practices, improved care coordination, and increased provider awareness, education, and responsiveness to patients' needs. PMID:29270089

Increasing access to care for Brazos Valley, Texas: a rural community of solution.

PubMed

Garney, Whitney R; Drake, Kelly; Wendel, Monica L; McLeroy, Kenneth; Clark, Heather R; Ryder, Byron

2013-01-01

Compared with their urban counterparts, rural populations face substantial disparities in terms of health care and health outcomes, particularly with regard to access to health services. To address ongoing inequities, community perspectives are increasingly important in identifying health issues and developing local solutions that are effective and sustainable. This article has been developed by both academic and community representatives and presents a brief case study of the evolution of a regional community of solution (COS) servicing a 7-county region called the Brazos Valley, Texas. The regional COS gave rise to multiple, more localized COSs that implemented similar strategies designed to address access to care within rural communities. The regional COS, known as the Brazos Valley Health Partnership, was a result of a 2002 health status assessment that revealed that rural residents face poorer access to health services and their care is often fragmented. Their localized strategy, called a health resource center, was created as a "one-stop shop" where multiple health and social service providers could be housed to deliver services to rural residents. Initially piloted in Madison County, the resource center model was expanded into Burleson, Grimes, and Leon Counties because of community buy-in at each of these sites. The resource center concept allowed service providers, who previously were able to offer services only in more populous areas, to expand into the rural communities because of reduced overhead costs. The services provided at the health resource centers include transportation, information and referral, and case management along with others, depending on the location. To ensure successful ongoing operations and future planning of the resource centers, local oversight bodies known as health resource commissions were organized within each of the rural communities to represent local COSs. Through collaboration with local entities, these partnerships have been successful in continuing to expand services and initiating health improvements within their rural communities.

Consequential Boards: Adding Value Where It Matters Most. Report of the National Commission on College and University Board Governance

ERIC Educational Resources Information Center

Association of Governing Boards of Universities and Colleges, 2014

2014-01-01

The value of American higher education faces multiple risks, and changes in governance are needed to address them. At risk are accessibility and degree attainment for current and future students, institutional fiscal sustainability, educational quality, economic development and social equity, service to communities, and knowledge creation. Higher…

Structure, Content, Delivery, Service, and Outcomes: Quality e-Learning in Higher Education

ERIC Educational Resources Information Center

MacDonald, Colla J.; Thompson, Terrie Lynn

2005-01-01

This paper addresses the need for quality e-Learning experiences. We used the Demand-Driven Learning Model (MacDonald, Stodel, Farres, Breithaupt, and Gabriel, 2001) to evaluate an online Masters in Education course. Multiple data collection methods were used to understand the experiences of stakeholders in this case study: the learners, design…

47 CFR 101.1331 - Treatment of incumbents.

Code of Federal Regulations, 2013 CFR

2013-10-01

... FIXED MICROWAVE SERVICES Multiple Address Systems System Requirements § 101.1331 Treatment of incumbents. (a) Any MAS station licensed by the Commission prior to July 1, 1999 in the 928.0-928.85 MHz/952.0....85 MHz/952.0-952.85 MHz/956.25-956.45 MHz bands will include incumbents as defined in § 101.1331(a...

47 CFR 101.1331 - Treatment of incumbents.

Code of Federal Regulations, 2014 CFR

2014-10-01

... FIXED MICROWAVE SERVICES Multiple Address Systems System Requirements § 101.1331 Treatment of incumbents. (a) Any MAS station licensed by the Commission prior to July 1, 1999 in the 928.0-928.85 MHz/952.0....85 MHz/952.0-952.85 MHz/956.25-956.45 MHz bands will include incumbents as defined in § 101.1331(a...

47 CFR 101.1331 - Treatment of incumbents.

Code of Federal Regulations, 2012 CFR

2012-10-01

... FIXED MICROWAVE SERVICES Multiple Address Systems System Requirements § 101.1331 Treatment of incumbents. (a) Any MAS station licensed by the Commission prior to July 1, 1999 in the 928.0-928.85 MHz/952.0....85 MHz/952.0-952.85 MHz/956.25-956.45 MHz bands will include incumbents as defined in § 101.1331(a...

47 CFR 101.1331 - Treatment of incumbents.

Code of Federal Regulations, 2011 CFR

2011-10-01

... FIXED MICROWAVE SERVICES Multiple Address Systems System Requirements § 101.1331 Treatment of incumbents. (a) Any MAS station licensed by the Commission prior to July 1, 1999 in the 928.0-928.85 MHz/952.0....85 MHz/952.0-952.85 MHz/956.25-956.45 MHz bands will include incumbents as defined in § 101.1331(a...

Changing Paradigm for Supporting Aging Individuals' Health and Well-Being: A Framework for Professional Development

ERIC Educational Resources Information Center

Kemeny, Elizabeth; Mabry, J. Beth

2015-01-01

This study addresses the transfer of training to quality care practices among leisure services professionals who serve older adults by applying the Social Structure and Personality approach, a social psychology framework that accounts for layers of influence in that process. Multiple demographic and policy changes contribute to a need for a…

Video-Mediated Microteaching--A Stimulus for Reflection and Teacher Growth

ERIC Educational Resources Information Center

Kourieos, Stella

2016-01-01

Numerous studies have been conducted on the effectiveness of video as an effective means of reflective practice in pre-service Teacher Education. However, only few studies have explored preservice teachers' own perceptions in this regard in the field of ELT and none of these was related to primary level. To address this gap, multiple forms of…

Urban ecosystem services for resilience planning and management in New York City.

PubMed

McPhearson, Timon; Hamstead, Zoé A; Kremer, Peleg

2014-05-01

We review the current state of knowledge about urban ecosystem services in New York City (NYC) and how these services are regulated, planned for, and managed. Focusing on ecosystem services that have presented challenges in NYC-including stormwater quality enhancement and flood control, drinking water quality, food provisioning and recreation-we find that mismatches between the scale of production and scale of management occur where service provision is insufficient. Adequate production of locally produced services and services which are more accessible when produced locally is challenging in the context of dense urban development that is characteristic of NYC. Management approaches are needed to address scale mismatches in the production and consumption of ecosystem services. By coordinating along multiple scales of management and promoting best management practices, urban leaders have an opportunity to ensure that nature and ecosystem processes are protected in cities to support the delivery of fundamental urban ecosystem services.

Operations analysis (study 2.1): Shuttle upper stage software requirements

NASA Technical Reports Server (NTRS)

Wolfe, R. R.

1974-01-01

An investigation of software costs related to space shuttle upper stage operations with emphasis on the additional costs attributable to space servicing was conducted. The questions and problem areas include the following: (1) the key parameters involved with software costs; (2) historical data for extrapolation of future costs; (3) elements of the basic software development effort that are applicable to servicing functions; (4) effect of multiple servicing on complexity of the operation; and (5) are recurring software costs significant. The results address these questions and provide a foundation for estimating software costs based on the costs of similar programs and a series of empirical factors.

Multiple beam antenna/switch system study

NASA Technical Reports Server (NTRS)

1989-01-01

In the study of the Multiple Beam Antenna/Switch for the space to ground link (SGL) uplink and downlink services, several issues related to system engineering, antenna, transmit/receive, and switch systems were addressed and the results are provided. Bandwidth allocation at Ku band is inadequate to serve the data rate requirements for the forward and return services. Rain and depolarization effects at EHF, especially at Ka band, pose a significant threat to the link availabilities at heavy rain areas. Hardware induced effects such as the nonlinear characteristics of the power amplifier may necessitate the use of linearizers and limiters. It is also important to identify the components that are susceptible to the space radiation effects and shield or redesign them with rad-hard technologies for meeting the requirements of the space environment.

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

PubMed

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

2018-03-22

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

[Being cared for and caring: living with multiple chronic diseases (Leila)-a qualitative study about APN contributions to integrated care].

PubMed

Müller-Staub, Maria; Zigan, Nicole; Händler-Schuster, Daniela; Probst, Sebastian; Monego, Renate; Imhof, Lorenz

2015-04-01

Living with multiple chronic diseases is complex and leads to enhanced care needs. To foster integrated care a project called "Living with chronic disease" (Leila) was initiated. The aim was to develop an Advanced Practice Nursing (APN) service in collaboration with medical centers for persons who are living with multiple chronic diseases. The following research questions were addressed: 1. What are patients' experiences, referring physicians and APNs with the Leila-Service? 2. How are referral processes performed? 3. How do the involved groups experience collaboration and APN role development? A qualitative approach according grounded theory of Corbin and Strauss was used to explore the experiences with the Leila project and the interaction of the persons involved. 38 interviews were conducted with patients who are living with multiple chronic diseases, their APN's and the referring physicians. The findings revealed "Being cared for and caring" as main category. The data demonstrated how patients responded to their involvement into care and that they were taken as serious partners in the care process. The category "organizing everyday life" describes how patients learned to cope with the consequences of living with multiple chronic diseases. "Using all resources" as another category demonstrates how capabilities and strengths were adopted. The results of the cooperation- and allocation processes showed that the APN recognition and APN role performance have to be negotiated. Prospective APN-services for this patient population should be integrated along with physician networks and other service providers including community health nursing.

Nursing home social services directors who report thriving at work.

PubMed

Liu, Jinyu; Bern-Klug, Mercedes

2013-01-01

Nationally representative data from a sample (n = 928) of full-time nursing home social services directors were used to investigate whether knowing characteristics of the social environment at work can help to explain which directors report job thriving. Two-thirds of directors reported they were thriving in their jobs. Multiple regression results show that thriving is increased by job autonomy, being treated like an important part of the team, having enough time to identify and meet resident psychosocial needs, not having to do things that others could do, and being clear what the social services role is. Findings suggest that addressing these aspects of the social environment and social services role will likely contribute to increasing a sense of thriving at work among social services staff members.

Linking an agency strategic review to increase knowledge management: San Francisco County Human Service Agency.

PubMed

Harrison, Lindsay

2012-01-01

Led by the agency director, the agency engaged in a Strategic Review, based on a comprehensive assessment of agency performance that identified strategies to improve organizational effectiveness through increased data-informed practice and knowledge management. The Strategic Review gathered information on staff perceptions, perceptions of external stakeholders, changing citywide and neighborhood demographics, policy mandates, and budget and workload issues. The need for the review was based upon multiple, substantial changes not addressed in the 2000 Strategic Plan, including the 2004 merger of the Department of Human Services and the Department of Aging and Adult Services, changes among the executive management team, transitions among key political entities, new policy mandates and changing budget allocations. This case study describes the Strategic Review process and content, summarizing key challenges and lessons related to addressing workload demands, fostering positive staff attitudes, balancing internal and external information needs, and integrating data use and planning processes across the agency. Copyright © Taylor & Francis Group, LLC

Estimation of the Percentage of Newly Diagnosed HIV-Positive Persons Linked to HIV Medical Care in CDC-Funded HIV Testing Programs.

PubMed

Wang, Guoshen; Pan, Yi; Seth, Puja; Song, Ruiguang; Belcher, Lisa

2017-01-01

Missing data create challenges for determining progress made in linking HIV-positive persons to HIV medical care. Statistical methods are not used to address missing program data on linkage. In 2014, 61 health department jurisdictions were funded by Centers for Disease Control and Prevention (CDC) and submitted data on HIV testing, newly diagnosed HIV-positive persons, and linkage to HIV medical care. Missing or unusable data existed in our data set. A new approach using multiple imputation to address missing linkage data was proposed, and results were compared to the current approach that uses data with complete information. There were 12,472 newly diagnosed HIV-positive persons from CDC-funded HIV testing events in 2014. Using multiple imputation, 94.1% (95% confidence interval (CI): [93.7%, 94.6%]) of newly diagnosed persons were referred to HIV medical care, 88.6% (95% CI: [88.0%, 89.1%]) were linked to care within any time frame, and 83.6% (95% CI: [83.0%, 84.3%]) were linked to care within 90 days. Multiple imputation is recommended for addressing missing linkage data in future analyses when the missing percentage is high. The use of multiple imputation for missing values can result in a better understanding of how programs are performing on key HIV testing and HIV service delivery indicators.

Making decisions in complex landscapes: Headwater stream management across multiple federal agencies

USGS Publications Warehouse

Katz, Rachel; Grant, Evan H. Campbell; Runge, Michael C.; Connery, Bruce; Crockett, Marquette; Herland, Libby; Johnson, Sheela; Kirk, Dawn; Wofford, Jeb; Bennett, Rick; Nislow, Keith; Norris, Marian; Hocking, Daniel; Letcher, Benjamin; Roy, Allison

2014-01-01

Headwater stream ecosystems are vulnerable to numerous threats associated with climate and land use change. In the northeastern US, many headwater stream species (e.g., brook trout and stream salamanders) are of special conservation concern and may be vulnerable to climate change influences, such as changes in stream temperature and streamflow. Federal land management agencies (e.g., US Fish and Wildlife Service, National Park Service, USDA Forest Service, Bureau of Land Management and Department of Defense) are required to adopt policies that respond to climate change and may have longer-term institutional support to enforce such policies compared to state, local, non-governmental, or private land managers. However, federal agencies largely make management decisions in regards to headwater stream ecosystems independently. This fragmentation of management resources and responsibilities across the landscape may significantly impede the efficiency and effectiveness of conservation actions, and higher degrees of collaboration may be required to achieve conservation goals. This project seeks to provide an example of cooperative landscape decision-making to address the conservation of headwater stream ecosystems. We identified shared and contrasting objectives of each federal agency and potential collaboration opportunities that may increase efficient and effective management of headwater stream ecosystems in two northeastern US watersheds. These workshops provided useful insights into the adaptive capacity of federal institutions to address threats to headwater stream ecosystems. Our ultimate goal is to provide a decision-making framework and analysis that addresses large-scale conservation threats across multiple stakeholders, as a demonstration of cooperative landscape conservation for aquatic ecosystems. Additionally, we aim to provide new scientific knowledge and a regional perspective to resource managers to help inform local management decisions.

Program Theory and Logic Model to Address the Co-Occurrence of Domestic Violence and Child Maltreatment

ERIC Educational Resources Information Center

Hill, Janice R.; Thies, Jeanie

2010-01-01

Social work and child welfare practitioners have long confronted the reality that child maltreatment and domestic violence often coexist within families. However, services for the victims of these types of family violence have been fragmented, forcing victims to go to multiple agencies for assistance. The purpose of this paper is to describe the…

Service differentiated and adaptive CSMA/CA over IEEE 802.15.4 for Cyber-Physical Systems.

PubMed

Xia, Feng; Li, Jie; Hao, Ruonan; Kong, Xiangjie; Gao, Ruixia

2013-01-01

Cyber-Physical Systems (CPS) that collect, exchange, manage information, and coordinate actions are an integral part of the Smart Grid. In addition, Quality of Service (QoS) provisioning in CPS, especially in the wireless sensor/actuator networks, plays an essential role in Smart Grid applications. IEEE 802.15.4, which is one of the most widely used communication protocols in this area, still needs to be improved to meet multiple QoS requirements. This is because IEEE 802.15.4 slotted Carrier Sense Multiple Access/Collision Avoidance (CSMA/CA) employs static parameter configuration without supporting differentiated services and network self-adaptivity. To address this issue, this paper proposes a priority-based Service Differentiated and Adaptive CSMA/CA (SDA-CSMA/CA) algorithm to provide differentiated QoS for various Smart Grid applications as well as dynamically initialize backoff exponent according to traffic conditions. Simulation results demonstrate that the proposed SDA-CSMA/CA scheme significantly outperforms the IEEE 802.15.4 slotted CSMA/CA in terms of effective data rate, packet loss rate, and average delay.

Service Differentiated and Adaptive CSMA/CA over IEEE 802.15.4 for Cyber-Physical Systems

PubMed Central

Gao, Ruixia

2013-01-01

Cyber-Physical Systems (CPS) that collect, exchange, manage information, and coordinate actions are an integral part of the Smart Grid. In addition, Quality of Service (QoS) provisioning in CPS, especially in the wireless sensor/actuator networks, plays an essential role in Smart Grid applications. IEEE 802.15.4, which is one of the most widely used communication protocols in this area, still needs to be improved to meet multiple QoS requirements. This is because IEEE 802.15.4 slotted Carrier Sense Multiple Access/Collision Avoidance (CSMA/CA) employs static parameter configuration without supporting differentiated services and network self-adaptivity. To address this issue, this paper proposes a priority-based Service Differentiated and Adaptive CSMA/CA (SDA-CSMA/CA) algorithm to provide differentiated QoS for various Smart Grid applications as well as dynamically initialize backoff exponent according to traffic conditions. Simulation results demonstrate that the proposed SDA-CSMA/CA scheme significantly outperforms the IEEE 802.15.4 slotted CSMA/CA in terms of effective data rate, packet loss rate, and average delay. PMID:24260021

Evaluating ecosystem services provided by non-native species: an experimental test in California grasslands.

PubMed

Stein, Claudia; Hallett, Lauren M; Harpole, W Stanley; Suding, Katharine N

2014-01-01

The concept of ecosystem services--the benefits that nature provides to human's society--has gained increasing attention over the past decade. Increasing global abiotic and biotic change, including species invasions, is threatening the secure delivery of these ecosystem services. Efficient evaluation methods of ecosystem services are urgently needed to improve our ability to determine management strategies and restoration goals in face of these new emerging ecosystems. Considering a range of multiple ecosystem functions may be a useful way to determine such strategies. We tested this framework experimentally in California grasslands, where large shifts in species composition have occurred since the late 1700's. We compared a suite of ecosystem functions within one historic native and two non-native species assemblages under different grazing intensities to address how different species assemblages vary in provisioning, regulatory and supporting ecosystem services. Forage production was reduced in one non-native assemblage (medusahead). Cultural ecosystem services, such as native species diversity, were inherently lower in both non-native assemblages, whereas most other services were maintained across grazing intensities. All systems provided similar ecosystem services under the highest grazing intensity treatment, which simulated unsustainable grazing intensity. We suggest that applying a more comprehensive ecosystem framework that considers multiple ecosystem services to evaluate new emerging ecosystems is a valuable tool to determine management goals and how to intervene in a changing ecosystem.

Frail elderly patients. New model for integrated service delivery.

PubMed Central

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

2003-01-01

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

MSAT signalling and network management architectures

NASA Technical Reports Server (NTRS)

Garland, Peter; Keelty, J. Malcolm

1989-01-01

Spar Aerospace has been active in the design and definition of Mobile Satellite Systems since the mid 1970's. In work sponsored by the Canadian Department of Communications, various payload configurations have evolved. In addressing the payload configuration, the requirements of the mobile user, the service provider and the satellite operator have always been the most important consideration. The current Spar 11 beam satellite design is reviewed, and its capabilities to provide flexibility and potential for network growth within the WARC87 allocations are explored. To enable the full capabilities of the payload to be realized, a large amount of ground based Switching and Network Management infrastructure will be required, when space segment becomes available. Early indications were that a single custom designed Demand Assignment Multiple Access (DAMA) switch should be implemented to provide efficient use of the space segment. As MSAT has evolved into a multiple service concept, supporting many service providers, this architecture should be reviewed. Some possible signalling and Network Management solutions are explored.

75 FR 41790 - Address Management Services-Elimination of the Manual Card Option for Address Sequencing Services

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

... Electronic Address Sequencing (EAS) service processes a customer's addresses file for walk sequence and/or... POSTAL SERVICE 39 CFR Part 111 Address Management Services--Elimination of the Manual Card Option for Address Sequencing Services AGENCY: Postal Service TM . ACTION: Proposed rule. SUMMARY: The Postal...

Adaptation of a Counseling Intervention to Address Multiple Cancer Risk Factors Among Overweight/Obese Latino Smokers

PubMed Central

Castro, Yessenia; Fernández, Maria E.; Strong, Larkin L.; Stewart, Diana W.; Krasny, Sarah; Robles, Eden Hernandez; Heredia, Natalia; Spears, Claire A.; Correa-Fernández, Virmarie; Eakin, Elizabeth; Resnicow, Ken; Basen-Engquist, Karen; Wetter, David W.

2015-01-01

More than 60% of cancer-related deaths in the United States are attributable to tobacco use, poor nutrition, and physical inactivity, and these risk factors tend to cluster together. Thus, strategies for cancer risk reduction would benefit from addressing multiple health risk behaviors. We adapted an evidence-based intervention grounded in social cognitive theory and principles of motivational interviewing originally developed for smoking cessation to also address physical activity and fruit/vegetable consumption among Latinos exhibiting multiple health risk behaviors. Literature reviews, focus groups, expert consultation, pretesting, and pilot testing were used to inform adaptation decisions. We identified common mechanisms underlying change in smoking, physical activity, and diet used as treatment targets; identified practical models of patient-centered cross-cultural service provision; and identified that family preferences and support as particularly strong concerns among the priority population. Adaptations made to the original intervention are described. The current study is a practical example of how an intervention can be adapted to maximize relevance and acceptability and also maintain the core elements of the original evidence-based intervention. The intervention has significant potential to influence cancer prevention efforts among Latinos in the United States and is being evaluated in a sample of 400 Latino overweight/obese smokers. PMID:25527143

Visually Exploring Transportation Schedules.

PubMed

Palomo, Cesar; Guo, Zhan; Silva, Cláudio T; Freire, Juliana

2016-01-01

Public transportation schedules are designed by agencies to optimize service quality under multiple constraints. However, real service usually deviates from the plan. Therefore, transportation analysts need to identify, compare and explain both eventual and systemic performance issues that must be addressed so that better timetables can be created. The purely statistical tools commonly used by analysts pose many difficulties due to the large number of attributes at trip- and station-level for planned and real service. Also challenging is the need for models at multiple scales to search for patterns at different times and stations, since analysts do not know exactly where or when relevant patterns might emerge and need to compute statistical summaries for multiple attributes at different granularities. To aid in this analysis, we worked in close collaboration with a transportation expert to design TR-EX, a visual exploration tool developed to identify, inspect and compare spatio-temporal patterns for planned and real transportation service. TR-EX combines two new visual encodings inspired by Marey's Train Schedule: Trips Explorer for trip-level analysis of frequency, deviation and speed; and Stops Explorer for station-level study of delay, wait time, reliability and performance deficiencies such as bunching. To tackle overplotting and to provide a robust representation for a large numbers of trips and stops at multiple scales, the system supports variable kernel bandwidths to achieve the level of detail required by users for different tasks. We justify our design decisions based on specific analysis needs of transportation analysts. We provide anecdotal evidence of the efficacy of TR-EX through a series of case studies that explore NYC subway service, which illustrate how TR-EX can be used to confirm hypotheses and derive new insights through visual exploration.

A conceptual model of the role of complexity in the care of patients with multiple chronic conditions.

PubMed

Grembowski, David; Schaefer, Judith; Johnson, Karin E; Fischer, Henry; Moore, Susan L; Tai-Seale, Ming; Ricciardi, Richard; Fraser, James R; Miller, Donald; LeRoy, Lisa

2014-03-01

Effective healthcare for people with multiple chronic conditions (MCC) is a US priority, but the inherent complexity makes both research and delivery of care particularly challenging. As part of AHRQ Multiple Chronic Conditions Research Network (MCCRN) efforts, the Network developed a conceptual model to guide research in this area. To synthesize methodological and topical issues relevant to MCC patient care into a framework that can improve the delivery of care and advance future research about caring for patients with MCC. The Network synthesized essential constructs for MCC research identified from roundtable discussion, input from expert advisors, and previously published models. The AHRQ MCCRN conceptual model defines complexity as the gap between patient needs and healthcare services, taking into account both the multiple considerations that affect the needs of MCC patients, as well as the contextual factors that influence service delivery. The model reframes processes and outcomes to include not only clinical care quality and experience, but also patient health, well being, and quality of life. The single-condition paradigm for treating needs one-by-one falls apart and highlights the need for care systems to address dynamic patient needs. Defining complexity in terms of the misalignment between patient needs and services offers new insights in how to research and develop solutions to patient care needs.

A Social Network Analysis of a Coalition Initiative to Prevent Underage Drinking in Los Angeles County

PubMed Central

Chu, Kar-Hai; Hoeppner, Elena; Valente, Thomas; Rohrbach, Luanne

2016-01-01

In 2011, the Los Angeles County Department of Public Health began a prevention services initiative to address problems dealing with alcohol and other drugs across the County. A major component of the strategy included the formation of eight coalitions. Defined by geographic borders, each coalition consisted of multiple service provider organizations, and were mandated to implement customized plans that would focus on preventing underage drinking by addressing availability and accessibility of alcohol. In this study, we collect survey data and observe coalition meetings to study the interactions within and between coalitions. We are informed by network tie strength theories to supplement our view of how organizations communicate. We apply social network analysis to learn how the multi-coalition network is functioning, and identify important unrealized connections. Our findings suggest there are many potential connections between coalitions that are not being leveraged. PMID:27899879

Historical dynamics in ecosystem service bundles.

PubMed

Renard, Delphine; Rhemtulla, Jeanine M; Bennett, Elena M

2015-10-27

Managing multiple ecosystem services (ES), including addressing trade-offs between services and preventing ecological surprises, is among the most pressing areas for sustainability research. These challenges require ES research to go beyond the currently common approach of snapshot studies limited to one or two services at a single point in time. We used a spatiotemporal approach to examine changes in nine ES and their relationships from 1971 to 2006 across 131 municipalities in a mixed-use landscape in Quebec, Canada. We show how an approach that incorporates time and space can improve our understanding of ES dynamics. We found an increase in the provision of most services through time; however, provision of ES was not uniformly enhanced at all locations. Instead, each municipality specialized in providing a bundle (set of positively correlated ES) dominated by just a few services. The trajectory of bundle formation was related to changes in agricultural policy and global trends; local biophysical and socioeconomic characteristics explained the bundles' increasing spatial clustering. Relationships between services varied through time, with some provisioning and cultural services shifting from a trade-off or no relationship in 1971 to an apparent synergistic relationship by 2006. By implementing a spatiotemporal perspective on multiple services, we provide clear evidence of the dynamic nature of ES interactions and contribute to identifying processes and drivers behind these changing relationships. Our study raises questions about using snapshots of ES provision at a single point in time to build our understanding of ES relationships in complex and dynamic social-ecological systems.

The Roles of Technology in Primary HIV Prevention for Men Who Have Sex with Men.

PubMed

Sullivan, Patrick S; Jones, Jeb; Kishore, Nishant; Stephenson, Rob

2015-12-01

Men who have sex with men (MSM) are at disproportionate risk for HIV infection globally. The past 5 years have seen considerable advances in biomedical interventions to reduce the risk of HIV infection. To be impactful in reducing HIV incidence requires the rapid and expansive scale-up of prevention. One mechanism for achieving this is technology-based tools to improve knowledge, acceptability, and coverage of interventions and services. This review provides a summary of the current gap in coverage of primary prevention services, how technology-based interventions and services can address gaps in coverage, and the current trends in the development and availability of technology-based primary prevention tools for use by MSM. Results from agent-based models of HIV epidemics of MSM suggest that 40-50 % coverage of multiple primary HIV prevention interventions and services, including biomedical interventions like preexposure prophylaxis, will be needed to reduce HIV incidence among MSM. In the USA, current levels of coverage for all interventions, except HIV testing and condom distribution, fall well short of this target. Recent findings illustrate how technology-based HIV prevention tools can be used to provide certain kinds of services at much larger scale, with marginal incremental costs. A review of mobile apps for primary HIV prevention revealed that most are designed by nonacademic, nonpublic health developers, and only a small proportion of available mobile apps specifically address MSM populations. We are unlikely to reach the required scale of HIV prevention intervention coverage for MSM unless we can leverage technologies to bring key services to broad coverage for MSM. Despite an exciting pipeline of technology-based prevention tools, there are broader challenges with funding structures and sustainability that need to be addressed to realize the full potential of this emerging public health field.

Analyzing multiple data sets by interconnecting RSAT programs via SOAP Web services: an example with ChIP-chip data.

PubMed

Sand, Olivier; Thomas-Chollier, Morgane; Vervisch, Eric; van Helden, Jacques

2008-01-01

This protocol shows how to access the Regulatory Sequence Analysis Tools (RSAT) via a programmatic interface in order to automate the analysis of multiple data sets. We describe the steps for writing a Perl client that connects to the RSAT Web services and implements a workflow to discover putative cis-acting elements in promoters of gene clusters. In the presented example, we apply this workflow to lists of transcription factor target genes resulting from ChIP-chip experiments. For each factor, the protocol predicts the binding motifs by detecting significantly overrepresented hexanucleotides in the target promoters and generates a feature map that displays the positions of putative binding sites along the promoter sequences. This protocol is addressed to bioinformaticians and biologists with programming skills (notions of Perl). Running time is approximately 6 min on the example data set.

CBM Reading, Mathematics, and Written Expression at the Secondary Level: Examining Latent Composite Relations among Indices and Unique Predictions with a State Achievement Test

ERIC Educational Resources Information Center

Codding, Robin S.; Petscher, Yaacov; Truckenmiller, Adrea

2015-01-01

A paucity of research has examined the utility of curriculum-based measurement (CBM) for data-based decision making at the secondary level. As schools move to multitiered systems of service delivery, it is conceivable that multiple screening measures will be used that address various academic subject areas. The value of including different CBM…

Engineering the ATLAS TAG Browser

NASA Astrophysics Data System (ADS)

Zhang, Qizhi; ATLAS Collaboration

2011-12-01

ELSSI is a web-based event metadata (TAG) browser and event-level selection service for ATLAS. In this paper, we describe some of the challenges encountered in the process of developing ELSSI, and the software engineering strategies adopted to address those challenges. Approaches to management of access to data, browsing, data rendering, query building, query validation, execution, connection management, and communication with auxiliary services are discussed. We also describe strategies for dealing with data that may vary over time, such as run-dependent trigger decision decoding. Along with examples, we illustrate how programming techniques in multiple languages (PHP, JAVASCRIPT, XML, AJAX, and PL/SQL) have been blended to achieve the required results. Finally, we evaluate features of the ELSSI service in terms of functionality, scalability, and performance.

Politics and patriarchy: barriers to health screening for socially disadvantaged women.

PubMed

Peters, Kathleen

2012-10-01

Health screening and early detection of cancer results in significantly better health outcomes and lower mortality. However barriers to such screening are multiple and complex. This paper specifically addresses barriers to women's health screening for socially disadvantaged women in an economically and service disadvantaged area. In this qualitative study, women's healthcare workers and consumers of women's health screening were interviewed and data related to issues for women who had special needs were analysed. Findings indicate there is a lack of access to appropriate services for socially disadvantaged women which affects their screening uptake rates. This study also highlights the difficulties socially disadvantaged women encountered when they were able to access these services which also influenced their decisions regarding subsequent health screening. Implications for nurses and other healthcare professionals are manifold and include advocating for greater access to services and more sensitive care in the delivery of health screening services for socially disadvantaged women.

Experiences from an interprofessional student-assisted chronic disease clinic.

PubMed

Frakes, Kerrie-Anne; Brownie, Sharon; Davies, Lauren; Thomas, Janelle; Miller, Mary-Ellen; Tyack, Zephanie

2014-11-01

Faced with significant health and workforce challenges in the region, the Central Queensland Health Service District (CQHSD) commenced a student-assisted clinical service. The Capricornia Allied Health Partnership (CAHP) is an interprofessional clinical placement program in which pre-entry students from exercise physiology, nutrition and dietetics, occupational therapy, pharmacy, podiatry and social work are embedded in a collaborative chronic disease service delivery model. The model coordinates multiple student clinical placements to: address service delivery gaps for previously underserved people with chronic disease in need of early intervention and management; provide an attractive clinical placement opportunity for students that will potentially lead to future recruitment success, and demonstrate leadership in developing future health workforce trainees to attain appropriate levels of interprofessional capacity. The CAHP clinic commenced student placements and client services in February 2010. This report provides early evaluative information regarding student experiences included self-reported changes in practice.

Failure Analysis for Composition of Web Services Represented as Labeled Transition Systems

NASA Astrophysics Data System (ADS)

Nadkarni, Dinanath; Basu, Samik; Honavar, Vasant; Lutz, Robyn

The Web service composition problem involves the creation of a choreographer that provides the interaction between a set of component services to realize a goal service. Several methods have been proposed and developed to address this problem. In this paper, we consider those scenarios where the composition process may fail due to incomplete specification of goal service requirements or due to the fact that the user is unaware of the functionality provided by the existing component services. In such cases, it is desirable to have a composition algorithm that can provide feedback to the user regarding the cause of failure in the composition process. Such feedback will help guide the user to re-formulate the goal service and iterate the composition process. We propose a failure analysis technique for composition algorithms that views Web service behavior as multiple sequences of input/output events. Our technique identifies the possible cause of composition failure and suggests possible recovery options to the user. We discuss our technique using a simple e-Library Web service in the context of the MoSCoE Web service composition framework.

A menu with prices: Annual per person costs of programs addressing community integration.

PubMed

Leff, H Stephen; Cichocki, Ben; Chow, Clifton; Salzer, Mark; Wieman, Dow

2016-02-01

Information on costs of programs addressing community integration for persons with serious mental illness in the United States, essential for program planning and evaluation, is largely lacking. To address this knowledge gap, community integration programs identified through directories and snowball sampling were sent an online survey addressing program costs and organizational attributes. 64 Responses were received for which annual per person costs (APPC) could be computed. Programs were categorized by type of services provided. Program types differed in median APPCs, though median APPCs identified were consistent with the ranges identified in the limited literature available. Multiple regression was used to identify organizational variables underlying APPCs such as psychosocial rehabilitation program type, provision of EBPs, number of volunteers, and percentage of budget spent on direct care staff, though effects sizes were moderate at best. This study adds tentative prices to the menu of community integration programs, and the implications of these findings for choosing, designing and evaluating programs addressing community integration are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

An Infrastructure for Multi-Level Secure Service-Oriented Architecture (MLS-SOA) Using the Multiple Single-Level Approach

DTIC Science & Technology

2009-12-17

IEEE TDKE, 1996. 8( 1). 14. Garvey, T.D., The inference Problem for Computer Security. 1992, SRI International. 15. Chaum , D ., Blind Signatures for...Pervasive Computing Environments. IEEE Transactions on Vehicular Technology, 2006. 55(4). 17. Chaum , D ., Security without Identification: Transaction...Systems to make Big Brother Obsolete. Communications of the ACM 1985. 28(10). 18. Chaum , D ., Untraceable Electronic Mail, Return Addresses, and Digital

Control Channel Vulnerability Analysis of the Institute of Electrical and Electronics Engineers 802.16m-2011 and 802.16- 2009 Standards

DTIC Science & Technology

2012-09-01

scheduler to adapt its uplink and downlink assignments to channel conditions. Sleep mode is used by the MS to minimize power drain and radio...is addressed in one resource unit, while for multi-user (MU) schemes , multiple users can be scheduled in one resource unit. Open-loop techniques...17  7.  Mobility and Power Management ......................................... 18  8.  Scheduling Services

Dual and multiple diagnosis among substance using runaway youth.

PubMed

Slesnick, Natasha; Prestopnik, Jillian

2005-01-01

Although research on runaway and homeless youth is increasing, relatively little is known about the diagnostic profile of runaway adolescents. The current study examined patterns of psychiatric dual and multiple diagnosis among a sample (N=226) of treatment-engaged substance-abusing youth (ages 13 to 17) who were residing at a runaway shelter. As part of a larger treatment outcome study, the youths' psychiatric status was assessed using the DSM-IV based computerized diagnostic interview schedule for children [CDISC; (1)]. The majority of the youth in our sample met criteria for dual or multiple diagnosis (60%) with many having more than one substance-use diagnosis (56%). The severity of mental-health and substance-use problems in this sample of substance-abusing runaways suggests the need for continued development of comprehensive services. The range and intensity of diagnoses seen indicates a need for greater focus on treatment development and strategies to address their multiple areas of risk.

Spatial diversification of agroecosystems to enhance biological control and other regulating services: An agroecological perspective.

PubMed

Hatt, Séverin; Boeraeve, Fanny; Artru, Sidonie; Dufrêne, Marc; Francis, Frédéric

2018-04-15

Spatial diversification of crop and non-crop habitats in farming systems is promising for enhancing natural regulation of insect pests. Nevertheless, results from recent syntheses show variable effects. One explanation is that the abundance and diversity of pests and natural enemies are affected by the composition, design and management of crop and non-crop habitats. Moreover, interactions between both local and landscape elements and practices carried out at different spatial scales may affect the regulation of insect pests. Hence, research is being conducted to understand these interdependencies. However, insects are not the only pests and pests are not the only elements to regulate in agroecosystems. Broadening the scope could allow addressing multiple issues simultaneously, but also solving them together by enhancing synergies. Indeed, spatial diversification of crop and non-crop habitats can allow addressing the issues of weeds and pathogens, along with being beneficial to several other regulating services like pollination, soil conservation and nutrient cycling. Although calls rise to develop multifunctional landscapes that optimize the delivery of multiple ecosystem services, it still represents a scientific challenge today. Enhancing interdisciplinarity in research institutions and building interrelations between scientists and stakeholders may help reach this goal. Despite obstacles, positive results from research based on such innovative approaches are encouraging for engaging science in this path. Hence, the aim of the present paper is to offer an update on these issues by exploring the most recent findings and discussing these results to highlight needs for future research. Copyright © 2017 Elsevier B.V. All rights reserved.

Patterns of targeting and encouraging participation of elder consumers in human services marketing.

PubMed

Kaye, L W

1996-01-01

Competition within the older adult services sector is fueling the widespread adoption of an organizational marketing mentality. Yet little is known of the degree of variation in marketing technology and commitment to elder consumer subgroups in different health and social service settings or the extent to which elders are involved actively in the marketing process. This paper addresses these issues drawing on study data collected from 274 elder service programs in six major U.S. metropolitan areas. Findings confirm that providers frequently co-market their services with other organizations and target multiple constituencies, but do not distinguish as well among specialized segments of the elder population varying in terms of gender, physical and mental capacity, age, financial status, or race. Significant predictors (p<.05) of increased levels of elder participation in the agency marketing pro cess include length of time marketing, specialized training in marketing, and nonsectarian auspice (R2=.22). Results lead to recommendations for mounting more cohort-sensitive marketing initiatives in human service agencies serving older adults.

A legal framework to enable sharing of Clinical Decision Support knowledge and services across institutional boundaries.

PubMed

Hongsermeier, Tonya; Maviglia, Saverio; Tsurikova, Lana; Bogaty, Dan; Rocha, Roberto A; Goldberg, Howard; Meltzer, Seth; Middleton, Blackford

2011-01-01

The goal of the CDS Consortium (CDSC) is to assess, define, demonstrate, and evaluate best practices for knowledge management and clinical decision support in healthcare information technology at scale - across multiple ambulatory care settings and Electronic Health Record technology platforms. In the course of the CDSC research effort, it became evident that a sound legal foundation was required for knowledge sharing and clinical decision support services in order to address data sharing, intellectual property, accountability, and liability concerns. This paper outlines the framework utilized for developing agreements in support of sharing, accessing, and publishing content via the CDSC Knowledge Management Portal as well as an agreement in support of deployment and consumption of CDSC developed web services in the context of a research project under IRB oversight.

Biobjective planning of GEO debris removal mission with multiple servicing spacecrafts

NASA Astrophysics Data System (ADS)

Jing, Yu; Chen, Xiao-qian; Chen, Li-hu

2014-12-01

The mission planning of GEO debris removal with multiple servicing spacecrafts (SScs) is studied in this paper. Specifically, the SScs are considered to be initially on the GEO belt, and they should rendezvous with debris of different orbital slots and different inclinations, remove them to the graveyard orbit and finally return to their initial locations. Three key problems should be resolved here: task assignment, mission sequence planning and transfer trajectory optimization for each SSc. The minimum-cost, two-impulse phasing maneuver is used for each rendezvous. The objective is to find a set of optimal planning schemes with minimum fuel cost and travel duration. Considering this mission as a hybrid optimal control problem, a mathematical model is proposed. A modified multi-objective particle swarm optimization is employed to address the model. Numerous examples are carried out to demonstrate the effectiveness of the model and solution method. In this paper, single-SSc and multiple-SSc scenarios with the same amount of fuel are compared. Numerous experiments indicate that for a definite GEO debris removal mission, that which alternative (single-SSc or multiple-SSc) is better (cost less fuel and consume less travel time) is determined by many factors. Although in some cases, multiple-SSc scenarios may perform worse than single-SSc scenarios, the extra costs are considered worth the gain in mission safety and robustness.

Profiles of service utilization and the resultant economic impact in preschoolers with attention deficit/hyperactivity disorder.

PubMed

Marks, David J; Mlodnicka, Agnieszka; Bernstein, Melissa; Chacko, Anil; Rose, Scott; Halperin, Jeffrey M

2009-07-01

To examine whether preschool children with Attention deficit/hyperactivity disorder (ADHD) utilize more speech and language therapy (ST), occupational therapy (OT), and physical therapy (PT) services and are more likely to be placed in special education (SPED) classrooms as compared to their peers. Corresponding financial consequences were also examined. The amount of ST, OT, and PT, as well as SPED placements, was examined in 3- and 4-year-old children with and without ADHD (n = 109 and n = 97, respectively) during the baseline portion of an ongoing, 5-year longitudinal study. Costs for individual services and aggregate cost were determined per child and compared across groups. Preschool children with ADHD were more likely to receive individual and multiple services. Higher rates of service utilization translated into increased costs for each individual service with the exception of PT. A comprehensive understanding of service utilization in the early years of development is important in addressing the increased service use in the preschool years and assist in guiding allocation of resources.

Servicing and Deployment of National Resources in Sun-Earth Libration Point Orbits

NASA Technical Reports Server (NTRS)

Folta, David C.; Beckman, Mark; Mar, Greg C.; Mesarch, Michael; Cooley, Steven; Leete, Steven J.

2002-01-01

Spacecraft travel between the Sun-Earth system, the Earth-Moon system, and beyond has received extensive attention recently. The existence of a connection between unstable regions enables mission designers to envision scenarios of multiple spacecraft traveling cheaply from system to system, rendezvousing, servicing, and refueling along the way. This paper presents examples of transfers between the Sun-Earth and Earth-Moon systems using a true ephemeris and perturbation model. It shows the (Delta)V costs associated with these transfers, including the costs to reach the staging region from the Earth. It explores both impulsive and low thrust transfer trajectories. Additionally, analysis that looks specifically at the use of nuclear power in libration point orbits and the issues associated with them such as inadvertent Earth return is addressed. Statistical analysis of Earth returns and the design of biased orbits to prevent any possible return are discussed. Lastly, the idea of rendezvous between spacecraft in libration point orbits using impulsive maneuvers is addressed.

Managing aquatic ecosystems and water resources under multiple stress--an introduction to the MARS project.

PubMed

Hering, Daniel; Carvalho, Laurence; Argillier, Christine; Beklioglu, Meryem; Borja, Angel; Cardoso, Ana Cristina; Duel, Harm; Ferreira, Teresa; Globevnik, Lidija; Hanganu, Jenica; Hellsten, Seppo; Jeppesen, Erik; Kodeš, Vit; Solheim, Anne Lyche; Nõges, Tiina; Ormerod, Steve; Panagopoulos, Yiannis; Schmutz, Stefan; Venohr, Markus; Birk, Sebastian

2015-01-15

Water resources globally are affected by a complex mixture of stressors resulting from a range of drivers, including urban and agricultural land use, hydropower generation and climate change. Understanding how stressors interfere and impact upon ecological status and ecosystem services is essential for developing effective River Basin Management Plans and shaping future environmental policy. This paper details the nature of these problems for Europe's water resources and the need to find solutions at a range of spatial scales. In terms of the latter, we describe the aims and approaches of the EU-funded project MARS (Managing Aquatic ecosystems and water Resources under multiple Stress) and the conceptual and analytical framework that it is adopting to provide this knowledge, understanding and tools needed to address multiple stressors. MARS is operating at three scales: At the water body scale, the mechanistic understanding of stressor interactions and their impact upon water resources, ecological status and ecosystem services will be examined through multi-factorial experiments and the analysis of long time-series. At the river basin scale, modelling and empirical approaches will be adopted to characterise relationships between multiple stressors and ecological responses, functions, services and water resources. The effects of future land use and mitigation scenarios in 16 European river basins will be assessed. At the European scale, large-scale spatial analysis will be carried out to identify the relationships amongst stress intensity, ecological status and service provision, with a special focus on large transboundary rivers, lakes and fish. The project will support managers and policy makers in the practical implementation of the Water Framework Directive (WFD), of related legislation and of the Blueprint to Safeguard Europe's Water Resources by advising the 3rd River Basin Management Planning cycle, the revision of the WFD and by developing new tools for diagnosing and predicting multiple stressors. Copyright © 2014. Published by Elsevier B.V.

SEL2 servicing: increased science return via on-orbit propellant replenishment

NASA Astrophysics Data System (ADS)

Reed, Benjamin B.; DeWeese, Keith; Kienlen, Michael; Aranyos, Thomas; Pellegrino, Joseph; Bacon, Charles; Qureshi, Atif

2016-07-01

Spacecraft designers are driving observatories to the distant Sun-Earth Lagrange Point 2 (SEL2) to meet ever-increasing science requirements. The mass fraction dedicated to propellant for these observatories to reach and operate at SEL2 will be allocated with the upmost care, as it comes at the expense of optics and instrument masses. As such, these observatories could benefit from on-orbit refueling, allowing greater dry-to-wet mass ratio at launch and/or longer mission life. NASA is developing technologies, capabilities and integrated mission designs for multiple servicing applications in low Earth orbit (LEO), geosynchronous Earth orbit (GEO) and cisluner locations. Restore-L, a mission officially in formulation, will launch a free-flying robotic servicer to refuel a government-owned satellite in LEO by mid 2020. This paper will detail the results of a point design mission study to extend Restore-L servicing technologies from LEO to SEL2. This SEL2 mission would launch an autonomous, robotic servicer spacecraft equipped to extend the life of two space assets through refueling. Two space platforms were chosen to 1) drive the requirements for achieving SEL2 orbit and rendezvous with a spacecraft, and 2) to drive the requirements to translate within SEL2 to conduct a follow-on servicing mission. Two fuels, xenon and hydrazine, were selected to assess a multiple delivery system. This paper will address key mission drivers, such as servicer autonomy (necessitated due to communications latency at L2). Also discussed will be the value of adding cooperative servicing elements to the client observatories to reduce mission risk.

The family empowerment program: an interdisciplinary approach to working with multi-stressed urban families.

PubMed

Cleek, Elizabeth N; Wofsy, Matt; Boyd-Franklin, Nancy; Mundy, Brian; Howell Lcsw, Tamika J

2012-06-01

The family empowerment program (FEP) is a multi-systemic family therapy program that partners multi-stressed families with an interdisciplinary resource team while remaining attached to a "traditional" mental health clinic. The rationale for this model is that far too often, families presenting at community mental health centers struggle with multiple psychosocial forces, for example problems with housing, domestic violence, child care, entitlements, racism, substance abuse, and foster care, as well as chronic medical and psychiatric illnesses, that exacerbate symptoms and impact traditional service delivery and access to effective treatment. Thus, families often experience fragmented care and are involved with multiple systems with contradictory and competing agendas. As a result, services frequently fail to harness the family's inherent strengths. The FEP partners the family with a unified team that includes representatives from Entitlements Services, Family Support and Parent Advocacy, and Clinical Staff from the agency's Outpatient Mental Health Clinic practicing from a strength-based family therapy perspective. The goal of the FEP is to support the family in achieving their goals. This is accomplished through co-construction of a service plan that addresses the family's needs in an efficient and coherent manner-emphasizing family strengths and competencies and supporting family self-sufficiency. © FPI, Inc.

Community hoarding task forces: a comparative case study of five task forces in the United States.

PubMed

Bratiotis, Christiana

2013-05-01

During the past decade, many community task forces have formed to address hoarding problems that come to public attention. Such task forces provide a societal-level intervention to assist people with the most severe cases of hoarding, who do not voluntarily seek or want help for their hoarding behaviour. This qualitative study of five U.S. hoarding task forces included sites selected for their diversity of purpose, approaches to hoarding intervention and community geography, composition and resources. Data were collected during the period of September 2007-March 2008. The case study methodology used multiple forms of data, including semi-structured interviews, analysis of documents, small group interviews and investigator observation. This study captured the perspectives of public and private sector service providers such as mental health, housing, social service, public health agencies and community enforcement organisations (fire, police, legal, animal control) to examine how task forces organise and operate and the emerging practice and policy changes. Study findings suggest that structural factors (e.g. leadership, purpose, funding and membership) impact hoarding task force viability, that participation on a task force influences practice and policy decisions about hoarding, and that social work can expand its role in task force leadership. Task forces may be a mechanism for improving community policies about hoarding and mechanisms for addressing other social problems across multiple sectors. © 2012 Blackwell Publishing Ltd.

Advancing Cyberinfrastructure to support high resolution water resources modeling

NASA Astrophysics Data System (ADS)

Tarboton, D. G.; Ogden, F. L.; Jones, N.; Horsburgh, J. S.

2012-12-01

Addressing the problem of how the availability and quality of water resources at large scales are sensitive to climate variability, watershed alterations and management activities requires computational resources that combine data from multiple sources and support integrated modeling. Related cyberinfrastructure challenges include: 1) how can we best structure data and computer models to address this scientific problem through the use of high-performance and data-intensive computing, and 2) how can we do this in a way that discipline scientists without extensive computational and algorithmic knowledge and experience can take advantage of advances in cyberinfrastructure? This presentation will describe a new system called CI-WATER that is being developed to address these challenges and advance high resolution water resources modeling in the Western U.S. We are building on existing tools that enable collaboration to develop model and data interfaces that link integrated system models running within an HPC environment to multiple data sources. Our goal is to enhance the use of computational simulation and data-intensive modeling to better understand water resources. Addressing water resource problems in the Western U.S. requires simulation of natural and engineered systems, as well as representation of legal (water rights) and institutional constraints alongside the representation of physical processes. We are establishing data services to represent the engineered infrastructure and legal and institutional systems in a way that they can be used with high resolution multi-physics watershed modeling at high spatial resolution. These services will enable incorporation of location-specific information on water management infrastructure and systems into the assessment of regional water availability in the face of growing demands, uncertain future meteorological forcings, and existing prior-appropriations water rights. This presentation will discuss the informatics challenges involved with data management and easy-to-use access to high performance computing being tackled in this project.

Barriers Accessing Mental Health Services Among Culturally and Linguistically Diverse (CALD) Immigrant Women in Australia: Policy Implications.

PubMed

Wohler, Yvonne; Dantas, Jaya Ar

2017-06-01

Immigrant and refugee women from diverse ethnic backgrounds encounter multiple barriers in accessing mental healthcare in various settings. A systematic review on the prevalence of mental health disorders among culturally and linguistically diverse (CALD) women in Australia documented the following barriers: logistical, language and communication, dissonance between participants and care providers and preference for alternative interventions. This article proposes recommendations for policies to better address the mental health needs of immigrant and refugee women. Key policy recommendations include: support for gender specific research, implementation and evaluation of transcultural policies, cultural responsiveness in service delivery, review of immigration and refugee claims policies and social integration of immigrants.

EnviroAtlas - Ecosystem Services Market-Based Programs Web Service, U.S., 2016, Forest Trends' Ecosystem Marketplace

EPA Pesticide Factsheets

This EnviroAtlas web service contains layers depicting market-based programs and projects addressing ecosystem services protection in the United States. Layers include data collected via surveys and desk research conducted by Forest Trends' Ecosystem Marketplace from 2008 to 2016 on biodiversity (i.e., imperiled species/habitats; wetlands and streams), carbon, and water markets and enabling conditions that facilitate, directly or indirectly, market-based approaches to protecting and investing in those ecosystem services. This dataset was produced by Forest Trends' Ecosystem Marketplace for EnviroAtlas in order to support public access to and use of information related to environmental markets. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

Toward the full and proper implementation of Jordan's Principle: An elusive goal to date.

PubMed

Blackstock, Cindy

2016-01-01

First Nations children experience service delays, disruptions and denials due to jurisdictional payment disputes within and between federal and provincial/territorial governments. The House of Commons sought to ensure First Nations children could access government services on the same terms as other children when it unanimously passed a private members motion in support of Jordan's Principle in 2007. Jordan's Principle states that when a jurisdictional dispute arises regarding public services for a First Nations child that are otherwise available to other children, the government of first contact pays for the service and addresses payment disputes later. Unfortunately, the federal government adopted a definition of Jordan's Principle that was so narrow (complex medical needs with multiple service providers) that no child ever qualified. This narrow definition has been found to be unlawful by the Federal Court of Canada and the Canadian Human Rights Tribunal. The present commentary describes Jordan's Principle, the legal cases that have considered it and the implications of those decisions for health care providers.

[Utility of conceptual schemes and mental maps on the teaching-learning process of residents in pediatrics].

PubMed

Cruza, Norberto Sotelo; Fierros, Luis E

2006-01-01

The present study was done at the internal medicine service oft he Hospital lnfantil in the State of Sonora, Mexico. We tried to address the question of the use of conceptual schemes and mind maps and its impact on the teaching-learning-evaluation process among medical residents. Analyze the effects of conceptual schemes, and mind maps as a teaching and evaluation tool and compare them with multiple choice exams among Pediatric residents. Twenty two residents (RI, RII, RIII)on service rotation during six months were assessed initially, followed by a lecture on a medical subject. Conceptual schemes and mind maps were then introduced as a teaching-learning-evaluation instrument. Comprehension impact and comparison with a standard multiple choice evaluation was done. The statistical package (JMP version 5, SAS inst. 2004) was used. We noted that when we used conceptual schemes and mind mapping, learning improvement was noticeable among the three groups of residents (P < 0.001) and constitutes a better evaluation tool when compared with multiple choice exams (P < 0.0005). Based on our experience we recommend the use of this educational technique for medical residents in training.

Assessing and managing multiple risks in a changing world ...

EPA Pesticide Factsheets

Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk—Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process; dealing with societal issues; risk-management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. The authors encourage both cross-disciplinary and interdisciplinary approaches to address their 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and nonchemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk-assessment process; 4) fully integrate risk assessors and communities of interest into the risk-management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological c

Linking functional diversity and social actor strategies in a framework for interdisciplinary analysis of nature's benefits to society

PubMed Central

Díaz, Sandra; Cáceres, Daniel M.; Trainor, Sarah F.; Pérez-Harguindeguy, Natalia; Bret-Harte, M. Syndonia; Finegan, Bryan; Peña-Claros, Marielos; Poorter, Lourens

2011-01-01

The crucial role of biodiversity in the links between ecosystems and societies has been repeatedly highlighted both as source of wellbeing and as a target of human actions, but not all aspects of biodiversity are equally important to different ecosystem services. Similarly, different social actors have different perceptions of and access to ecosystem services, and therefore, they have different wants and capacities to select directly or indirectly for particular biodiversity and ecosystem characteristics. Their choices feed back onto the ecosystem services provided to all parties involved and in turn, affect future decisions. Despite this recognition, the research communities addressing biodiversity, ecosystem services, and human outcomes have yet to develop frameworks that adequately treat the multiple dimensions and interactions in the relationship. Here, we present an interdisciplinary framework for the analysis of relationships between functional diversity, ecosystem services, and human actions that is applicable to specific social environmental systems at local scales. We connect the mechanistic understanding of the ecological role of diversity with its social relevance: ecosystem services. The framework permits connections between functional diversity components and priorities of social actors using land use decisions and ecosystem services as the main links between these ecological and social components. We propose a matrix-based method that provides a transparent and flexible platform for quantifying and integrating social and ecological information and negotiating potentially conflicting land uses among multiple social actors. We illustrate the applicability of our framework by way of land use examples from temperate to subtropical South America, an area of rapid social and ecological change. PMID:21220325

Incorporating climate change into ecosystem service assessments and decisions: a review.

PubMed

Runting, Rebecca K; Bryan, Brett A; Dee, Laura E; Maseyk, Fleur J F; Mandle, Lisa; Hamel, Perrine; Wilson, Kerrie A; Yetka, Kathleen; Possingham, Hugh P; Rhodes, Jonathan R

2017-01-01

Climate change is having a significant impact on ecosystem services and is likely to become increasingly important as this phenomenon intensifies. Future impacts can be difficult to assess as they often involve long timescales, dynamic systems with high uncertainties, and are typically confounded by other drivers of change. Despite a growing literature on climate change impacts on ecosystem services, no quantitative syntheses exist. Hence, we lack an overarching understanding of the impacts of climate change, how they are being assessed, and the extent to which other drivers, uncertainties, and decision making are incorporated. To address this, we systematically reviewed the peer-reviewed literature that assesses climate change impacts on ecosystem services at subglobal scales. We found that the impact of climate change on most types of services was predominantly negative (59% negative, 24% mixed, 4% neutral, 13% positive), but varied across services, drivers, and assessment methods. Although uncertainty was usually incorporated, there were substantial gaps in the sources of uncertainty included, along with the methods used to incorporate them. We found that relatively few studies integrated decision making, and even fewer studies aimed to identify solutions that were robust to uncertainty. For management or policy to ensure the delivery of ecosystem services, integrated approaches that incorporate multiple drivers of change and account for multiple sources of uncertainty are needed. This is undoubtedly a challenging task, but ignoring these complexities can result in misleading assessments of the impacts of climate change, suboptimal management outcomes, and the inefficient allocation of resources for climate adaptation. © 2016 John Wiley & Sons Ltd.

Learning to Select Supplier Portfolios for Service Supply Chain

PubMed Central

Zhang, Rui; Li, Jingfei; Wu, Shaoyu; Meng, Dabin

2016-01-01

The research on service supply chain has attracted more and more focus from both academia and industrial community. In a service supply chain, the selection of supplier portfolio is an important and difficult problem due to the fact that a supplier portfolio may include multiple suppliers from a variety of fields. To address this problem, we propose a novel supplier portfolio selection method based on a well known machine learning approach, i.e., Ranking Neural Network (RankNet). In the proposed method, we regard the problem of supplier portfolio selection as a ranking problem, which integrates a large scale of decision making features into a ranking neural network. Extensive simulation experiments are conducted, which demonstrate the feasibility and effectiveness of the proposed method. The proposed supplier portfolio selection model can be applied in a real corporation easily in the future. PMID:27195756

Meeting the challenge of interacting threats in freshwater ecosystems: A call to scientists and managers

USGS Publications Warehouse

Craig, Laura S.; Olden, Julian D.; Arthington, Angela; Entrekin, Sally; Hawkins, Charles P.; Kelly, John J.; Kennedy, Theodore A.; Maitland, Bryan M.; Rosi, Emma J.; Roy, Allison; Strayer, David L.; Tank, Jennifer L.; West, Amie O.; Wooten, Matthew S.

2017-01-01

Human activities create threats that have consequences for freshwater ecosystems and, in most watersheds, observed ecological responses are the result of complex interactions among multiple threats and their associated ecological alterations. Here we discuss the value of considering multiple threats in research and management, offer suggestions for filling knowledge gaps, and provide guidance for addressing the urgent management challenges posed by multiple threats in freshwater ecosystems. There is a growing literature assessing responses to multiple alterations, and we build off this background to identify three areas that require greater attention: linking observed alterations to threats, understanding when and where threats overlap, and choosing metrics that best quantify the effects of multiple threats. Advancing science in these areas will help us understand existing ecosystem conditions and predict future risk from multiple threats. Because addressing the complex issues and novel ecosystems that arise from the interaction of multiple threats in freshwater ecosystems represents a significant management challenge, and the risks of management failure include loss of biodiversity, ecological goods, and ecosystem services, we also identify actions that could improve decision-making and management outcomes. These actions include drawing insights from management of individual threats, using threat attributes (e.g., causes and spatio-temporal dynamics) to identify suitable management approaches, testing management strategies that are likely to be successful despite uncertainties about the nature of interactions among threats, avoiding unintended consequences, and maximizing conservation benefits. We also acknowledge the broadly applicable challenges of decision-making within a socio-political and economic framework, and suggest that multidisciplinary teams will be needed to innovate solutions to meet the current and future challenge of interacting threats in freshwater ecosystems. 

Addressing data access challenges in seismology

NASA Astrophysics Data System (ADS)

Trabant, C. M.; Ahern, T.; Weertman, B.; Benson, R. B.; Van Fossen, M.; Weekly, R. T.; Casey, R. E.; Suleiman, Y. Y.; Stults, M.

2016-12-01

The development of web services at the IRIS Data Management Center (DMC) over the last 6 years represents the most significant enhancement of data access ever introduced at the DMC. These web services have allowed the us to focus our internal operations around a single, consistent data access layer while facilitating development of a new generation of tools and methods for researchers to conduct their work. This effort led the DMC to propose standardized web service interfaces within the International Federation of Digital Seismograph Networks (FDSN), enabling other seismological data centers to offer data using compatible interfaces. With this new foundation, we now turn our attention to more advanced data access challenges. In particular, we will present the status of two developments intending to address 1) access to data of consistent quality for science and 2) discovery and access of data from multiple data centers. To address the challenge of requesting high or consistent quality data we will introduce our Research-Ready Data Sets (RRDS) initiative. The purpose of the RRDS project is to reduce the time a researcher spends culling and otherwise identifying data appropriate for given study. RRDS will provide users with additional criteria related to data quality that can be specified when requesting data. Leveraging the data quality measurements provided by our MUSTANG system, these criteria will include ambient noise, completeness, dead channel identification and more. To address the challenge of seismological data discovery and access, we have built and continue to improve the IRIS Federator. The Federator takes advantage of the FDSN-standard web services at various data centers to help a user locate specific channels, wherever they may be offered globally. The search interface provides results that are pre-formatted requests, ready for submission to each data center that serves that data. These two developments are aimed squarely at reducing the time researchers spend searching for, collecting and preparing data for processing.

Multiple Employment Training Programs. How Legislative Proposals Address Concerns. Testimony before the Subcommittee on Employment, Housing and Aviation, Committee on Government Operations, House of Representatives. Statement of Clarence C. Crawford, Associate Director, Education and Employment Issues, Health, Education, and Human Services Division.

ERIC Educational Resources Information Center

Crawford, Clarence C.

In the fragmented federal system, over 150 programs provide employment training assistance to adults and out-of-school youth. Individually, these programs have well-intended purposes. Collectively, they raise four concerns: (1) they are difficult for job seekers and employers to access and for administrators to implement; (2) they overlap and…

Structural barriers to HIV prevention among men who have sex with men (MSM) in Vietnam: Diversity, stigma, and healthcare access.

PubMed

Philbin, Morgan M; Hirsch, Jennifer S; Wilson, Patrick A; Ly, An Thanh; Giang, Le Minh; Parker, Richard G

2018-01-01

Men who have sex with men (MSM) in Vietnam experience disproportionate rates of HIV infection. To advance understanding of how structural barriers may shape their engagement with HIV prevention services, we draw on 32 in-depth interviews and four focus groups (n = 31) conducted with MSM in Hanoi between October 2015- March 2016. Three primary factors emerged: (1) Diversity, both in relation to identity and income; Vietnamese MSM described themselves as segregated into Bóng kín (hidden, often heterosexually-identified MSM) and Bóng lộ ('out,' transgender, or effeminate MSM). Lower-income, 'hidden' MSM from rural areas were reluctant to access MSM-targeted services; (2) Stigma: MSM reported being stigmatized by the healthcare system, family, and other MSM; and (3) Healthcare access: this was limited due to economic barriers and lack of MSM-friendly services. Our research suggests the need for multiple strategies to reach diverse types of MSM as well as to address barriers in access to health services such as stigma and costs. While a great deal has been written about the diversity of MSM in relation to gender performance and sexual identities, our research points to the substantial structural-level barriers that must be addressed in order to achieve meaningful and effective HIV prevention for MSM worldwide.

Indicators of biodiversity and ecosystem services: A synthesis across ecosystems and spatial scales

USGS Publications Warehouse

Feld, C.K.; Da Silva, P.M.; Sousa, J.P.; De Bello, F.; Bugter, R.; Grandin, U.; Hering, D.; Lavorel, S.; Mountford, O.; Pardo, I.; Partel, M.; Rombke, J.; Sandin, Leonard; Jones, K. Bruce; Harrison, P.

2009-01-01

According to the Millennium Ecosystem Assessment, common indicators are needed to monitor the loss of biodiversity and the implications for the sustainable provision of ecosystem services. However, a variety of indicators are already being used resulting in many, mostly incompatible, monitoring systems. In order to synthesise the different indicator approaches and to detect gaps in the development of common indicator systems, we examined 531 indicators that have been reported in 617 peer-reviewed journal articles between 1997 and 2007. Special emphasis was placed on comparing indicators of biodiversity and ecosystem services across ecosystems (forests, grass- and shrublands, wetlands, rivers, lakes, soils and agro-ecosystems) and spatial scales (from patch to global scale). The application of biological indicators was found most often focused on regional and finer spatial scales with few indicators applied across ecosystem types. Abiotic indicators, such as physico-chemical parameters and measures of area and fragmentation, are most frequently used at broader (regional to continental) scales. Despite its multiple dimensions, biodiversity is usually equated with species richness only. The functional, structural and genetic components of biodiversity are poorly addressed despite their potential value across habitats and scales. Ecosystem service indicators are mostly used to estimate regulating and supporting services but generally differ between ecosystem types as they reflect ecosystem-specific services. Despite great effort to develop indicator systems over the past decade, there is still a considerable gap in the widespread use of indicators for many of the multiple components of biodiversity and ecosystem services, and a need to develop common monitoring schemes within and across habitats. Filling these gaps is a prerequisite for linking biodiversity dynamics with ecosystem service delivery and to achieving the goals of global and sub-global initiatives to halt the loss of biodiversity. ?? 2009 Oikos.

Policy challenges and approaches for the conservation of mangrove forests in Southeast Asia.

PubMed

Friess, Daniel A; Thompson, Benjamin S; Brown, Ben; Amir, A Aldrie; Cameron, Clint; Koldewey, Heather J; Sasmito, Sigit D; Sidik, Frida

2016-10-01

Many drivers of mangrove forest loss operate over large scales and are most effectively addressed by policy interventions. However, conflicting or unclear policy objectives exist at multiple tiers of government, resulting in contradictory management decisions. To address this, we considered four approaches that are being used increasingly or could be deployed in Southeast Asia to ensure sustainable livelihoods and biodiversity conservation. First, a stronger incorporation of mangroves into marine protected areas (that currently focus largely on reefs and fisheries) could resolve some policy conflicts and ensure that mangroves do not fall through a policy gap. Second, examples of community and government comanagement exist, but achieving comanagement at scale will be important in reconciling stakeholders and addressing conflicting policy objectives. Third, private-sector initiatives could protect mangroves through existing and novel mechanisms in degraded areas and areas under future threat. Finally, payments for ecosystem services (PES) hold great promise for mangrove conservation, with carbon PES schemes (known as blue carbon) attracting attention. Although barriers remain to the implementation of PES, the potential to implement them at multiple scales exists. Closing the gap between mangrove conservation policies and action is crucial to the improved protection and management of this imperiled coastal ecosystem and to the livelihoods that depend on them. © 2016 Society for Conservation Biology.

Extension of specification language for soundness and completeness of service workflow

NASA Astrophysics Data System (ADS)

Viriyasitavat, Wattana; Xu, Li Da; Bi, Zhuming; Sapsomboon, Assadaporn

2018-05-01

A Service Workflow is an aggregation of distributed services to fulfill specific functionalities. With ever increasing available services, the methodologies for the selections of the services against the given requirements become main research subjects in multiple disciplines. A few of researchers have contributed to the formal specification languages and the methods for model checking; however, existing methods have the difficulties to tackle with the complexity of workflow compositions. In this paper, we propose to formalize the specification language to reduce the complexity of the workflow composition. To this end, we extend a specification language with the consideration of formal logic, so that some effective theorems can be derived for the verification of syntax, semantics, and inference rules in the workflow composition. The logic-based approach automates compliance checking effectively. The Service Workflow Specification (SWSpec) has been extended and formulated, and the soundness, completeness, and consistency of SWSpec applications have been verified; note that a logic-based SWSpec is mandatory for the development of model checking. The application of the proposed SWSpec has been demonstrated by the examples with the addressed soundness, completeness, and consistency.

Rapid emergence of climate change in environmental drivers of marine ecosystems.

PubMed

Henson, Stephanie A; Beaulieu, Claudie; Ilyina, Tatiana; John, Jasmin G; Long, Matthew; Séférian, Roland; Tjiputra, Jerry; Sarmiento, Jorge L

2017-03-07

Climate change is expected to modify ecological responses in the ocean, with the potential for important effects on the ecosystem services provided to humankind. Here we address the question of how rapidly multiple drivers of marine ecosystem change develop in the future ocean. By analysing an ensemble of models we find that, within the next 15 years, the climate change-driven trends in multiple ecosystem drivers emerge from the background of natural variability in 55% of the ocean and propagate rapidly to encompass 86% of the ocean by 2050 under a 'business-as-usual' scenario. However, we also demonstrate that the exposure of marine ecosystems to climate change-induced stress can be drastically reduced via climate mitigation measures; with mitigation, the proportion of ocean susceptible to multiple drivers within the next 15 years is reduced to 34%. Mitigation slows the pace at which multiple drivers emerge, allowing an additional 20 years for adaptation in marine ecological and socio-economic systems alike.

Rapid emergence of climate change in environmental drivers of marine ecosystems

PubMed Central

Henson, Stephanie A.; Beaulieu, Claudie; Ilyina, Tatiana; John, Jasmin G.; Long, Matthew; Séférian, Roland; Tjiputra, Jerry; Sarmiento, Jorge L.

2017-01-01

Climate change is expected to modify ecological responses in the ocean, with the potential for important effects on the ecosystem services provided to humankind. Here we address the question of how rapidly multiple drivers of marine ecosystem change develop in the future ocean. By analysing an ensemble of models we find that, within the next 15 years, the climate change-driven trends in multiple ecosystem drivers emerge from the background of natural variability in 55% of the ocean and propagate rapidly to encompass 86% of the ocean by 2050 under a ‘business-as-usual' scenario. However, we also demonstrate that the exposure of marine ecosystems to climate change-induced stress can be drastically reduced via climate mitigation measures; with mitigation, the proportion of ocean susceptible to multiple drivers within the next 15 years is reduced to 34%. Mitigation slows the pace at which multiple drivers emerge, allowing an additional 20 years for adaptation in marine ecological and socio-economic systems alike. PMID:28267144

Iterative channel decoding of FEC-based multiple-description codes.

PubMed

Chang, Seok-Ho; Cosman, Pamela C; Milstein, Laurence B

2012-03-01

Multiple description coding has been receiving attention as a robust transmission framework for multimedia services. This paper studies the iterative decoding of FEC-based multiple description codes. The proposed decoding algorithms take advantage of the error detection capability of Reed-Solomon (RS) erasure codes. The information of correctly decoded RS codewords is exploited to enhance the error correction capability of the Viterbi algorithm at the next iteration of decoding. In the proposed algorithm, an intradescription interleaver is synergistically combined with the iterative decoder. The interleaver does not affect the performance of noniterative decoding but greatly enhances the performance when the system is iteratively decoded. We also address the optimal allocation of RS parity symbols for unequal error protection. For the optimal allocation in iterative decoding, we derive mathematical equations from which the probability distributions of description erasures can be generated in a simple way. The performance of the algorithm is evaluated over an orthogonal frequency-division multiplexing system. The results show that the performance of the multiple description codes is significantly enhanced.

Rapid emergence of climate change in environmental drivers of marine ecosystems

NASA Astrophysics Data System (ADS)

Henson, Stephanie A.; Beaulieu, Claudie; Ilyina, Tatiana; John, Jasmin G.; Long, Matthew; Séférian, Roland; Tjiputra, Jerry; Sarmiento, Jorge L.

2017-03-01

Climate change is expected to modify ecological responses in the ocean, with the potential for important effects on the ecosystem services provided to humankind. Here we address the question of how rapidly multiple drivers of marine ecosystem change develop in the future ocean. By analysing an ensemble of models we find that, within the next 15 years, the climate change-driven trends in multiple ecosystem drivers emerge from the background of natural variability in 55% of the ocean and propagate rapidly to encompass 86% of the ocean by 2050 under a `business-as-usual' scenario. However, we also demonstrate that the exposure of marine ecosystems to climate change-induced stress can be drastically reduced via climate mitigation measures; with mitigation, the proportion of ocean susceptible to multiple drivers within the next 15 years is reduced to 34%. Mitigation slows the pace at which multiple drivers emerge, allowing an additional 20 years for adaptation in marine ecological and socio-economic systems alike.

Quantifying multiple telecouplings using an integrated suite of spatially-explicit tools

NASA Astrophysics Data System (ADS)

Tonini, F.; Liu, J.

2016-12-01

Telecoupling is an interdisciplinary research umbrella concept that enables natural and social scientists to understand and generate information for managing how humans and nature can sustainably coexist worldwide. To systematically study telecoupling, it is essential to build a comprehensive set of spatially-explicit tools for describing and quantifying multiple reciprocal socioeconomic and environmental interactions between a focal area and other areas. Here we introduce the Telecoupling Toolbox, a new free and open-source set of tools developed to map and identify the five major interrelated components of the telecoupling framework: systems, flows, agents, causes, and effects. The modular design of the toolbox allows the integration of existing tools and software (e.g. InVEST) to assess synergies and tradeoffs associated with policies and other local to global interventions. We show applications of the toolbox using a number of representative studies that address a variety of scientific and management issues related to telecouplings throughout the world. The results suggest that the toolbox can thoroughly map and quantify multiple telecouplings under various contexts while providing users with an easy-to-use interface. It provides a powerful platform to address globally important issues, such as land use and land cover change, species invasion, migration, flows of ecosystem services, and international trade of goods and products.

Global Climate Change Adaptation Priorities for Biodiversity and Food Security

PubMed Central

Hannah, Lee; Ikegami, Makihiko; Hole, David G.; Seo, Changwan; Butchart, Stuart H. M.; Peterson, A. Townsend; Roehrdanz, Patrick R.

2013-01-01

International policy is placing increasing emphasis on adaptation to climate change, including the allocation of new funds to assist adaptation efforts. Climate change adaptation funding may be most effective where it meets integrated goals, but global geographic priorities based on multiple development and ecological criteria are not well characterized. Here we show that human and natural adaptation needs related to maintaining agricultural productivity and ecosystem integrity intersect in ten major areas globally, providing a coherent set of international priorities for adaptation funding. An additional seven regional areas are identified as worthy of additional study. The priority areas are locations where changes in crop suitability affecting impoverished farmers intersect with changes in ranges of restricted-range species. Agreement among multiple climate models and emissions scenarios suggests that these priorities are robust. Adaptation funding directed to these areas could simultaneously address multiple international policy goals, including poverty reduction, protecting agricultural production and safeguarding ecosystem services. PMID:23991125

Global climate change adaptation priorities for biodiversity and food security.

PubMed

Hannah, Lee; Ikegami, Makihiko; Hole, David G; Seo, Changwan; Butchart, Stuart H M; Peterson, A Townsend; Roehrdanz, Patrick R

2013-01-01

International policy is placing increasing emphasis on adaptation to climate change, including the allocation of new funds to assist adaptation efforts. Climate change adaptation funding may be most effective where it meets integrated goals, but global geographic priorities based on multiple development and ecological criteria are not well characterized. Here we show that human and natural adaptation needs related to maintaining agricultural productivity and ecosystem integrity intersect in ten major areas globally, providing a coherent set of international priorities for adaptation funding. An additional seven regional areas are identified as worthy of additional study. The priority areas are locations where changes in crop suitability affecting impoverished farmers intersect with changes in ranges of restricted-range species. Agreement among multiple climate models and emissions scenarios suggests that these priorities are robust. Adaptation funding directed to these areas could simultaneously address multiple international policy goals, including poverty reduction, protecting agricultural production and safeguarding ecosystem services.

U.S. federally funded television public service announcements (PSAs) to prevent HIV/AIDS: a content analysis.

PubMed

Dejong, W; Wolf, R C; Austin, S B

2001-01-01

This article reports a content analysis of 56 English-language public service announcements (PSAs) for HIV/AIDS prevention produced since 1987 by the U.S. federal government for television broadcast. These PSAs do not lead target audiences through a logical sequence from awareness to motivation, skill building, and maintenance. The PSAs underutilize a strategy of "strategic ambiguity" to craft individual PSAs that can address the needs of and appeal to multiple target audiences, thereby directing information not only to heterosexuals, the primary target of these PSAs, but also to homosexuals and bisexuals. The PSAs largely ignore issues related to injection drug use and needle sharing. What drug-related portrayals there are focus on African American street junkies, which perpetuates racial stereotypes and fails to address occasional injection drug use. The PSAs exploit fear of HIV/AIDS to discourage drug use but do not offer drug treatment or counseling information. PSAs produced by the Clinton administration to promote condom use do not fully address key reasons why people fail to use condoms: concern about sexual pleasure, embarrassment about obtaining condoms, and lack of skills to negotiate condom use with sexual partners. Implications of these conclusions for the future of U.S. HIV/AIDS prevention are discussed.

Challenge of improving postoperative pain management: case studies of three acute pain services in the UK National Health Service.

PubMed

Powell, A E; Davies, H T O; Bannister, J; Macrae, W A

2009-06-01

Previous national survey research has shown significant deficits in routine postoperative pain management in the UK. This study used an organizational change perspective to explore in detail the organizational challenges faced by three acute pain services in improving postoperative pain management. Case studies were conducted comprising documentary review and semi-structured interviews (71) with anaesthetists, surgeons, nurses, other health professionals, and managers working in and around three broadly typical acute pain services. Although the precise details differed to some degree, the three acute pain services all faced the same broad range of inter-related challenges identified in the organizational change literature (i.e. structural, political, cultural, educational, emotional, and physical/technological challenges). The services were largely isolated from wider organizational objectives and activities and struggled to engage other health professionals in improving postoperative pain management against a background of limited resources, turbulent organizational change, and inter- and intra-professional politics. Despite considerable efforts they struggled to address these challenges effectively. The literature on organizational change and quality improvement in health care suggests that it is only by addressing the multiple challenges in a comprehensive way across all levels of the organization and health-care system that sustained improvements in patient care can be secured. This helps to explain why the hard work and commitment of acute pain services over the years have not always resulted in significant improvements in routine postoperative pain management for all surgical patients. Using this literature and adopting a whole-organization quality improvement approach tailored to local circumstances may produce a step-change in the quality of routine postoperative pain management.

An integrated Ka/Ku-band payload for personal, mobile and private business communications

NASA Technical Reports Server (NTRS)

Hayes, Edward J.; Keelty, J. Malcolm

1991-01-01

The Canadian Department of Communications has been studying options for a government-sponsored demonstration payload to be launched before the end of the century. A summary of the proposed system concepts and network architectures for providing an advanced private business network service at Ku-band and personal and mobile communications at Ka-band is presented. The system aspects addressed include coverage patterns, traffic capacity, and grade of service, multiple access options as well as special problems, such as Doppler in mobile applications. Earth terminal types and the advanced payload concept proposed in a feasibility study for the demonstration mission are described. This concept is a combined Ka-band/Ku-band payload which incorporates a number of advanced satellite technologies including a group demodulator to convert single-channel-per-carrier frequency division multiple access uplink signals to a time division multiplex downlink, on-board signal regeneration, and baseband switching to support packet switched data operation. The on-board processing capability of the payload provides a hubless VSAT architecture which permits single-hop full mesh interconnectivity. The Ka-band and Ku-band portions of the payload are fully integrated through an on-board switch, thereby providing the capability for fully integrated services, such as using the Ku-band VSAT terminals as gateway stations for the Ka-band personal and mobile communications services.

Access to medicines from a health system perspective

PubMed Central

Bigdeli, Maryam; Jacobs, Bart; Tomson, Goran; Laing, Richard; Ghaffar, Abdul; Dujardin, Bruno; Van Damme, Wim

2013-01-01

Most health system strengthening interventions ignore interconnections between systems components. In particular, complex relationships between medicines and health financing, human resources, health information and service delivery are not given sufficient consideration. As a consequence, populations' access to medicines (ATM) is addressed mainly through fragmented, often vertical approaches usually focusing on supply, unrelated to the wider issue of access to health services and interventions. The objective of this article is to embed ATM in a health system perspective. For this purpose, we perform a structured literature review: we examine existing ATM frameworks, review determinants of ATM and define at which level of the health system they are likely to occur; we analyse to which extent existing ATM frameworks take into account access constraints at different levels of the health system. Our findings suggest that ATM barriers are complex and interconnected as they occur at multiple levels of the health system. Existing ATM frameworks only partially address the full range of ATM barriers. We propose three essential paradigm shifts that take into account complex and dynamic relationships between medicines and other components of the health system. A holistic view of demand-side constraints in tandem with consideration of multiple and dynamic relationships between medicines and other health system resources should be applied; it should be recognized that determinants of ATM are rooted in national, regional and international contexts. These are schematized in a new framework proposing a health system perspective on ATM. PMID:23174879

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

PubMed

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

2014-10-06

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

Sensor Alerting Capability

NASA Astrophysics Data System (ADS)

Henriksson, Jakob; Bermudez, Luis; Satapathy, Goutam

2013-04-01

There is a large amount of sensor data generated today by various sensors, from in-situ buoys to mobile underwater gliders. Providing sensor data to the users through standardized services, language and data model is the promise of OGC's Sensor Web Enablement (SWE) initiative. As the amount of data grows it is becoming difficult for data providers, planners and managers to ensure reliability of data and services and to monitor critical data changes. Intelligent Automation Inc. (IAI) is developing a net-centric alerting capability to address these issues. The capability is built on Sensor Observation Services (SOSs), which is used to collect and monitor sensor data. The alerts can be configured at the service level and at the sensor data level. For example it can alert for irregular data delivery events or a geo-temporal statistic of sensor data crossing a preset threshold. The capability provides multiple delivery mechanisms and protocols, including traditional techniques such as email and RSS. With this capability decision makers can monitor their assets and data streams, correct failures or be alerted about a coming phenomena.

Integrating Health and Prevention Services in Syringe Access Programs: A Strategy to Address Unmet Needs in a High-Risk Population

PubMed Central

Storm, Deborah S.; Hoyt, Mary Jo; Dutton, Loretta; Berezny, Linda; Allread, Virginia; Paul, Sindy

2014-01-01

Injection drug users are at a high risk for a number of preventable diseases and complications of drug use. This article describes the implementation of a nurse-led health promotion and disease prevention program in New Jersey's syringe access programs. Initially designed to target women as part of a strategy to decrease missed opportunities for perinatal HIV prevention, the program expanded by integrating existing programs and funding streams available through the state health department. The program now offers health and prevention services to both men and women, with 3,488 client visits in 2011. These services extend the reach of state health department programs, such as adult vaccination and hepatitis and tuberculosis screening, which clients would have had to seek out at multiple venues. The integration of prevention, treatment, and health promotion services in syringe access programs reaches a vulnerable and underserved population who otherwise may receive only urgent and episodic care. PMID:24385646

Data-centric multiobjective QoS-aware routing protocol for body sensor networks.

PubMed

Razzaque, Md Abdur; Hong, Choong Seon; Lee, Sungwon

2011-01-01

In this paper, we address Quality-of-Service (QoS)-aware routing issue for Body Sensor Networks (BSNs) in delay and reliability domains. We propose a data-centric multiobjective QoS-Aware routing protocol, called DMQoS, which facilitates the system to achieve customized QoS services for each traffic category differentiated according to the generated data types. It uses modular design architecture wherein different units operate in coordination to provide multiple QoS services. Their operation exploits geographic locations and QoS performance of the neighbor nodes and implements a localized hop-by-hop routing. Moreover, the protocol ensures (almost) a homogeneous energy dissipation rate for all routing nodes in the network through a multiobjective Lexicographic Optimization-based geographic forwarding. We have performed extensive simulations of the proposed protocol, and the results show that DMQoS has significant performance improvements over several state-of-the-art approaches.

Communication architecture for large geostationary platforms

NASA Technical Reports Server (NTRS)

Bond, F. E.

1979-01-01

Large platforms have been proposed for supporting multipurpose communication payloads to exploit economy of scale, reduce congestion in the geostationary orbit, provide interconnectivity between diverse earth stations, and obtain significant frequency reuse with large multibeam antennas. This paper addresses a specific system design, starting with traffic projections in the next two decades and discussing tradeoffs and design approaches for major components including: antennas, transponders, and switches. Other issues explored are selection of frequency bands, modulation, multiple access, switching methods, and techniques for servicing areas with nonuniform traffic demands. Three-major services are considered: a high-volume trunking system, a direct-to-user system, and a broadcast system for video distribution and similar functions. Estimates of payload weight and d.c. power requirements are presented. Other subjects treated are: considerations of equipment layout for servicing by an orbit transfer vehicle, mechanical stability requirements for the large antennas, and reliability aspects of the large number of transponders employed.

A Conceptual Framework to Address Stress-Associated ...

EPA Pesticide Factsheets

Chronic stress leads to a variety of mental and physiological disorders, and stress effects are the primary concern after traumatic injury and exposure to infectious diseases or toxic agents from disaster events. We developed a conceptual model to address the question of whether degradation of ecosystem services (ES) by disasters such as recent hurricanes and the Deepwater Horizon oil catastrophe produce acute and chronic stress that ultimately result in short- and long-term negative health outcomes in people. An interdisciplinary team with expertise in data mining, ecology, ecosystem services, ecotoxicology, landscape ecology, mental health, psychiatry, and stress physiology utilized the Driver-Pressure-State-Ecosystem Service model of Kelble et al. (2013), the mental health framework of Palinkas (2012) and McEwen’s (1993) allostatic load model of chronic stress as starting points. Initial modeling results were augmented via expert workshops and peer review. Our conceptual model connects effects of disasters to changes in specific ecosystem components (e.g., water quality, biodiversity, fishery populations) with resulting degradation of multiple ES such as commercial and recreational fishing, tourism, and sense of place. The model shows how the degraded ES produce acute and chronic stress in people and how such stress may lead to a variety of negative mental, physical and behavioral health outcomes. Using this framework, one can trace potential for str

The aging population: imperative to uncouple sex and gender to establish "gender equal" health care.

PubMed

Bachmann, Gloria A; Mussman, Brianna

2015-04-01

The transgender community has long been marginalized in society. As the world's population ages, gender-unbiased health services for this growing population, with age-related chronic illnesses, will be essential. To optimally eliminate hurdles that trans individuals often confront when requesting services, it appears judicious to eliminate the strict and antiquated definition of what constitutes "normal" female and "normal" male. A review of literature on transgender medicine on PubMed over the last five years was conducted. Existing statistics indicate that unacceptable bias and discrimination are occurring, making trans patients less likely to seek care. There are emerging initiatives that address the transgender and gender non-conforming population. Ongoing needs include defining what constitutes "gender equal," understanding the continuum of gender identity, and establishing and implementing guidelines for gender equal counseling and care. With the routine practice of defining sex at birth and equating sex with gender in the health care setting, the transgender patient encounters multiple barriers to accessing and acquiring health care services. These strict gender labels appear to preclude the institution of gender equal care. Care templates on gender equal patient encounters should be implemented to better address transgender health needs in a non-biased manner. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

NASA Astrophysics Data System (ADS)

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

2014-11-01

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

SOA-based model for value-added ITS services delivery.

PubMed

Herrera-Quintero, Luis Felipe; Maciá-Pérez, Francisco; Marcos-Jorquera, Diego; Gilart-Iglesias, Virgilio

2014-01-01

Integration is currently a key factor in intelligent transportation systems (ITS), especially because of the ever increasing service demands originating from the ITS industry and ITS users. The current ITS landscape is made up of multiple technologies that are tightly coupled, and its interoperability is extremely low, which limits ITS services generation. Given this fact, novel information technologies (IT) based on the service-oriented architecture (SOA) paradigm have begun to introduce new ways to address this problem. The SOA paradigm allows the construction of loosely coupled distributed systems that can help to integrate the heterogeneous systems that are part of ITS. In this paper, we focus on developing an SOA-based model for integrating information technologies (IT) into ITS to achieve ITS service delivery. To develop our model, the ITS technologies and services involved were identified, catalogued, and decoupled. In doing so, we applied our SOA-based model to integrate all of the ITS technologies and services, ranging from the lowest-level technical components, such as roadside unit as a service (RSUAAS), to the most abstract ITS services that will be offered to ITS users (value-added services). To validate our model, a functionality case study that included all of the components of our model was designed.

Unmet Needs of Patients Feeling Severely Affected by Multiple Sclerosis in Germany: A Qualitative Study

PubMed Central

Golla, Heidrun; Strupp, Julia; Karbach, Ute; Kaiser, Claudia; Ernstmann, Nicole; Pfaff, Holger; Ostgathe, Christoph; Voltz, Raymond

2014-01-01

Abstract Background: The needs of patients feeling severely affected by multiple sclerosis (MS) have rarely been investigated. However this is essential information to know before care can be improved, including adding palliative care (PC) services where helpful. Since it remains unclear at what point specialized palliative care should begin for this patient group, this study focuses on needs in general. Objective: The objective was to explore the subjectively unmet needs of patients feeling severely affected by MS. Methods: The study used a qualitative cross-sectional approach for needs assessment. Fifteen patients self-reporting feeling severely affected by MS were recruited and interviewed using a combination of purposive and convenience sampling (five were accompanied by a caregiver relative). Interviews were recorded and transcribed verbatim, followed by qualitative content analysis. Results: Unmet needs were identified in the main categories “support of family and friends,” “health care services,” “managing everyday life,” and “maintaining biographical continuity.” Patients expressed the desire for more support from their families and to be viewed as distinct individuals. They see a substantial deficit in the physician-patient relationship and in the coordination of services. A decrease in expressed unmet needs was found for patients more severely affected and less socially integrated. Conclusions: To address the unmet needs of severely affected MS patients, health care services need to be improved and linked with existing PC services. Special attention is required to form supporting professional-patient relationships. Multiprofessional services should be accessible for patients, while integrating relatives. All services should have an individual approach to provide needs-tailored support. PMID:24527993

Addressing health concerns of pregnant African American women using the lens of complexity theory.

PubMed

Sims, Traci

2014-01-01

Pregnant African American women are at higher risk for multiple complex health issues, including depression, than their European American counterparts (Canady, Bullen, Holzman, Broman, & Tian, 2008; Martin et al, 2011; Mathews & MacDorman, 2007; Orr, Blazer, & James, 2006; Segre, Losch, & O'Hara, 2006). Various strategies must be used to address depression through preventive care and promotion of access to appropriate mental health services. Nurses and other health care providers need to examine the relationships between the multifactorial problems to improve the health and well-being of pregnant African American women and their unborn children. This article presents a case study demonstrating the use of complexity science theory to understand and prevent poor health outcomes for pregnant African American women with depression and their unborn children.

Convex Formulations of Learning from Crowds

NASA Astrophysics Data System (ADS)

Kajino, Hiroshi; Kashima, Hisashi

It has attracted considerable attention to use crowdsourcing services to collect a large amount of labeled data for machine learning, since crowdsourcing services allow one to ask the general public to label data at very low cost through the Internet. The use of crowdsourcing has introduced a new challenge in machine learning, that is, coping with low quality of crowd-generated data. There have been many recent attempts to address the quality problem of multiple labelers, however, there are two serious drawbacks in the existing approaches, that are, (i) non-convexity and (ii) task homogeneity. Most of the existing methods consider true labels as latent variables, which results in non-convex optimization problems. Also, the existing models assume only single homogeneous tasks, while in realistic situations, clients can offer multiple tasks to crowds and crowd workers can work on different tasks in parallel. In this paper, we propose a convex optimization formulation of learning from crowds by introducing personal models of individual crowds without estimating true labels. We further extend the proposed model to multi-task learning based on the resemblance between the proposed formulation and that for an existing multi-task learning model. We also devise efficient iterative methods for solving the convex optimization problems by exploiting conditional independence structures in multiple classifiers.

Improving medical records filing in a municipal hospital in Ghana.

PubMed

Teviu, E A A; Aikins, M; Abdulai, T I; Sackey, S; Boni, P; Afari, E; Wurapa, F

2012-09-01

Medical records are kept in the interest of both the patient and clinician. Proper filing of patient's medical records ensures easy retrieval and contributes to decreased patient waiting time at the hospital and continuity of care. This paper reports on an intervention study to address the issue of misfiling and multiple patient folders in a health facility. Intervention study. Municipal Hospital, Goaso, Asunafo North District, Brong Ahafo Region, Ghana. Methods employed for data collection were records review, direct observation and tracking of folders. Interventions instituted were staff durbars, advocacy and communication, consultations, in-service trainings, procurement and monitoring. Factors contributing to issuance of multiple folders and misfiling were determined. Proportion of multiple folders was estimated. Results revealed direct and indirect factors contributing to issuance of multiple patient folders and misfiling. Interventions and monitoring reduce acquisition of numerous medical folders per patient and misfiling. After the intervention, there was significant reduction in the use of multiple folders (i.e., overall 97% reduction) and a high usage of single patient medical folders (i.e., 99%). In conclusion, a defined medical records filing system with adequate training, logistics and regular monitoring and supervision minimises issuance of multiple folders and misfiling.

Mechanisms and risk of cumulative impacts to coastal ecosystem services: An expert elicitation approach.

PubMed

Singh, Gerald G; Sinner, Jim; Ellis, Joanne; Kandlikar, Milind; Halpern, Benjamin S; Satterfield, Terre; Chan, Kai M A

2017-09-01

Coastal environments are some of the most populated on Earth, with greater pressures projected in the future. Managing coastal systems requires the consideration of multiple uses, which both benefit from and threaten multiple ecosystem services. Thus understanding the cumulative impacts of human activities on coastal ecosystem services would seem fundamental to management, yet there is no widely accepted approach for assessing these. This study trials an approach for understanding the cumulative impacts of anthropogenic change, focusing on Tasman and Golden Bays, New Zealand. Using an expert elicitation procedure, we collected information on three aspects of cumulative impacts: the importance and magnitude of impacts by various activities and stressors on ecosystem services, and the causal processes of impact on ecosystem services. We assessed impacts to four ecosystem service benefits - fisheries, shellfish aquaculture, marine recreation and existence value of biodiversity-addressing three main research questions: (1) how severe are cumulative impacts on ecosystem services (correspondingly, what potential is there for restoration)?; (2) are threats evenly distributed across activities and stressors, or do a few threats dominate?; (3) do prominent activities mainly operate through direct stressors, or do they often exacerbate other impacts? We found (1) that despite high uncertainty in the threat posed by individual stressors and impacts, total cumulative impact is consistently severe for all four ecosystem services. (2) A subset of drivers and stressors pose important threats across the ecosystem services explored, including climate change, commercial fishing, sedimentation and pollution. (3) Climate change and commercial fishing contribute to prominent indirect impacts across ecosystem services by exacerbating regional impacts, namely sedimentation and pollution. The prevalence and magnitude of these indirect, networked impacts highlights the need for approaches like this to understand mechanisms of impact, in order to develop strategies to manage them. Copyright © 2017 Elsevier Ltd. All rights reserved.

Workplace and HIV-related sexual behaviours and perceptions among female migrant workers.

PubMed

Yang, H; Li, X; Stanton, B; Fang, X; Lin, D; Mao, R; Liu, H; Chen, X; Severson, R

2005-10-01

Data from 1,543 female migrants working in eight occupational clusters in Beijing and Nanjing, China were analysed to examine the association of workplace with HIV-related behaviours and perceptions. For sexually experienced women (n = 666, 43.2%), those working in entertainment establishments or personal service (e.g., nightclubs, dancing halls, barbershops, beauty salons, massage parlours, etc.) engaged in risky sexual practices twice as frequently as those working in non-entertainment establishments (e.g. restaurants, stalls, domestic service, factories, etc.). About 10% of women in the entertainment establishments reported having sold sex, 30% having multiple sexual partners and 40% having sex with men with multiple sexual partners. The rate of consistent condom use was less than 15%. They also tended to have a higher level of perceptions of both peer risk involvement and positive expectancy of risk behaviours, and lower perceptions of severity of STDs and HIV. For women who were not sexually experienced, those working in 'stalls' or 'domestic service' tended to perceive higher peer risk involvement, less severity of HIV infection, and less effectiveness of protective behaviour. The occupational pattern of sexual risk behaviours and perceptions observed in the current study indicates employment conditions are associated with HIV risk. Intervention strategies should be tailored to address occupational-related factors.

Multi-service highly sensitive rectifier for enhanced RF energy scavenging.

PubMed

Shariati, Negin; Rowe, Wayne S T; Scott, James R; Ghorbani, Kamran

2015-05-07

Due to the growing implications of energy costs and carbon footprints, the need to adopt inexpensive, green energy harvesting strategies are of paramount importance for the long-term conservation of the environment and the global economy. To address this, the feasibility of harvesting low power density ambient RF energy simultaneously from multiple sources is examined. A high efficiency multi-resonant rectifier is proposed, which operates at two frequency bands (478-496 and 852-869 MHz) and exhibits favorable impedance matching over a broad input power range (-40 to -10 dBm). Simulation and experimental results of input reflection coefficient and rectified output power are in excellent agreement, demonstrating the usefulness of this innovative low-power rectification technique. Measurement results indicate an effective efficiency of 54.3%, and an output DC voltage of 772.8 mV is achieved for a multi-tone input power of -10 dBm. Furthermore, the measured output DC power from harvesting RF energy from multiple services concurrently exhibits a 3.14 and 7.24 fold increase over single frequency rectification at 490 and 860 MHz respectively. Therefore, the proposed multi-service highly sensitive rectifier is a promising technique for providing a sustainable energy source for low power applications in urban environments.

Multiple Chronic Conditions and Disabilities: Implications for Health Services Research and Data Demands

PubMed Central

Iezzoni, Lisa I

2010-01-01

Increasing numbers of Americans are living with multiple chronic conditions (MCCs) and disabilities. Addressing health care needs of persons with MCCs or disabilities presents challenges on many levels. For health services researchers, priorities include (1) considering MCCs and disabilities in comparative effectiveness research (CER) and assessing quality of care; and (2) identifying and evaluating the data needed to conduct CER, performance measure development, and other research to inform health policy and public health decisions concerning persons with MCCs or disabilities. Little information is available to guide CER or treatment choices for persons with MCCs or disabilities, however, because they are typically excluded from clinical trials that produce the scientific evidence base. Furthermore, most research funding flows through public and private agencies oriented around single organ systems or diseases. Likely changes in the data landscape—notably wider dissemination of electronic health records (EHRs) and moving toward updated coding nomenclatures—may increase the information available to monitor health care service delivery and quality for persons with MCCs and disabilities. Generating this information will require new methods to extract and code information about MCCs and functional status from EHRs, especially narrative texts, and incorporating coding nomenclatures that capture critical dimensions of functional status and disability. PMID:21054370

Multi-Service Highly Sensitive Rectifier for Enhanced RF Energy Scavenging

PubMed Central

Shariati, Negin; Rowe, Wayne S. T.; Scott, James R.; Ghorbani, Kamran

2015-01-01

Due to the growing implications of energy costs and carbon footprints, the need to adopt inexpensive, green energy harvesting strategies are of paramount importance for the long-term conservation of the environment and the global economy. To address this, the feasibility of harvesting low power density ambient RF energy simultaneously from multiple sources is examined. A high efficiency multi-resonant rectifier is proposed, which operates at two frequency bands (478–496 and 852–869 MHz) and exhibits favorable impedance matching over a broad input power range (−40 to −10 dBm). Simulation and experimental results of input reflection coefficient and rectified output power are in excellent agreement, demonstrating the usefulness of this innovative low-power rectification technique. Measurement results indicate an effective efficiency of 54.3%, and an output DC voltage of 772.8 mV is achieved for a multi-tone input power of −10 dBm. Furthermore, the measured output DC power from harvesting RF energy from multiple services concurrently exhibits a 3.14 and 7.24 fold increase over single frequency rectification at 490 and 860 MHz respectively. Therefore, the proposed multi-service highly sensitive rectifier is a promising technique for providing a sustainable energy source for low power applications in urban environments. PMID:25951137

Community Schools: a Public Health Opportunity to Reverse Urban Cycles of Disadvantage.

PubMed

Diamond, Catherine; Freudenberg, Nicholas

2016-12-01

Community schools link students, families, and communities to educate children and strengthen neighborhoods. They have become a popular model for education in many US cities in part because they build on community assets and address multiple determinants of educational disadvantage. Since community schools seek to have an impact on populations, not just the children enrolled, they provide an opportunity to improve community health. Community schools influence the health and education of neighborhood residents though three pathways: building trust, establishing norms, and linking people to networks and services. Through such services as school-based health centers, nutrition education, family mental health counseling, violence prevention, and sexuality education, these schools build on the multiple reciprocal relationships between health and education. By developing closer ties between community schools and neighborhood health programs, public health professionals can help to mobilize a powerful new resource for reducing the health and educational inequalities that now characterize US cities. We suggest an agenda for research, practice, and policy that can build the evidence needed to guide such a strategy.

Characteristics of people living with HIV who use community-based services in Ontario, Canada: implications for service providers.

PubMed

Williams, Peter; Narciso, Lea; Browne, Gina; Roberts, Jacqueline; Weir, Robin; Gafni, Amiram

2005-01-01

Community-based AIDS service organizations (CBAOs) direct services to multiple-needs people living with HIV/AIDS who are less likely to use mainstream health promotion services. As people live longer with HIV, the potential to enhance quality of life increases, yet little is known about who uses CBAOs or how this use affects other health and social services. This study of people living with AIDS in Ontario, Canada (n = 297) examined the demographic and health-related characteristics of people with AIDS who do and do not use CBAOs and their patterns of mainstream service utilization. It found that users of CBAOs were significantly less healthy, less able to sustain normal activities, and more often depressed. They reported physical disabilities significantly more often. Their quality of life was also lower along certain dimensions. They were significantly poorer and more reliant on government income supports. They consumed significantly more nonhospital health and social services and had significantly higher out-of-pocket costs. These results suggest CBAOs are being accessed appropriately by those most vulnerable. In an effort to strengthen CBAO capacity to recognize and address depression and physical health problems prevalent among their clients, links to other mainstream health promotion and social services is recommended.

Facing uncertainty in ecosystem services-based resource management.

PubMed

Grêt-Regamey, Adrienne; Brunner, Sibyl H; Altwegg, Jürg; Bebi, Peter

2013-09-01

The concept of ecosystem services is increasingly used as a support for natural resource management decisions. While the science for assessing ecosystem services is improving, appropriate methods to address uncertainties in a quantitative manner are missing. Ignoring parameter uncertainties, modeling uncertainties and uncertainties related to human-environment interactions can modify decisions and lead to overlooking important management possibilities. In this contribution, we present a new approach for mapping the uncertainties in the assessment of multiple ecosystem services. The spatially explicit risk approach links Bayesian networks to a Geographic Information System for forecasting the value of a bundle of ecosystem services and quantifies the uncertainties related to the outcomes in a spatially explicit manner. We demonstrate that mapping uncertainties in ecosystem services assessments provides key information for decision-makers seeking critical areas in the delivery of ecosystem services in a case study in the Swiss Alps. The results suggest that not only the total value of the bundle of ecosystem services is highly dependent on uncertainties, but the spatial pattern of the ecosystem services values changes substantially when considering uncertainties. This is particularly important for the long-term management of mountain forest ecosystems, which have long rotation stands and are highly sensitive to pressing climate and socio-economic changes. Copyright © 2012 Elsevier Ltd. All rights reserved.

Reducing risks by transforming landscapes: Cross-scale effects of land-use changes on ecosystem services.

PubMed

Fedele, Giacomo; Locatelli, Bruno; Djoudi, Houria; Colloff, Matthew J

2018-01-01

Globally, anthropogenic environmental change is exacerbating the already vulnerable conditions of many people and ecosystems. In order to obtain food, water, raw materials and shelter, rural people modify forests and other ecosystems, affecting the supply of ecosystem services that contribute to livelihoods and well-being. Despite widespread awareness of the nature and extent of multiple impacts of land-use changes, there remains limited understanding of how these impacts affect trade-offs among ecosystem services and their beneficiaries across spatial scales. We assessed how rural communities in two forested landscapes in Indonesia have changed land uses over the last 20 years to adapt their livelihoods that were at risk from multiple hazards. We estimated the impact of these adaptation strategies on the supply of ecosystem services by comparing different benefits provided to people from these land uses (products, water, carbon, and biodiversity), using forest inventories, remote sensing, and interviews. Local people converted forests to rubber plantations, reforested less productive croplands, protected forests on hillsides, and planted trees in gardens. Our results show that land-use decisions were propagated at the landscape scale due to reinforcing loops, whereby local actors perceived that such decisions contributed positively to livelihoods by reducing risks and generating co-benefits. When land-use changes become sufficiently widespread, they affect the supply of multiple ecosystem services, with impacts beyond the local scale. Thus, adaptation implemented at the local-scale may not address development and climate adaptation challenges at regional or national scale (e.g. as part of UN Sustainable Development Goals or actions taken under the UNFCCC Paris Agreement). A better understanding of the context and impacts of local ecosystem-based adaptation is fundamental to the scaling up of land management policies and practices designed to reduce risks and improve well-being for people at different scales.

SDN architecture for optical packet and circuit integrated networks

NASA Astrophysics Data System (ADS)

Furukawa, Hideaki; Miyazawa, Takaya

2016-02-01

We have been developing an optical packet and circuit integrated (OPCI) network, which realizes dynamic optical path, high-density packet multiplexing, and flexible wavelength resource allocation. In the OPCI networks, a best-effort service and a QoS-guaranteed service are provided by employing optical packet switching (OPS) and optical circuit switching (OCS) respectively, and users can select these services. Different wavelength resources are assigned for OPS and OCS links, and the amount of their wavelength resources are dynamically changed in accordance with the service usage conditions. To apply OPCI networks into wide-area (core/metro) networks, we have developed an OPCI node with a distributed control mechanism. Moreover, our OPCI node works with a centralized control mechanism as well as a distributed one. It is therefore possible to realize SDN-based OPCI networks, where resource requests and a centralized configuration are carried out. In this paper, we show our SDN architecture for an OPS system that configures mapping tables between IP addresses and optical packet addresses and switching tables according to the requests from multiple users via a web interface. While OpenFlow-based centralized control protocol is coming into widespread use especially for single-administrative, small-area (LAN/data-center) networks. Here, we also show an interworking mechanism between OpenFlow-based networks (OFNs) and the OPCI network for constructing a wide-area network, and a control method of wavelength resource selection to automatically transfer diversified flows from OFNs to the OPCI network.

Multiple strategies are required to address the information and support needs of gay and bisexual men with hepatitis C in Australia.

PubMed

Hopwood, Max; Lea, Toby; Aggleton, Peter

2016-03-01

Hepatitis C virus (HCV) infection is increasingly reported among gay and bisexual men. However, little is known about the personal and social dimensions of HCV-related experience among these men in Australia. An online survey of 474 Australian gay and bisexual men was conducted from August to December 2013. A subsample of 48 HCV mono-infected and HIV/HCV co-infected men was analysed to explore HCV knowledge, sources of information, unmet information needs and use of HCV-related services. More than half of respondents in the subsample were unaware that HIV infection increases the risk of sexually acquired HCV and most wanted information about how to prevent the sexual transmission of HCV. A majority of respondents requested gay-specific HCV services, and approximately similar proportions of men indicated that they would like these services delivered by a hepatitis organization, a lesbian, gay, bisexual, transgender and intersex (LGBTI) organization and a HIV organization. Men in receipt of HIV antiretroviral treatments were most likely to request that gay-specific HCV information and support services be delivered by a LGBTI or HIV organization (OR = 8.63). These findings suggest that a variety of organizations are required to address the information and support needs of Australian gay and bisexual men with HCV. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Satellite services system analysis study: Propellant transfer system

NASA Technical Reports Server (NTRS)

1982-01-01

General servicing requirements, a servicing mission concept and scenario, overall servicing needs, basic servicing equipment, and a general servicing mission configuration layout are addressed. Servicing needs, equipment concepts, system requirements equipment specifications, preliminary designs, and resource requirements for flight hardware for the propellant transfer system are also addressed.

Design of price incentives for adjunct policy goals in formula funding for hospitals and health services

PubMed Central

Duckett, Stephen J

2008-01-01

Background Hospital policy involves multiple objectives: efficiency of service delivery, pursuit of high quality care, promoting access. Funding policy based on hospital casemix has traditionally been considered to be only about promoting efficiency. Discussion Formula-based funding policy can be (and has been) used to pursue a range of policy objectives, not only efficiency. These are termed 'adjunct' goals. Strategies to incorporate adjunct goals into funding design must, implicitly or explicitly, address key decision choices outlined in this paper. Summary Policy must be clear and explicit about the behaviour to be rewarded; incentives must be designed so that all facilities with an opportunity to improve have an opportunity to benefit; the reward structure is stable and meaningful; and the funder monitors performance and gaming. PMID:18384694

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

NASA Technical Reports Server (NTRS)

Won, Young-In; Wanchoo, Lalit; Behnke, Jeanne

2016-01-01

This study reviews the key metrics (users, distributed volume, and files) in multiple ways to gain an understanding of the significance of the metadata. Characterizing the usability of data by key metadata elements, such as discipline and study area, will assist in understanding how the user needs have evolved over time. The data usage pattern based on product level provides insight into the level of data quality. In addition, the data metrics by various services, such as the Open-source Project for a Network Data Access Protocol (OPeNDAP) and subsets, address how these services have extended the usage of data. Over-all, this study presents the usage of data and metadata by metrics analyses, which may assist data centers in better supporting the needs of the users.

Variables contributing to an excellent customer service management profile within the regulated electric utility industry: A comparison of self-concept with customer satisfaction for customer service management

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

Johnson, L.E.

1991-01-01

This research sought to address the relationship between self-concept and customer satisfaction: can customer satisfaction with a major electric utility be explained in terms of the self-reported, self-concept of the utility's managers The population to which the results of this study were generalized consisted of customer service managers in public electric utilities across the United States. In order to represent this population, a sample was selected consisting of customer service managers at a midwestern electric utility based in a large metropolitan area. Participants in this study were managers of four direct customer contact service organizations within six geographic division organizations.more » The methodology included comparisons of these four customer contact service organizations on twelve independent, self-concept variables and six customer satisfaction dependent variables using Analysis of Variance (ANOVA), Scheffe' tests, Chi-Square, and Stepwise multiple regression. The groups were found not to be significantly different and knowledge of the self-concept scores for managers will not increase the ability to predict customer satisfaction over no knowledge of self-concept scores.« less

Testing an Adapted Modified Delphi Method: Synthesizing Multiple Stakeholder Ratings of Health Care Service Effectiveness.

PubMed

Escaron, Anne L; Chang Weir, Rosy; Stanton, Petra; Vangala, Sitaram; Grogan, Tristan R; Clarke, Robin M

2016-03-01

The Affordable Care Act incentivizes health systems for better meeting patient needs, but often guidance about patient preferences for particular health services is limited. All too often vulnerable patient populations are excluded from these decision-making settings. A community-based participatory approach harnesses the in-depth knowledge of those experiencing barriers to health care. We made three modifications to the RAND-UCLA appropriateness method, a modified Delphi approach, involving patients, adding an advisory council group to characterize existing knowledge in this little studied area, and using effectiveness rather than "appropriateness" as the basis for rating. As a proof of concept, we tested this method by examining the broadly delivered but understudied nonmedical services that community health centers provide. This method created discrete, new knowledge about these services by defining 6 categories and 112 unique services and by prioritizing among these services based on effectiveness using a 9-point scale. Consistent with the appropriateness method, we found statistical convergence of ratings among the panelists. Challenges include time commitment and adherence to a clear definition of effectiveness of services. This diverse stakeholder engagement method efficiently addresses gaps in knowledge about the effectiveness of health care services to inform population health management. © 2015 Society for Public Health Education.

Towards a Global Service Registry for the World-Wide LHC Computing Grid

NASA Astrophysics Data System (ADS)

Field, Laurence; Alandes Pradillo, Maria; Di Girolamo, Alessandro

2014-06-01

The World-Wide LHC Computing Grid encompasses a set of heterogeneous information systems; from central portals such as the Open Science Grid's Information Management System and the Grid Operations Centre Database, to the WLCG information system, where the information sources are the Grid services themselves. Providing a consistent view of the information, which involves synchronising all these informations systems, is a challenging activity that has lead the LHC virtual organisations to create their own configuration databases. This experience, whereby each virtual organisation's configuration database interfaces with multiple information systems, has resulted in the duplication of effort, especially relating to the use of manual checks for the handling of inconsistencies. The Global Service Registry aims to address this issue by providing a centralised service that aggregates information from multiple information systems. It shows both information on registered resources (i.e. what should be there) and available resources (i.e. what is there). The main purpose is to simplify the synchronisation of the virtual organisation's own configuration databases, which are used for job submission and data management, through the provision of a single interface for obtaining all the information. By centralising the information, automated consistency and validation checks can be performed to improve the overall quality of information provided. Although internally the GLUE 2.0 information model is used for the purpose of integration, the Global Service Registry in not dependent on any particular information model for ingestion or dissemination. The intention is to allow the virtual organisation's configuration databases to be decoupled from the underlying information systems in a transparent way and hence simplify any possible future migration due to the evolution of those systems. This paper presents the Global Service Registry architecture, its advantages compared to the current situation and how it can support the evolution of information systems.

A Climate Information Portal for Copernicus: a central portal for European climate services?

NASA Astrophysics Data System (ADS)

Juckes, Martin; Swart, Rob; Thysse, Peter; Som de Cerff, Wim; Groot, Annemarie; Bennett, Victoria; Costa, Luis; Lückenkötter, Johannes; Callaghan, Sarah

2015-04-01

The FP7 project "Climate Information Portal for Copernicus" (CLIPC) is developing a demonstration portal for the Copernicus Climate Change Service (C3S). This project is one of a suite of FP7 research activities which are administratively independent of Copernicus, focussed on creating the technical and scientific building blocks needed for the service. It is to be expected that at EGU 2015 there will be many presentations describing portals delivering new and innovative ranges of services. It would be unwise to seek to replace all this creative activity with a single portal -- instead CLIPC is designing a portal to make distributed resources more accessible through flexible discovery systems. CLIPC needs to deliver more than a directory of resources: resources need to be presented in common protocols so that users can access multiple datasets. More information about the project objectives is available at www.clipc.eu. The gulf between the climate science communities and the end user communities is a central challenge being addressed in the project. It is important to understand that there is significant diversity and multiple communication barriers within these two sets of communities as well as between them. The CLIPC services must presentation will provide a review of progress towards this ambitious goal, through a discussion of user requirements activities, an overview of the proposed architecture, work on assessing and adjusting model biasses, and a discussion of the climate impact indicators which will be provided through the portal. When looking at the usability of data for the various users, CLIPC will implement a set of services functioning as a "knowledge base" supplying information to users about the data, including definitions of terminology used, quality of datasets, versioning, and user annotations.

Load Index Metrics for an Optimized Management of Web Services: A Systematic Evaluation

PubMed Central

Souza, Paulo S. L.; Santana, Regina H. C.; Santana, Marcos J.; Zaluska, Ed; Faical, Bruno S.; Estrella, Julio C.

2013-01-01

The lack of precision to predict service performance through load indices may lead to wrong decisions regarding the use of web services, compromising service performance and raising platform cost unnecessarily. This paper presents experimental studies to qualify the behaviour of load indices in the web service context. The experiments consider three services that generate controlled and significant server demands, four levels of workload for each service and six distinct execution scenarios. The evaluation considers three relevant perspectives: the capability for representing recent workloads, the capability for predicting near-future performance and finally stability. Eight different load indices were analysed, including the JMX Average Time index (proposed in this paper) specifically designed to address the limitations of the other indices. A systematic approach is applied to evaluate the different load indices, considering a multiple linear regression model based on the stepwise-AIC method. The results show that the load indices studied represent the workload to some extent; however, in contrast to expectations, most of them do not exhibit a coherent correlation with service performance and this can result in stability problems. The JMX Average Time index is an exception, showing a stable behaviour which is tightly-coupled to the service runtime for all executions. Load indices are used to predict the service runtime and therefore their inappropriate use can lead to decisions that will impact negatively on both service performance and execution cost. PMID:23874776

Monitoring of the data processing and simulated production at CMS with a web-based service: the Production Monitoring Platform (pMp)

NASA Astrophysics Data System (ADS)

Franzoni, G.; Norkus, A.; Pol, A. A.; Srimanobhas, N.; Walker, J.

2017-10-01

Physics analysis at the Compact Muon Solenoid requires both the production of simulated events and processing of the data collected by the experiment. Since the end of the LHC Run-I in 2012, CMS has produced over 20 billion simulated events, from 75 thousand processing requests organised in one hundred different campaigns. These campaigns emulate different configurations of collision events, the detector, and LHC running conditions. In the same time span, sixteen data processing campaigns have taken place to reconstruct different portions of the Run-I and Run-II data with ever improving algorithms and calibrations. The scale and complexity of the events simulation and processing, and the requirement that multiple campaigns must proceed in parallel, demand that a comprehensive, frequently updated and easily accessible monitoring be made available. The monitoring must serve both the analysts, who want to know which and when datasets will become available, and the central production teams in charge of submitting, prioritizing, and running the requests across the distributed computing infrastructure. The Production Monitoring Platform (pMp) web-based service, has been developed in 2015 to address those needs. It aggregates information from multiple services used to define, organize, and run the processing requests. Information is updated hourly using a dedicated elastic database and the monitoring provides multiple configurable views to assess the status of single datasets as well as entire production campaigns. This contribution will describe the pMp development, the evolution of its functionalities, and one and half year of operational experience.

Wetlands as large-scale nature-based solutions: status and future challenges for research and management

NASA Astrophysics Data System (ADS)

Thorslund, Josefin; Jarsjö, Jerker; Destouni, Georgia

2017-04-01

Wetlands are often considered as nature-based solutions that can provide a multitude of services of great social, economic and environmental value to humankind. The services may include recreation, greenhouse gas sequestration, contaminant retention, coastal protection, groundwater level and soil moisture regulation, flood regulation and biodiversity support. Changes in land-use, water use and climate can all impact wetland functions and occur at scales extending well beyond the local scale of an individual wetland. However, in practical applications, management decisions usually regard and focus on individual wetland sites and local conditions. To understand the potential usefulness and services of wetlands as larger-scale nature-based solutions, e.g. for mitigating negative impacts from large-scale change pressures, one needs to understand the combined function multiple wetlands at the relevant large scales. We here systematically investigate if and to what extent research so far has addressed the large-scale dynamics of landscape systems with multiple wetlands, which are likely to be relevant for understanding impacts of regional to global change. Our investigation regards key changes and impacts of relevance for nature-based solutions, such as large-scale nutrient and pollution retention, flow regulation and coastal protection. Although such large-scale knowledge is still limited, evidence suggests that the aggregated functions and effects of multiple wetlands in the landscape can differ considerably from those observed at individual wetlands. Such scale differences may have important implications for wetland function-effect predictability and management under large-scale change pressures and impacts, such as those of climate change.

Every Child Left Behind -- Addressing One Important Effect of Multiple Deployments

DTIC Science & Technology

2009-03-25

St ra te gy Re se ar ch Pr oj ec t EVERY CHILD LEFT BEHIND – ADDRESSING ONE IMPORTANT EFFECT OF MULTIPLE DEPLOYMENTS BY LIEUTENANT COLONEL TYLER J...To) 4. TITLE AND SUBTITLE Every Child Left Behind – Addressing One Important Effect of Multiple Deployments 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...Form 298 (Rev. 8-98) Prescribed by ANSI Std. Z39.18 USAWC STRATEGY RESEARCH PROJECT EVERY CHILD LEFT BEHIND – ADDRESSING ONE IMPORTANT EFFECT OF

Bridging the gaps: a global review of intersections of violence against women and violence against children

PubMed Central

Guedes, Alessandra; Bott, Sarah; Garcia-Moreno, Claudia; Colombini, Manuela

2016-01-01

Background The international community recognises violence against women (VAW) and violence against children (VAC) as global human rights and public health problems. Historically, research, programmes, and policies on these forms of violence followed parallel but distinct trajectories. Some have called for efforts to bridge these gaps, based in part on evidence that individuals and families often experience multiple forms of violence that may be difficult to address in isolation, and that violence in childhood elevates the risk of violence against women. Methods This article presents a narrative review of evidence on intersections between VAC and VAW – including sexual violence by non-partners, with an emphasis on low- and middle-income countries. Results We identify and review evidence for six intersections: 1) VAC and VAW have many shared risk factors. 2) Social norms often support VAW and VAC and discourage help-seeking. 3) Child maltreatment and partner violence often co-occur within the same household. 4) Both VAC and VAW can produce intergenerational effects. 5) Many forms of VAC and VAW have common and compounding consequences across the lifespan. 6) VAC and VAW intersect during adolescence, a time of heightened vulnerability to certain kinds of violence. Conclusions Evidence of common correlates suggests that consolidating efforts to address shared risk factors may help prevent both forms of violence. Common consequences and intergenerational effects suggest a need for more integrated early intervention. Adolescence falls between and within traditional domains of both fields and deserves greater attention. Opportunities for greater collaboration include preparing service providers to address multiple forms of violence, better coordination between services for women and for children, school-based strategies, parenting programmes, and programming for adolescent health and development. There is also a need for more coordination among researchers working on VAC and VAW as countries prepare to measure progress towards 2030 Sustainable Development Goals. PMID:27329936

MITRE sensor layer prototype

NASA Astrophysics Data System (ADS)

Duff, Francis; McGarry, Donald; Zasada, David; Foote, Scott

2009-05-01

The MITRE Sensor Layer Prototype is an initial design effort to enable every sensor to help create new capabilities through collaborative data sharing. By making both upstream (raw) and downstream (processed) sensor data visible, users can access the specific level, type, and quantities of data needed to create new data products that were never anticipated by the original designers of the individual sensors. The major characteristic that sets sensor data services apart from typical enterprise services is the volume (on the order of multiple terabytes) of raw data that can be generated by most sensors. Traditional tightly coupled processing approaches extract pre-determined information from the incoming raw sensor data, format it, and send it to predetermined users. The community is rapidly reaching the conclusion that tightly coupled sensor processing loses too much potentially critical information.1 Hence upstream (raw and partially processed) data must be extracted, rapidly archived, and advertised to the enterprise for unanticipated uses. The authors believe layered sensing net-centric integration can be achieved through a standardize-encapsulate-syndicateaggregate- manipulate-process paradigm. The Sensor Layer Prototype's technical approach focuses on implementing this proof of concept framework to make sensor data visible, accessible and useful to the enterprise. To achieve this, a "raw" data tap between physical transducers associated with sensor arrays and the embedded sensor signal processing hardware and software has been exploited. Second, we encapsulate and expose both raw and partially processed data to the enterprise within the context of a service-oriented architecture. Third, we advertise the presence of multiple types, and multiple layers of data through geographic-enabled Really Simple Syndication (GeoRSS) services. These GeoRSS feeds are aggregated, manipulated, and filtered by a feed aggregator. After filtering these feeds to bring just the type and location of data sought by multiple processes to the attention of each processing station, just that specifically sought data is downloaded to each process application. The Sensor Layer Prototype participated in a proof-of-concept demonstration in April 2008. This event allowed multiple MITRE innovation programs to interact among themselves to demonstrate the ability to couple value-adding but previously unanticipated users to the enterprise. For this event, the Sensor Layer Prototype was used to show data entering the environment in real time. Multiple data types were encapsulated and added to the database via the Sensor Layer Prototype, specifically National Imagery Transmission Format 2.1 (NITF), NATO Standardization Format 4607 (STANAG 4607), Cursor-on-Target (CoT), Joint Photographic Experts Group (JPEG), Hierarchical Data Format (HDF5) and several additional sensor file formats describing multiple sensors addressing a common scenario.

Transportation and socioemotional well-being of urban students with and without disabilities.

PubMed

Graham, Benjamin C; Keys, Christopher B; McMahon, Susan D

2014-01-01

This study explored the extent to which transportation difficulties were associated with social, psychological, and academic experiences of urban, at-risk students who recently experienced a school transition. Participants included 165 predominantly African American and Latino/a high school youth with and without disabilities, a critical population for community psychology to address given their likelihood of multiple marginalizations. Results suggested transportation problems within school predicted more school stressors and aggressive behavior. Transportation problems to and from school predicted fewer school resources, less school belonging, and more school stressors, anxiety, and depression. Greater time to get to school predicted fewer school resources, less school belonging, and more depressive symptoms. This study demonstrates the importance of including transportation in how the school day is conceptualized, and offers several implications for how transportation services can be best addressed.

Provider and consumer perspectives of community mental health services: Implications for consumer-driven care.

PubMed

Kelly, Erin L; Davis, Lisa; Mendon, Sapna; Kiger, Holly; Murch, Lezlie; Pancake, Laura; Giambone, Leslie; Brekke, John S

2018-05-03

Public mental health services in the community are broad and continue to expand to address the multiple issues faced by those with serious mental illnesses. However, few studies examine and contrast how helpful consumers and providers find the spectrum of services. The present study examines the services at community mental health service clinics (CMHCs) from the perspectives of providers and consumers. There were 351 consumers and 147 providers from 15 CMHCs who rated and ranked the helpfulness of 24 types of common services. All of the agencies were participating in a Practice-Based Research Network (PBRN). Social support was the highest rated service by both types of respondents, and the creation of a welcoming environment was the highest ranked service by both. There were also areas of disagreement. Consumers identified traditional mental health services (individual therapy and medication services) as being most helpful to them whereas providers selected longer-term services that promote self-reliance (e.g., securing housing, and promoting self-sufficiency) as the most helpful. Understanding how consumers and providers perceive the range of CMHC services provided in usual care is important to develop new targets for intervention. A welcoming milieu and providing social support appear important to both, but significant differences exist between these groups regarding other aspects of services. This holds implications for the design and implementation of consumer-driven services. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A Virtual Science Data Environment for Carbon Dioxide Observations

NASA Astrophysics Data System (ADS)

Verma, R.; Goodale, C. E.; Hart, A. F.; Law, E.; Crichton, D. J.; Mattmann, C. A.; Gunson, M. R.; Braverman, A. J.; Nguyen, H. M.; Eldering, A.; Castano, R.; Osterman, G. B.

2011-12-01

Climate science data are often distributed cross-institutionally and made available using heterogeneous interfaces. With respect to observational carbon-dioxide (CO2) records, these data span across national as well as international institutions and are typically distributed using a variety of data standards. Such an arrangement can yield challenges from a research perspective, as users often need to independently aggregate datasets as well as address the issue of data quality. To tackle this dispersion and heterogeneity of data, we have developed the CO2 Virtual Science Data Environment - a comprehensive approach to virtually integrating CO2 data and metadata from multiple missions and providing a suite of computational services that facilitate analysis, comparison, and transformation of that data. The Virtual Science Environment provides climate scientists with a unified web-based destination for discovering relevant observational data in context, and supports a growing range of online tools and services for analyzing and transforming the available data to suit individual research needs. It includes web-based tools to geographically and interactively search for CO2 observations collected from multiple airborne, space, as well as terrestrial platforms. Moreover, the data analysis services it provides over the Internet, including offering techniques such as bias estimation and spatial re-gridding, move computation closer to the data and reduce the complexity of performing these operations repeatedly and at scale. The key to enabling these services, as well as consolidating the disparate data into a unified resource, has been to focus on leveraging metadata descriptors as the foundation of our data environment. This metadata-centric architecture, which leverages the Dublin Core standard, forgoes the need to replicate remote datasets locally. Instead, the system relies upon an extensive, metadata-rich virtual data catalog allowing on-demand browsing and retrieval of CO2 records from multiple missions. In other words, key metadata information about remote CO2 records is stored locally while the data itself is preserved at its respective archive of origin. This strategy has been made possible by our method of encapsulating the heterogeneous sources of data using a common set of web-based services, including services provided by Jet Propulsion Laboratory's Climate Data Exchange (CDX). Furthermore, this strategy has enabled us to scale across missions, and to provide access to a broad array of CO2 observational data. Coupled with on-demand computational services and an intuitive web-portal interface, the CO2 Virtual Science Data Environment effectively transforms heterogeneous CO2 records from multiple sources into a unified resource for scientific discovery.

Routine Immunization Service Delivery Through the Basic Package of Health Services Program in Afghanistan: Gaps, Challenges, and Opportunities.

PubMed

Mbaeyi, Chukwuma; Kamawal, Noor Shah; Porter, Kimberly A; Azizi, Adam Khan; Sadaat, Iftekhar; Hadler, Stephen; Ehrhardt, Derek

2017-07-01

The Basic Package of Health Services (BPHS) program has increased access to immunization services for children living in rural Afghanistan. However, multiple surveys have indicated persistent immunization coverage gaps. Hence, to identify gaps in implementation, an assessment of the BPHS program was undertaken, with specific focus on the routine immunization (RI) component. A cross-sectional survey was conducted in 2014 on a representative sample drawn from a sampling frame of 1858 BPHS health facilities. Basic descriptive analysis was performed, capturing general characteristics of survey respondents and assessing specific RI components, and χ2 tests were used to evaluate possible differences in service delivery by type of health facility. Of 447 survey respondents, 27% were health subcenters (HSCs), 30% were basic health centers, 32% were comprehensive health centers, and 12% were district hospitals. Eighty-seven percent of all respondents offered RI services, though only 61% of HSCs did so. Compared with other facility types, HSCs were less likely to have adequate stock of vaccines, essential cold-chain equipment, or proper documentation of vaccination activities. There is an urgent need to address manpower and infrastructural deficits in RI service delivery through the BPHS program, especially at the HSC level. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Remote sensing, geographical information systems, and spatial modeling for analyzing public transit services

NASA Astrophysics Data System (ADS)

Wu, Changshan

Public transit service is a promising transportation mode because of its potential to address urban sustainability. Current ridership of public transit, however, is very low in most urban regions, particularly those in the United States. This woeful transit ridership can be attributed to many factors, among which poor service quality is key. Given this, there is a need for transit planning and analysis to improve service quality. Traditionally, spatially aggregate data are utilized in transit analysis and planning. Examples include data associated with the census, zip codes, states, etc. Few studies, however, address the influences of spatially aggregate data on transit planning results. In this research, previous studies in transit planning that use spatially aggregate data are reviewed. Next, problems associated with the utilization of aggregate data, the so-called modifiable areal unit problem (MAUP), are detailed and the need for fine resolution data to support public transit planning is argued. Fine resolution data is generated using intelligent interpolation techniques with the help of remote sensing imagery. In particular, impervious surface fraction, an important socio-economic indicator, is estimated through a fully constrained linear spectral mixture model using Landsat Enhanced Thematic Mapper Plus (ETM+) data within the metropolitan area of Columbus, Ohio in the United States. Four endmembers, low albedo, high albedo, vegetation, and soil are selected to model heterogeneous urban land cover. Impervious surface fraction is estimated by analyzing low and high albedo endmembers. With the derived impervious surface fraction, three spatial interpolation methods, spatial regression, dasymetric mapping, and cokriging, are developed to interpolate detailed population density. Results suggest that cokriging applied to impervious surface is a better alternative for estimating fine resolution population density. With the derived fine resolution data, a multiple route maximal covering/shortest path (MRMCSP) model is proposed to address the tradeoff between public transit service quality and access coverage in an established bus-based transit system. Results show that it is possible to improve current transit service quality by eliminating redundant or underutilized service stops. This research illustrates that fine resolution data can be efficiently generated to support urban planning, management and analysis. Further, this detailed data may necessitate the development of new spatial optimization models for use in analysis.

Evidence-based treatment and supervision practices for co-occurring mental and substance use disorders in the criminal justice system.

PubMed

Peters, Roger H; Young, M Scott; Rojas, Elizabeth C; Gorey, Claire M

2017-07-01

Over seven million persons in the United States are supervised by the criminal justice system, including many who have co-occurring mental and substance use disorders (CODs). This population is at high risk for recidivism and presents numerous challenges to those working in the justice system. To provide a contemporary review of the existing research and examine key issues and evidence-based treatment and supervision practices related to CODs in the justice system. We reviewed COD research involving offenders that has been conducted over the past 20 years and provide an analysis of key findings. Several empirically supported frameworks are available to guide services for offenders who have CODs, including Integrated Dual Disorders Treatment (IDDT), the Risk-Need-Responsivity (RNR) model, and Cognitive-Behavioral Therapy (CBT). Evidence-based services include integrated assessment that addresses both sets of disorders and the risk for criminal recidivism. Although several evidence-based COD interventions have been implemented at different points in the justice system, there remains a significant gap in services for offenders who have CODs. Existing program models include Crisis Intervention Teams (CIT), day reporting centers, specialized community supervision teams, pre- and post-booking diversion programs, and treatment-based courts (e.g., drug courts, mental health courts, COD dockets). Jail-based COD treatment programs provide stabilization of acute symptoms, medication consultation, and triage to community services, while longer-term prison COD programs feature Modified Therapeutic Communities (MTCs). Despite the availability of multiple evidence-based interventions that have been implemented across diverse justice system settings, these services are not sufficiently used to address the scope of treatment and supervision needs among offenders with CODs.

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

NASA Technical Reports Server (NTRS)

Johnston, William E.

2002-01-01

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

77 FR 61828 - Surety Companies Acceptable on Federal Bonds; Change in Business Address: Hudson Insurance Company

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-11

... DEPARTMENT OF THE TREASURY Fiscal Service Surety Companies Acceptable on Federal Bonds; Change in Business Address: Hudson Insurance Company AGENCY: Financial Management Service, Fiscal Service, Department... Insurance Company (NAIC 25054) has changed its business address to: 100 William Street, 5th Floor, New York...

Life Goals in Vision Rehabilitation: Are They Addressed and How?

ERIC Educational Resources Information Center

Cimarolli, Verena R.; Boerner, Kathrin; Wang, Shu-wen

2006-01-01

This study explored if and how vision rehabilitation services address important life goals of young and middle-aged adults who are visually impaired. It found that services that teach functional skills and offer psychosocial therapeutic-type services were instrumental in addressing life goals and that independence-related goals were most often…

Hearing the voices of service user researchers in collaborative qualitative data analysis: the case for multiple coding.

PubMed

Sweeney, Angela; Greenwood, Kathryn E; Williams, Sally; Wykes, Til; Rose, Diana S

2013-12-01

Health research is frequently conducted in multi-disciplinary teams, with these teams increasingly including service user researchers. Whilst it is common for service user researchers to be involved in data collection--most typically interviewing other service users--it is less common for service user researchers to be involved in data analysis and interpretation. This means that a unique and significant perspective on the data is absent. This study aims to use an empirical report of a study on Cognitive Behavioural Therapy for psychosis (CBTp) to demonstrate the value of multiple coding in enabling service users voices to be heard in team-based qualitative data analysis. The CBTp study employed multiple coding to analyse service users' discussions of CBT for psychosis (CBTp) from the perspectives of a service user researcher, clinical researcher and psychology assistant. Multiple coding was selected to enable multiple perspectives to analyse and interpret data, to understand and explore differences and to build multi-disciplinary consensus. Multiple coding enabled the team to understand where our views were commensurate and incommensurate and to discuss and debate differences. Through the process of multiple coding, we were able to build strong consensus about the data from multiple perspectives, including that of the service user researcher. Multiple coding is an important method for understanding and exploring multiple perspectives on data and building team consensus. This can be contrasted with inter-rater reliability which is only appropriate in limited circumstances. We conclude that multiple coding is an appropriate and important means of hearing service users' voices in qualitative data analysis. © 2012 John Wiley & Sons Ltd.

On Designing Thermal-Aware Localized QoS Routing Protocol for in-vivo Sensor Nodes in Wireless Body Area Networks.

PubMed

Monowar, Muhammad Mostafa; Bajaber, Fuad

2015-06-15

In this paper, we address the thermal rise and Quality-of-Service (QoS) provisioning issue for an intra-body Wireless Body Area Network (WBAN) having in-vivo sensor nodes. We propose a thermal-aware QoS routing protocol, called TLQoS, that facilitates the system in achieving desired QoS in terms of delay and reliability for diverse traffic types, as well as avoids the formation of highly heated nodes known as hotspot(s), and keeps the temperature rise along the network to an acceptable level. TLQoS exploits modular architecture wherein different modules perform integrated operations in providing multiple QoS service with lower temperature rise. To address the challenges of highly dynamic wireless environment inside the human body. TLQoS implements potential-based localized routing that requires only local neighborhood information. TLQoS avoids routing loop formation as well as reduces the number of hop traversal exploiting hybrid potential, and tuning a configurable parameter. We perform extensive simulations of TLQoS, and the results show that TLQoS has significant performance improvements over state-of-the-art approaches.

On Designing Thermal-Aware Localized QoS Routing Protocol for in-vivo Sensor Nodes in Wireless Body Area Networks

PubMed Central

Monowar, Muhammad Mostafa; Bajaber, Fuad

2015-01-01

In this paper, we address the thermal rise and Quality-of-Service (QoS) provisioning issue for an intra-body Wireless Body Area Network (WBAN) having in-vivo sensor nodes. We propose a thermal-aware QoS routing protocol, called TLQoS, that facilitates the system in achieving desired QoS in terms of delay and reliability for diverse traffic types, as well as avoids the formation of highly heated nodes known as hotspot(s), and keeps the temperature rise along the network to an acceptable level. TLQoS exploits modular architecture wherein different modules perform integrated operations in providing multiple QoS service with lower temperature rise. To address the challenges of highly dynamic wireless environment inside the human body. TLQoS implements potential-based localized routing that requires only local neighborhood information. TLQoS avoids routing loop formation as well as reduces the number of hop traversal exploiting hybrid potential, and tuning a configurable parameter. We perform extensive simulations of TLQoS, and the results show that TLQoS has significant performance improvements over state-of-the-art approaches. PMID:26083228

Managing Nitrogen in Croplands: Implications for Increasing Ecosystem Services in Agricultural Landscapes

NASA Astrophysics Data System (ADS)

Jackson, L.

2011-12-01

Many agricultural landscapes in the temperate zone are dominated by agroecosystems that are managed with high inputs of agrochemicals, including synthetic nitrogen (N) fertilizers. The process of agricultural intensification increases crop production per unit area, but also often results in loss of environmental quality (such as N contamination of waters, eutrophication, atmospheric N deposition, and emissions of nitrous oxide (N2O), a potent greenhouse gas). Loss of biodiversity and its 'functional homogenization' is another concern. Not only does little land in these landscapes remain in natural ecosystems, but there are negative off-site impacts of intensive agriculture on non-target organisms. Segregating agroecosystems with high-input agricultural production from natural ecosystems (land sparing) is one view to support both food security and biodiversity conservation. But proponents of land sparing rarely address the loss of other ecosystem services, such as those related to environmental quality, health, and human well-being (e.g., livelihoods and cultural values). An emerging view is that increased reliance on ecological processes in agroecosystems ('ecological intensification') is more feasible when the landscape mosaic includes planned and unplanned biodiversity. This requires research on how to support multiple ecosystem services through the integration of agricultural production and biodiversity conservation in the same landscape, and how ecological and physico-chemical processes at various spatial scales are interlinked. It is an enormous challenge to increase reliance on ecological processes for N availability for crop productivity. There are skeptics who think that this will be detrimental for food security, despite benefits for other types of ecosystem services. Using examples from agricultural landscapes in California, mechanisms for ecologically-based N cycling will be discussed, such as: 1) increasing the reservoir of soil organic N and the dynamic turnover and supply of N via soil microbial N transformations and root symbioses; 2) developing farming systems that rely on crop rotations and functional groups that increase N supply and retention; 3) minimizing N losses through better understanding of agroecosystem biogeochemistry; and 4) overcoming the problems associated with open N cycles in agroecosystems with landscape features such buffer strips, managed riparian corridors, and patchy land use types. The capacity to compensate for high non-renewable inputs in specific farming situations will be addressed, along with factors that increase the capacity for different types of farmers to adopt N management practices that enhance the provision of multiple types of ecosystem services.

Medical rehabilitation of leprosy patients discharged home in abia and ebonyi States of Nigeria.

PubMed

Enwereji, Ezinne Ezinna; Ahuizi, Eke Reginald; Iheanocho, Okereke Chukwunenye; Enwereji, Kelechi Okechukwu

2011-11-01

To examine the extent to which medical coverage is available to discharged leprosy patients in communities. Evidence has shown that after care services, follow-up visits and national disease prevention programs are important components of medical rehabilitation to leprosy patients discharged home after treatment. Denying them accessibility to these services could expose them to multiple disabilities as well as several disease conditions including HIV/AIDS. These adverse health conditions could be averted if health workers extend healthcare services to discharged leprosy patients. This study was conducted to examine the extent to which discharged leprosy patients have access to healthcare services in the communities. All 33 leprosy patients who were fully treated with multi-drug therapy (MDT) and discharged home in the two leprosy settlements in Abia and Ebonyi States of Nigeria were included in this study. The list of discharged leprosy patients studied and their addresses were provided by the leprosy settlements where they were treated. Also, snowball-sampling method was used to identify some of the leprosy patients whose addresses were difficult to locate in the communities. Instruments for data collection were questionnaire, interview guide and checklist. These were administered because respondents were essentially those with no formal education. Analysis of data was done quantitatively and qualitatively. Findings showed that 20 (60.6%) of discharged patients did not receive health programs like HIV/AIDS prevention or family planning. Also, follow-up visits and after-care services were poor. About 14 (42.4%) of the patients live in dirty and overcrowded houses. On the whole, discharged patients were poorly medically rehabilitated (mean score: 4.7±1.1 out of total score of 7). Denying discharged leprosy patients opportunity of accessing health care services could increase prevalence of infectious diseases including HIV/AIDS among them. There is need to extend national prevention programs, follow-up visits, after-care services and free treatment to discharged patients in the communities.

Medical Rehabilitation of Leprosy Patients Discharged Home in Abia and Ebonyi States of Nigeria

PubMed Central

Enwereji, Ezinne Ezinna; Ahuizi, Eke Reginald; Iheanocho, Okereke Chukwunenye; Enwereji, Kelechi Okechukwu

2011-01-01

Objectives To examine the extent to which medical coverage is available to discharged leprosy patients in communities. Evidence has shown that after care services, follow-up visits and national disease prevention programs are important components of medical rehabilitation to leprosy patients discharged home after treatment. Denying them accessibility to these services could expose them to multiple disabilities as well as several disease conditions including HIV/AIDS. These adverse health conditions could be averted if health workers extend healthcare services to discharged leprosy patients. This study was conducted to examine the extent to which discharged leprosy patients have access to healthcare services in the communities. Methods All 33 leprosy patients who were fully treated with multi-drug therapy (MDT) and discharged home in the two leprosy settlements in Abia and Ebonyi States of Nigeria were included in this study. The list of discharged leprosy patients studied and their addresses were provided by the leprosy settlements where they were treated. Also, snowball-sampling method was used to identify some of the leprosy patients whose addresses were difficult to locate in the communities. Instruments for data collection were questionnaire, interview guide and checklist. These were administered because respondents were essentially those with no formal education. Analysis of data was done quantitatively and qualitatively. Results Findings showed that 20 (60.6%) of discharged patients did not receive health programs like HIV/AIDS prevention or family planning. Also, follow-up visits and after-care services were poor. About 14 (42.4%) of the patients live in dirty and overcrowded houses. On the whole, discharged patients were poorly medically rehabilitated (mean score: 4.7±1.1 out of total score of 7). Conclusion Denying discharged leprosy patients opportunity of accessing health care services could increase prevalence of infectious diseases including HIV/AIDS among them. There is need to extend national prevention programs, follow-up visits, after-care services and free treatment to discharged patients in the communities. PMID:22253946

Impact of a population based intervention to increase the adoption of multiple physical activity practices in centre based childcare services: a quasi experimental, effectiveness study

PubMed Central

2012-01-01

Background There is considerable scope to improve the delivery of practices that increase the physical activity of children in centre based childcare services. Few studies have reported the effectiveness of interventions to address this, particularly at a population level. The primary aim of this study was to describe the impact of an intervention to increase the adoption of multiple policies and practices to promote physical activity in centre based childcare services. Methods A quasi experimental study was conducted in centre based childcare services (n =228) in New South Wales (NSW), Australia and involved a three month intervention to increase the adoption of eight practices within childcare services that have been suggested to promote child physical activity. Intervention strategies to support the adoption of practices included staff training, resources, incentives, follow-up support and performance monitoring and feedback. Randomly selected childcare services in the remainder of NSW acted as a comparison group (n = 164) and did not receive the intervention but may have been exposed to a concurrent NSW government healthy eating and physical activity initiative. Self reported information on physical activity policies, fundamental movement skills sessions, structured physical activity opportunities, staff involvement in active play and provision of verbal prompts to encourage physical activity, small screen recreation opportunities, sedentary time, and staff trained in physical activity were collected by telephone survey with childcare service managers at baseline and 18 months later. Results Compared with the comparison area, the study found significantly greater increases in the prevalence of intervention services with a written physical activity policy, with policy referring to placing limits on small screen recreation, and with staff trained in physical activity. In addition, non-significant trends towards a greater increase in the proportion of intervention services conducting daily fundamental movement skill sessions, and such services having a physical activity policy supporting physical activity training for staff were also evident. Conclusion The intervention was effective in improving a number of centre based childcare service policies and practices associated with promoting child physical activity. Adoption of a broader range of practices may require more intensive and prolonged intervention support. PMID:22929434

Multi-layer service function chaining scheduling based on auxiliary graph in IP over optical network

NASA Astrophysics Data System (ADS)

Li, Yixuan; Li, Hui; Liu, Yuze; Ji, Yuefeng

2017-10-01

Software Defined Optical Network (SDON) can be considered as extension of Software Defined Network (SDN) in optical networks. SDON offers a unified control plane and makes optical network an intelligent transport network with dynamic flexibility and service adaptability. For this reason, a comprehensive optical transmission service, able to achieve service differentiation all the way down to the optical transport layer, can be provided to service function chaining (SFC). IP over optical network, as a promising networking architecture to interconnect data centers, is the most widely used scenarios of SFC. In this paper, we offer a flexible and dynamic resource allocation method for diverse SFC service requests in the IP over optical network. To do so, we firstly propose the concept of optical service function (OSF) and a multi-layer SFC model. OSF represents the comprehensive optical transmission service (e.g., multicast, low latency, quality of service, etc.), which can be achieved in multi-layer SFC model. OSF can also be considered as a special SF. Secondly, we design a resource allocation algorithm, which we call OSF-oriented optical service scheduling algorithm. It is able to address multi-layer SFC optical service scheduling and provide comprehensive optical transmission service, while meeting multiple optical transmission requirements (e.g., bandwidth, latency, availability). Moreover, the algorithm exploits the concept of Auxiliary Graph. Finally, we compare our algorithm with the Baseline algorithm in simulation. And simulation results show that our algorithm achieves superior performance than Baseline algorithm in low traffic load condition.

Family-centered care to promote successful community reintegration after war: it takes a nation.

PubMed

Glynn, Shirley M

2013-12-01

The papers in this section focus on public health responses and implementation considerations in addressing the challenges military families confront when parents go to war. While many military families show resilience, the challenges resulting from a decade of war with multiple deployments are detailed, as are innovative military and civilian programs designed to help service members and their families reintegrate successfully into the community. As more and more service members leave active duty, the burden of meeting military families' psychological needs will transition from the Department of Defense (DoD) and into the Veterans Administration (VA) and civilian arenas. While many strategies to support successful readjustment are offered, in this time of dwindling mental health resources and competing needs, it is unclear what priority the broader society places on meeting the needs of returning service members and their families. A growing emphasis on family-centered care in the Veterans Administration may help meet this gap.

Hierarchical Marginal Land Assessment for Land Use Planning

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

Kang, Shujiang; Post, Wilfred M; Wang, Dali

2013-01-01

Marginal land provides an alternative potential for food and bioenergy production in the face of limited land resources; however, effective assessment of marginal lands is not well addressed. Concerns over environmental risks, ecosystem services and sustainability for marginal land have been widely raised. The objective of this study was to develop a hierarchical marginal land assessment framework for land use planning and management. We first identified major land functions linking production, environment, ecosystem services and economics, and then classified land resources into four categories of marginal land using suitability and limitations associated with major management goals, including physically marginal land,more » biologically marginal land, environmental-ecological marginal land, and economically marginal land. We tested this assessment framework in south-western Michigan, USA. Our results indicated that this marginal land assessment framework can be potentially feasible on land use planning for food and bioenergy production, and balancing multiple goals of land use management. We also compared our results with marginal land assessment from the Conservation Reserve Program (CRP) and land capability classes (LCC) that are used in the US. The hierarchical assessment framework has advantages of quantitatively reflecting land functions and multiple concerns. This provides a foundation upon which focused studies can be identified in order to improve the assessment framework by quantifying high-resolution land functions associated with environment and ecosystem services as well as their criteria are needed to improve the assessment framework.« less

Building capacity in VA to provide emergency gynecology services for women.

PubMed

Cordasco, Kristina M; Huynh, Alexis K; Zephyrin, Laurie; Hamilton, Alison B; Lau-Herzberg, Amy E; Kessler, Chad S; Yano, Elizabeth M

2015-04-01

Visits to Veterans Administration (VA) emergency departments (EDs) are increasingly being made by women. A 2011 national inventory of VA emergency services for women revealed that many EDs have gaps in their resources and processes for gynecologic emergency care. To guide VA in addressing these gaps, we sought to understand factors acting as facilitators and/or barriers to improving VA ED capacity for, and quality of, emergency gynecology care. Semistructured interviews with VA emergency and women's health key informants. ED directors/providers (n=14), ED nurse managers (n=13), and Women Veteran Program Managers (n=13) in 13 VA facilities. Leadership, staff, space, demand, funding, policies, and community were noted as important factors influencing VA EDs building capacity and improving emergency gynecologic care for women Veterans. These factors are intertwined and cross multiple organizational levels so that each ED's capacity is a reflection not only of its own factors, but also those of its local medical center and non-VA community context as well as VA regional and national trends and policies. Policies and quality improvement initiatives aimed at building VA's emergency gynecologic services for women need to be multifactorial and aimed at multiple organizational levels. Policies need to be flexible to account for wide variations across EDs and their medical center and community contexts. Approaches that build and encourage local leadership engagement, such as evidence-based quality improvement methodology, are likely to be most effective.

Referral patterns of special needs patients at the Royal Dental Hospital of Melbourne, Victoria, Australia.

PubMed

Mohamed Rohani, M; Calache, H; Borromeo, G L

2017-06-01

Special Needs Dentistry (SND) has been recognized as a dental specialty in Australia since 2003 but there have been no studies addressing the profile of patients for specialist care. The purpose of this study is to identify, via referrals received, the profile of patients and quality of referrals at the largest public SND unit in Victoria, Australia. All referrals received over a 6-month period (1 January-30 June 2013) by the integrated SND unit (ISNU) were reviewed prior to allocation to the outpatient clinic (OP), domiciliary (DOM) or general anaesthetic (GA) services. Six-hundred and eighty-eight referrals were received with the majority for the OP clinic (68.3%), followed by DOM (22.4%) and GA services (9.3%) (χ 2  = 360.2, P < 0.001). A referral may have specified more than one special needs condition with the most common category being those who were medically compromised (81.7%). The reasons for referral included lack of compliance (27.2%), further management due to multiple medical conditions or GA services required (9.9%), or for multiple other reasons (62.9%). A diverse pattern of SND patients was referred to the ISNU with a majority of referrals having no specific referral reason cited, suggesting poor quality of referrals. © 2016 Australian Dental Association.

Economist intelligence unit democracy index in relation to health services accessibility: a regression analysis.

PubMed

Walker, Mary Ellen; Anonson, June; Szafron, Michael

2015-01-01

The relationship between political environment and health services accessibility (HSA) has not been the focus of any specific studies. The purpose of this study was to address this gap in the literature by examining the relationship between political environment and HSA. This relationship that HSA indicators (physicians, nurses and hospital beds per 10 000 people) has with political environment was analyzed with multiple least-squares regression using the components of democracy (electoral processes and pluralism, functioning of government, political participation, political culture, and civil liberties). The components of democracy were represented by the 2011 Economist Intelligence Unit Democracy Index (EIUDI) sub-scores. The EIUDI sub-scores and the HSA indicators were evaluated for significant relationships with multiple least-squares regression. While controlling for a country's geographic location and level of democracy, we found that two components of a nation's political environment: functioning of government and political participation, and their interaction had significant relationships with the three HSA indicators. These study findings are of significance to health professionals because they examine the political contexts in which citizens access health services, they come from research that is the first of its kind, and they help explain the effect political environment has on health. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A satellite-based personal communication system for the 21st century

NASA Technical Reports Server (NTRS)

Sue, Miles K.; Dessouky, Khaled; Levitt, Barry; Rafferty, William

1990-01-01

Interest in personal communications (PCOMM) has been stimulated by recent developments in satellite and terrestrial mobile communications. A personal access satellite system (PASS) concept was developed at the Jet Propulsion Laboratory (JPL) which has many attractive user features, including service diversity and a handheld terminal. Significant technical challenges addressed in formulating the PASS space and ground segments are discussed. PASS system concept and basic design features, high risk enabling technologies, an optimized multiple access scheme, alternative antenna coverage concepts, the use of non-geostationary orbits, user terminal radiation constraints, and user terminal frequency reference are covered.

Center for Plasma Edge Simulation (CPES) -- Rutgers University Final Report

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

Parashar, Manish

2014-03-06

The CPES scientific simulations run at scale on leadership class machines, collaborate at runtime and produce and exchange large data sizes, which present multiple I/O and data management challenges. During the CPES project, the Rutgers team worked with the rest of the CPES team to address these challenges at different levels, and specifically (1) at the data transport and communication level through the DART (Decoupled and Asynchronous Remote Data Transfers) framework, and (2) at the data management and services level through the DataSpaces and ActiveSpaces frameworks. These frameworks and their impact are briefly described.

A framework for predicting impacts on ecosystem services from (sub)organismal responses to chemicals.

PubMed

Forbes, Valery E; Salice, Chris J; Birnir, Bjorn; Bruins, Randy J F; Calow, Peter; Ducrot, Virginie; Galic, Nika; Garber, Kristina; Harvey, Bret C; Jager, Henriette; Kanarek, Andrew; Pastorok, Robert; Railsback, Steve F; Rebarber, Richard; Thorbek, Pernille

2017-04-01

Protection of ecosystem services is increasingly emphasized as a risk-assessment goal, but there are wide gaps between current ecological risk-assessment endpoints and potential effects on services provided by ecosystems. The authors present a framework that links common ecotoxicological endpoints to chemical impacts on populations and communities and the ecosystem services that they provide. This framework builds on considerable advances in mechanistic effects models designed to span multiple levels of biological organization and account for various types of biological interactions and feedbacks. For illustration, the authors introduce 2 case studies that employ well-developed and validated mechanistic effects models: the inSTREAM individual-based model for fish populations and the AQUATOX ecosystem model. They also show how dynamic energy budget theory can provide a common currency for interpreting organism-level toxicity. They suggest that a framework based on mechanistic models that predict impacts on ecosystem services resulting from chemical exposure, combined with economic valuation, can provide a useful approach for informing environmental management. The authors highlight the potential benefits of using this framework as well as the challenges that will need to be addressed in future work. Environ Toxicol Chem 2017;36:845-859. © 2017 SETAC. © 2017 SETAC.

Standardised Embedded Data framework for Drones [SEDD

NASA Astrophysics Data System (ADS)

Wyngaard, J.; Barbieri, L.; Peterson, F. S.

2015-12-01

A number of barriers to entry remain for UAS use in science. One in particular is that of implementing an experiment and UAS specific software stack. Currently this stack is most often developed in-house and customised for a particular UAS-sensor pairing - limiting its reuse. Alternatively, when adaptable a suitable commercial package may be used, but such systems are both costly and usually suboptimal.In order to address this challenge the Standardised Embedded Data framework for Drones [SEDD] is being developed in μpython. SEDD provides an open source, reusable, and scientist-accessible drop in solution for drone data capture and triage. Targeted at embedded hardware, and offering easy access to standard I/O interfaces, SEDD provides an easy solution for simply capturing data from a sensor. However, the intention is rather to enable more complex systems of multiple sensors, computer hardware, and feedback loops, via 3 primary components.A data asset manager ensures data assets are associated with appropriate metadata as they are captured. Thereafter, the asset is easily archived or otherwise redirected, possibly to - onboard storage, onboard compute resource for processing, an interface for transmission, another sensor control system, remote storage and processing (such as EarthCube's CHORDS), or to any combination of the above.A service workflow managerenables easy implementation of complex onboard systems via dedicated control of multiple continuous and periodic services. Such services will include the housekeeping chores of operating a UAS and multiple sensors, but will also permit a scientist to drop in an initial scientific data processing code utilising on-board compute resources beyond the autopilot. Having such capabilities firstly enables easy creation of real-time feedback, to the human- or auto- pilot, or other sensors, on data quality or needed flight path changes. Secondly, compute hardware provides the opportunity to carry out real-time data triage, for the purposes of conserving on-board storage space or transmission bandwidth in inherently poor connectivity environments.A compute manager is finally included. Depending on system complexity, and given the need for power efficient parallelism, it can quickly become necessary to provide a scheduling service for multiple workflows.

GLOBECOM '88 - IEEE Global Telecommunications Conference and Exhibition, Hollywood, FL, Nov. 28-Dec. 1, 1988, Conference Record. Volumes 1, 2, & 3

NASA Astrophysics Data System (ADS)

Various papers on communications for the information age are presented. Among the general topics considered are: telematic services and terminals, satellite communications, telecommunications mangaement network, control of integrated broadband networks, advances in digital radio systems, the intelligent network, broadband networks and services deployment, future switch architectures, performance analysis of computer networks, advances in spread spectrum, optical high-speed LANs, and broadband switching and networks. Also addressed are: multiple access protocols, video coding techniques, modulation and coding, photonic switching, SONET terminals and applications, standards for video coding, digital switching, progress in MANs, mobile and portable radio, software design for improved maintainability, multipath propagation and advanced countermeasure, data communication, network control and management, fiber in the loop, network algorithm and protocols, and advances in computer communications.

Air ambulance and hospital services for critically ill and injured in Greenland, Iceland and the Faroe Islands: how can we improve?

PubMed Central

Gunnarsson, Björn; Jensen, Niels S Kieler; Garði, Tummas i; Harðardóttir, Helga; Stefánsdóttir, Lilja; Heimisdóttir, María

2015-01-01

The Nordic Atlantic Cooperation (NORA) is an intergovernmental organization under the auspices of the Nordic Council of Ministers. The NORA region comprises Greenland, Iceland, Faroe Islands and western coastal areas of Norway. Historical, cultural and institutional links bind these nations together in multiple ways, and regional co-operation has in recent years become a focus of interest. This commentary addresses air medical services (AMSs) and available advanced hospital services in the 3 smallest NORA countries challenged sparse populations, hereafter referred to as the region. It seems likely that strengthened regional co-operation can help these countries to address common challenges within health care by exchanging know-how and best practices, pooling resources and improving the efficiency of care delivery. The 4 largest hospitals in the region, Dronning Ingrids Hospital in Nuuk (Greenland), Landspítali in Reykjavík and Sjúkrahúsið á Akureyri, (both in Iceland) and Landssjúkrahúsið Tórshavn on the Faroe Islands, have therefore undertaken the project Network for patient transport in the North-West Atlantic (in Danish: Netværk for patienttransport i Vest-Norden). The goal of the project, and of this article, is to exchange information and provide an overview of current AMSs and access to acute hospital care for severely ill or injured patients in the 3 participating countries. Of equal importance is the intention to highlight the need for increased regional co-operation to optimize use of limited resources in the provision of health care services. PMID:26066019

Implementing a Fee-for-Service Cervical Cancer Screening and Treatment Program in Cameroon: Challenges and Opportunities.

PubMed

DeGregorio, Geneva; Manga, Simon; Kiyang, Edith; Manjuh, Florence; Bradford, Leslie; Cholli, Preetam; Wamai, Richard; Ogembo, Rebecca; Sando, Zacharie; Liu, Yuxin; Sheldon, Lisa Kennedy; Nulah, Kathleen; Welty, Thomas; Welty, Edith; Ogembo, Javier Gordon

2017-07-01

Cervical cancer screening is one of the most effective cancer prevention strategies, but most women in Africa have never been screened. In 2007, the Cameroon Baptist Convention Health Services, a large faith-based health care system in Cameroon, initiated the Women's Health Program (WHP) to address this disparity. The WHP provides fee-for-service cervical cancer screening using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC), prioritizing care for women living with HIV/AIDS. They also provide clinical breast examination, family planning (FP) services, and treatment for reproductive tract infection (RTI). Here, we document the strengths and challenges of the WHP screening program and the unique aspects of the WHP model, including a fee-for-service payment system and the provision of other women's health services. We retrospectively reviewed WHP medical records from women who presented for cervical cancer screening from 2007-2014. In 8 years, WHP nurses screened 44,979 women for cervical cancer. The number of women screened increased nearly every year. The WHP is sustained primarily on fees-for-service, with external funding totaling about $20,000 annually. In 2014, of 12,191 women screened for cervical cancer, 99% received clinical breast exams, 19% received FP services, and 4.7% received treatment for RTIs. We document successes, challenges, solutions implemented, and recommendations for optimizing this screening model. The WHP's experience using a fee-for-service model for cervical cancer screening demonstrates that in Cameroon VIA-DC is acceptable, feasible, and scalable and can be nearly self-sustaining. Integrating other women's health services enabled women to address additional health care needs. The Cameroon Baptist Convention Health Services Women's Health Program successfully implemented a nurse-led, fee-for-service cervical cancer screening program using visual inspection with acetic acid-enhanced by digital cervicography in the setting of a large faith-based health care system in Cameroon. It is potentially replicable in many African countries, where faith-based organizations provide a large portion of health care. The cost-recovery model and concept of offering multiple services in a single clinic rather than stand-alone "silo" cervical cancer screening could provide a model for other low-and-middle-income countries planning to roll out a new, or make an existing, cervical cancer screening services accessible, comprehensive, and sustainable. © AlphaMed Press 2017.

Psychiatric rehabilitation education for physicians.

PubMed

Rudnick, Abraham; Eastwood, Diane

2013-06-01

As part of a rapidly spreading reform toward recovery-oriented services, mental health care systems are adopting Psychiatric/Psychosocial Rehabilitation (PSR). Accordingly, PSR education and training programs are now available and accessible. Although psychiatrists and sometimes other physicians (such as family physicians) provide important services to people with serious mental illnesses and may, therefore, need knowledge and skill in PSR, it seems that the medical profession has been slow to participate in PSR education. Based on our experience working in Canada as academic psychiatrists who are also Certified Psychiatric Rehabilitation Practitioners (CPRPs), we offer descriptions of several Canadian initiatives that involve physicians in PSR education. Multiple frameworks guide PSR education for physicians. First, guidance is provided by published PSR principles, such as the importance of self-determination (www.psrrpscanada.ca). Second, guidance is provided by adult education (andragogy) principles, emphasizing the importance of addressing attitudes in addition to knowledge and skills (Knowles, Holton, & Swanson, 2011). Third, guidance in Canada is provided by Canadian Medical Education Directives for Specialists (CanMEDS) principles, which delineate the multiple roles of physicians beyond that of medical expert (Frank, 2005) and have recently been adopted in Australia (Boyce, Spratt, Davies, & McEvoy, 2011). (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Services used by perinatal substance-users with child welfare involvement: a descriptive study

PubMed Central

2010-01-01

Background Substance use during pregnancy often leads to involvement in the child welfare system, resulting in multiple social service systems and service providers working with families to achieve successful child welfare outcomes. The Vulnerable Infants Program of Rhode Island (VIP-RI) is a care coordination program developed to work with perinatal substance-users to optimize opportunities for reunification and promote permanency for substance-exposed infants. This paper describes services used by VIP-RI participants and child welfare outcomes. Methods Data collected during the first four years of VIP-RI were used to identify characteristics of program participants, services received, and child welfare outcomes: closed child welfare cases, reunification with biological mothers and identified infant permanent placements. Descriptive Results Medical and financial services were associated with positive child welfare outcomes. Medical services included family planning, pre- and post-natal care and HIV test counseling. Financial services included assistance with obtaining entitlement benefits and receiving tangible support such as food and clothing. Conclusions Findings from this study suggest services that address basic family needs were related to positive child welfare outcomes. The provision of basic services, such as health care and financial assistance through entitlement benefits and tangible donations, may help to establish a foundation so mothers can concentrate on recovery and parenting skills. Identification of services for perinatal substance users that are associated with more successful child welfare outcomes has implications for the child welfare system, treatment providers, courts and families. PMID:20807432

Services used by perinatal substance-users with child welfare involvement: a descriptive study.

PubMed

McCann, Kenneth J; Twomey, Jean E; Caldwell, Donna; Soave, Rosemary; Fontaine, Lynne Andreozzi; Lester, Barry M

2010-08-31

Substance use during pregnancy often leads to involvement in the child welfare system, resulting in multiple social service systems and service providers working with families to achieve successful child welfare outcomes. The Vulnerable Infants Program of Rhode Island (VIP-RI) is a care coordination program developed to work with perinatal substance-users to optimize opportunities for reunification and promote permanency for substance-exposed infants. This paper describes services used by VIP-RI participants and child welfare outcomes. Data collected during the first four years of VIP-RI were used to identify characteristics of program participants, services received, and child welfare outcomes: closed child welfare cases, reunification with biological mothers and identified infant permanent placements. DESCRIPTIVE RESULTS: Medical and financial services were associated with positive child welfare outcomes. Medical services included family planning, pre- and post-natal care and HIV test counseling. Financial services included assistance with obtaining entitlement benefits and receiving tangible support such as food and clothing. Findings from this study suggest services that address basic family needs were related to positive child welfare outcomes. The provision of basic services, such as health care and financial assistance through entitlement benefits and tangible donations, may help to establish a foundation so mothers can concentrate on recovery and parenting skills. Identification of services for perinatal substance users that are associated with more successful child welfare outcomes has implications for the child welfare system, treatment providers, courts and families.

Multiple service use: the impact of consistency in service quality for vulnerable youth.

PubMed

Sanders, Jackie; Munford, Robyn; Liebenberg, Linda; Ungar, Michael

2014-04-01

Little is known about the way in which variations in service quality influence outcomes when youth are clients of more than one service system. This article reports on a study of 1,210 adolescents (aged 13-17 years), half were concurrent clients of two or more services and half were not involved in two or more services. Youth completed a self-report questionnaire administered by a trained interviewer. It was hypothesized that youth reporting two positive service experiences would report lower risks, higher resilience, and better outcomes than youth reporting inconsistent or two negative service experiences and that their resilience, risks, and outcomes would be similar to those of youth not involved in two or more services. MANCOVA was used to determine the relationship among service quality and resilience, risk, and outcomes with four covariates that assessed family and neighborhood environments, history of abuse and neglect, and chronic need. Results indicate that service quality had an effect on resilience, risks, and outcomes. These relationships were mediated quite strongly by the influence of the risks youth faced in their neighborhoods and to a lesser extent by the other three covariates. Of the three dependent variables, risk appeared to be the most consistently influenced by all the covariates, and it also differentiated service experience groups. Results point to the importance of services developing strategies to effectively address risks confronted by youth and also to ensure that when more than one service is involved with youth, consistency in service delivery is achieved. Copyright © 2013 Elsevier Ltd. All rights reserved.

Profiles of youth in therapeutic group care: Associations with involuntary psychiatric examinations and readmissions.

PubMed

Yampolskaya, Svetlana; Mowery, Debra

2017-01-01

The study aims were to identify distinct subgroups among youth placed in therapeutic group care (TGC) and to examine the effect of specific constellations of risk factors on readmission to residential mental health care and involuntary psychiatric examination among youth in TGC. Several administrative databases were merged to examine outcomes for youth placed in TGC during fiscal year FY04-05 through FY07-08 (N = 1,009). Latent class analysis (LCA) was conducted. Two classes were identified: youth with multiple needs (Class 1) and lower risk youth (Class 2). Class 1 represented 45% of youth in TGC. Compared with Class 2, these youth had a greater probability of having physical health problems, parents with substance abuse problems, and more extensive histories of maltreatment. Compared with Class 2, youth with multiple needs were almost twice more likely to exhibit self-injurious behavior leading to involuntary mental health examinations, but they were less likely to be readmitted to a residential mental health care of higher level of restrictiveness, such as state inpatient psychiatric programs (SIPPs). Youth placed in Florida TGC represent a heterogeneous population and services tailored to these youth's needs are important. Youth with multiple risk factors would benefit from interventions that would address multiple areas of risk. Lower risk youth (Class 2) would benefit from interventions that would focus on promoting mental health, especially among those who have experienced threatened harm, and providing services and supports necessary for stabilizing these youth in the community. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

75 FR 70128 - 2011 Changes for Domestic Mailing Services

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

...LOT, RDI, and Five-Digit ZIP. The Postal Service certifies software meeting its standards until the... Delivery Point Validation (DPV) service in conjunction with CASS-Certified address matching software... interface between address-matching software and the LACS \\Link\\ database service. 1.21.2 Interface...

Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review.

PubMed

Shahid, Shaouli; Taylor, Emma V; Cheetham, Shelley; Woods, John A; Aoun, Samar M; Thompson, Sandra C

2018-05-08

Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples' preferences, needs, opportunities and barriers to palliative care. A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly's hierarchy of evidence-for-practice in qualitative research. Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples' experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas.

Risk and protective factors of intimate partner violence among South Asian immigrant women and perceived need for services.

PubMed

Sabri, Bushra; Simonet, Michelle; Campbell, Jacquelyn C

2018-05-24

Limited research exists on multilevel influences of intimate partner violence (IPV) among immigrant groups in the United States, particularly South Asians. Using a socioecological framework, this study examined risk and protective factors of IPV among a diverse group of South Asian immigrant survivors of IPV and identified their perceived need for services. Sixteen South Asian immigrant survivors were recruited from New York; Maryland; Virginia; and Washington, DC, using a snowball sampling method. Participants were 1st-generation and 2nd-generation immigrants born in India (n = 4), Bangladesh (n = 4), Pakistan (n = 5), the United States (n = 2), and Sri Lanka (n = 1). Data were collected using in-depth interviews (n = 16) and a focus group (n = 1). A thematic analysis procedure was used to analyze the data and to identify themes across different ecological levels. IPV was related to factors at multiple levels, such as cultural normalization of abuse, gender role expectations, need to protect family honor, arranged marriage system, abusive partner characteristics, and women's fear of losing children and being on own. Protective factors included supportive family and friends, religion, safety strategies, education, and empowerment. Women highlighted the need for community education and empowerment efforts and culturally responsive services for addressing IPV in South Asian communities. South Asian survivors of IPV have experienced, and some continue to experience, abuse due to factors operating at multiple levels of the ecological framework. Consideration of culturally specific risk and protective factors for IPV at multiple contexts in women's lives could inform culturally responsive IPV prevention and intervention strategies for South Asian communities in the United States. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

[10 theses of the disabled persons' organizations - why participation research with a social perspective is needed].

PubMed

Hinz, T

2012-12-01

The 5 professional associations for the disabled and the self-help organisations of disabled people state that in Germany a general concept for "participation research" is needed. This concept should address expectations and processes in developing aid services and improve self-determined participation of people with disabilities according to the human rights postulated in the UN Convention on the Rights of People with Disabilities (2006). A concept of "participation research" will go beyond the objectives and methods of i. e., disability studies - it is a focus in the context of which the social and equal participation of the disabled (especially those with multiple and/or intellectual handicaps) has to be addressed. In this context the 5 professional associations for the disabled have drafted 10 theses which are presented in the following article. © Georg Thieme Verlag KG Stuttgart · New York.

Intimate Partner Violence among West African Immigrants

PubMed Central

AKINSULURE-SMITH, ADEYINKA M.; CHU, TRACY; KEATLEY, EVA; RASMUSSEN, ANDREW

2013-01-01

Although the number of African immigrants arriving to the United States has increased significantly, there has been little investigation regarding their experiences of intimate partner violence or coping strategies. This study used focus groups and individual interviews to explore intimate partner violence among 32 heterosexual West African immigrants. Results suggest that although cultural expectations influence their coping strategies, West African–born men and women face different realities, with women reporting multiple instances of abuse and a sense of frustration with the existing options for assistance. Although participants discussed multilevel support structures within the immediate West African community to address intimate partner violence, all of these options maintained a gender hierarchy, leaving women dissatisfied. Challenges and barriers to partner violence resolution and coping strategies are identified. Results are examined in terms of their implications for addressing the needs of this underserved population. Implications for future research and services are discussed and highlighted. PMID:23730146

Addressing maternal and child health in post-conflict Afghanistan: the way forward.

PubMed

Singh, P K; Rai, R K; Alagarajan, M

2013-09-01

Afghanistan's maternal and child mortality rates are among the highest in the world. The country faces challenges to meet the Millennium Development Goals set for 2015 which can be attributed to multiple causes related to accessibility, affordability and availability of health-care services. This report addresses the challenges in strengthening maternal and child health care in Afghanistan, as well discussing the areas to be prioritized. In order to ensure sound maternal and child health care in Afghanistan, policy-makers must prioritize monitoring and surveillance systems, integrating maternal and child health care with rights-based family planning methods, building human resources, offering incentives (such as the provision of a conditional cash transfer to women) and promoting action-oriented, community-based interventions. On a wider scale, the focus must be to improve the health infrastructure, organizing international collaboration and expanding sources of funding.

What are your priorities right now? Identifying service needs across recovery stages to inform service development.

PubMed

Laudet, Alexandre B; White, William

2010-01-01

Substance use disorders (SUD) are, for many, chronic conditions that are typically associated with severe impairments in multiple areas of functioning. "Recovery" from SUD is, for most, a lengthy process; improvements in other areas of functioning do not necessarily follow the attainment of abstinence. The current SUD service model providing intense, short-term, symptom-focused services is ill-suited to address these issues. A recovery-oriented model of care is emerging, which provides coordinated recovery-support services using a chronic-care model of sustained recovery management. Information is needed about substance users' priorities, particularly persons in recovery who are not currently enrolled in treatment, to guide the development of recovery-oriented systems. As a first step in filling this gap, we present qualitative data on current life priorities among a sample of individuals that collectively represent successive recovery stages (N = 356). Findings suggest that many areas of functioning remain challenging long after abstinence is attained, most notably employment and education, family/social relations, and housing. Although the ranking of priorities changes somewhat across recovery stages, employment is consistently the second most important priority, behind working on one's recovery. Study limitations are noted, and the implications of findings for the development and evaluation of recovery-oriented services are discussed.

Demand access communications for TDRSS users

NASA Technical Reports Server (NTRS)

Zillig, David; Weinberg, Aaron; Mcomber, Robert

1994-01-01

The Tracking and Data Relay Satellite System (TDRSS) has long been used to provide reliable low and high-data rate relay services between user spacecraft in Earth orbit and the ground. To date, these TDRSS services have been implemented via prior scheduling based upon estimates of user needs and mission event timelines. While this approach may be necessary for large users that require greater amounts of TDRSS resources, TDRSS can potentially offer the planned community of smaller science missions (e.g., the small explorer missions), and other emerging users, the unique opportunity for services on demand. In particular, innovative application of the existing TDRSS Multiple Access (MA) subsystem, with its phased array antenna, could be used to implement true demand access services without modification to either the TDRSS satellites or the user transponder, thereby introducing operational and performance benefits to both the user community and the Space Network. In this paper, candidate implementations of demand access service via the TDRSS MA subsystem are examined in detail. Both forward and return link services are addressed and a combination of qualitative and quantitative assessments are provided. The paper also identifies further areas for investigation in this ongoing activity that is being conducted by GSFC/Code 531 under the NASA Code O Advanced Systems Program.

31 CFR 351.2 - How do I contact Fiscal Service?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Service by e-mail at [email protected]gov, or by writing to the following address: Bureau of the Fiscal Service, Parkersburg, West Virginia 26106-1328. Our website address is www.savingsbonds.gov. ...

Caregiver perceptions about mental health services after child sexual abuse.

PubMed

Fong, Hiu-fai; Bennett, Colleen E; Mondestin, Valerie; Scribano, Philip V; Mollen, Cynthia; Wood, Joanne N

2016-01-01

The objective of this study was to describe caregiver perceptions about mental health services (MHS) after child sexual abuse (CSA) and to explore factors that affected whether their children linked to services. We conducted semi-structured, in-person interviews with 22 non-offending caregivers of suspected CSA victims<13 years old seen at a child advocacy center in Philadelphia. Purposive sampling was used to recruit caregivers who had (n=12) and had not (n=10) linked their children to MHS. Guided by the Health Belief Model framework, interviews assessed perceptions about: CSA severity, the child's susceptibility for adverse outcomes, the benefits of MHS, and the facilitators and barriers to MHS. Interviews were audio-recorded, transcribed, coded, and analyzed using modified grounded theory. Recruitment ended when thematic saturation was reached. Caregivers expressed strong reactions to CSA and multiple concerns about adverse child outcomes. Most caregivers reported that MHS were generally necessary for children after CSA. Caregivers who had not linked to MHS, however, believed MHS were not necessary for their children, most commonly because they were not exhibiting behavioral symptoms. Caregivers described multiple access barriers to MHS, but caregivers who had not linked reported that they could have overcome these barriers if they believed MHS were necessary for their children. Caregivers who had not linked to services also expressed concerns about MHS being re-traumatizing and stigmatizing. Interventions to increase MHS linkage should focus on improving communication with caregivers about the specific benefits of MHS for their children and proactively addressing caregiver concerns about MHS. Copyright © 2015 Elsevier Ltd. All rights reserved.

Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems.

PubMed

2014-05-01

Understanding a care coordination framework, its functions, and its effects on children and families is critical for patients and families themselves, as well as for pediatricians, pediatric medical subspecialists/surgical specialists, and anyone providing services to children and families. Care coordination is an essential element of a transformed American health care delivery system that emphasizes optimal quality and cost outcomes, addresses family-centered care, and calls for partnership across various settings and communities. High-quality, cost-effective health care requires that the delivery system include elements for the provision of services supporting the coordination of care across settings and professionals. This requirement of supporting coordination of care is generally true for health systems providing care for all children and youth but especially for those with special health care needs. At the foundation of an efficient and effective system of care delivery is the patient-/family-centered medical home. From its inception, the medical home has had care coordination as a core element. In general, optimal outcomes for children and youth, especially those with special health care needs, require interfacing among multiple care systems and individuals, including the following: medical, social, and behavioral professionals; the educational system; payers; medical equipment providers; home care agencies; advocacy groups; needed supportive therapies/services; and families. Coordination of care across settings permits an integration of services that is centered on the comprehensive needs of the patient and family, leading to decreased health care costs, reduction in fragmented care, and improvement in the patient/family experience of care. Copyright © 2014 by the American Academy of Pediatrics.

Enabling appropriate personnel skill-mix for progressive realization of equitable access to assistive technology.

PubMed

Smith, Emma M; Gowran, Rosemary Joan; Mannan, Hasheem; Donnelly, Brian; Alvarez, Liliana; Bell, Diane; Contepomi, Silvana; Ennion Wegner, Liezel; Hoogerwerf, Evert-Jan; Howe, Tracey; Jan, Yih-Kuen; Kagwiza, Jeanne; Layton, Natasha; Ledgerd, Ritchard; MacLachlan, Malcolm; Oggero, Giulia; Pettersson, Cecilia; Pousada, Thais; Scheffler, Elsje; Wu, Sam

2018-05-17

This paper reviews the current capacity of personnel in enabling access to assistive technology (AT) as well as the systems and processes within which they work, and was reviewed, discussed, and refined during and following the Global Research, Innovation, and Education in Assistive Technology (GREAT) Summit. Key concepts addressed include a person-centred team approach; sustainability indicators to monitor, measure, and respond to needs for service design and delivery; education, research, and training for competent practice, using the six rehab-workforce challenges framework; and credentialing frameworks. We propose development of a competence framework and associated education and training programs, and development and implementation of a certification framework for AT personnel. There is a resolve to address the challenges faced by People globally to access assistive technology. Context specific needs assessment is required to understand the AT Personnel landscape, to shape and strengthen credentialing frameworks through competencies and certification, acknowledging both general and specific skill mix requirements. Implications for Rehabilitation Personnel in assistive technology (AT) provision should be trained using a person-centred team approach, which emphasizes appropriate skill-mix to address multiple needs within the community. Sustainability indicators should be used which allow personnel to monitor, measure and respond to needs for service design and delivery. A competence framework with associated education and training program, coupled with the development and implementation of a certification framework for AT personnel needs, will promote quality in AT personnel training globally.

Ecosystem services capacity across heterogeneous forest types: understanding the interactions and suggesting pathways for sustaining multiple ecosystem services.

PubMed

Alamgir, Mohammed; Turton, Stephen M; Macgregor, Colin J; Pert, Petina L

2016-10-01

As ecosystem services supply from tropical forests is declining due to deforestation and forest degradation, much effort is essential to sustain ecosystem services supply from tropical forested landscapes, because tropical forests provide the largest flow of multiple ecosystem services among the terrestrial ecosystems. In order to sustain multiple ecosystem services, understanding ecosystem services capacity across heterogeneous forest types and identifying certain ecosystem services that could be managed to leverage positive effects across the wider bundle of ecosystem services are required. We sampled three forest types, tropical rainforests, sclerophyll forests, and rehabilitated plantation forests, over an area of 32,000m(2) from Wet Tropics bioregion, Australia, aiming to compare supply and evaluate interactions and patterns of eight ecosystem services (global climate regulation, air quality regulation, erosion regulation, nutrient regulation, cyclone protection, habitat provision, energy provision, and timber provision). On average, multiple ecosystem services were highest in the rainforests, lowest in sclerophyll forests, and intermediate in rehabilitated plantation forests. However, a wide variation was apparent among the plots across the three forest types. Global climate regulation service had a synergistic impact on the supply of multiple ecosystem services, while nutrient regulation service was found to have a trade-off impact. Considering multiple ecosystem services, most of the rehabilitated plantation forest plots shared the same ordination space with rainforest plots in the ordination analysis, indicating that rehabilitated plantation forests may supply certain ecosystem services nearly equivalent to rainforests. Two synergy groups and one trade-off group were identified. Apart from conserving rainforests and sclerophyll forests, our findings suggest two additional integrated pathways to sustain the supply of multiple ecosystem services from a heterogeneous tropical forest landscape: (i) rehabilitation of degraded forests aiming to provide global climate regulation and habitat provision ecosystem services and (ii) management intervention to sustain global climate regulation and habitat provision ecosystem services. Copyright © 2016 Elsevier B.V. All rights reserved.

77 FR 5213 - Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA): Applicability to Hospital...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-02

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 489... & Medicaid Services (CMS), HHS. ACTION: Request for comments. SUMMARY: This request for comments addresses... comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and...

World Health Organization Public Health Model: A Roadmap for Palliative Care Development.

PubMed

Callaway, Mary V; Connor, Stephen R; Foley, Kathleen M

2018-02-01

The Open Society Foundation's International Palliative Care Initiative (IPCI) began to support palliative care development in Central and Eastern Europe and the Former Soviet Union in 1999. Twenty-five country representatives were invited to discuss the need for palliative care in their countries and to identify key areas that should be addressed to improve the care of adults and children with life-limiting illnesses. As a public health concern, progress in palliative care requires integration into health policy, education and training of health care professionals, availability of essential pain relieving medications, and health care services. IPCI created the Palliative Care Roadmap to serve as a model for government and/or nongovernment organizations to use to frame the necessary elements and steps for palliative care integration. The roadmap includes the creation of multiple Ministry of Health-approved working groups to address: palliative care inclusion in national health policy, legislation, and finance; availability of essential palliative care medications, especially oral opioids; education and training of health care professionals; and the implementation of palliative care services at home or in inpatient settings for adults and children. Each working group is tasked with developing a pathway with multiple signposts as indicators of progress made. The roadmap may be entered at different signposts depending upon the state of palliative care development in the country. The progress of the working groups often takes place simultaneously but at variable rates. Based on our experience, the IPCI Roadmap is one possible framework for palliative care development in resource constrained countries but requires both health care professional engagement and political will for progress to be made. Copyright © 2017. Published by Elsevier Inc.

Identifying Programmatic Gaps: Inequities in Harm Reduction Service Utilization among Male and Female Drug Users in Dar es Salaam, Tanzania

PubMed Central

Lambdin, Barrot H.; Bruce, R. Douglas; Chang, Olivia; Nyandindi, Cassian; Sabuni, Norman; Zamudio-Haas, Sophia; McCurdy, Sheryl; Masao, Frank; Ivo, Yovin; Msami, Amani; Ubuguy, Omar; Mbwambo, Jessie

2013-01-01

Introduction Current estimates suggest an HIV prevalence of 42% among people who inject drugs (PWIDs) in Dar es Salaam, while HIV prevalence is estimated to be 8.8% among the general population in the city. To address the HIV epidemic in this population, the government of Tanzania began establishing HIV prevention, treatment and care services including outreach and medication assisted treatment (MAT) for PWIDs in 2010. We assessed gender inequities in utilization of outreach and MAT services and evaluated differences in HIV risk behaviors between female and male PWIDs. Materials and Methods Routine outreach data between December 2010 to mid-August 2012 and baseline data on clients enrolling in methadone from February 2011 to August 2012 were utilized. Binomial regression was used to estimate adjusted relative risk estimates comparing females to males. Results From December 2010 to August 2012, 8,578 contacts were made to drug users; among them 1,898 were injectors. A total of 453 injectors were eligible and referred to MAT, of which, 443 enrolled in treatment. However, regarding total outreach contacts, outreach to PWID, referral to MAT and enrollment in MAT, 8% or less of drug users accessing services were women. In contrast, weighted estimations from surveys suggest that 34% of PWIDs are female, and this approximation is similar to recent population size estimations. Overall, 43% of traditional outreach workers conducting outreach with drug users were female. Though reporting higher levels of condom usage, female PWID were more likely to report multiple sex partners, anal sex, commercial sex work and struggle under a higher burden of addiction, mental disorders and abuse. Conclusions Services have not been mobilized adequately to address the clear needs of females who inject drugs. A clear and urgent need exists for women-centered strategies that effectively engage female PWID into HIV prevention services. PMID:23825620

The role of organizational context in the implementation of a statewide initiative to integrate mental health services into pediatric primary care.

PubMed

King, Melissa A; Wissow, Lawrence S; Baum, Rebecca A

Although there is evidence that mental health services can be delivered in pediatric primary care with good outcomes, few changes in service delivery have been seen over the past decade. Practices face a number of barriers, making interventions that address determinants of change at multiple levels a promising solution. However, these interventions may need appropriate organizational contexts in place to be successfully implemented. The objective of this study was to test whether organizational context (culture, climate, structures/processes, and technologies) influenced uptake of a complex intervention to implement mental health services in pediatric primary care. We incorporated our research into the implementation and evaluation of Ohio Building Mental Wellness Wave 3, a learning collaborative with on-site trainings and technical assistance supporting key drivers of mental health care implementation. Simple linear regression was used to test the effects of organizational context and external or fixed organizational characteristics on program uptake. Culture, structure/processes, and technologies scores indicating a more positive organizational context for mental health at the project's start, as well as general cultural values that were more group/developmental, were positively associated with uptake. Patient-centered medical home certification and use of electronic medical records were also associated with greater uptake. Changes in context over the course of Building Mental Wellness did not influence uptake. Organizational culture, structures/processes, and technologies are important determinants of the uptake of activities to implement mental health services in pediatric primary care. Interventions may be able to change these aspects of context to make them more favorable to integration, but baseline characteristics more heavily influence the more proximal uptake of program activities. Pediatric primary care practices would benefit from assessing their organizational context and taking steps to address it prior to or in a phased approach with mental health service implementation.

Experiences of care by Australians with a diagnosis of borderline personality disorder

PubMed Central

McMahon, J.

2015-01-01

Accessible summary Borderline personality disorder (BPD) is a complex and challenging mental health condition for the person and service providers who support them.This paper reports on the results of a survey of 153 people with a diagnosis of BPD about their experiences of attempting to receive support in managing this mental health condition. It provides their perceptions of a range of experiences not reported in the existing literature, including general practitioner roles, urban and rural differences, public and private hospital differences, and comparison of usefulness of support across multiple support types.People with a diagnosis of BPD continue to experience significant discrimination when attempting to get their needs met within both public and private health services. Further education for nurses and other health professionals is indicated to address pervasive negative attitudes towards people with a diagnosis of BPD. Abstract There is limited understanding of the experience of seeking and receiving treatment and care by people with a diagnosis of borderline personality disorder (BPD), their perceptions of barriers to care and the quality of services they receive. This study aimed to explore these experiences from the perspective of Australians with this diagnosis. An invitation to participate in an online survey was distributed across multiple consumer and carer organizations and mental health services, by the Private Mental Health Consumer Carer Network (Australia) in 2011. Responses from 153 people with a diagnosis of BPD showed that they experience significant challenges and discrimination when attempting to get their needs met within both public and private health services, including general practice. Seeking help from hospital emergency departments during crises was particularly challenging. Metropolitan and rural differences, and gender differences, were also apparent. Community supports were perceived as inadequate to meet their needs. This study provides data on a range of experiences not reported in existing literature, including general practitioner roles, urban and rural differences, public and private hospital differences, and comparison of usefulness of support across multiple support types. Its findings can help inform better training for health professionals and better care for this population. PMID:26122817

Mapping of multiple parameter m-health scenarios to mobile WiMAX QoS variables.

PubMed

Alinejad, Ali; Philip, N; Istepanian, R S H

2011-01-01

Multiparameter m-health scenarios with bandwidth demanding requirements will be one of key applications in future 4 G mobile communication systems. These applications will potentially require specific spectrum allocations with higher quality of service requirements. Furthermore, one of the key 4 G technologies targeting m-health will be medical applications based on WiMAX systems. Hence, it is timely to evaluate such multiple parametric m-health scenarios over mobile WiMAX networks. In this paper, we address the preliminary performance analysis of mobile WiMAX network for multiparametric telemedical scenarios. In particular, we map the medical QoS to typical WiMAX QoS parameters to optimise the performance of these parameters in typical m-health scenario. Preliminary performance analyses of the proposed multiparametric scenarios are evaluated to provide essential information for future medical QoS requirements and constraints in these telemedical network environments.

A subjective scheduler for subjective dedicated networks

NASA Astrophysics Data System (ADS)

Suherman; Fakhrizal, Said Reza; Al-Akaidi, Marwan

2017-09-01

Multiple access technique is one of important techniques within medium access layer in TCP/IP protocol stack. Each network technology implements the selected access method. Priority can be implemented in those methods to differentiate services. Some internet networks are dedicated for specific purpose. Education browsing or tutorial video accesses are preferred in a library hotspot, while entertainment and sport contents could be subjects of limitation. Current solution may use IP address filter or access list. This paper proposes subjective properties of users or applications are used for priority determination in multiple access techniques. The NS-2 simulator is employed to evaluate the method. A video surveillance network using WiMAX is chosen as the object. Subjective priority is implemented on WiMAX scheduler based on traffic properties. Three different traffic sources from monitoring video: palace, park, and market are evaluated. The proposed subjective scheduler prioritizes palace monitoring video that results better quality, xx dB than the later monitoring spots.

Using landscape limnology to classify freshwater ecosystems for multi-ecosystem management and conservation

USGS Publications Warehouse

Soranno, Patricia A.; Cheruvelil, Kendra Spence; Webster, Katherine E.; Bremigan, Mary T.; Wagner, Tyler; Stow, Craig A.

2010-01-01

Governmental entities are responsible for managing and conserving large numbers of lake, river, and wetland ecosystems that can be addressed only rarely on a case-by-case basis. We present a system for predictive classification modeling, grounded in the theoretical foundation of landscape limnology, that creates a tractable number of ecosystem classes to which management actions may be tailored. We demonstrate our system by applying two types of predictive classification modeling approaches to develop nutrient criteria for eutrophication management in 1998 north temperate lakes. Our predictive classification system promotes the effective management of multiple ecosystems across broad geographic scales by explicitly connecting management and conservation goals to the classification modeling approach, considering multiple spatial scales as drivers of ecosystem dynamics, and acknowledging the hierarchical structure of freshwater ecosystems. Such a system is critical for adaptive management of complex mosaics of freshwater ecosystems and for balancing competing needs for ecosystem services in a changing world.

48 CFR 52.222-43 - Fair Labor Standards Act and Service Contract Act-Price Adjustment (Multiple Year and Option...

Code of Federal Regulations, 2010 CFR

2010-10-01

... and Service Contract Act-Price Adjustment (Multiple Year and Option Contracts). 52.222-43 Section 52... Standards Act and Service Contract Act—Price Adjustment (Multiple Year and Option Contracts). As prescribed...—Price Adjustment (Multiple Year and Option Contracts) (SEP 2009) (a) This clause applies to both...

Direction Finding Using Multiple MEMS Acoustic Sensors

DTIC Science & Technology

2015-09-01

ADDRESS(ES) Naval Postgraduate School Monterey, CA 93943-5000 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING /MONITORING AGENCY NAME...6 B. OBJECTIVE AND THESIS ORGANIZATION ..................................10 II. DIRECTION FINDING USING MULTIPLE

What Do Veterans Service Organizations’ Websites Say About Tobacco Control?

PubMed Central

Poston, Walker S.C.; Haddock, Christopher K.; Jahnke, Sara A.; Jitnarin, Nattinee

2013-01-01

Purpose Little is known about Veterans Service Organizations (VSOs) and their perspectives on veterans smoking or military tobacco control. Veterans have high smoking rates and many started smoking in the military, where a culture promoting use exists. Design We conducted a cross-sectional qualitative content analysis of VSO websites to classify health topics and identify tobacco-related information. Setting Websites were coded by trained raters from January-June of 2011. Data were entered, cleaned and analyzed from July 2011-January 2012. Participants 24 active VSO websites meeting inclusion criteria were rated independently. Method A comprehensive form was used to code 15 veteran-relevant health topics across multiple content areas/domains within the websites. Raters achieved 94.5% inter-rater agreement over nearly 5,000 data-points. Results A total of 277 health topics were addressed with the top five being Insurance/Tricare/VA issues (28.2%), PTSD (15.5%), disability/amputation/wounds (13.4%), Agent Orange (10.5%), and traumatic brain injury (TBI; 9.0%). Tobacco was mentioned four times (1.4%) across all 24 VSO websites and smoking cessation was never addressed. Conclusions VSO websites provide little information on tobacco-related topics and none offered information about smoking cessation. Given the high rates of tobacco use among veterans and active duty service members, and the interaction between smoking and PTSD symptoms and treatment outcomes, VSOs should consider making tobacco control and smoking cessation higher priority health issues on their websites. PMID:23631454

Family violence and maternal mortality in the south Asian community: the role of obstetrical care providers.

PubMed

Janssen, Patricia A; Henderson, Angela D; MacKay, Kathleen L

2009-11-01

South Asian women face multiple barriers to accessing information and support if they are experiencing spousal abuse. We conducted a study among South Asian women in Surrey, British Columbia, to define a role for obstetrical care providers in assisting women who experience family violence. South Asian women survivors of abuse participated with representatives of family and victim services agencies in a workshop to identify key opportunities for violence prevention and intervention by obstetrical care providers. Participants grouped issues affecting women's vulnerability to violence into four themes and identified strategies to address them. Themes focused on cultural issues, services and supports, education and prevention, and policy and advocacy. Participants highlighted challenges posed by the patriarchal nature of their culture and, for many families, by recent immigration. They emphasized the importance of routine assessment for family violence by obstetrical care providers and stressed the need to treat the entire family, not just the identified victim. They focused on the role of the caregiver as a conduit of information about social services and other resources. Community-level interventions to address abuse were endorsed, including the use of lay media to deliver key messages about health and safety. Pregnancy offers caregivers an opportunity to be advocates and to provide information and referrals for women in the South Asian community who may be at risk of violence. Obstetrical caregivers may be an important influence in protecting women from lethal harm.

Accounting for ecosystem services in life cycle assessment, Part I: a critical review.

PubMed

Zhang, Yi; Singh, Shweta; Bakshi, Bhavik R

2010-04-01

If life cycle oriented methods are to encourage sustainable development, they must account for the role of ecosystem goods and services, since these form the basis of planetary activities and human well-being. This article reviews methods that are relevant to accounting for the role of nature and that could be integrated into life cycle oriented approaches. These include methods developed by ecologists for quantifying ecosystem services, by ecological economists for monetary valuation, and life cycle methods such as conventional life cycle assessment, thermodynamic methods for resource accounting such as exergy and emergy analysis, variations of the ecological footprint approach, and human appropriation of net primary productivity. Each approach has its strengths: economic methods are able to quantify the value of cultural services; LCA considers emissions and assesses their impact; emergy accounts for supporting services in terms of cumulative exergy; and ecological footprint is intuitively appealing and considers biocapacity. However, no method is able to consider all the ecosystem services, often due to the desire to aggregate all resources in terms of a single unit. This review shows that comprehensive accounting for ecosystem services in LCA requires greater integration among existing methods, hierarchical schemes for interpreting results via multiple levels of aggregation, and greater understanding of the role of ecosystems in supporting human activities. These present many research opportunities that must be addressed to meet the challenges of sustainability.

Evaluation of outpatient service quality in Eastern Saudi Arabia

PubMed Central

Fraihi, Khalid J. Al; FAMCO, Dip; FAMCO, Fellow; Latif, Shahid A.

2016-01-01

Objectives: To investigate perceptions and expectations of patients regarding hospital outpatient services by using a service quality gap model and factors influencing such gaps. Methods: In this cross-sectional descriptive study conducted between October and November 2014 in the outpatient waiting areas of a hospital in the Eastern Province of Saudi Arabia, a sample of 306 patients was selected by convenience sampling technique. The data was collected through an Arabic version of the service quality (SERVQUAL) questionnaire consisting of 2 parts: patients’ demographic characteristics, and 22 items scales of patients’ expectations and perceptions of SERVQUAL. The data was analyzed by confirmatory factor analysis, independent, and paired t samples tests and one way analysis of variance test. Results: The results showed that the proposed model for service quality dimensions had a good fit by satisfying the recommended values. The patients’ expectations exceeded perceptions in all service quality dimensions indicating statistically significant service quality gaps (t=26.3, p<0.000). Findings revealed that the empathy dimension contributed most patients’ expectations (4.7 ± 0.5) and perceptions (3.7 ± 0.8) scores, and responsiveness contributed least to expectations (4.5 ± 0.6) and perceptions (3.2 ± 0.8) scores. Prompt services showed highest service quality gap, while observation of privacy showed the smallest service quality gap in the statements. The study showed a significant association between gender, age, education, multiple visits, and service quality dimensions. Conclusion: The proposed model is valid and reliable and significant service quality gaps of all 5 dimensions need to be prioritized and addressed by focused improvement efforts of hospital management. PMID:27052285

School Mental Health Resources and Adolescent Mental Health Service Use

PubMed Central

Green, Jennifer Greif; McLaughlin, Katie A.; Alegría, Margarita; Costello, E. Jane; Gruber, Michael J.; Hoagwood, Kimberly; Leaf, Philip J.; Olin, Serene; Sampson, Nancy A,; Kessler, Ronald C.

2014-01-01

Objective Although schools are identified as critical for detecting youth mental disorders, little is known about whether the number of mental health providers and types of resources they offer influence student mental health service use. Such information could inform the development and allocation of appropriate school-based resources to increase service use. This paper examines associations of school resources with past-year mental health service use among students with 12-month DSM-IV mental disorders. Method Data come from the U.S. National Comorbidity Survey Adolescent Supplement (NCS-A), a national survey of adolescent mental health that included 4,445 adolescent-parent pairs in 227 schools in which principals and mental health coordinators completed surveys about school resources-policies for addressing student emotional problems. Adolescents and parents completed the Composite International Diagnostic Interview and reported mental health service use across multiple sectors. Multilevel multivariate regression was used to examine associations of school mental health resources and individual-level service use. Results Roughly half (45.3%) of adolescents with a 12-month DSM-IV disorder received past-year mental health services. Substantial variation existed in school resources. Increased school engagement in early identification was significantly associated with mental health service use for adolescents with mild/moderate mental and behavior disorders. The ratio of students-to-mental health providers was not associated with overall service use, but was associated with sector of service use. Conclusions School mental health resources, particularly those related to early identification, may facilitate mental health service use and influence sector of service use for youths with DSM disorders. PMID:23622851

Evaluation of outpatient service quality in Eastern Saudi Arabia. Patient's expectations and perceptions.

PubMed

Al Fraihi, Khalid J; Latif, Shahid A

2016-04-01

To investigate perceptions and expectations of patients regarding hospital outpatient services by using a service quality gap model and factors influencing such gaps. In this cross-sectional descriptive study conducted between October and November 2014 in the outpatient waiting areas of a hospital in the Eastern Province of Saudi Arabia, a sample of 306 patients was selected by convenience sampling technique. The data was collected through an Arabic version of the service quality (SERVQUAL) questionnaire consisting of 2 parts: patients' demographic characteristics, and 22 items scales of patients' expectations and perceptions of SERVQUAL. The data was analyzed by confirmatory factor analysis, independent, and paired t samples tests and one way analysis of variance test The results showed that the proposed model for service quality dimensions had a good fit by satisfying the recommended values. The patients' expectations exceeded perceptions in all service quality dimensions indicating statistically significant service quality gaps (t=26.3, p less than 0.000). Findings revealed that the empathy dimension contributed most patients' expectations (4.7 ± 0.5) and perceptions (3.7 ± 0.8) scores, and responsiveness contributed least to expectations (4.5 ± 0.6) and perceptions (3.2 ± 0.8) scores. Prompt services showed highest service quality gap, while observation of privacy showed the smallest service quality gap in the statements. The study showed a significant association between gender, age, education, multiple visits, and service quality dimensions. The proposed model is valid and reliable and significant service quality gaps of all 5 dimensions need to be prioritized and addressed by focused improvement efforts of hospital management.

75 FR 11610 - Notice Announcing Addresses for Service of Process

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-11

... SOCIAL SECURITY ADMINISTRATION [Docket No. SSA-2009-0076] Notice Announcing Addresses for Service of Process AGENCY: Social Security Administration. ACTION: Notice announcing addresses for summonses and complaints. SUMMARY: The Office of the General Counsel (OGC) is responsible for processing and...

Space assets, technology and services in support of energy policy

NASA Astrophysics Data System (ADS)

Vasko, C. A.; Adriaensen, M.; Bretel, A.; Duvaux-Bechon, I.; Giannopapa, C. G.

2017-09-01

Space can be used as a tool by decision and policy makers in developing, implementing and monitoring various policy areas including resource management, environment, transport, security and energy. This paper focuses on the role of space for the energy policy. Firstly, the paper summarizes the European Union's (EU) main objectives in energy policy enclosed in the Energy Strategy 2020-2030-2050 and demonstrates how space assets can contribute to achieving those objectives. Secondly, the paper addresses how the European Space Agency (ESA) has established multiple initiatives and programs that directly finance the development of space assets, technology and applications that deliver services in support of the EU energy policy and sector. These efforts should be continued and strengthened in order to overcome identified technological challenges. The use of space assets, technology and applications, can help achieve the energy policy objectives for the next decades.

Evidence for the Propositions of the Interpersonal Theory of Suicide Among a Military Sample.

PubMed

Silva, Caroline; Hagan, Christopher R; Rogers, Megan L; Chiurliza, Bruno; Podlogar, Matthew C; Hom, Melanie A; Tzoneva, Mirela; Lim, Ingrid C; Joiner, Thomas E

2017-06-01

Although the interpersonal theory of suicide may explain the elevated suicide risk among military service members, past explorations have been equivocal. This study aimed to investigate the propositions of the interpersonal theory in a sample of U.S. Army recruiters. Participants (N = 3,428) completed self-report measures assessing the interpersonal theory's constructs (i.e., thwarted belongingness (TB), perceived burdensomeness (PB), acquired capability for suicide), current suicidal ideation, agitation, and insomnia. History of depression was obtained from medical records. Hierarchical multiple regression analyses revealed that the interaction between TB and PB was associated with current suicidal ideation, controlling for depression, agitation, and insomnia. This effect was especially notable among those with high capability for suicide. Findings provide support for the interpersonal theory in a large, diverse military sample. It may be advantageous to assess and therapeutically address TB and PB among at-risk service members. © 2016 Wiley Periodicals, Inc.

Improving Community-Based Mental Health Care for Children: Translating Knowledge into Action

PubMed Central

Haine-Schlagel, Rachel; Brookman-Frazee, Lauren; Baker-Ericzen, Mary; Trask, Emily; Fawley-King, Kya

2013-01-01

There is urgent need for improvement in community-based mental health care for children and families. Multiple studies have documented serious limitations in the effectiveness of “usual care.” Fortunately, many empirically-supported strategies to improve care have been developed, and thus there is now a great deal of knowledge available to address this significant public health problem. The goal of this selective review is to highlight and synthesize that empirically-supported knowledge to stimulate and facilitate the needed translation of knowledge into action. The review provides a sound foundation for constructing improved services by consolidating descriptive data on the status quo in children’s mental health care, as well as evidence for an array of promising strategies to improve (a) Service access and engagement; (b) Delivery of evidence-based practices; and (c) Outcome accountability. A multi-level framework is used to highlight recommended care improvement targets. PMID:23212902

In Their Own Words: Exploring Family Pathways to Housing Instability.

PubMed

Gultekin, Laura; Brush, Barbara L

2017-02-01

Housing instability threatens the health and well-being of millions of families across the United States, yet little is known about the characteristics or housing trajectories of at-risk families. To address this gap in our understanding of family risk for housing instability and homelessness, we undertook a qualitative descriptive study utilizing a convenience sample of 16 mothers recruited from a housing service agency living in Detroit and receiving emergency services to avoid homelessness. Participants completed the Brief Patient Health Questionnaire (PHQ), then narrated their life events and reasons for housing instability and disclosed desired interventions for homelessness prevention. Data analysis reveals that women experienced high rates of previously undisclosed trauma, broken family relationships, early parenting responsibilities, social isolation, and system failures that contributed to recurrent episodes of housing instability. We argue that housing instability is a symptom of multiple chronic underlying issues that need more than a temporary financial patch.

S4AC Case Study: Enhancing Underserved Seniors' Access to Health Promotion Programs.

PubMed

Koehn, Sharon; Habib, Sanzida; Bukhari, Syeda

2016-03-01

The Seniors Support Services for South Asian Community (S4AC) project was developed in response to the underutilization of available recreation and seniors' facilities by South Asian seniors who were especially numerous in a suburban neighbourhood in British Columbia. Addressing the problem required the collaboration of the municipality and a registered non-profit agency offering a wide range of services and programs to immigrant and refugee communities. Through creative outreach and accommodation, the project has engaged more than 100 Punjabi-speaking seniors annually in diverse exercise activities. Case study research methods with staff and current and former senior participants of S4AC include participant observation, individual interviews, and focus groups. Viewed through the critical interpretive lens of the "candidacy framework", findings reveal the myriad ways in which access to health promotion and physical activity for immigrant older adults is a complex iterative process of negotiation at multiple levels.

Assessing and managing stressors in a changing marine environment.

PubMed

Chapman, Peter M

2017-11-30

We are facing a dynamic future in the face of multiple stressors acting individually and in combination: climate change; habitat change/loss; overfishing; invasive species; harmful algal blooms/eutrophication; and, chemical contaminants. Historic assessment and management approaches will be inadequate for addressing risks from climate change and other stressors. Wicked problems (non-linear, complex, competing risks and benefits, not easily solvable), will become increasingly common. We are facing irreversible changes to our planetary living conditions. Agreed protection goals and considering both the negatives (risks) and the positives (benefits) of all any and all actions are required, as is judicious and appropriate use of the Precautionary Principle. Researchers and managers need to focus on: determining tipping points (alternative stable points); maintaining ecosystem services; and, managing competing ecosystem services. Marine (and other) scientists are urged to focus their research on wicked problems to allow for informed decision-making on a planetary basis. Copyright © 2016 Elsevier Ltd. All rights reserved.

Investing in soils as an infrastructure to maintain and enhance food water and carbon services

NASA Astrophysics Data System (ADS)

Davies, Jessica

2017-04-01

Soils are a life support system for global society and our planet. In addition to providing the vast majority of our food; soils regulate water quality and quantity reducing the risk of floods, droughts and pollution; and as the largest store of carbon in the earth system they are critical to climate change. By providing these multiple essential services, soils act a natural form of infrastructure that is critical to supporting both rural and urban communities and economies. Can natural infrastructure and natural capital concepts be used to motivate and enable investment and regulation of soils for purposes such as soil carbon sequestration? What scientific knowledge and tools would we need to support soil infrastructure decision making - in policy arenas and elsewhere? This poster will present progress from a new research project supported by the UK research council (EP/N030532/1) that addresses these questions.

Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning or resources for services to address depression disparities.

PubMed

Wells, Kenneth B; Jones, Loretta; Chung, Bowen; Dixon, Elizabeth L; Tang, Lingqi; Gilmore, Jim; Sherbourne, Cathy; Ngo, Victoria K; Ong, Michael K; Stockdale, Susan; Ramos, Esmeralda; Belin, Thomas R; Miranda, Jeanne

2013-10-01

Depression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors. To compare the effectiveness of Community Engagement and Planning (CEP) and Resources for Services (RS) to implement depression QI on clients' mental health-related quality of life (HRQL) and services use. Matched programs from health, social and other service sectors were randomized to community engagement and planning (promoting inter-agency collaboration) or resources for services (individual program technical assistance plus outreach) to implement depression QI toolkits in Hollywood-Metro and South Los Angeles. From 93 randomized programs, 4,440 clients were screened and of 1,322 depressed by the 8-item Patient Health Questionnaire (PHQ-8) and providing contact information, 1,246 enrolled and 1,018 in 90 programs completed baseline or 6-month follow-up. Self-reported mental HRQL and probable depression (primary), physical activity, employment, homelessness risk factors (secondary) and services use. CEP was more effective than RS at improving mental HRQL, increasing physical activity and reducing homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users (i.e. psychiatrists, mental health providers) while increasing depression visits among users of primary care/public health for depression and users of faith-based and park programs (each p < 0.05). Employment, use of antidepressants, and total contacts were not significantly affected (each p > 0.05). Community engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients.

Developing a Framework to Help Bedside Nurses Bring About Change.

PubMed

Porter, Jordan S; Strout, Kelley A

2016-12-01

: Nurses across all care settings and experience levels are being called upon to lead. In a 2011 report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine examined the ways nurses could more fully apply their knowledge of direct patient care to address the increasing demands placed on the health care system since the passage of the Affordable Care Act. The report asked: "What roles can nursing assume to address the increasing demand for safe, high-quality, and effective health care services?"Multiple variables influence a nurse's ability to assume a leadership role, and multiple barriers to these roles continue to exist. This article uses the first-person voice to share the experience of a new graduate nurse in a formal nurse residency program who found himself in a position to identify the need for, advocate for, and ultimately influence a policy change in the staffing practice of floating as it was applied to new RNs on his unit. In a retrospective analysis of the process, the new graduate RN and his former professor acting as a writing mentor developed a leadership framework for nurses called RN LEADER, which they hope will empower and guide other nurses to lead evidence-based change in their workplaces.

How agricultural multiple ecosystem services respond to socioeconomic factors in Mengyin County, China.

PubMed

Chen, Yajuan; Yu, Zhenrong; Li, Xuedong; Li, Pengyao

2018-07-15

Provisioning services have always been the main focus of agriculture, and which have led to a decline in biodiversity and have damaged a number of other services. Agriculture should contribute to current and future food security while producing multiple ecosystem services (ES). Restoration outcomes of multiple ES were affected by different socioeconomic drivers, thus a better understanding of how multiple ES respond to socioeconomic drivers can help to restore multiple ES. This paper used rural people's perceptions of ES to quantify and map ecosystem service obtainment and demand in the Mengyin County, China. An integrative index of multiple ecosystem services (IMES) was used to effectively aggregate the values of multiple ES. The threat categorization framework is designed to communicate the degree to which the adequate and sustainable provision of multiple ES is threatened, in order to prioritize conservation actions. The results revealed that 6 townships in the Mengyin County exhibited an excessive obtainment situation (demand is less than obtainment) of multiple ES; an insufficient obtainment situation (demand is greater than obtainment) of multiple ES was mainly situated in the northern part of Mengyin County. Overall, the current state of multiple ES across Mengyin County is classified as "Endangered" classification according to application of threat categorization framework. It is necessary to restructure and manage socioeconomic factors for multiple ES. At national level, the macro decision-making (controlling population density) and the mechanisms (attracting high-quality human resources into the rural) will play an important role in promoting multiple ES management, and it is necessary to provide 3 or more years of tailored educational resources for rural residents to advance multiple ES in agricultural landscape. Development of agricultural PES programs in China that enable farmers to profit from production ES is a sustainable strategy for increasing multiple ecosystem services. Copyright © 2018 Elsevier B.V. All rights reserved.

Multi-target drugs to address multiple checkpoints in complex inflammatory pathologies: evolutionary cues for novel "first-in-class" anti-inflammatory drug candidates: a reviewer's perspective.

PubMed

Mathew, Geetha; Unnikrishnan, M K

2015-10-01

Inflammation is a complex, metabolically expensive process involving multiple signaling pathways and regulatory mechanisms which have evolved over evolutionary timescale. Addressing multiple targets of inflammation holistically, in moderation, is probably a more evolutionarily viable strategy, as compared to current therapy which addresses drug targets in isolation. Polypharmacology, addressing multiple targets, is commonly used in complex ailments, suggesting the superior safety and efficacy profile of multi-target (MT) drugs. Phenotypic drug discovery, which generated successful MT and first-in-class drugs in the past, is now re-emerging. A multi-pronged approach, which modulates the evolutionarily conserved, robust and pervasive cellular mechanisms of tissue repair, with AMPK at the helm, regulating the complex metabolic/immune/redox pathways underlying inflammation, is perhaps a more viable strategy than addressing single targets in isolation. Molecules that modulate multiple molecular mechanisms of inflammation in moderation (modulating TH cells toward the anti-inflammatory phenotype, activating AMPK, stimulating Nrf2 and inhibiting NFκB) might serve as a model for a novel Darwinian "first-in-class" therapeutic category that holistically addresses immune, redox and metabolic processes associated with inflammatory repair. Such a multimodal biological activity is supported by the fact that several non-calorific pleiotropic natural products with anti-inflammatory action have been incorporated into diet (chiefly guided by the adaptive development of olfacto-gustatory preferences over evolutionary timescales) rendering such molecules, endowed with evolutionarily privileged molecular scaffolds, naturally oriented toward multiple targets.

Initiating an undiagnosed diseases program in the Western Australian public health system.

PubMed

Baynam, Gareth; Broley, Stephanie; Bauskis, Alicia; Pachter, Nicholas; McKenzie, Fiona; Townshend, Sharron; Slee, Jennie; Kiraly-Borri, Cathy; Vasudevan, Anand; Hawkins, Anne; Schofield, Lyn; Helmholz, Petra; Palmer, Richard; Kung, Stefanie; Walker, Caroline E; Molster, Caron; Lewis, Barry; Mina, Kym; Beilby, John; Pathak, Gargi; Poulton, Cathryn; Groza, Tudor; Zankl, Andreas; Roscioli, Tony; Dinger, Marcel E; Mattick, John S; Gahl, William; Groft, Stephen; Tifft, Cynthia; Taruscio, Domenica; Lasko, Paul; Kosaki, Kenjiro; Wilhelm, Helene; Melegh, Bela; Carapetis, Jonathan; Jana, Sayanta; Chaney, Gervase; Johns, Allison; Owen, Peter Wynn; Daly, Frank; Weeramanthri, Tarun; Dawkins, Hugh; Goldblatt, Jack

2017-05-03

New approaches are required to address the needs of complex undiagnosed diseases patients. These approaches include clinical genomic diagnostic pipelines, utilizing intra- and multi-disciplinary platforms, as well as specialty-specific genomic clinics. Both are advancing diagnostic rates. However, complementary cross-disciplinary approaches are also critical to address those patients with multisystem disorders who traverse the bounds of multiple specialties and remain undiagnosed despite existing intra-specialty and genomic-focused approaches. The diagnostic possibilities of undiagnosed diseases include genetic and non-genetic conditions. The focus on genetic diseases addresses some of these disorders, however a cross-disciplinary approach is needed that also simultaneously addresses other disorder types. Herein, we describe the initiation and summary outcomes of a public health system approach for complex undiagnosed patients - the Undiagnosed Diseases Program-Western Australia (UDP-WA). Briefly the UDP-WA is: i) one of a complementary suite of approaches that is being delivered within health service, and with community engagement, to address the needs of those with severe undiagnosed diseases; ii) delivered within a public health system to support equitable access to health care, including for those from remote and regional areas; iii) providing diagnoses and improved patient care; iv) delivering a platform for in-service and real time genomic and phenomic education for clinicians that traverses a diverse range of specialties; v) retaining and recapturing clinical expertise; vi) supporting the education of junior and more senior medical staff; vii) designed to integrate with clinical translational research; and viii) is supporting greater connectedness for patients, families and medical staff. The UDP-WA has been initiated in the public health system to complement existing clinical genomic approaches; it has been targeted to those with a specific diagnostic need, and initiated by redirecting existing clinical and financial resources. The UDP-WA supports the provision of equitable and sustainable diagnostics and simultaneously supports capacity building in clinical care and translational research, for those with undiagnosed, typically rare, conditions.

Challenges of training and delivery of pediatric surgical services in Africa.

PubMed

Chirdan, Lohfa B; Ameh, Emmanuel A; Abantanga, Francis A; Sidler, Daniel; Elhalaby, Essam A

2010-03-01

The practice of pediatric surgery in Africa presents multiple challenges. This report presents an overview of problems encountered in the training of pediatric surgeons as well as the delivery of pediatric surgical services in Africa. A returned structured self-administered questionnaire sent to pediatric surgeons practicing in Africa was reviewed and analyzed using SPSS version 11.5 (SPSS, Chicago, IL). Forty-nine (57%) of 86 questionnaires were returned from 8 countries. Great variability in the requirements and training of pediatric surgeons, even within the same country, was found. Many surgical colleges are responsible for standardization and board certification of pediatric surgeons across Africa. There were 6 (12%) centers that train middle level manpower. Twenty-six (53%) participants have 1 to 2 trainees, whereas 22 (45%) have irregular or no trainee. A pediatric surgical trainee needs 2 to 4 (median, 2) years of training in general surgery to be accepted for training in pediatric surgery, and it takes a trainee between 2 to 4 (median, 3) years to complete training as a pediatric surgeon in the countries surveyed. The number of pediatric surgeons per million populations is lowest in Malawi (0.06) and highest in Egypt (1.5). Problems facing adequate delivery of pediatric surgical services enumerated by participants included poor facilities, lack of support laboratory facilities, shortage of manpower, late presentation, and poverty. The training of pediatric surgical manpower in some African countries revealed great variability in training with multiple challenges. Delivery of pediatric surgical services in Africa presents problems like severe manpower shortage, high pediatric surgeon workload, and poor facilities. Standardization of pediatric surgery training across the continent is advocated, and the problems of delivery of pediatric surgical services need to be addressed urgently, not only by health care planners in Africa but by the international community and donor agencies, if the African child is to have access to essential pediatric surgical services like his or her counterpart in other developed parts of the world.

77 FR 74631 - General Services Administration Acquisition Regulation: Modifications (Multiple Award Schedules...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-17

...-0001; Sequence 21] General Services Administration Acquisition Regulation: Modifications (Multiple... Modifications (Multiple Award Schedule). DATES: Submit comments on or before: February 15, 2013. FOR FURTHER INFORMATION CONTACT: Ms. Dana Munson, General Services Acquisition Policy Division, GSA, (202) 357-9652 or...

Methodological considerations when translating “burnout”☆

PubMed Central

Squires, Allison; Finlayson, Catherine; Gerchow, Lauren; Cimiotti, Jeannie P.; Matthews, Anne; Schwendimann, Rene; Griffiths, Peter; Busse, Reinhard; Heinen, Maude; Brzostek, Tomasz; Moreno-Casbas, Maria Teresa; Aiken, Linda H.; Sermeus, Walter

2014-01-01

No study has systematically examined how researchers address cross-cultural adaptation of burnout. We conducted an integrative review to examine how researchers had adapted the instruments to the different contexts. We reviewed the Content Validity Indexing scores for the Maslach Burnout Inventory-Human Services Survey from the 12-country comparative nursing workforce study, RN4CAST. In the integrative review, multiple issues related to translation were found in existing studies. In the cross-cultural instrument analysis, 7 out of 22 items on the instrument received an extremely low kappa score. Investigators may need to employ more rigorous cross-cultural adaptation methods when attempting to measure burnout. PMID:25343131

Transitioning to Adulthood from Foster Care.

PubMed

Lee, Terry; Morgan, Wynne

2017-04-01

Transitional age foster youth do not typically receive the types of family supports their nonfoster peers enjoy. Many foster youth experience multiple adversities and often fare worse than nonfoster peers on long-term functional outcomes. Governments increasingly recognize their responsibility to act as parents for state dependents transitioning to adulthood and the need to provide services to address social/emotional supports, living skills, finances, housing, education, employment, and physical and mental health. More research is needed to inform the development of effective programs. Transitional age foster youth benefit from policies promoting a developmentally appropriate, comprehensive, and integrated transition system of care. Copyright © 2016 Elsevier Inc. All rights reserved.

Superstorm Sandy's forgotten patient: a lesson in emergency preparedness in severe obesity.

PubMed

Ramme, Austin J; Vira, Shaleen; McLaurin, Toni M

2015-02-01

Superstorm Sandy gained national attention in late 2012 after its impact on the Northeastern US. In New York City, thousands of residents lost power, and multiple hospitals were forced to evacuate. Bellevue Hospital Center (BHC), the nation's oldest public hospital, was forced to close for the first time in over 275 years. Two patients remained in BHC three days after the primary evacuation without water service and minimal power. Herein, we describe the challenges associated with evacuating a severely obese patient. Obesity management is challenging and at an institutional level must be addressed in emergency preparedness plans. © 2014 The Obesity Society.

VSAT communications networks - An overview

NASA Astrophysics Data System (ADS)

Chakraborty, D.

1988-05-01

The very-small-aperture-terminal (VSAT) fixed satellite communication network is a star network in which many dispersed micro terminals attempt to send data in a packet form through a random access/time-division multiple-access (RA/TDMA) satellite channel with transmission delay. The basic concept of the VSAT and its service potential are discussed. Two classes of traffic are addressed, namely, business-oriented low-rate-data traffic and bulk data traffic of corporate networks. Satellite access, throughput, and delay are considered. The size of the network population that can be served in an RA/TDMA environment is calculated. User protocols are examined. A typical VSAT business scenario is described.

49 CFR 604.9 - When no registered charter provider responds to notice from a recipient.

Code of Federal Regulations, 2011 CFR

2011-10-01

... interest in providing the service. (c) After providing the service, a recipient shall record: (1) The group's name, address, phone number, and e-mail address; (2) The date and time of service; (3) The number...

49 CFR 604.9 - When no registered charter provider responds to notice from a recipient.

Code of Federal Regulations, 2012 CFR

2012-10-01

... interest in providing the service. (c) After providing the service, a recipient shall record: (1) The group's name, address, phone number, and e-mail address; (2) The date and time of service; (3) The number...

49 CFR 604.9 - When no registered charter provider responds to notice from a recipient.

Code of Federal Regulations, 2010 CFR

2010-10-01

... interest in providing the service. (c) After providing the service, a recipient shall record: (1) The group's name, address, phone number, and e-mail address; (2) The date and time of service; (3) The number...

49 CFR 604.9 - When no registered charter provider responds to notice from a recipient.

Code of Federal Regulations, 2014 CFR

2014-10-01

... interest in providing the service. (c) After providing the service, a recipient shall record: (1) The group's name, address, phone number, and e-mail address; (2) The date and time of service; (3) The number...

49 CFR 604.9 - When no registered charter provider responds to notice from a recipient.

Code of Federal Regulations, 2013 CFR

2013-10-01

... interest in providing the service. (c) After providing the service, a recipient shall record: (1) The group's name, address, phone number, and e-mail address; (2) The date and time of service; (3) The number...

A methodology for adaptable and robust ecosystem services assessment.

PubMed

Villa, Ferdinando; Bagstad, Kenneth J; Voigt, Brian; Johnson, Gary W; Portela, Rosimeiry; Honzák, Miroslav; Batker, David

2014-01-01

Ecosystem Services (ES) are an established conceptual framework for attributing value to the benefits that nature provides to humans. As the promise of robust ES-driven management is put to the test, shortcomings in our ability to accurately measure, map, and value ES have surfaced. On the research side, mainstream methods for ES assessment still fall short of addressing the complex, multi-scale biophysical and socioeconomic dynamics inherent in ES provision, flow, and use. On the practitioner side, application of methods remains onerous due to data and model parameterization requirements. Further, it is increasingly clear that the dominant "one model fits all" paradigm is often ill-suited to address the diversity of real-world management situations that exist across the broad spectrum of coupled human-natural systems. This article introduces an integrated ES modeling methodology, named ARIES (ARtificial Intelligence for Ecosystem Services), which aims to introduce improvements on these fronts. To improve conceptual detail and representation of ES dynamics, it adopts a uniform conceptualization of ES that gives equal emphasis to their production, flow and use by society, while keeping model complexity low enough to enable rapid and inexpensive assessment in many contexts and for multiple services. To improve fit to diverse application contexts, the methodology is assisted by model integration technologies that allow assembly of customized models from a growing model base. By using computer learning and reasoning, model structure may be specialized for each application context without requiring costly expertise. In this article we discuss the founding principles of ARIES--both its innovative aspects for ES science and as an example of a new strategy to support more accurate decision making in diverse application contexts.

A methodology for adaptable and robust ecosystem services assessment

USGS Publications Warehouse

Villa, Ferdinando; Bagstad, Kenneth J.; Voigt, Brian; Johnson, Gary W.; Portela, Rosimeiry; Honzák, Miroslav; Batker, David

2014-01-01

Ecosystem Services (ES) are an established conceptual framework for attributing value to the benefits that nature provides to humans. As the promise of robust ES-driven management is put to the test, shortcomings in our ability to accurately measure, map, and value ES have surfaced. On the research side, mainstream methods for ES assessment still fall short of addressing the complex, multi-scale biophysical and socioeconomic dynamics inherent in ES provision, flow, and use. On the practitioner side, application of methods remains onerous due to data and model parameterization requirements. Further, it is increasingly clear that the dominant “one model fits all” paradigm is often ill-suited to address the diversity of real-world management situations that exist across the broad spectrum of coupled human-natural systems. This article introduces an integrated ES modeling methodology, named ARIES (ARtificial Intelligence for Ecosystem Services), which aims to introduce improvements on these fronts. To improve conceptual detail and representation of ES dynamics, it adopts a uniform conceptualization of ES that gives equal emphasis to their production, flow and use by society, while keeping model complexity low enough to enable rapid and inexpensive assessment in many contexts and for multiple services. To improve fit to diverse application contexts, the methodology is assisted by model integration technologies that allow assembly of customized models from a growing model base. By using computer learning and reasoning, model structure may be specialized for each application context without requiring costly expertise. In this article we discuss the founding principles of ARIES - both its innovative aspects for ES science and as an example of a new strategy to support more accurate decision making in diverse application contexts.

A Methodology for Adaptable and Robust Ecosystem Services Assessment

PubMed Central

Villa, Ferdinando; Bagstad, Kenneth J.; Voigt, Brian; Johnson, Gary W.; Portela, Rosimeiry; Honzák, Miroslav; Batker, David

2014-01-01

Ecosystem Services (ES) are an established conceptual framework for attributing value to the benefits that nature provides to humans. As the promise of robust ES-driven management is put to the test, shortcomings in our ability to accurately measure, map, and value ES have surfaced. On the research side, mainstream methods for ES assessment still fall short of addressing the complex, multi-scale biophysical and socioeconomic dynamics inherent in ES provision, flow, and use. On the practitioner side, application of methods remains onerous due to data and model parameterization requirements. Further, it is increasingly clear that the dominant “one model fits all” paradigm is often ill-suited to address the diversity of real-world management situations that exist across the broad spectrum of coupled human-natural systems. This article introduces an integrated ES modeling methodology, named ARIES (ARtificial Intelligence for Ecosystem Services), which aims to introduce improvements on these fronts. To improve conceptual detail and representation of ES dynamics, it adopts a uniform conceptualization of ES that gives equal emphasis to their production, flow and use by society, while keeping model complexity low enough to enable rapid and inexpensive assessment in many contexts and for multiple services. To improve fit to diverse application contexts, the methodology is assisted by model integration technologies that allow assembly of customized models from a growing model base. By using computer learning and reasoning, model structure may be specialized for each application context without requiring costly expertise. In this article we discuss the founding principles of ARIES - both its innovative aspects for ES science and as an example of a new strategy to support more accurate decision making in diverse application contexts. PMID:24625496

Adapting the Crisis Intervention Team (CIT) model of police-mental health collaboration in a low-income, post-conflict country: curriculum development in Liberia, West Africa.

PubMed

Kohrt, Brandon A; Blasingame, Elise; Compton, Michael T; Dakana, Samuel F; Dossen, Benedict; Lang, Frank; Strode, Patricia; Cooper, Janice

2015-03-01

We sought to develop a curriculum and collaboration model for law enforcement and mental health services in Liberia, West Africa. In 2013 we conducted key informant interviews with law enforcement officers, mental health clinicians, and mental health service users in Liberia, and facilitated a 3-day curriculum workshop. Mental health service users reported prior violent interactions with officers. Officers and clinicians identified incarceration and lack of treatment of mental health service users as key problems, and they jointly drafted a curriculum based upon the Crisis Intervention Team (CIT) model adapted for Liberia. Officers' mental health knowledge improved from 64% to 82% on workshop assessments (t=5.52; P<.01). Clinicians' attitudes improved (t=2.42; P=.03). Six months after the workshop, 69% of clinicians reported improved engagement with law enforcement. Since the Ebola outbreak, law enforcement and clinicians have collaboratively addressed diverse public health needs. Collaborations between law enforcement and mental health clinicians can benefit multiple areas of public health, as demonstrated by partnerships to improve responses during the Ebola epidemic. Future research should evaluate training implementation and outcomes including stigma reduction, referrals, and use of force.

Housing and Child Welfare: Emerging Evidence and Implications for Scaling up Services

PubMed Central

Farrell, Anne F.; Marcal, Katherine E.; Chung, Saras; Hovmand, Peter S.

2018-01-01

Inadequate housing threatens family stability in communities across the United States. This study reviews emerging evidence on housing interventions in the context of scale-up for the child welfare system. In child welfare, scale-up refers to the extent to which fully implemented interventions sustainably alleviate family separations associated with housing instability. It incorporates multiple aspects beyond traditional measures of effectiveness including costs, potential reach, local capacities for implementation, and fit within broader social services. The framework further encompasses everyday circumstances faced by service providers, program administrators, and policymakers who allocate resources under conditions of scarcity and uncertainty. The review of current housing interventions reveals a number of systemic constraints for scale-up in child welfare. Reliance on rental assistance programs limits capacity to address demand, while current practices that target the most vulnerable families may inadvertently diminish effectiveness of the intervention and increase overall demand. Alternative approaches that focus on homelessness prevention and early intervention must be tested in conjunction with community initiatives to increase accessibility of affordable housing. By examining system performance over time, the scalability framework provides an opportunity for more efficient coordination of housing services within and outside of the child welfare system. PMID:28815623

Comparing medical and dental providers of oral health services on early dental caries experience.

PubMed

Kranz, Ashley M; Rozier, R Gary; Preisser, John S; Stearns, Sally C; Weinberger, Morris; Lee, Jessica Y

2014-07-01

Most state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children. We examined the association between who (PCP, dentist, or both) provides these services to Medicaid enrollees before age 3 years and oral health at age 5 years. We linked North Carolina Medicaid claims (1999-2006) to oral health surveillance data (2005-2006). Regression models estimated oral health status (number of decayed, missing, and filled primary teeth) and untreated disease (proportion of untreated decayed teeth), with adjustment for relevant characteristics and by using inverse-probability-of-treatment weights to address confounding. We analyzed data for 5235 children with 2 or more oral health visits from a PCP, dentist, or both. Children with multiple PCP or dentist visits had a similar number of overall mean decayed, missing, and filled primary teeth in kindergarten, whereas children with only PCP visits had a higher proportion of untreated decayed teeth. The setting and provider type did not influence the effectiveness of preventive oral health services on children's overall oral health. However, children having only PCP visits may encounter barriers to obtaining dental treatment.

77 FR 75894 - Telecommunications Relay Services and Speech-to-Speech Services for Individuals With Hearing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-26

... Individuals With Hearing and Speech Disabilities; E911 Requirements for IP-Enabled Service Providers AGENCY... no uniform numbering system for iTRS services; some iTRS users were reached via an IP address, while...-digit number and his IP address, making it relatively traceable (unlike conventional PSTN spoofing...

Aerial Application of Acetaminophen treated Baits for Control of Brown Treesnakes

DTIC Science & Technology

2016-01-22

Brian S. Dorr USDA/ Wildlife Services/National Wildlife Research Center, Starkville, MS Craig S. Clark USDA/ Wildlife Services, Honolulu, HI...Pete Savarie USDA/ Wildlife Services/National Wildlife Research Center, Ft. Collins, CO Distribution Statement A...7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER USDA/ Wildlife Services/National Wildlife

The Lorenzini Foundation in a changing scenario of patient management.

PubMed

Peracino, A; Paoletti, R

2009-06-10

The loss of life, disability, and economic burden attributed to cardiovascular disease (CVD) in Europe has created an urgent need for all stakeholders in CVD prevention to partner together to address the barriers in local health policy and produce effective programs in individual and population risk reduction and rational use of health services. Countries have a legal and moral obligation to achieve the highest standard of CV health care for citizens and to improve national health care systems accordingly. As part of a vision for future potential opportunities in CVD prevention, the Lorenzini Foundation would like to raise awareness of several key areas among the European authorities: Integration of interventions aimed at several risk factors within an individual country's health care system; implementation of a comprehensive approach combining policy development, capacity building, partnership and information support at all levels; promotion of transversal health policies, including coordinated action outside of the health sector to address major determinants of ill health; a combination of health policy and high-risk strategies to link health promotion, public health services, primary care, and hospital care; and, finally, reduction in ethnic, cultural, socioeconomic, and gender inequalities to multiple risk factor management among and within countries through use of cost-effective medications and medical technologies.

Emotional and behavioural barriers to learning and development in the inclusive education classrooms in South Africa: Developing a training programme for teachers.

PubMed

Potgieter-Groot, Lucia; Visser, Maretha; Lubbe-de Beer, Carien

2012-07-01

The interaction between teachers, classroom strategies and learners experiencing emotional and behavioural barriers to learning and development in a system of inclusive education results in multiple dynamics on different levels. Many teachers in mainstream education lack training to deal with learners experiencing emotional and behavioural barriers. Resistance towards inclusive education is therefore evident. This paper describes the process of developing an in-service training programme for teachers who deal with learners with emotional and behavioural barriers in their classrooms. A process of action research was used to allow the researcher, in collaboration with 47 teachers from 2 primary schools, to develop a training programme to address the specific needs of teachers in dealing with learners experiencing emotional and behavioural barriers in their classes. Qualitative feedback from teachers and observations by the researcher and external observers were used to evaluate the appropriateness of the training. Teachers experienced that appropriate classroom management strategies made a significant difference in the behaviour of learners experiencing emotional and behavioural barriers. The training affected teachers' attitudes, teacher-learner interaction, learner behaviour and school organisation. In-service training for teachers can affect the effective implementation of inclusive education. This programme can be adapted to address the needs of teachers in other areas.

Toward Information Infrastructure Studies: Ways of Knowing in a Networked Environment

NASA Astrophysics Data System (ADS)

Bowker, Geoffrey C.; Baker, Karen; Millerand, Florence; Ribes, David

This article presents Information Infrastructure Studies, a research area that takes up some core issues in digital information and organization research. Infrastructure Studies simultaneously addresses the technical, social, and organizational aspects of the development, usage, and maintenance of infrastructures in local communities as well as global arenas. While infrastructure is understood as a broad category referring to a variety of pervasive, enabling network resources such as railroad lines, plumbing and pipes, electrical power plants and wires, this article focuses on information infrastructure, such as computational services and help desks, or federating activities such as scientific data repositories and archives spanning the multiple disciplines needed to address such issues as climate warming and the biodiversity crisis. These are elements associated with the internet and, frequently today, associated with cyberinfrastructure or e-science endeavors. We argue that a theoretical understanding of infrastructure provides the context for needed dialogue between design, use, and sustainability of internet-based infrastructure services. This article outlines a research area and outlines overarching themes of Infrastructure Studies. Part one of the paper presents definitions for infrastructure and cyberinfrastructure, reviewing salient previous work. Part two portrays key ideas from infrastructure studies (knowledge work, social and political values, new forms of sociality, etc.). In closing, the character of the field today is considered.

Employment barriers, skills, and aspirations among unemployed job seekers with and without social anxiety disorder.

PubMed

Himle, Joseph A; Weaver, Addie; Bybee, Deborah; O'Donnell, Lisa; Vlnka, Sarah; Laviolette, Wayne; Steinberger, Edward; Golenberg, Zipora; Levine, Debra Siegel

2014-07-01

The literature has consistently demonstrated that social anxiety disorder has substantial negative impacts on occupational functioning. However, to date, no empirical work has focused on understanding the specific nature of vocational problems among persons with social anxiety disorder. This study examined the association between perceived barriers to employment, employment skills, and job aspirations and social anxiety among adults seeking vocational rehabilitation services. Data from intake assessments (June 2010-December 2011) of 265 low-income, unemployed adults who initiated vocational rehabilitation services in urban Michigan were examined to assess perceived barriers to employment, employment skills, job aspirations, and demographic characteristics among participants who did or did not screen positive for social anxiety disorder. Bivariate and multiple logistic regression analyses were performed. After adjustment for other factors, the multiple logistic regression analysis revealed that perceiving more employment barriers involving experience and skills, reporting fewer skills related to occupations requiring social skills, and having less education were significantly associated with social anxiety disorder. Participants who screened positive for social anxiety disorder were significantly less likely to aspire to social jobs. Employment-related characteristics that were likely to have an impact on occupational functioning were significantly different between persons with and without social anxiety problems. Identifying these differences in employment barriers, skills, and job aspirations revealed important information for designing psychosocial interventions for treatment of social anxiety disorder. The findings underscored the need for vocational services professionals to assess and address social anxiety among their clients.

Usage of insecure E-mail services among researchers with different scientific background.

PubMed

Solić, Kresimir; Grgić, Krešimir; Ilakovac, Vesna; Zagar, Drago

2011-08-01

Free web‑based e-mail services are considered to have more security flaws than institutional ones, but they are frequently used among scientific researchers for professional communication. The aim of this study was to analyze frequency of usage of the insecure free e-mail services for professional communication among biomedical, economical and technical researchers, who published papers in one of three different journals: Croatian Medical Journal, Automatika and Economic Research. Contact details of the authors who provided their e‑mail address from the papers published in those three journals during one year period were collected. These e‑mail addresses were collected from the electronic archive of the journals in question. The domains of all e‑mail addresses were assessed and contacts were categorized into three groups according to the following types: world-wide known free web‑based e‑mail services, national Internet Service Provider (ISP) e-mail services, and institutional or corporate e-mail addresses. The proportion of authors using free web-based e-mail services, the least secure group type, was highest among biomedical researchers (17.8%) while every e‑mail address collected from the technical journal belonged to the secured institutional e‑mail group type. It seems that all researchers from the technical scientific field and most of the researchers from the economical field value good security practice and use more secure systems for professional communication. High percentage of the biomedical researchers who use insecure e‑mail services may mean that they need to be warned of the possible security disadvantages of those kinds of e‑mail addresses.

A collaborative network middleware project by Lambda Station, TeraPaths, and Phoebus

NASA Astrophysics Data System (ADS)

Bobyshev, A.; Bradley, S.; Crawford, M.; DeMar, P.; Katramatos, D.; Shroff, K.; Swany, M.; Yu, D.

2010-04-01

The TeraPaths, Lambda Station, and Phoebus projects, funded by the US Department of Energy, have successfully developed network middleware services that establish on-demand and manage true end-to-end, Quality-of-Service (QoS) aware, virtual network paths across multiple administrative network domains, select network paths and gracefully reroute traffic over these dynamic paths, and streamline traffic between packet and circuit networks using transparent gateways. These services improve network QoS and performance for applications, playing a critical role in the effective use of emerging dynamic circuit network services. They provide interfaces to applications, such as dCache SRM, translate network service requests into network device configurations, and coordinate with each other to setup up end-to-end network paths. The End Site Control Plane Subsystem (ESCPS) builds upon the success of the three projects by combining their individual capabilities into the next generation of network middleware. ESCPS addresses challenges such as cross-domain control plane signalling and interoperability, authentication and authorization in a Grid environment, topology discovery, and dynamic status tracking. The new network middleware will take full advantage of the perfSONAR monitoring infrastructure and the Inter-Domain Control plane efforts and will be deployed and fully vetted in the Large Hadron Collider data movement environment.

Research ethics consultation: ethical and professional practice challenges and recommendations.

PubMed

Sharp, Richard R; Taylor, Holly A; Brinich, Margaret A; Boyle, Mary M; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin

2015-05-01

The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical and Translational Science Award Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: (1) managing multiple institutional roles and responsibilities, (2) managing sensitive information, and (3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services.

An environmental scan of emergency response systems and services in remote First Nations communities in Northern Ontario.

PubMed

Mew, E J; Ritchie, S D; VanderBurgh, D; Beardy, J L; Gordon, J; Fortune, M; Mamakwa, S; Orkin, A M

2017-01-01

Approximately 24,000 Ontarians live in remote Indigenous communities with no road access. These communities are a subset of Nishnawbe Aski Nation (NAN), a political grouping of 49 First Nations communities in Northern Ontario, Canada. Limited information is available regarding the status of emergency care in these communities. We aimed to understand emergency response systems, services, and training in remote NAN communities. We used an environmental scan approach to compile information from multiple sources including community-based participatory research. This included the analysis of data collected from key informant interviews (n=10) with First Nations community health leaders and a multi-stakeholder roundtable meeting (n=33) in October 2013. Qualitative analysis of the interview data revealed four issues related to emergency response systems and training: (1) inequity in response capacity and services, (2) lack of formalised dispatch systems, (3) turnover and burnout in volunteer emergency services, and (4) challenges related to first aid training. Roundtable stakeholders supported the development of a community-based emergency care system to address gaps. Existing first response, paramedical, and ambulance service models do not meet the unique geographical, epidemiological and cultural needs in most NAN communities. Sustainable, context-appropriate, and culturally relevant emergency care systems are needed.

Facilitating access to sexual health services for men who have sex with men and male-to-female transgender persons in Guatemala City.

PubMed

Boyce, Sabrina; Barrington, Clare; Bolaños, Herbert; Arandi, Cesar Galindo; Paz-Bailey, Gabriela

2012-01-01

The purpose of this study was to identify barriers to accessing sexual health services among gay, bisexual and heterosexual-identifying men who have sex with men and male-to-female transgender persons in Guatemala City, to inform the development of high quality and population-friendly services. In-depth, semi-structured interviews were conducted with 29 purposively sampled individuals, including 8 transgender, 16 gay/bisexual and 5 heterosexual-identifying participants. Topical codes were applied to the data using software Atlas.ti™ to compare data between sub-groups. Analysis revealed that public clinics were most commonly used due to their lower cost and greater accessibility, but many participants experienced discrimination, violation of confidentiality and distrust of these services. Transgender and gay/bisexual-identifying participants preferred clinics where they felt a sense of belonging, while heterosexual-identifying participants preferred clinics unassociated with the men who have sex with men community. The most prominent barriers to sexual health services included fear of discrimination, fear of having HIV, cost and lack of social support. Findings highlight the need to strengthen existing public sexually transmitted infection clinics so that they address the multiple layers of stigma and discrimination that men who have sex with men and transgender persons experience.

3D medical volume reconstruction using web services.

PubMed

Kooper, Rob; Shirk, Andrew; Lee, Sang-Chul; Lin, Amy; Folberg, Robert; Bajcsy, Peter

2008-04-01

We address the problem of 3D medical volume reconstruction using web services. The use of proposed web services is motivated by the fact that the problem of 3D medical volume reconstruction requires significant computer resources and human expertise in medical and computer science areas. Web services are implemented as an additional layer to a dataflow framework called data to knowledge. In the collaboration between UIC and NCSA, pre-processed input images at NCSA are made accessible to medical collaborators for registration. Every time UIC medical collaborators inspected images and selected corresponding features for registration, the web service at NCSA is contacted and the registration processing query is executed using the image to knowledge library of registration methods. Co-registered frames are returned for verification by medical collaborators in a new window. In this paper, we present 3D volume reconstruction problem requirements and the architecture of the developed prototype system at http://isda.ncsa.uiuc.edu/MedVolume. We also explain the tradeoffs of our system design and provide experimental data to support our system implementation. The prototype system has been used for multiple 3D volume reconstructions of blood vessels and vasculogenic mimicry patterns in histological sections of uveal melanoma studied by fluorescent confocal laser scanning microscope.

A framework for predicting impacts on ecosystem services ...

EPA Pesticide Factsheets

Protection of ecosystem services is increasingly emphasized as a risk-assessment goal, but there are wide gaps between current ecological risk-assessment endpoints and potential effects on services provided by ecosystems. The authors present a framework that links common ecotoxicological endpoints to chemical impacts on populations and communities and the ecosystem services that they provide. This framework builds on considerable advances in mechanistic effects models designed to span multiple levels of biological organization and account for various types of biological interactions and feedbacks. For illustration, the authors introduce 2 case studies that employ well-developed and validated mechanistic effects models: the inSTREAM individual-based model for fish populations and the AQUATOX ecosystem model. They also show how dynamic energy budget theory can provide a common currency for interpreting organism-level toxicity. They suggest that a framework based on mechanistic models that predict impacts on ecosystem services resulting from chemical exposure, combined with economic valuation, can provide a useful approach for informing environmental management. The authors highlight the potential benefits of using this framework as well as the challenges that will need to be addressed in future work. The framework introduced here represents an ongoing initiative supported by the National Institute of Mathematical and Biological Synthesis (NIMBioS; http://www.nimbi

Research Ethics Consultation: Ethical and Professional Practice Challenges and Recommendations

PubMed Central

Sharp, Richard R.; Taylor, Holly A.; Brinich, Margaret A.; Boyle, Mary M.; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin

2015-01-01

The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include: assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical Translational Science Award (CTSA) Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: 1) managing multiple institutional roles and responsibilities, 2) managing sensitive information, and 3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services. PMID:25607942

Barriers to Mental Health Service Use and Preferences for Addressing Emotional Concerns among Lung Cancer Patients

PubMed Central

Mosher, Catherine E.; Winger, Joseph G.; Hanna, Nasser; Jalal, Shadia I.; Fakiris, Achilles J.; Einhorn, Lawrence H.; Birdas, Thomas J.; Kesler, Kenneth A.; Champion, Victoria L.

2014-01-01

Objective This study examined barriers to mental health service use and preferences for addressing emotional concerns among lung cancer patients (N=165) at two medical centers in the midwestern United States. Methods Lung cancer patients completed an assessment of anxiety and depressive symptoms, mental health service use, barriers to using these services, and preferences for addressing emotional concerns. Results Only 45% of distressed patients received mental health care since their lung cancer diagnosis. The most prevalent patient-reported barriers to mental health service use among non-users of these services (n=110) included the desire to independently manage emotional concerns (58%) and inadequate knowledge of services (19%). In addition, 57% of distressed patients who did not access mental health services did not perceive the need for help. Seventy-five percent of respondents (123/164) preferred to talk to a primary care physician if they were to have an emotional concern. Preferences for counseling, psychiatric medication, peer support, spiritual care, or independently managing emotional concerns also were endorsed by many patients (range=40%–50%). Older age was associated with a lower likelihood of preferring to see a counselor. Conclusions Findings suggest that many distressed lung cancer patients underuse mental health services and do not perceive the need for such services. Efforts to increase appropriate use of services should address patients' desire for autonomy and lack of awareness of services. PMID:24493634

Building Format-Agnostic Metadata Repositories

NASA Astrophysics Data System (ADS)

Cechini, M.; Pilone, D.

2010-12-01

This presentation will discuss the problems that surround persisting and discovering metadata in multiple formats; a set of tenets that must be addressed in a solution; and NASA’s Earth Observing System (EOS) ClearingHOuse’s (ECHO) proposed approach. In order to facilitate cross-discipline data analysis, Earth Scientists will potentially interact with more than one data source. The most common data discovery paradigm relies on services and/or applications facilitating the discovery and presentation of metadata. What may not be common are the formats in which the metadata are formatted. As the number of sources and datasets utilized for research increases, it becomes more likely that a researcher will encounter conflicting metadata formats. Metadata repositories, such as the EOS ClearingHOuse (ECHO), along with data centers, must identify ways to address this issue. In order to define the solution to this problem, the following tenets are identified: - There exists a set of ‘core’ metadata fields recommended for data discovery. - There exists a set of users who will require the entire metadata record for advanced analysis. - There exists a set of users who will require a ‘core’ set of metadata fields for discovery only. - There will never be a cessation of new formats or a total retirement of all old formats. - Users should be presented metadata in a consistent format. ECHO has undertaken an effort to transform its metadata ingest and discovery services in order to support the growing set of metadata formats. In order to address the previously listed items, ECHO’s new metadata processing paradigm utilizes the following approach: - Identify a cross-format set of ‘core’ metadata fields necessary for discovery. - Implement format-specific indexers to extract the ‘core’ metadata fields into an optimized query capability. - Archive the original metadata in its entirety for presentation to users requiring the full record. - Provide on-demand translation of ‘core’ metadata to any supported result format. With this identified approach, the Earth Scientist is provided with a consistent data representation as they interact with a variety of datasets that utilize multiple metadata formats. They are then able to focus their efforts on the more critical research activities which they are undertaking.

General Use of UAS in EW Environment-EW Concepts and Tactics for Single or Multiple UAS Over the Net-Centric Battlefield

DTIC Science & Technology

2009-09-01

Tactics for Single or Multiple UAS over the Net-Centric Battlefield 6. AUTHOR( S ) Mustafa Gokhan Erdemli 5. FUNDING NUMBERS 7. PERFORMING ORGANIZATION...NAME( S ) AND ADDRESS(ES) Naval Postgraduate School Monterey, CA 93943-5000 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING...MONITORING AGENCY NAME( S ) AND ADDRESS(ES) N/A 10. SPONSORING/MONITORING AGENCY REPORT NUMBER 11. SUPPLEMENTARY NOTES The views expressed in this

Accessibility of Catering Service Venues and Adolescent Drinking in Beijing, China.

PubMed

Lu, Shijun; Du, Songming; Ren, Zhoupeng; Zhao, Jing; Chambers, Christina; Wang, Jinfeng; Ma, Guansheng

2015-06-26

This study assessed the association between accessibility of catering service venues and adolescents' alcohol use over the previous 30 days. The data were collected from cross-sectional surveys conducted in 2014, 2223 students at 27 high schools in Chaoyang and Xicheng districts, Beijing using self-administered questionnaires to collect the adolescents information on socio-demographic characteristics and recent alcohol experiences. The accessibility of, and proximity to, catering service venues were summarized by weights, which were calculated by multiplication of the type-weight and the distance-weight. All sampled schools were categorized into three subgroups (low, middle, and high geographic density) based on the tertile of nearby catering service venues, and a multi-level logistic regression analysis was performed to explore variance between the school levels. Considering the setting characteristics, the catering service venues weighted value was found to account for 8.6% of the school level variance of adolescent alcohol use. The odds ratios (OR) and 95% confidence intervals (CI) of drinking over the past 30-days among adolescents with medium and high accessibility of catering service venues were 1.17 (0.86, 1.57) and 1.47 (1.06, 2.02), respectively (p < 0.001 for trend test). This study addressed a gap in the adolescent drinking influence by the catering service venues around schools in China. Results suggest that the greater accessibility of catering service venues around schools is associated with a growing risk of recent drinking.

Accessibility of Catering Service Venues and Adolescent Drinking in Beijing, China

PubMed Central

Lu, Shijun; Du, Songming; Ren, Zhoupeng; Zhao, Jing; Chambers, Christina; Wang, Jinfeng; Ma, Guansheng

2015-01-01

This study assessed the association between accessibility of catering service venues and adolescents’ alcohol use over the previous 30 days. The data were collected from cross-sectional surveys conducted in 2014, 2223 students at 27 high schools in Chaoyang and Xicheng districts, Beijing using self-administered questionnaires to collect the adolescents information on socio-demographic characteristics and recent alcohol experiences. The accessibility of, and proximity to, catering service venues were summarized by weights, which were calculated by multiplication of the type-weight and the distance-weight. All sampled schools were categorized into three subgroups (low, middle, and high geographic density) based on the tertile of nearby catering service venues, and a multi-level logistic regression analysis was performed to explore variance between the school levels. Considering the setting characteristics, the catering service venues weighted value was found to account for 8.6% of the school level variance of adolescent alcohol use. The odds ratios (OR) and 95% confidence intervals (CI) of drinking over the past 30-days among adolescents with medium and high accessibility of catering service venues were 1.17 (0.86, 1.57) and 1.47 (1.06, 2.02), respectively (p < 0.001 for trend test). This study addressed a gap in the adolescent drinking influence by the catering service venues around schools in China. Results suggest that the greater accessibility of catering service venues around schools is associated with a growing risk of recent drinking. PMID:26132475

The need for simultaneous evaluation of ecosystem services and land use change

USGS Publications Warehouse

Euliss, Ned H.; Smith, Loren M.; Liu, Shu-Guang; Feng, Min; Mushet, David M.; Auch, Roger F.; Loveland, Thomas R.

2010-01-01

We are living in a period of massive global change. This rate of change may be almost without precedent in geologic history (1). Even the most remote areas of the planet are influenced by human activities. Modern landscapes have been highly modified to accommodate a growing human population that the United Nations has forecast to peak at 9.1 billion by 2050. Over this past century, reliance on services from ecosystems has increased significantly and, over past decades, sustainability of our modern, intensively managed ecosystems has been a topic of serious international concern (1). Numerous papers addressing a particular land-use change effect on specific ecosystem services have recently been published. For example, there is currently great interest in increasing biofuel production to achieve energy inde- pendence goals and recent papers have independently focused attention on impacts of land-use change on single ecosystem services such as carbon sequestration (2) and many others (e.g., water availability, biodiversity, pollination). However, land-use change clearly affects myriad ecosystem services simultaneously. Hence, a broader perspective and context is needed to evaluate and understand interrelated affects on multiple ecosystem services, especially as we strive for the goal of sustainably managing global ecosystems. Similarly, land uses affect ecosystem services synergistically; single land-use evaluations may be misleading because the overall impact on an ecosystem is not evaluated. A more holistic approach would provide a means and framework to characterize how land-use change affects provisioning of goods and services of complete ecosystems.

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

PubMed

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

2016-01-01

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

Defining the scope of systems of care: an ecological perspective.

PubMed

Cook, James R; Kilmer, Ryan P

2010-02-01

The definition of a system of care (SOC) can guide those intending to develop and sustain SOCs. Hodges, Ferreira, Israel, and Mazza [Hodges, S., Ferreira, K., Israel, N., & Mazza, J. (in press). Systems of care, featherless bipeds, and the measure of all things. Evaluation and Program Planning] have emphasized contexts in which services are provided to families, plus the adaptive, dynamic, complex nature of systems and multiple components that comprise SOCs. However, two areas need additional clarification: (1) the nature of the "system" of concern in a "system of care," and how it should differ from a "service delivery system"; and (2) the degree to which intended, or desired, outcomes of a SOC extend beyond increased access to "necessary" services and supports. These prime issues in the conceptualization of SOCs are addressed, drawing on ecological theory to underscore the need for broader systems--including factors in the proximal and distal contexts of children and families--to be engaged in the process of promoting well-being and helping children and families function and participate fully in their communities. A revised definition is proposed, with implications for the implementation of SOCs.

The work and recovery project: changing organizational culture and practice in New York City outpatient services.

PubMed

Pascaris, Alysia; Shields, Leslie Reed; Wolf, Jessica

2008-01-01

Complex and multiple barriers confront out-patient programs in promoting recovery and addressing mental health recipients' work-related goals. This article describes a focused organizational change project utilizing intensive consultation and technical assistance within five New York City outpatient psychiatric services. The project aimed to increase staff exposure to, understanding and use of work-related and recovery-based concepts to promote consumers' recovery and attainment of employment goals. Tailored assessment, curriculum delivery, and identification and implementation of change objectives were useful strategies in promoting change. This change model can serve to assist programs in their efforts to integrate new approaches and to better understand changes among leadership, staff and consumers, and changes in organizational culture and practice required to support a work and recovery-oriented service paradigm. The project experience suggests that adopting and embracing new practices takes time. Varied and incremental steps toward programmatic and operational changes can be significant and can reap authentic sustainable change occurring in the process of learning, experiencing, internalizing and adjusting to new methods of practice.

Barriers and Facilitators to Successful Transition from Long-Term Residential Substance Abuse Treatment

PubMed Central

Yuan, Yeqing; Herman, Daniel; Svikis, Dace; Nichols, Obie; Palmer, Erin; Deren, Sherry

2016-01-01

Although residential substance abuse treatment has been shown to improve substance use and other outcomes, relapse is common. This qualitative study explores factors that hinder and help individuals during the transition from long-term residential substance abuse treatment to the community. Semi-structured interviews were conducted with 32 individuals from residential substance abuse treatment. Based on the socio-ecological model, barriers and facilitators to transition were identified across five levels: individual, interpersonal, organizational, community, and policy. The major results indicate that primary areas of intervention needed to improve outcomes for these high-risk individuals include access to stable housing and employment, aftercare services and positive support networks; expanded discharge planning services and transitional assistance; and funding to address gaps in service delivery and to meet individuals’ basic needs. This study contributes to the literature by identifying transition barriers and facilitators from the perspectives of individuals in residential treatment, and by using the socio-ecological model to understand the complexity of this transition at multiple levels. Findings identify potential targets for enhanced support post-discharge from residential treatment. PMID:28132695

Resolving mobility constraints impeding rural seniors' access to regionalized services.

PubMed

Ryser, Laura; Halseth, Greg

2012-01-01

Rural and small town places in developed economies are aging. While attention has been paid to the local transportation needs of rural seniors, fewer researchers have explored their regional transportation needs. This is important given policies that have reduced and regionalized many services and supports. This article explores mobility constraints impeding rural seniors' access to regionalized services using the example of northern British Columbia. Drawing upon several qualitative studies, we explore geographical, maintenance, organizational, communication, human resources, infrastructure, and financial constraints that affect seniors' regional mobility. Our findings indicate that greater coordination across multiple government agencies and jurisdictions is needed and more supportive policies and resources must be in place to facilitate a comprehensive regional transportation strategy. In addition to discussing the complexities of these geographies, the article identifies innovative solutions that have been deployed in northern British Columbia to support an aging population. This research provides a foundation for developing a comprehensive understanding of the key issues that need to be addressed to inform strategic investments in infrastructure and programs that support the regional mobility and, hence, healthy aging of rural seniors.

Barriers and facilitators to successful transition from long-term residential substance abuse treatment.

PubMed

Manuel, Jennifer I; Yuan, Yeqing; Herman, Daniel B; Svikis, Dace S; Nichols, Obie; Palmer, Erin; Deren, Sherry

2017-03-01

Although residential substance abuse treatment has been shown to improve substance use and other outcomes, relapse is common. This qualitative study explores factors that hinder and help individuals during the transition from long-term residential substance abuse treatment to the community. Semi-structured interviews were conducted with 32 individuals from residential substance abuse treatment. Based on the socio-ecological model, barriers and facilitators to transition were identified across five levels: individual, interpersonal, organizational, community, and policy. The major results indicate that primary areas of intervention needed to improve outcomes for these high-risk individuals include access to stable housing and employment, aftercare services and positive support networks; expanded discharge planning services and transitional assistance; and funding to address gaps in service delivery and to meet individuals' basic needs. This study contributes to the literature by identifying transition barriers and facilitators from the perspectives of individuals in residential treatment, and by using the socio-ecological model to understand the complexity of this transition at multiple levels. Findings identify potential targets for enhanced support post-discharge from residential treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Can a Healthcare "Lean Sweep" Deliver on What Matters to Patients? Comment on "Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping".

PubMed

Verma, Jennifer Y; Amar, Claudia

2015-07-28

Disconnects and defects in care - such as duplication, poor integration between services or avoidable adverse events - are costly to the health system and potentially harmful to patients and families. For patients living with multiple chronic conditions, such disconnects can be particularly detrimental. Lean is an approach to optimizing value by reducing waste (eg, duplication and defects) and containing costs (eg, improving integration of services) as well as focusing on what matters to patients. Lean works particularly well to optimize existing processes and services. However, as the burden of chronic illness and frailty overtake episodic care needs, health systems require far greater complex, adaptive change. Such change ought to take into account outcomes in population health in addition to care experiences and costs (together, comprising the Triple Aim); and involve patients and families in co-designing new models of care that better address complex, longer-term health needs. © 2015 by Kerman University of Medical Sciences.

The Virtual Observatory as Critical Scientific Cyber Infrastructure.

NASA Astrophysics Data System (ADS)

Fox, P.

2006-12-01

Virtual Observatories can provide access to vast stores of scientific data: observations and models as well as services to analyze, visualize and assimilate multiple data sources. As these electronic resource become widely used, there is potential to improve the efficiency, interoperability, collaborative potential, and impact of a wide range of interdisciplinary scientific research. In addition, we know that as the diversity of collaborative science and volume of accompanying data and data generators/consumers grows so do the challenges. In order for Virtual Observatories to realize their potential and become indispensible infrastructure, social, political and technical challenges need to be addressed concerning (at least) roles and responsibilities, data and services policies, representations and interoperability of services, data search, access, and usability. In this presentation, we discuss several concepts and instances of the Virtual Observatory and related projects that may, and may not, be meeting the abovementioned challanges. We also argue that science driven needs and architecture development are critical in the development of sustainable (and thus agile) cyberinfrastructure. Finally we some present or emerging candidate technologies and organizational constructs that will need to be pursued.

78 FR 44438 - Notice of Organization Name and Address Change

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-24

... POSTAL SERVICE 39 CFR Part 501 Notice of Organization Name and Address Change AGENCY: Postal Service\\TM\\. ACTION: Final rule. SUMMARY: The Postal Service is revising the rules concerning... is the Office of Payment Technology (PT) or successor organization. All submissions to the Postal...

24 CFR 902.51 - Updating of public housing unit address information.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Service and Satisfaction § 902.51 Updating of public housing unit address information. (a) Electronic updating. The survey process for the Resident Service and Satisfaction Indicator is dependent upon... any points for the PHAS Resident Service and Satisfaction Indicator. (c) Electronic updating of the...

Implementing a Fee‐for‐Service Cervical Cancer Screening and Treatment Program in Cameroon: Challenges and Opportunities

PubMed Central

DeGregorio, Geneva; Manga, Simon; Kiyang, Edith; Manjuh, Florence; Bradford, Leslie; Cholli, Preetam; Wamai, Richard; Ogembo, Rebecca; Sando, Zacharie; Liu, Yuxin; Sheldon, Lisa Kennedy; Nulah, Kathleen; Welty, Thomas; Welty, Edith

2017-01-01

Abstract Background. Cervical cancer screening is one of the most effective cancer prevention strategies, but most women in Africa have never been screened. In 2007, the Cameroon Baptist Convention Health Services, a large faith‐based health care system in Cameroon, initiated the Women's Health Program (WHP) to address this disparity. The WHP provides fee‐for‐service cervical cancer screening using visual inspection with acetic acid enhanced by digital cervicography (VIA‐DC), prioritizing care for women living with HIV/AIDS. They also provide clinical breast examination, family planning (FP) services, and treatment for reproductive tract infection (RTI). Here, we document the strengths and challenges of the WHP screening program and the unique aspects of the WHP model, including a fee‐for‐service payment system and the provision of other women's health services. Methods. We retrospectively reviewed WHP medical records from women who presented for cervical cancer screening from 2007–2014. Results. In 8 years, WHP nurses screened 44,979 women for cervical cancer. The number of women screened increased nearly every year. The WHP is sustained primarily on fees‐for‐service, with external funding totaling about $20,000 annually. In 2014, of 12,191 women screened for cervical cancer, 99% received clinical breast exams, 19% received FP services, and 4.7% received treatment for RTIs. We document successes, challenges, solutions implemented, and recommendations for optimizing this screening model. Conclusion. The WHP's experience using a fee‐for‐service model for cervical cancer screening demonstrates that in Cameroon VIA‐DC is acceptable, feasible, and scalable and can be nearly self‐sustaining. Integrating other women's health services enabled women to address additional health care needs. Implication for Practice. The Cameroon Baptist Convention Health Services Women's Health Program successfully implemented a nurse‐led, fee‐for‐service cervical cancer screening program using visual inspection with acetic acid‐enhanced by digital cervicography in the setting of a large faith‐based health care system in Cameroon. It is potentially replicable in many African countries, where faith‐based organizations provide a large portion of health care. The cost‐recovery model and concept of offering multiple services in a single clinic rather than stand‐alone “silo” cervical cancer screening could provide a model for other low‐and‐middle‐income countries planning to roll out a new, or make an existing, cervical cancer screening services accessible, comprehensive, and sustainable. PMID:28536303

LANDSCAPE MANAGEMENT FOR SUSTAINABLE SUPPLIES OF BIOENERGY FEEDSTOCK AND ENHANCED SOIL QUALITY

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

Douglas L. Karlen; David J. Muth, Jr.

2012-09-01

Agriculture can simultaneously address global food, feed, fiber, and energy challenges provided our soil, water, and air resources are not compromised in doing so. As we embark on the 19th Triennial Conference of the International Soil and Tillage Research Organization (ISTRO), I am pleased to proclaim that our members are well poised to lead these endeavors because of our comprehensive understanding of soil, water, agricultural and bio-systems engineering processes. The concept of landscape management, as an approach for integrating multiple bioenergy feedstock sources, including biomass residuals, into current crop production systems, is used as the focal point to show howmore » these ever-increasing global challenges can be met in a sustainable manner. Starting with the 2005 Billion Ton Study (BTS) goals, research and technology transfer activities leading to the 2011 U.S. Department of Energy (DOE) Revised Billion Ton Study (BT2) and development of a residue management tool to guide sustainable crop residue harvest will be reviewed. Multi-location USDA-Agricultural Research Service (ARS) Renewable Energy Assessment Project (REAP) team research and on-going partnerships between public and private sector groups will be shared to show the development of landscape management strategies that can simultaneously address the multiple factors that must be balanced to meet the global challenges. Effective landscape management strategies recognize the importance of nature’s diversity and strive to emulate those conditions to sustain multiple critical ecosystem services. To illustrate those services, the soil quality impact of harvesting crop residues are presented to show how careful, comprehensive monitoring of soil, water and air resources must be an integral part of sustainable bioenergy feedstock production systems. Preliminary analyses suggest that to sustain soil resources within the U.S. Corn Belt, corn (Zea mays L.) stover should not be harvested if average grain yields are less than 11 Mg ha-1 (175 bu ac-1) unless more intensive landscape management practices are implemented. Furthermore, although non-irrigated corn grain yields east and west of the primary Corn Belt may not consistently achieve the 11 Mg ha-1 yield levels, corn can still be part of an overall landscape approach for sustainable feedstock production. Another option for producers with consistently high yields (> 12.6 Mg ha-1 or 200 bu ac-1) that may enable them to sustainably harvest even more stover is to decrease their tillage intensity which will reduce fuel use, preserve rhizosphere carbon, and/or help maintain soil structure and soil quality benefits often attributed to no-till production systems. In conclusion, I challenge all ISTRO scientists to critically ask if your research is contributing to improved soil and crop management strategies that effectively address the complexity associated with sustainable food, feed, fiber and fuel production throughout the world.« less

What to do with a Dead Research Code

NASA Astrophysics Data System (ADS)

Nemiroff, Robert J.

2016-01-01

The project has ended -- should all of the computer codes that enabled the project be deleted? No. Like research papers, research codes typically carry valuable information past project end dates. Several possible end states to the life of research codes are reviewed. Historically, codes are typically left dormant on an increasingly obscure local disk directory until forgotten. These codes will likely become any or all of: lost, impossible to compile and run, difficult to decipher, and likely deleted when the code's proprietor moves on or dies. It is argued here, though, that it would be better for both code authors and astronomy generally if project codes were archived after use in some way. Archiving is advantageous for code authors because archived codes might increase the author's ADS citable publications, while astronomy as a science gains transparency and reproducibility. Paper-specific codes should be included in the publication of the journal papers they support, just like figures and tables. General codes that support multiple papers, possibly written by multiple authors, including their supporting websites, should be registered with a code registry such as the Astrophysics Source Code Library (ASCL). Codes developed on GitHub can be archived with a third party service such as, currently, BackHub. An important code version might be uploaded to a web archiving service like, currently, Zenodo or Figshare, so that this version receives a Digital Object Identifier (DOI), enabling it to found at a stable address into the future. Similar archiving services that are not DOI-dependent include perma.cc and the Internet Archive Wayback Machine at archive.org. Perhaps most simply, copies of important codes with lasting value might be kept on a cloud service like, for example, Google Drive, while activating Google's Inactive Account Manager.

Conservation of soil organic carbon, biodiversity and the provision of other ecosystem services along climatic gradients in West Africa

NASA Astrophysics Data System (ADS)

Marks, E.; Aflakpui, G. K. S.; Nkem, J.; Poch, R. M.; Khouma, M.; Kokou, K.; Sagoe, R.; Sebastiã, M.-T.

2009-08-01

Terrestrial carbon resources are major drivers of development in West Africa. The distribution of these resources co-varies with ecosystem type and rainfall along a strong Northeast-Southwest climatic gradient. Soil organic carbon, a strong indicator of soil quality, has been severely depleted in some areas by human activities, which leads to issues of soil erosion and desertification, but this trend can be altered with appropriate management. There is significant potential to enhance existing soil carbon stores in West Africa, with benefits at the global and local scale, for atmospheric CO2 mitigation as well as supporting and provisioning ecosystem services. Three key factors impacting carbon stocks are addressed in this review: climate, biotic factors, and human activities. Climate risks must be considered in a framework of global change, especially in West Africa, where landscape managers have few resources available to adapt to climatic perturbations. Among biotic factors, biodiversity conservation paired with carbon conservation may provide a pathway to sustainable development, and biodiversity conservation is also a global priority with local benefits for ecosystem resilience, biomass productivity, and provisioning services such as foodstuffs. Finally, human management has largely been responsible for reduced carbon stocks, but this trend can be reversed through the implementation of appropriate carbon conservation strategies in the agricultural sector, as shown by multiple studies. Owing to the strong regional climatic gradient, country-level initiatives will need to consider carbon sequestration approaches for multiple ecosystem types. Given the diversity of environments, global policies must be adapted and strategies developed at the national or sub-national levels to improve carbon storage above and belowground. Initiatives of this sort must act locally at farmer scale, and focus on ecosystem services rather than on carbon sequestration solely.

‘Why does it happen like this?’ Consulting with users and providers prior to an evaluation of services for children with life limiting conditions and their families

PubMed Central

Brown, Erica; Coad, Jane; Staniszewska, Sophie; Hacking, Suzanne; Chesworth, Brigit; Chambers, Lizzie

2015-01-01

Children with life limiting conditions and their families have complex needs. Evaluations must consider their views and perspectives to ensure care is relevant, appropriate and acceptable. We consulted with children, young people, their parents and local professionals to gain a more informed picture of issues affecting them prior to preparing a bid to evaluate services in the area. Multiple methods included focus groups, face-to-face and telephone interviews and participatory activities. Recordings and products from activities were analysed for content to identify areas of relevance and concern. An overarching theme from parents was ‘Why does it happen like this?’ Services did not seem designed to meet their needs. Whilst children and young people expressed ideas related to quality of environment, services and social life, professionals focused on ways of meeting the families’ needs. The theme that linked families’ concerns with those of professionals was ‘assessing individual needs’. Two questions to be addressed by the evaluation are (1) to what extent are services designed to meet the needs of children and families and (2) to what extent are children, young people and their families consulted about what they need? Consultations with families and service providers encouraged us to continue their involvement as partners in the evaluation. PMID:24270996

Enabling information management systems in tactical network environments

NASA Astrophysics Data System (ADS)

Carvalho, Marco; Uszok, Andrzej; Suri, Niranjan; Bradshaw, Jeffrey M.; Ceccio, Philip J.; Hanna, James P.; Sinclair, Asher

2009-05-01

Net-Centric Information Management (IM) and sharing in tactical environments promises to revolutionize forward command and control capabilities by providing ubiquitous shared situational awareness to the warfighter. This vision can be realized by leveraging the tactical and Mobile Ad hoc Networks (MANET) which provide the underlying communications infrastructure, but, significant technical challenges remain. Enabling information management in these highly dynamic environments will require multiple support services and protocols which are affected by, and highly dependent on, the underlying capabilities and dynamics of the tactical network infrastructure. In this paper we investigate, discuss, and evaluate the effects of realistic tactical and mobile communications network environments on mission-critical information management systems. We motivate our discussion by introducing the Advanced Information Management System (AIMS) which is targeted for deployment in tactical sensor systems. We present some operational requirements for AIMS and highlight how critical IM support services such as discovery, transport, federation, and Quality of Service (QoS) management are necessary to meet these requirements. Our goal is to provide a qualitative analysis of the impact of underlying assumptions of availability and performance of some of the critical services supporting tactical information management. We will also propose and describe a number of technologies and capabilities that have been developed to address these challenges, providing alternative approaches for transport, service discovery, and federation services for tactical networks.

A novel virtual hub approach for multisource downstream service integration

NASA Astrophysics Data System (ADS)

Previtali, Mattia; Cuca, Branka; Barazzetti, Luigi

2016-08-01

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

Workplace and HIV-related sexual behaviours and perceptions among female migrant workers

PubMed Central

YANG, H.; LI, X.; STANTON, B.; FANG, X.; LIN, D.; MAO, R.; LIU, H.; CHEN, X.; SEVERSON, R.

2007-01-01

Data from 1,543 female migrants working in eight occupational clusters in Beijing and Nanjing, China were analysed to examine the association of workplace with HIV-related behaviours and perceptions. For sexually experienced women (n = 666, 43.2%), those working in entertainment establishments or personal service (e.g., nightclubs, dancing halls, barbershops, beauty salons, massage parlours, etc.) engaged in risky sexual practices twice as frequently as those working in non-entertainment establishments (e.g. restaurants, stalls, domestic service, factories, etc.). About 10% of women in the entertainment establishments reported having sold sex, 30% having multiple sexual partners and 40% having sex with men with multiple sexual partners. The rate of consistent condom use was less than 15%. They also tended to have a higher level of perceptions of both peer risk involvement and positive expectancy of risk behaviours, and lower perceptions of severity of STDs and HIV. For women who were not sexually experienced, those working in ‘stalls’ or ‘domestic service’ tended to perceive higher peer risk involvement, less severity of HIV infection, and less effectiveness of protective behaviour. The occupational pattern of sexual risk behaviours and perceptions observed in the current study indicates employment conditions are associated with HIV risk. Intervention strategies should be tailored to address occupational-related factors. PMID:16120499

Modeling, Simulation and Performance Analysis of Multiple-Input Multiple-Output (MIMO) Systems with Multicarrier Time Delay Diversity Modulation

DTIC Science & Technology

2005-09-01

6. AUTHOR( S ) Muhammad Shahid 5. FUNDING NUMBERS 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) Naval Postgraduate School Monterey, CA 93943...5000 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING /MONITORING AGENCY NAME( S ) AND ADDRESS(ES) N/A 10. SPONSORING/MONITORING...streams which are assigned to the K subcarriers [1]. The symbol duration of the input serial data is ’sT with serial data rate of ’ 𔃻s s f T

78 FR 8220 - Surety Companies Acceptable on Federal Bonds-Change In Business Address and Redomestication...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-05

... DEPARTMENT OF THE TREASURY Fiscal Service Surety Companies Acceptable on Federal Bonds--Change In Business Address and Redomestication: American Fire and Casualty Company (NAIC 24066) and The Ohio Casualty Insurance Company (NA1C 24074) AGENCY: Financial Management Service, Fiscal Service, Department of the...

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…

Allocation and management issues in multiple-transaction open access transmission networks

NASA Astrophysics Data System (ADS)

Tao, Shu

This thesis focuses on some key issues related to allocation and management by the independent grid operator (IGO) of unbundled services in multiple-transaction open access transmission networks. The three unbundled services addressed in the thesis are transmission real power losses, reactive power support requirements from generation sources, and transmission congestion management. We develop the general framework that explicitly represents multiple transactions undertaken simultaneously in the transmission grid. This framework serves as the basis for formulating various problems treated in the thesis. We use this comprehensive framework to develop a physical-flow-based mechanism to allocate the total transmission losses to each transaction using the system. An important property of the allocation scheme is its capability to effectively deal with counter flows that result in the presence of specific transactions. Using the loss allocation results as the basis, we construct the equivalent loss compensation concept and apply it to develop flexible and effective procedures for compensating losses in multiple-transaction networks. We present a new physical-flow-based mechanism for allocating the reactive power support requirements provided by generators in multiple-transaction networks. The allocatable reactive support requirements are formulated as the sum of two specific components---the voltage magnitude variation component and the voltage angle variation component. The formulation utilizes the multiple-transaction framework and makes use of certain simplifying approximations. The formulation leads to a natural allocation as a function of the amount of each transaction. The physical interpretation of each allocation as a sensitivity of the reactive output of a generator is discussed. We propose a congestion management allocation scheme for multiple-transaction networks. The proposed scheme determines the allocation of congestion among the transactions on a physical-flow basis. It also proposes a congestion relief scheme that removes the congestion attributed to each transaction on the network in a least-cost manner to the IGO and determines the appropriate transmission charges to each transaction for its transmission usage. The thesis provides a compendium of problems that are natural extensions of the research results reported here and appear to be good candidates for future work.

Return to the Primary Acute Care Service Among Patients With Multiple Myeloma on an Acute Inpatient Rehabilitation Unit.

PubMed

Fu, Jack B; Lee, Jay; Shin, Ben C; Silver, Julie K; Smith, Dennis W; Shah, Jatin J; Bruera, Eduardo

2017-06-01

Pancytopenia, immunosuppression, and other factors may place patients with multiple myeloma at risk for medical complications. These patients often require inpatient rehabilitation. No previous studies have looked at risk factors for return to the primary acute care service of this patient population. To determine the percentage of and factors associated with return to the primary acute care service of multiple myeloma rehabilitation inpatients. Retrospective review. Acute inpatient rehabilitation unit within a National Cancer Institute Comprehensive Cancer Center. All patients with multiple myeloma admitted to the inpatient rehabilitation unit between March 1, 2004, and February 28, 2015. Return to the primary acute care service was analyzed with demographic information, multiple myeloma characteristics, medications, laboratory values, and hospital admission characteristics. One hundred forty-three inpatient rehabilitation admissions were found during the study period. After we removed multiple admissions of the same patients and planned transfers to the primary acute care service, 122 admissions were analyzed. Thirty-two (26%) patients transferred back to the primary acute care service for unplanned reasons. Multivariate analysis revealed male gender and thrombocytopenia as significantly associated with return to the primary acute care service. The median survival of patients who transferred back to the inpatient primary acute care service was 180 days versus 550 days for those who did not (P < .001). Because of their medical fragility, clinicians caring for rehabilitation inpatients with multiple myeloma should maintain close contact with the primary oncology service. Factors associated with an increased risk of transfer back to the primary acute care service include male gender and thrombocytopenia. IV. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Mediators of disability and hope for people with spinal cord injury.

PubMed

Phillips, Brian N; Smedema, Susan M; Fleming, Allison R; Sung, Connie; Allen, Michael G

2016-08-01

To test potential strength-based mediators of functional disability and hope in adults with spinal cord injury. Two hundred and forty-two participants with spinal cord injury were recruited for this study. The mean age of participants was 44.6 years (standard deviation = 13.2), and 66.1% were men. Participants completed a survey containing a demographic questionnaire, as well as measures of functional disability, hope, self-esteem, proactive coping, perceived social support and disability acceptance. Mediation analysis was conducted using a bootstrap test for multiple mediators. Proactive coping, self-esteem and perceived social support significantly mediated the relationship between functional disability and hope, while disability acceptance did not. The combination of mediators resulted in functional disability no longer being a significant predictor of hope. The strength-based constructs of proactive coping, self-esteem and social support appear effective in predicting hope regardless of severity of spinal cord injury. Functional disability was no longer predictive of hope after controlling for these strength-based constructs. Disability acceptance did not significantly add to the mediation model. These results provide further evidence for strength-based interventions in rehabilitation. Implications for Rehabilitation Strength-based constructs of proactive coping, self-esteem and social support are important factors for addressing hope following spinal cord injury, regardless of level of severity. Rehabilitation services providers should focus efforts on supporting clients in the accurate appraisal of predictable stressors and then generate means for addressing them as a form of proactive coping. Rehabilitation services providers must be cautious when addressing self-esteem to focus on perceived competence and learning processes rather than self-esteem directly or through the accomplishment of goals that may not be achieved. Knowing that social supports are related to hope post-spinal cord injury, it is important for rehabilitation services providers to recognize potential social supports early in the rehabilitation process and involve those social supports in the rehabilitation process when possible.

School mental health resources and adolescent mental health service use.

PubMed

Green, Jennifer Greif; McLaughlin, Katie A; Alegría, Margarita; Costello, E Jane; Gruber, Michael J; Hoagwood, Kimberly; Leaf, Philip J; Olin, Serene; Sampson, Nancy A; Kessler, Ronald C

2013-05-01

Although schools are identified as critical for detecting youth mental disorders, little is known about whether the number of mental health providers and types of resources that they offer influence student mental health service use. Such information could inform the development and allocation of appropriate school-based resources to increase service use. This article examines associations of school resources with past-year mental health service use among students with 12-month DSM-IV mental disorders. Data come from the U.S. National Comorbidity Survey Adolescent Supplement (NCS-A), a national survey of adolescent mental health that included 4,445 adolescent-parent pairs in 227 schools in which principals and mental health coordinators completed surveys about school resources and policies for addressing student emotional problems. Adolescents and parents completed the Composite International Diagnostic Interview and reported mental health service use across multiple sectors. Multilevel multivariate regression was used to examine associations of school mental health resources and individual-level service use. Nearly half (45.3%) of adolescents with a 12-month DSM-IV disorder received past-year mental health services. Substantial variation existed in school resources. Increased school engagement in early identification was significantly associated with mental health service use for adolescents with mild/moderate mental and behavior disorders. The ratio of students to mental health providers was not associated with overall service use, but was associated with sector of service use. School mental health resources, particularly those related to early identification, may facilitate mental health service use and may influence sector of service use for youths with DSM disorders. Copyright © 2013 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

An Examination of Multiple Intelligence Domains and Learning Styles of Pre-Service Mathematics Teachers: Their Reflections on Mathematics Education

ERIC Educational Resources Information Center

Ozgen, Kemal; Tataroglu, Berna; Alkan, Huseyin

2011-01-01

The present study aims to identify pre-service mathematics teachers' multiple intelligence domains and learning style profiles, and to establish relationships between them. Employing the survey model, the study was conducted with the participation of 243 pre-service mathematics teachers. The study used the "multiple intelligence domains…

DL-sQUAL: A Multiple-Item Scale for Measuring Service Quality of Online Distance Learning Programs

ERIC Educational Resources Information Center

Shaik, Naj; Lowe, Sue; Pinegar, Kem

2006-01-01

Education is a service with multiplicity of student interactions over time and across multiple touch points. Quality teaching needs to be supplemented by consistent quality supporting services for programs to succeed under the competitive distance learning landscape. ServQual and e-SQ scales have been proposed for measuring quality of traditional…

Physician ancillary services: fad or fashion? Part 1.

PubMed

Reiboldt, John

2005-01-01

Ancillary services are quite fashionable in today's medical practice, but perhaps you've wondered if they are only a fad. If you're considering adding services to increase your revenue, you're not too late; this trend seems here to stay. Doing your homework and due diligence is key to the success of your ancillary service. Before introducing a service into your practice or investing in an ancillary venture, make sure that you get off on sound footing. Major investments call for experienced consulting and tapping into financial, operational, and legal specialists to address specific needs. Part 1 of this two-part article defines ancillary services and addresses the following topics: performing the feasibility study; writing the business plan; and addressing the legal and regulatory issues. Part 2 will discuss financing arrangements, opening, operational, and ongoing management elements critical to success.

42 CFR 84.1103 - Approval labels and markings; approval of contents; use.

Code of Federal Regulations, 2010 CFR

2010-10-01

...; use. 84.1103 Section 84.1103 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... Administration and the seal of the Department of Health and Human Services, the applicant's name and address, an... and the seal of the Department of Health and Human Services, the applicant's name and address, an...

42 CFR 84.1103 - Approval labels and markings; approval of contents; use.

Code of Federal Regulations, 2011 CFR

2011-10-01

...; use. 84.1103 Section 84.1103 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... Administration and the seal of the Department of Health and Human Services, the applicant's name and address, an... and the seal of the Department of Health and Human Services, the applicant's name and address, an...

42 CFR 84.1103 - Approval labels and markings; approval of contents; use.

Code of Federal Regulations, 2012 CFR

2012-10-01

...; use. 84.1103 Section 84.1103 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... Administration and the seal of the Department of Health and Human Services, the applicant's name and address, an... and the seal of the Department of Health and Human Services, the applicant's name and address, an...

42 CFR 84.1103 - Approval labels and markings; approval of contents; use.

Code of Federal Regulations, 2014 CFR

2014-10-01

...; use. 84.1103 Section 84.1103 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... Administration and the seal of the Department of Health and Human Services, the applicant's name and address, an... and the seal of the Department of Health and Human Services, the applicant's name and address, an...

42 CFR 84.1103 - Approval labels and markings; approval of contents; use.

Code of Federal Regulations, 2013 CFR

2013-10-01

...; use. 84.1103 Section 84.1103 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN... Administration and the seal of the Department of Health and Human Services, the applicant's name and address, an... and the seal of the Department of Health and Human Services, the applicant's name and address, an...

A survey and audit of the first ‘Guides to Local Health Services’ produced by Primary Care Trusts in England

PubMed Central

Noble, Jenny; Hann, Mark; Sheaff, Rod; Marshall, Martin

2005-01-01

Abstract Background  Providing more information for the public about the range and quality of health services is an important part of improving accountability, quality and public responsiveness. Most sources of information to date have failed to address the information needs of people about their local services. The launch in England in 2002 of a new publication, Guides to Local Health Services, was designed to address this deficiency. We conducted an audit of the first Guides, and surveyed those responsible for their production, in order to examine the Guides’ development, content, presentation and dissemination, and to critique the purpose of the initiative. Methods  A semi‐structured questionnaire survey of those responsible for producing the Guides, and an audit of the Guides produced by Primary Care Trusts (PCTs). Results  Most PCTs complied with central guidance about structure and content, but in meeting multiple requirements the Guides lost their clarity of purpose. The content was dominated by information relating to financial and strategic accountability. In producing the Guides, external consultation was limited, particularly with the public but also with local partnership providers of health and social care. The main issues were the lack of a clear focus for Guide information, the level of central direction, the short production lead times, difficulties with distribution, and the many competing demands being made on PCT resources. Conclusions  Guide content should be clearly focused on information that the public wants. Greater responsibility should be devolved to front line PCT staff to determine content in consultation with local users. PMID:15860054

Business Case Analysis: Costs of Laundry Services

DTIC Science & Technology

2006-05-01

CONTRACT NUMBER Business Case Analysis: Costs of Laundry Services 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR( S ) 5d. PROJECT NUMBER Butler...Jonathan, B, Major, MSC 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION William Beaumont...Army Medical Center REPORT NUMBER 5005 N. Piedras Street El Paso, Texas 79920 9. SPONSORING/MONITORING AGENCY NAME( S ) AND ADDRESS(ES) 10. SPONSOR

The Effect of Military Service and Skill Transferability on the Civilian Earnings of Veterans.

DTIC Science & Technology

1998-03-01

as well as job performance . The impact of children on the post-service earnings of veterans has been examined in several studies. Hirsch and Mehay...AUTHOR(S) Petroff Steven J. 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Naval Postgraduate School Monterey, CA 93943-5000 9. SPONSORING...MONITORING AGENCY NAME(S) AND ADDRESS(ES) 5. FUNDING NUMBERS 8. PERFORMING ORGANIZATION REPORT NUMBER 10. SPONSORING / MONITORING AGENCY REPORT

Addressing overuse of health services in health systems: a critical interpretive synthesis.

PubMed

Ellen, Moriah E; Wilson, Michael G; Vélez, Marcela; Shach, Ruth; Lavis, John N; Grimshaw, Jeremy M; Moat, Kaelan A

2018-06-15

Health systems are increasingly focusing on the issue of 'overuse' of health services and how to address it. We developed a framework focused on (1) the rationale and context for health systems prioritising addressing overuse, (2) elements of a comprehensive process and approach to reduce overuse and (3) implementation considerations for addressing overuse. We conducted a critical interpretive synthesis informed by a stakeholder-engagement process. The synthesis identified relevant empirical and non-empirical articles about system-level overuse. Two reviewers independently screened records, assessed for inclusion and conceptually mapped included articles. From these, we selected a purposive sample, created structured summaries of key findings and thematically synthesised the results. Our search identified 3545 references, from which we included 251. Most articles (76%; n = 192) were published within 5 years of conducting the review and addressed processes for addressing overuse (63%; n = 158) or political and health system context (60%; n = 151). Besides negative outcomes at the patient, system and global level, there were various contextual factors to addressing service overuse that seem to be key issue drivers. Processes for addressing overuse can be grouped into three elements comprising a comprehensive approach, including (1) approaches to identify overused health services, (2) stakeholder- or patient-led approaches and (3) government-led initiatives. Key implementation considerations include the need to develop 'buy in' from stakeholders and citizens. Health systems want to ensure the use of high-value services to keep citizens healthy and avoid harm. Our synthesis can be used by policy-makers, stakeholders and researchers to understand how the issue has been prioritised, what approaches have been used to address it and implementation considerations. PROSPERO CRD42014013204 .

Wealth inequality and utilization of reproductive health services in the Republic of Vanuatu: insights from the multiple indicator cluster survey, 2007

PubMed Central

2011-01-01

Background Although the Republic of Vanuatu has improved maternal indicators, more needs to be done to improve equity among the poorest in the use of reproductive health services to expedite the progress towards the Millennium Development Goal 5(MDG 5) target. While large developing country studies provide evidence of a rich-poor gap in reproductive health services utilization, not much is written in terms of Pacific Islands. Thus, this study aims to examine the degree of inequality in utilization of reproductive health services in a nationally representative sample of Vanuatu households. Methods This paper used data from the 2007 Vanuatu Multiple Indicator Cluster Survey (MICS). The analyses were based on responses from 615 ever married women, living with at least one child below two years of age. Outcomes included antenatal care (ANC) and use of birth attendants at delivery, place of delivery, and counseling and testing for HIV/AIDS. Descriptive statistics and multivariate logistic regression methods were employed in the analysis. Results Findings revealed that the economic well-being status of the household to which women belong, played a crucial role in explaining the variation in service utilization. Inequality in utilization was found to be more pronounced between the poorest and richest groups within the wealth quintiles. In adjusted models, mothers in the richest bands of wealth were 5.50 (95% confidence interval [CI]: 1.34-22.47), 2.12 (95% CI: 1.02-3.42), 4.0 (95% CI 1.58-10.10), and 2.0 (95% CI 1.02-5.88) times more likely to have assisted delivery from medically trained personnel, have institutional deliveries, and have counseling and testing for HIV/AIDS. Conclusions Association between household wealth inequality and utilization of ANC and delivery assistance from medically trained personnel, institutional delivery, and counseling and testing for HIV/AIDS suggest that higher utilization of reproductive health care services in Vanuatu poor-rich inequalities need to be addressed. Reducing poverty and making services more available and accessible to the poor may be essential for improving overall reproductive health care utilization rate in Vanuatu. PMID:22132828

Measuring students' attitudes toward college education's role in addressing social issues.

PubMed

Weber, James E; Weber, Paula S; Craven, Barney L

2008-06-01

As service-learning projects have spread throughout academia, efforts to assess the service-learning experience have assumed a greater importance. The BERSI scale (Business Education's Role in addressing Social Issues) was developed as a measure of business students' attitudes toward social issues being addressed as part of a business education. As such, it was intended to be useful in assessing attitudinal outcomes of service learning. In order for the BERSI to be useful for nonbusiness students, the scale would need to be reconceptualized and revalidated. This study modified the BERSI items with a focus on college students in general rather than business students, making the resulting scale, College Education's Role in addressing Social Issues (CERSI), potentially helpful to service-learning researchers in a broader setting. The CERSI scale was then validated using standard techniques and normative data were reported.

Responses to occupational and environmental exposures in the U.S. military--World War II to the present.

PubMed

Richards, Erin E

2011-07-01

Since the Civil War, a proportion of U.S. service members continues to return from war with new health problems and continues to reference battlefield exposures as the cause. Hence, one of the most pressing public health debates in military policy, the determination of causality and linking of battlefield exposures to health outcomes in veterans, continues. The advances in military environmental and occupational epidemiologic research and Department of Defense policy concerning battlefield exposures are summarized and examples from World War II through the first Gulf War are provided. The limitations associated with the unique battlefield environment, multiple environmental exposures, and the inherent stresses of war, beget challenges for researchers responsible for determining causality. In light of these difficulties, six strategies for addressing environmental exposures and their possible impact on veterans were recommended by the Institute of Medicine post Operation Desert Storm. These strategies, along with their respective progress and remaining gaps, are addressed.

Ethical issues in exercise psychology.

PubMed

Pauline, Jeffrey S; Pauline, Gina A; Johnson, Scott R; Gamble, Kelly M

2006-01-01

Exercise psychology encompasses the disciplines of psychiatry, clinical and counseling psychology, health promotion, and the movement sciences. This emerging field involves diverse mental health issues, theories, and general information related to physical activity and exercise. Numerous research investigations across the past 20 years have shown both physical and psychological benefits from physical activity and exercise. Exercise psychology offers many opportunities for growth while positively influencing the mental and physical health of individuals, communities, and society. However, the exercise psychology literature has not addressed ethical issues or dilemmas faced by mental health professionals providing exercise psychology services. This initial discussion of ethical issues in exercise psychology is an important step in continuing to move the field forward. Specifically, this article will address the emergence of exercise psychology and current health behaviors and offer an overview of ethics and ethical issues, education/training and professional competency, cultural and ethnic diversity, multiple-role relationships and conflicts of interest, dependency issues, confidentiality and recording keeping, and advertisement and self-promotion.

Managing bay and estuarine ecosystems for multiple services

USGS Publications Warehouse

Needles, Lisa A.; Lester, Sarah E.; Ambrose, Richard; Andren, Anders; Beyeler, Marc; Connor, Michael S.; Eckman, James E.; Costa-Pierce, Barry A.; Gaines, Steven D.; Lafferty, Kevin D.; Lenihan, Junter S.; Parrish, Julia; Peterson, Mark S.; Scaroni, Amy E.; Weis, Judith S.; Wendt, Dean E.

2013-01-01

Managers are moving from a model of managing individual sectors, human activities, or ecosystem services to an ecosystem-based management (EBM) approach which attempts to balance the range of services provided by ecosystems. Applying EBM is often difficult due to inherent tradeoffs in managing for different services. This challenge particularly holds for estuarine systems, which have been heavily altered in most regions and are often subject to intense management interventions. Estuarine managers can often choose among a range of management tactics to enhance a particular service; although some management actions will result in strong tradeoffs, others may enhance multiple services simultaneously. Management of estuarine ecosystems could be improved by distinguishing between optimal management actions for enhancing multiple services and those that have severe tradeoffs. This requires a framework that evaluates tradeoff scenarios and identifies management actions likely to benefit multiple services. We created a management action-services matrix as a first step towards assessing tradeoffs and providing managers with a decision support tool. We found that management actions that restored or enhanced natural vegetation (e.g., salt marsh and mangroves) and some shellfish (particularly oysters and oyster reef habitat) benefited multiple services. In contrast, management actions such as desalination, salt pond creation, sand mining, and large container shipping had large net negative effects on several of the other services considered in the matrix. Our framework provides resource managers a simple way to inform EBM decisions and can also be used as a first step in more sophisticated approaches that model service delivery.

Integrating Multiple Social Statuses in Health Disparities Research: The Case of Lung Cancer

PubMed Central

Williams, David R; Kontos, Emily Z; Viswanath, K; Haas, Jennifer S; Lathan, Christopher S; MacConaill, Laura E; Chen, Jarvis; Ayanian, John Z

2012-01-01

Objective To illustrate the complex patterns that emerge when race/ethnicity, socioeconomic status (SES), and gender are considered simultaneously in health care disparities research and to outline the needed research to understand them by using disparities in lung cancer risks, treatment, and outcomes as an example. Principal Findings SES, gender, and race/ethnicity are social categories that are robust predictors of variations in health and health services utilization. These are usually considered separately, but intersectionality theory indicates that the impact of each depends on the others. Each reflects historically and culturally contingent variations in social, economic, and political status. Distinct patterns of risk and resilience emerge at the intersections of multiple social categories and shape the experience of health, health care access, utilization, quality, and outcomes where these categories intersect. Intersectional approaches call for greater attention to understand social processes at multiple levels of society and require the collection of relevant data and utilization of appropriate analytic approaches to understand how multiple risk factors and resources combine to affect the distribution of disease and its management. Conclusions Understanding how race/ethnicity, gender, and SES are interactive, interdependent, and social identities can provide new knowledge to enhance our efforts to effectively address health disparities. PMID:22568674

The influence of socio-cultural interpretations of pregnancy threats on health-seeking behavior among pregnant women in urban Accra, Ghana.

PubMed

Dako-Gyeke, Phyllis; Aikins, Moses; Aryeetey, Richmond; McCough, Laura; Adongo, Philip Baba

2013-11-19

Although antenatal care coverage in Ghana is high, there exist gaps in the continued use of maternity care, especially utilization of skilled assistance during delivery. Many pregnant women seek care from different sources aside the formal health sector. This is due to negative perceptions resulting from poor service quality experiences in health facilities. Moreover, the socio-cultural environment plays a major role for this care-seeking behavior. This paper seeks to examine beliefs, knowledge and perceptions about pregnancy and delivery and care-seeking behavior among pregnant women in urban Accra, Ghana. A qualitative study with 6 focus group discussions and 13 in-depth interviews were conducted at Taifa-Kwabenya and Madina sub-districts, Accra. Participants included mothers who had delivered within the past 12 months, pregnant women, community members, religious and community leaders, orthodox and non-orthodox healthcare providers. Interviews and discussions were audio-taped, transcribed and coded into larger themes and categories. Evidence showed perceived threats, which are often given socio-cultural interpretations, increased women's anxieties, driving them to seek multiple sources of care. Crucially, care-seeking behavior among pregnant women indicated sequential or concurrent use of biomedical care and other forms of care including herbalists, traditional birth attendants, and spiritual care. Use of multiple sources of care in some cases disrupted continued use of skilled provider care. Furthermore, use of multiple forms of care is encouraged by a perception that facility-based care is useful only for antenatal services and emergencies. It also highlights the belief among some participants that care from multiple sources are complementary to each other. Socio-cultural interpretations of threats to pregnancy mediate pregnant women's use of available healthcare services. Efforts to encourage continued use of maternity care, especially skilled birth assistance at delivery, should focus on addressing generally perceived dangers to pregnancy. Also, the attractiveness of facility-based care offers important opportunities for building collaborations between orthodox and alternative care providers with the aim of increasing use of skilled obstetric care. Conventional antenatal care should be packaged to provide psychosocial support that helps women deal with pregnancy-related fear.

Burnout, stress and satisfaction among Australian and New Zealand radiation oncology trainees.

PubMed

Leung, John; Rioseco, Pilar

2017-02-01

To evaluate the incidence of burnout among radiation oncology trainees in Australia and New Zealand and the stress and satisfaction factors related to burnout. A survey of trainees was conducted in mid-2015. There were 42 Likert scale questions on stress, 14 Likert scale questions on satisfaction and the Maslach Burnout Inventory-Human Services Survey assessed burnout. A principal component analysis identified specific stress and satisfaction areas. Categorical variables for the stress and satisfaction factors were computed. Associations between respondent's characteristics and stress and satisfaction subscales were examined by independent sample t-tests and analysis of variance. Effect sizes were calculated using Cohens's d when significant mean differences were observed. This was also done for respondent characteristics and the three burnout subscales. Multiple regression analyses were performed. The response rate was 81.5%. The principal component analysis for stress identified five areas: demands on time, professional development/training, delivery demands, interpersonal demands and administration/organizational issues. There were no significant differences by demographic group or area of interest after P-values were adjusted for the multiple tests conducted. The principal component analysis revealed two satisfaction areas: resources/professional activities and value/delivery of services. There were no significant differences by demographic characteristics or area of interest in the level of satisfaction after P-values were adjusted for the multiple tests conducted. The burnout results revealed 49.5% of respondents scored highly in emotional exhaustion and/or depersonalization and 13.1% had burnout in all three measures. Multiple regression analysis revealed the stress subscales 'demands on time' and 'interpersonal demands' were associated with emotional exhaustion. 'Interpersonal demands' was also associated with depersonalization and correlated negatively with personal accomplishment. The satisfaction of value/delivery of services subscale was associated with higher levels of personal accomplishment. There is a significant level of burnout among radiation oncology trainees in Australia and New Zealand. Further work addressing intervention would be appropriate to reduce levels of burnout. © 2016 The Authors. Journal of Medical Imaging and Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of The Royal Australian and New Zealand College of Radiologists.

49 CFR 7.27 - What are the designated DOT FOIA Requester Service Centers?

Code of Federal Regulations, 2014 CFR

2014-10-01

... numbers identified at http://www.dot.gov/foia or the mailing addresses indicated below (unless a more up-to-date mailing address has been designated at http://www.dot.gov/foia): (1) FOIA Requester Service... Highway Administration, Room E64-302 (unless a more specific address has been designated by FHWA at http...

Women and substance use: a qualitative study on sexual and reproductive health of women who use drugs in Delhi, India.

PubMed

Sharma, Vartika; Sarna, Avina; Tun, Waimar; Saraswati, Lopamudra Ray; Thior, Ibou; Madan, Ira; Luchters, Stanley

2017-11-19

To explore contextual factors that increase vulnerabilities to negative sexual and reproductive health (SRH) outcomes and possible differences in SRH-related behaviours and the needs of women who use drugs (WUD) through non-injecting and injecting routes. Qualitative study design using semi-structured in-depth interviews. Twenty women who injected drugs in the past 3 months and 28 women who reported using drugs through non-injecting routes in the past 1 month. Interviews were conducted at community-based, drop-in centres in Delhi, India. Study findings illustrate that WUD were sexually active and had multiple sex partners including clients of sex work. Transient relationships were reported and many participants engaged in unsafe sex. Factors which affected safe sex behaviours included: gender power imbalance, limited agency for decision-making, lack of accurate information for correct self-risk assessment, and being under the influence of drugs. Despite high awareness, low and inconsistent contraceptive use was reported. Some participants were coerced to conceive while a few others reported their inability to conceive. Violence was a key determinant for SRH outcomes. Perception of certain adverse health outcomes (such as infertility) to be 'common and expected among WUD' influenced access to healthcare. Further, healthcare providers' stigmatising attitudes and lack of women-centric services deterred women from uptake of healthcare services. Findings highlight that SRH-related behaviours and needs of this group are a complex interplay of multiple determinants which need to be addressed at all levels: individual, family, community and institutional. It is imperative to roll out a 'one-stop-shop' for a comprehensive package of health services. Expansion of existing drop-in-centres could be considered for setting-up community-based women-centric services with appropriate linkage to drug dependence treatment and reproductive health services. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Women and substance use: a qualitative study on sexual and reproductive health of women who use drugs in Delhi, India

PubMed Central

Sharma, Vartika; Sarna, Avina; Tun, Waimar; Saraswati, Lopamudra Ray; Thior, Ibou; Madan, Ira; Luchters, Stanley

2017-01-01

Objectives To explore contextual factors that increase vulnerabilities to negative sexual and reproductive health (SRH) outcomes and possible differences in SRH-related behaviours and the needs of women who use drugs (WUD) through non-injecting and injecting routes. Design Qualitative study design using semi-structured in-depth interviews. Participants Twenty women who injected drugs in the past 3 months and 28 women who reported using drugs through non-injecting routes in the past 1 month. Setting Interviews were conducted at community-based, drop-in centres in Delhi, India. Results Study findings illustrate that WUD were sexually active and had multiple sex partners including clients of sex work. Transient relationships were reported and many participants engaged in unsafe sex. Factors which affected safe sex behaviours included: gender power imbalance, limited agency for decision-making, lack of accurate information for correct self-risk assessment, and being under the influence of drugs. Despite high awareness, low and inconsistent contraceptive use was reported. Some participants were coerced to conceive while a few others reported their inability to conceive. Violence was a key determinant for SRH outcomes. Perception of certain adverse health outcomes (such as infertility) to be ‘common and expected among WUD’ influenced access to healthcare. Further, healthcare providers’ stigmatising attitudes and lack of women-centric services deterred women from uptake of healthcare services. Conclusion Findings highlight that SRH-related behaviours and needs of this group are a complex interplay of multiple determinants which need to be addressed at all levels: individual, family, community and institutional. It is imperative to roll out a ‘one-stop-shop’ for a comprehensive package of health services. Expansion of existing drop-in-centres could be considered for setting-up community-based women-centric services with appropriate linkage to drug dependence treatment and reproductive health services. PMID:29158326

Diagnostic and psychosocial differences in psychiatrically hospitalized military service members with single versus multiple suicide attempts.

PubMed

Kochanski-Ruscio, Kristen M; Carreno-Ponce, Jaime T; DeYoung, Kathryn; Grammer, Geoffrey; Ghahramanlou-Holloway, Marjan

2014-04-01

Individuals with multiple versus single suicide attempts present a more severe clinical picture and may be at greater risk for suicide. Yet group differences within military samples have been vastly understudied. The objective is to determine demographic, diagnostic, and psychosocial differences, based on suicide attempt status, among military inpatients admitted for suicide-related events. A retrospective chart review design was used with a total of 423 randomly selected medical records of psychiatric admissions to a military hospital from 2001 to 2006. Chi-square analyses indicated that individuals with multiple versus single suicide attempts were significantly more likely to have documented childhood sexual abuse (p =.025); problem substance use (p=.001); mood disorder diagnosis (p=.005); substance disorder diagnosis (p =.050); personality disorder not otherwise specified diagnosis (p =.018); and Axis II traits or diagnosis (p=.038) when compared to those with a single attempt history. Logistic regression analyses showed that males with multiple suicide attempts were more likely to have problem substance use (p=.005) and a mood disorder diagnosis (p =.002), while females with a multiple attempt history were more likely to have a history of childhood sexual (p =.027). Clinically meaningful differences among military inpatients with single versus multiple suicide attempts exist. Targeted Department of Defense suicide prevention and intervention efforts that address the unique needs of these two specific at-risk subgroups are additionally needed. Published by Elsevier Inc.

Distributed Generation: Challenges and Opportunities, 7. edition

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

NONE

2007-10-15

The report is a comprehensive study of the Distributed Generation (DG) industry. The report takes a wide-ranging look at the current and future state of DG and both individually and collectively addresses the technologies of Microturbines, Reciprocating Engines, Stirling Engines, Fuel Cells, Photovoltaics, Concentrating Solar, Wind, and Microgrids. Topics covered include: the key technologies being used or planned for DG; the uses of DG from utility, energy service provider, and customer viewpoints; the economics of DG; the benefits of DG from multiple perspectives; the barriers that exist to implementing DG; the government programs supporting the DG industry; and, an analysismore » of DG interconnection and net metering rules.« less

Experiences of detained young offenders in need of mental health care.

PubMed

Shelton, Deborah

2004-01-01

To explore the experiences of young people detained in the juvenile justice system and in need of mental health services. An ethnomethodological analysis was done using Kleinman's Explanatory Model Interview Guide to explore the perceptions of detained young people in need of mental health treatment. Five themes were extracted from focus groups, indicating lack of control in their lives and lack of family and community support. Although participants expressed feelings of hopelessness and depression, they perceived that it was better to be tough than to be sick. The findings indicate the need for multimodal treatment interventions to sequentially address the multiple internal and external factors contributing to persistent problem behaviors in children.

77 FR 5714 - Change of Addresses for Regional Offices, Addition of One New Address, and Correction of Names of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-06

...We, the U.S. Fish and Wildlife Service (we, or the Service), are revising our rights-of-way (ROW) general regulations, to update or add addresses of several Service Regional Offices, and to correct the names of the House and Senate Committees we must notify upon receipt of an application for a right-of-way for an oil and gas pipeline that is 24 inches or more in diameter and again before granting a right-of-way.

Visions of Restoration in Fire-Adapted Forest Landscapes: Lessons from the Collaborative Forest Landscape Restoration Program.

PubMed

Urgenson, Lauren S; Ryan, Clare M; Halpern, Charles B; Bakker, Jonathan D; Belote, R Travis; Franklin, Jerry F; Haugo, Ryan D; Nelson, Cara R; Waltz, Amy E M

2017-02-01

Collaborative approaches to natural resource management are becoming increasingly common on public lands. Negotiating a shared vision for desired conditions is a fundamental task of collaboration and serves as a foundation for developing management objectives and monitoring strategies. We explore the complex socio-ecological processes involved in developing a shared vision for collaborative restoration of fire-adapted forest landscapes. To understand participant perspectives and experiences, we analyzed interviews with 86 respondents from six collaboratives in the western U.S., part of the Collaborative Forest Landscape Restoration Program established to encourage collaborative, science-based restoration on U.S. Forest Service lands. Although forest landscapes and group characteristics vary considerably, collaboratives faced common challenges to developing a shared vision for desired conditions. Three broad categories of challenges emerged: meeting multiple objectives, collaborative capacity and trust, and integrating ecological science and social values in decision-making. Collaborative groups also used common strategies to address these challenges, including some that addressed multiple challenges. These included use of issue-based recommendations, field visits, and landscape-level analysis; obtaining support from local agency leadership, engaging facilitators, and working in smaller groups (sub-groups); and science engagement. Increased understanding of the challenges to, and strategies for, developing a shared vision of desired conditions is critical if other collaboratives are to learn from these efforts.

Epidemiology of multiple chronic conditions: an international perspective.

PubMed

Schellevis, François G

2013-01-01

The epidemiology of multimorbidity, or multiple chronic conditions (MCCs), is one of the research priority areas of the U.S. Department of Health and Human Services (HHS) by its Strategic Framework on MCCs. A conceptual model addressing methodological issues leading to a valid measurement of the prevalence rates of MCCs has been developed and applied in descriptive epidemiological studies. Comparing these results with those from prevalence studies performed earlier and in other countries is hampered by methodological limitations. Therefore, this paper aims to put the size and patterns of MCCs in the USA, as established within the HHS Strategic Framework on MCCs, in perspective of the findings on the prevalence of MCCs in other countries. General common trends can be observed: increasing prevalence rates with increasing age, and multimorbidity being the rule rather than the exception at old age. Most frequent combinations of chronic diseases include the most frequently occurring single chronic diseases. New descriptive epidemiological studies will probably not provide new results; therefore, future descriptive studies should focus on the prevalence rates of MCCs in subpopulations, statistical clustering of chronic conditions, and the development of the prevalence rates of MCCs over time. The finding of common trends also indicates the necessary transition to a next phase of MCC research, addressing the quality of care of patients with MCCs from an organizational perspective and with respect to the content of care. Journal of Comorbidity 2013;3:36-40.

Visions of Restoration in Fire-Adapted Forest Landscapes: Lessons from the Collaborative Forest Landscape Restoration Program

NASA Astrophysics Data System (ADS)

Urgenson, Lauren S.; Ryan, Clare M.; Halpern, Charles B.; Bakker, Jonathan D.; Belote, R. Travis; Franklin, Jerry F.; Haugo, Ryan D.; Nelson, Cara R.; Waltz, Amy E. M.

2017-02-01

Collaborative approaches to natural resource management are becoming increasingly common on public lands. Negotiating a shared vision for desired conditions is a fundamental task of collaboration and serves as a foundation for developing management objectives and monitoring strategies. We explore the complex socio-ecological processes involved in developing a shared vision for collaborative restoration of fire-adapted forest landscapes. To understand participant perspectives and experiences, we analyzed interviews with 86 respondents from six collaboratives in the western U.S., part of the Collaborative Forest Landscape Restoration Program established to encourage collaborative, science-based restoration on U.S. Forest Service lands. Although forest landscapes and group characteristics vary considerably, collaboratives faced common challenges to developing a shared vision for desired conditions. Three broad categories of challenges emerged: meeting multiple objectives, collaborative capacity and trust, and integrating ecological science and social values in decision-making. Collaborative groups also used common strategies to address these challenges, including some that addressed multiple challenges. These included use of issue-based recommendations, field visits, and landscape-level analysis; obtaining support from local agency leadership, engaging facilitators, and working in smaller groups (sub-groups); and science engagement. Increased understanding of the challenges to, and strategies for, developing a shared vision of desired conditions is critical if other collaboratives are to learn from these efforts.

Afghanistan: Politics, Elections, and Government Performance

DTIC Science & Technology

2012-11-30

Kenneth Katzman Specialist in Middle Eastern Affairs November 30, 2012 Congressional Research Service 7-5700 www.crs.gov RS21922 Report...ORGANIZATION NAME(S) AND ADDRESS(ES) The Library of Congress ,Congressional Research Service,101 Independence Ave, SE,Washington,DC,20540 8. PERFORMING...Afghanistan: Politics, Elections, and Government Performance Congressional Research Service Summary The capacity and transparency of Afghan governance

47 CFR 64.1509 - Disclosure and dissemination of pay-per-call information.

Code of Federal Regulations, 2010 CFR

2010-10-01

... each such service; and (4) A statement of the pay-per-call service provider's name, business address... name and mailing address of any provider of pay-per-call services offered by that carrier; and (2... 47 Telecommunication 3 2010-10-01 2010-10-01 false Disclosure and dissemination of pay-per-call...

A comparison of unemployed job-seekers with and without social anxiety

PubMed Central

Himle, Joseph A; Weaver, Addie; Bybee, Deborah; O'Donnell, Lisa; Vlnka, Sarah; Laviolette, Wayne; Steinberger, Edward; Zipora, Golenberg; Levine, Debra Siegel

2014-01-01

Objective Literature consistently demonstrates that social anxiety disorder has substantial negative impacts on occupational functioning. However, to date, no identified empirical work has focused on understanding the specific nature of vocational problems among persons with social anxiety disorder. This study examines the association between employment-related factors (i.e., barriers to employment; skills related to employment; and job aspirations) and social anxiety among a sample of adults seeking vocational rehabilitation services. Methods Data from intake assessments, including a screen for social anxiety disorder, of 265 low-income, unemployed adults who initiated vocational rehabilitation services in urban Michigan was examined to assess differences in barriers to employment, employment skills, job aspirations, and demographic characteristics among participants who screened positive for social anxiety disorder compared to those who did not. Bivariate and multiple logistic regression analyses were performed. Results Multiple logistic regression analysis revealed that greater perceived experience and skill barriers to employment, fewer skills related to social-type occupations, and less education were significantly associated with social anxiety, after adjusting for other factors. Bivariate analysis also suggested that participants who screened positive for social anxiety disorder were significantly less likely to aspire to social jobs. Conclusions Employment-related factors likely impacting occupational functioning were significantly different between persons with and without social anxiety problems. Identifying these differences in employment barriers, skills, and job aspirations offer potentially important functional targets for psychosocial interventions aimed at social anxiety disorder and suggest the need for vocational service professionals to assess and address social anxiety among their clients. PMID:24733524

Farm to Institution: Creating Access to Healthy Local and Regional Foods12

PubMed Central

Harris, Diane; Lott, Megan; Lakins, Velma; Bowden, Brian; Kimmons, Joel

2012-01-01

Farm to Institution (FTI) programs are one approach to align food service operations with health and sustainability guidelines, such as those recently developed by the U.S. Department of Health and Human Services and General Services Administration. Programs and policies that support sourcing local and regional foods for schools, hospitals, faith-based organizations, and worksites may benefit institutional customers and their families, farmers, the local community, and the economy. Different models of FTI programs exist. On-site farmer’s markets at institutions have been promoted on federal government property, healthcare facilities, and private institutions nationwide. Farm to School programs focus on connecting schools with local agricultural production with the goal of improving school meals and increasing intake of fruits and vegetables in children. Sourcing food from local farms presents a number of challenges including cost and availability of local products, food safety, and liability considerations and lack of skilled labor for food preparation. Institutions utilize multiple strategies to address these barriers, and local, state, and federal polices can help facilitate FTI approaches. FTI enables the purchasing power of institutions to contribute to regional and local food systems, thus potentially affecting social, economic, and ecological systems. Local and state food policy councils can assist in bringing stakeholders together to inform this process. Rigorous research and evaluation is needed to determine and document best practices and substantiate links between FTI and multiple outcomes. Nutritionists, public health practitioners, and researchers can help communities work with institutions to develop, implement, and evaluate programs and policies supporting FTI. PMID:22585910

Facilitating successful reintegration: Attending to the needs of military families.

PubMed

Gil-Rivas, Virginia; Kilmer, Ryan P; Larson, Jacqueline C; Armstrong, Laura Marie

2017-01-01

Subsequent to the wars in Afghanistan and Iraq, the experiences of military service members (MSVMs) and veterans have garnered increasing attention. A growing body of work has begun to shed light on their reintegration, a process that can bring with it transitions and challenges for service members and their families. Although many families adapt effectively, some have difficulty navigating this process, which can lead to a host of short- and long-term negative consequences for families. The literature to date is not well-developed regarding strategies for supporting successful reintegration of MSVMs and veterans in the context of military families. Guided by the ecological framework, this article summarizes selected evidence regarding factors that influence reintegration and puts forth recommendations for research and practice to promote the wellness of military families. Informed by findings regarding the diverse challenges faced by these families and grounded in the ecological framework, the authors highlight the need to assess both proximal and distal factors related to families' reintegration experiences and the need to intervene at multiple levels and across multiple contexts. Of primary importance, the authors recommend strategies to enhance the capacity of families' natural settings and describe selected capacity- and resource- enhancement approaches for families, neighborhoods, schools, and communities that facilitate resilience and promote wellness. Other recommendations include focusing on the accessibility, integration, and coordination of services; considering the long-view and developing strategies for longer-term support; developing mechanisms for family support; and evaluating efforts to address needs of families and promote family resilience. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Integration of Cloud resources in the LHCb Distributed Computing

NASA Astrophysics Data System (ADS)

Úbeda García, Mario; Méndez Muñoz, Víctor; Stagni, Federico; Cabarrou, Baptiste; Rauschmayr, Nathalie; Charpentier, Philippe; Closier, Joel

2014-06-01

This contribution describes how Cloud resources have been integrated in the LHCb Distributed Computing. LHCb is using its specific Dirac extension (LHCbDirac) as an interware for its Distributed Computing. So far, it was seamlessly integrating Grid resources and Computer clusters. The cloud extension of DIRAC (VMDIRAC) allows the integration of Cloud computing infrastructures. It is able to interact with multiple types of infrastructures in commercial and institutional clouds, supported by multiple interfaces (Amazon EC2, OpenNebula, OpenStack and CloudStack) - instantiates, monitors and manages Virtual Machines running on this aggregation of Cloud resources. Moreover, specifications for institutional Cloud resources proposed by Worldwide LHC Computing Grid (WLCG), mainly by the High Energy Physics Unix Information Exchange (HEPiX) group, have been taken into account. Several initiatives and computing resource providers in the eScience environment have already deployed IaaS in production during 2013. Keeping this on mind, pros and cons of a cloud based infrasctructure have been studied in contrast with the current setup. As a result, this work addresses four different use cases which represent a major improvement on several levels of our infrastructure. We describe the solution implemented by LHCb for the contextualisation of the VMs based on the idea of Cloud Site. We report on operational experience of using in production several institutional Cloud resources that are thus becoming integral part of the LHCb Distributed Computing resources. Furthermore, we describe as well the gradual migration of our Service Infrastructure towards a fully distributed architecture following the Service as a Service (SaaS) model.

Achieving development goals for HIV, tuberculosis and malaria in sub-Saharan Africa through integrated antenatal care: barriers and challenges.

PubMed

Fowkes, Freya J I; Draper, Bridget L; Hellard, Margaret; Stoové, Mark

2016-12-12

The global health community is currently transitioning from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs). Unfortunately, progress towards maternal, newborn and infant health MDGs has lagged significantly behind other key health goals, demanding a renewed global effort in this key health area. The World Health Organization and other institutions heralded integrated antenatal care (ANC) as the best way to address the inter-related health issues of HIV, tuberculosis (TB) and malaria in the high risk groups of pregnant women and infants; integrated ANC services also offer a mechanism to address slow progress towards improved maternal health. There is remarkably limited evidence on best practice approaches of program implementation, acceptability and effectiveness for integrated ANC models targeting multiple diseases. Here, we discuss current integrated ANC global guidelines and the limited literature describing integrated ANC implementation and evidence for their role in addressing HIV, malaria and TB during pregnancy in sub-Saharan Africa. We highlight the paucity of data on the effectiveness of integrated ANC models and identify significant structural barriers in the health system (funding, infrastructure, distribution, human resources), the adoption system (limited buy-in from implementers, leadership, governance) and, in the broader context, patient-centred barriers (fear, stigma, personal burdens) and barriers in funding structures. We highlight recommendations for action and discuss avenues for the global health community to develop systems to integrate multiple disease programs into ANC models of care that better address these three priority infectious diseases. With the current transition to the SDGs and concerns regarding the failure to meet maternal health MDGs, the global health community, researchers, implementers and funding bodies must work together to ensure the establishment of quality operational and implementation research to inform integrated ANC models. It is imperative that the global health community engages in a timely discussion about such implementation innovations and instigates appropriate actions to ensure advances in maternal health are sufficient to meet applicable SDGs.

The Challenges of Creating Climate Change Education Cross-Sector Partnerships

NASA Astrophysics Data System (ADS)

Ledley, T. S.

2017-12-01

Communities will have to address the impacts of climate change on their environment whether it is for adaptation - to build resilience and establish preparedness, or for mitigation - to migrate to cleaner energy sources and reduce energy use. To effectively address these impacts community leaders and professionals will need to develop an understanding of and solutions to the problems that result from climate change. The effort will need to be conducted with a cross-sector approach as all members of a community (individuals and organizations/businesses/ groups) will be impacted. Students should be involved in this effort to help them develop the critical thinking and data analysis skills they will need in the future to make responsible decisions for themselves, their community, and professionally. However, engaging businesses, organizations, and government in a coherent aligned partnership that addresses short and long term local impacts of climate change as well as the longer-term goal of preparing the future climate ready workforce has multiple challenges. Each business, organization and government agency has it own mission and goals, and metrics of achieving them. In creating an effective cross-sector partnership it is essential to determine for each partner where their mission, services, products, and activities can benefit the partnership and where the partnership can help them improve their multiple bottom lines (financial, social, envionmental) and show the value of their participation to their boards and leadership. Cross-sector partnerships have begun to form in many communities, however, financing them is difficult and most do not include education, a critical leverage element, for either the future workforce or to support current decision makers. In this presentation we will examine community partnerships that are working to address local climate issues and explore the obstacles to integrating education in these cross-sector climate change partnerships and how to overcome them.

The blackboard model - A framework for integrating multiple cooperating expert systems

NASA Technical Reports Server (NTRS)

Erickson, W. K.

1985-01-01

The use of an artificial intelligence (AI) architecture known as the blackboard model is examined as a framework for designing and building distributed systems requiring the integration of multiple cooperating expert systems (MCXS). Aerospace vehicles provide many examples of potential systems, ranging from commercial and military aircraft to spacecraft such as satellites, the Space Shuttle, and the Space Station. One such system, free-flying, spaceborne telerobots to be used in construction, servicing, inspection, and repair tasks around NASA's Space Station, is examined. The major difficulties found in designing and integrating the individual expert system components necessary to implement such a robot are outlined. The blackboard model, a general expert system architecture which seems to address many of the problems found in designing and building such a system, is discussed. A progress report on a prototype system under development called DBB (Distributed BlackBoard model) is given. The prototype will act as a testbed for investigating the feasibility, utility, and efficiency of MCXS-based designs developed under the blackboard model.

Achieving interoperability for metadata registries using comparative object modeling.

PubMed

Park, Yu Rang; Kim, Ju Han

2010-01-01

Achieving data interoperability between organizations relies upon agreed meaning and representation (metadata) of data. For managing and registering metadata, many organizations have built metadata registries (MDRs) in various domains based on international standard for MDR framework, ISO/IEC 11179. Following this trend, two pubic MDRs in biomedical domain have been created, United States Health Information Knowledgebase (USHIK) and cancer Data Standards Registry and Repository (caDSR), from U.S. Department of Health & Human Services and National Cancer Institute (NCI), respectively. Most MDRs are implemented with indiscriminate extending for satisfying organization-specific needs and solving semantic and structural limitation of ISO/IEC 11179. As a result it is difficult to address interoperability among multiple MDRs. In this paper, we propose an integrated metadata object model for achieving interoperability among multiple MDRs. To evaluate this model, we developed an XML Schema Definition (XSD)-based metadata exchange format. We created an XSD-based metadata exporter, supporting both the integrated metadata object model and organization-specific MDR formats.

Maternal characteristics associated with vaccination of young children.

PubMed

Luman, Elizabeth T; McCauley, Mary Mason; Shefer, Abigail; Chu, Susan Y

2003-05-01

Mothers can be instrumental in gaining access to vaccination services for their children. This study examines maternal characteristics associated with vaccination in US preschool children. We analyzed data from 21 212 children aged 19 to 35 months in the National Immunization Survey. Bivariate and multivariate analyses were used to identify maternal characteristics associated with completion of all recommended vaccinations in these children. Factors most strongly associated with undervaccination included having mothers who were black; had less than a high school education; were divorced, separated, or widowed; had multiple children; were eligible for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) but not participating; or had incomes below 50% of the federal poverty level. Because most mothers play an important role in their children's vaccination, it is important to address maternal concerns and barriers when developing public health interventions for promoting childhood vaccinations. Encouraging eligible women and their children to participate in the WIC program and providing support and encouragement for immunization to mothers with multiple children may improve early childhood vaccination coverage.

Personalised Care Plan Management Utilizing Guideline-Driven Clinical Decision Support Systems.

PubMed

Laleci Erturkmen, Gokce Banu; Yuksel, Mustafa; Sarigul, Bunyamin; Lilja, Mikael; Chen, Rong; Arvanitis, Theodoros N

2018-01-01

Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans.

Food and nutrition programs for Aboriginal and Torres Strait Islander Australians: an overview of systematic reviews.

PubMed

Browne, Jennifer; Adams, Karen; Atkinson, Petah; Gleeson, Deborah; Hayes, Rick

2017-09-19

Objective To provide an overview of previous reviews of programs that aimed to improve nutritional status or diet-related health outcomes for Aboriginal and Torres Strait Islander peoples, in order to determine what programs are effective and why. Methods A systematic search of databases and relevant websites was undertaken to identify reviews of nutrition interventions for Aboriginal and Torres Strait Islander Australians. Pairs of reviewers undertook study selection and data extraction and performed quality assessment using a validated tool. Results Twelve papers reporting 11 reviews were identified. Two reviews were rated high quality, three were rated medium and six were rated low quality. The reviews demonstrated that a positive effect on nutrition and chronic disease indicators can be a result of: 1) incorporating nutrition and breastfeeding advice into maternal and child health care services; and 2) multifaceted community nutrition programs. The evidence suggests that the most important factor determining the success of Aboriginal and Torres Strait Islander food and nutrition programs is community involvement in (and, ideally, control of) program development and implementation. Conclusions Community-directed food and nutrition programs, especially those with multiple components that address the underlying causes of nutrition issues, can be effective in improving nutrition-related outcomes. What is known about the topic? More effective action is urgently required in order to reduce the unacceptable health inequalities between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Food insecurity and nutrition-related chronic conditions are responsible for a large proportion of the ill health experienced by Australia's First Peoples. What does this paper add? This narrative overview of 11 reviews published between 2005 and 2015 provides a synthesis of the current evidence for improving Aboriginal and Torres Strait Islander nutrition across the lifespan. The findings suggest that community-based and community-controlled programs, especially those with multiple components that address the underlying causes of nutrition issues, have the greatest potential to improve nutrition-related health outcomes. What are the implications for practitioners? Food and nutrition programs that are initiated and designed by local Aboriginal and Torres Strait Islander people are most likely to be effective. Nutrition and breastfeeding education and advice should be consistently incorporated into maternal and child healthcare services. Nutrition issues should be addressed through multifaceted approaches that address improving individual knowledge and skills, as well as strategies that increase access to nutritious food and provide a healthy food environment.

Using and understanding consumer satisfaction to effect an improvement in mental health service delivery.

PubMed

Brunero, S; Lamont, S; Fairbrother, G

2009-04-01

Consumer satisfaction is today, widely accepted as a measure of the level and quality of service received by consumers. The aim of this survey-based study is to explore consumer satisfaction with quality of care, staff, environment and discharge in a south eastern Sydney adult acute inpatient mental health unit. A cross-sectional analysis is pursued in order to identify aspects of the patient stay, which form an associative relationship with an overall rating of consumer satisfaction on a 10-point scale. During the survey period, there were 182 discharges. Seventy questionnaires (38.5%) were returned from this group. The survey results highlight a number of areas of identified need, enabling the service to prioritize organizational systems around meeting these needs. Multiple regression analysis identified three items in the survey, which were independently significant associates of overall consumer satisfaction. They included being happy with the service provided by the consumer support worker, having support for services on discharge and feeling safe and secure on the ward. The model containing these three items accounted for 50% of the variation in overall satisfaction. Two primary interventions have been developed because survey administration which, it is hoped, will address issues raised in the survey. The interventions were the development of an admission and discharge pathway and a ward-based psychosocial intervention programme, which includes the involvement of consumer support workers.

EnviroAtlas - Ecosystem Service Market and Project Areas, U.S., 2015, Forest Trends' Ecosystem Marketplace

EPA Pesticide Factsheets

This EnviroAtlas dataset contains polygons depicting the geographic areas of market-based programs, referred to herein as markets, and projects addressing ecosystem services protection in the United States. Depending upon the type of market or project and data availability, polygons reflect market coverage areas, project footprints, or project primary impact areas in which ecosystem service markets and projects operate. The data were collected via surveys and desk research conducted by Forest Trends' Ecosystem Marketplace from 2008 to 2016 on biodiversity (i.e., imperiled species/habitats; wetlands and streams), carbon, and water markets. Additional biodiversity data were obtained from the Regulatory In-lieu Fee and Bank Information Tracking System (RIBITS) database in 2015. Attribute data include information regarding the methodology, design, and development of biodiversity, carbon, and water markets and projects. This dataset was produced by Forest Trends' Ecosystem Marketplace for EnviroAtlas in order to support public access to and use of information related to environmental markets. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about thi

Ecosystem services altered by human changes in the nitrogen cycle: a new perspective for US decision making.

PubMed

Compton, Jana E; Harrison, John A; Dennis, Robin L; Greaver, Tara L; Hill, Brian H; Jordan, Stephen J; Walker, Henry; Campbell, Holly V

2011-08-01

Human alteration of the nitrogen (N) cycle has produced benefits for health and well-being, but excess N has altered many ecosystems and degraded air and water quality. US regulations mandate protection of the environment in terms that directly connect to ecosystem services. Here, we review the science quantifying effects of N on key ecosystem services, and compare the costs of N-related impacts or mitigation using the metric of cost per unit of N. Damage costs to the provision of clean air, reflected by impaired human respiratory health, are well characterized and fairly high (e.g. costs of ozone and particulate damages of $28 per kg NO(x)-N). Damage to services associated with productivity, biodiversity, recreation and clean water are less certain and although generally lower, these costs are quite variable (<$2.2-56 per kg N). In the current Chesapeake Bay restoration effort, for example, the collection of available damage costs clearly exceeds the projected abatement costs to reduce N loads to the Bay ($8-15 per kg N). Explicit consideration and accounting of effects on multiple ecosystem services provides decision-makers an integrated view of N sources, damages and abatement costs to address the significant challenges associated with reducing N pollution. Published 2011. This article is a US Government work and is in the public domain in the USA.

Land use efficiency: anticipating future demand for land-sector greenhouse gas emissions abatement and managing trade-offs with agriculture, water, and biodiversity.

PubMed

Bryan, Brett A; Crossman, Neville D; Nolan, Martin; Li, Jing; Navarro, Javier; Connor, Jeffery D

2015-11-01

Competition for land is increasing, and policy needs to ensure the efficient supply of multiple ecosystem services from land systems. We modelled the spatially explicit potential future supply of ecosystem services in Australia's intensive agricultural land in response to carbon markets under four global outlooks from 2013 to 2050. We assessed the productive efficiency of greenhouse gas emissions abatement, agricultural production, water resources, and biodiversity services and compared these to production possibility frontiers (PPFs). While interacting commodity markets and carbon markets produced efficient outcomes for agricultural production and emissions abatement, more efficient outcomes were possible for water resources and biodiversity services due to weak price signals. However, when only two objectives were considered as per typical efficiency assessments, efficiency improvements involved significant unintended trade-offs for the other objectives and incurred substantial opportunity costs. Considering multiple objectives simultaneously enabled the identification of land use arrangements that were efficient over multiple ecosystem services. Efficient land use arrangements could be selected that meet society's preferences for ecosystem service provision from land by adjusting the metric used to combine multiple services. To effectively manage competition for land via land use efficiency, market incentives are needed that effectively price multiple ecosystem services. © 2015 John Wiley & Sons Ltd.

An architecture for integrating distributed and cooperating knowledge-based Air Force decision aids

NASA Technical Reports Server (NTRS)

Nugent, Richard O.; Tucker, Richard W.

1988-01-01

MITRE has been developing a Knowledge-Based Battle Management Testbed for evaluating the viability of integrating independently-developed knowledge-based decision aids in the Air Force tactical domain. The primary goal for the testbed architecture is to permit a new system to be added to a testbed with little change to the system's software. Each system that connects to the testbed network declares that it can provide a number of services to other systems. When a system wants to use another system's service, it does not address the server system by name, but instead transmits a request to the testbed network asking for a particular service to be performed. A key component of the testbed architecture is a common database which uses a relational database management system (RDBMS). The RDBMS provides a database update notification service to requesting systems. Normally, each system is expected to monitor data relations of interest to it. Alternatively, a system may broadcast an announcement message to inform other systems that an event of potential interest has occurred. Current research is aimed at dealing with issues resulting from integration efforts, such as dealing with potential mismatches of each system's assumptions about the common database, decentralizing network control, and coordinating multiple agents.

Significant factors in family difficulties for fathers and mothers who use support services for children with hikikomori.

PubMed

Funakoshi, Akiko; Miyamoto, Yuki

2015-04-01

Hikikomori is a new psychosociological phenomenon among youth, of almost complete withdrawal from social interaction, and it has received considerable attention in community mental health in Japan. The aims of the present study were to identify the influential factors of family difficulties of parents who use support services for children with hikikomori, and compare them between fathers and mothers. Data were collected from 110 parents (55 couples) of children with hikikomori with regard to family difficulties, quality of life, and depression variables via self-report questionnaires. To assess the influential factors of Family Difficulties for parents with children with hikikomori, hierarchical multiple linear regression analysis was carried out for gender. While 94.5% of mothers received some kind of family support, only 61.9% of fathers received it. For both genders, the number of services that the fathers received was significantly correlated with marital cooperation, and the number of services that the mothers received was significantly correlated with support resource utilization. It is necessary for fathers to receive more support, and it is important for professionals to encourage parents to address their difficulties together. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

Leadership, Innovation Climate, and Attitudes toward Evidence-Based Practice during a Statewide Implementation

PubMed Central

Aarons, Gregory A.; Sommerfeld, David H.

2013-01-01

Objective Leadership is important in practice change, yet there are few studies addressing this issue in mental health and social services. This study examined the differential roles of transformational (i.e., charismatic) leadership and leader member exchange (i.e., the relationship between a supervisor and their direct service providers) on team innovation climate (i.e., openness to new innovations) and provider attitudes toward adopting evidence-based practice (EBP) during a statewide evidence-based practice implementation (EBPI) of an intervention to reduce child neglect. Methods Participants were 140 case-managers in 30 teams providing home-based services to families in a statewide child-welfare system. Teams were assigned by region to EBPI or services as usual (SAU) conditions. Multiple group path analysis was used to examine associations of transformational leadership and leader member exchange with innovation climate and attitudes toward adoption and use of EBP. Results Transformational leadership predicted higher innovation climate during implementation while leader member exchange predicted higher innovation climate during SAU. Innovation climate was, in turn, associated with more positive attitudes toward EBP for the EBPI group. Conclusions Strategies designed to enhance supervisor transformational leadership have the potential to facilitate implementation efforts by promoting a strong climate for EBPI and positive provider attitudes toward adoption and use of EBP. PMID:22449648

Adapting the Crisis Intervention Team (CIT) Model of Police–Mental Health Collaboration in a Low-Income, Post-Conflict Country: Curriculum Development in Liberia, West Africa

PubMed Central

Blasingame, Elise; Compton, Michael T.; Dakana, Samuel F.; Dossen, Benedict; Lang, Frank; Strode, Patricia; Cooper, Janice

2015-01-01

Objectives. We sought to develop a curriculum and collaboration model for law enforcement and mental health services in Liberia, West Africa. Methods. In 2013 we conducted key informant interviews with law enforcement officers, mental health clinicians, and mental health service users in Liberia, and facilitated a 3-day curriculum workshop. Results. Mental health service users reported prior violent interactions with officers. Officers and clinicians identified incarceration and lack of treatment of mental health service users as key problems, and they jointly drafted a curriculum based upon the Crisis Intervention Team (CIT) model adapted for Liberia. Officers’ mental health knowledge improved from 64% to 82% on workshop assessments (t = 5.52; P < .01). Clinicians’ attitudes improved (t = 2.42; P = .03). Six months after the workshop, 69% of clinicians reported improved engagement with law enforcement. Since the Ebola outbreak, law enforcement and clinicians have collaboratively addressed diverse public health needs. Conclusions. Collaborations between law enforcement and mental health clinicians can benefit multiple areas of public health, as demonstrated by partnerships to improve responses during the Ebola epidemic. Future research should evaluate training implementation and outcomes including stigma reduction, referrals, and use of force. PMID:25602903

Inclusive practices for children and youths with communication disorders. Ad Hoc Committee on Inclusion for students with Communication Disorders.

PubMed

1996-01-01

An array of inclusive service delivery models is recommended for the implementation of services to children and youths with communication disorders. Inclusive practices are intervention services that are based on the unique and specific needs of the individual, and provided in a context that is least restrictive. There are a variety of models through which inclusive practices can be provided, including a direct (pull-out) program, in classroom-based service delivery, community-based models, and consultative interventions. These models should be seen as flexible options that may change depending on student needs. The speech-language pathologist, in collaboration with parents, the student, teachers, support personnel, and administrators, is in the ideal position to decide the model or combination of models that best serves each individual student's communication needs. Implementation of inclusive practices requires consideration of multiple issues, including general education reform, cost effectiveness, and program efficacy. In addition, administrative and school system support, personnel qualifications, staff development, flexible scheduling, and the effects of inclusive practices on all learners need to be considered. At present, available research suggests guarded optimism for the effectiveness of inclusive practices. However, many critical questions have not yet been addressed and additional research is needed to assess the full impact of inclusive practices for students with communication disorders.

Eliciting Provider and Patient Perspectives on New Obesity Management Services in a Team-Based Primary Care Organization.

PubMed

Royall, Dawna; Brauer, Paula; Atta-Konadu, Edwoba; Dwyer, John J M; Edwards, A Michelle; Hussey, Tracy; Kates, Nick

2017-09-01

Both providers and patients may have important insights to inform the development of obesity prevention and management services in Canadian primary care settings. In this formative study, insights for new obesity management services were sought from both providers and patients in 1 progressive citywide organization (150 physicians, team services, separate offices). Seven focus groups with interprofessional health providers (n = 56) and 4 focus groups with patients (n = 34) were conducted. Two clinical vignettes (adult, child) were used to focus discussion. Four analysts coded for descriptive content and interpretative themes on possible tools and care processes using NVivo. Participants identified numerous strategies for care processes, most of which could be categorized into 1 or more of 11 themes: 6 directed at clinical care of patients (raising awareness, screening, clinical care, skill building, ongoing support, and social/peer support) and 5 directed at the organization (coordination/collaboration, creating awareness among health professionals, adding new expertise to the team, marketing, and lobbying/advocacy). The approach was successful in generating an extensive list of diverse activities to be considered for implementation studies. Both patients and providers identified that multiple strategies and systems approaches will be needed to address obesity management in primary care.

Discovery through maps: Exploring real-world applications of ...

EPA Pesticide Factsheets

Background/Question/Methods U.S. EPA’s EnviroAtlas provides a collection of interactive tools and resources for exploring ecosystem goods and services. The purpose of EnviroAtlas is to provide better access to consistently derived ecosystems and socio-economic data to facilitate decision-making while also providing data for research and education. EnviroAtlas tools and resources are well-suited for educational use, as they encourage systems thinking, cover a broad range of topics, are freely available, and do not require specialized software to use. To use EnviroAtlas only requires a computer and an internet connection, making it a useful tool for community planning, education, and decision-making at multiple scales. To help users understand how EnviroAtlas resources may be used in different contexts, we provide example use cases. These use cases highlight a real-world issue which EnviroAtlas data, in conjunction with other available data or resources, may be used to address. Here we present three use cases that approach incorporating ecosystem services in decision-making in different decision contexts: 1) to minimize the negative impacts of excessive summer heat due to urbanization in Portland, Oregon 2) to explore selecting a pilot route for a community greenway, and 3) to reduce nutrient loading through a regional manure transport program. Results/Conclusions EnviroAtlas use cases provide step-by-step approaches for using maps and data to address real-wo

Slum Upgrading and Health Equity.

PubMed

Corburn, Jason; Sverdlik, Alice

2017-03-24

Informal settlement upgrading is widely recognized for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Almost one in seven people on the planet are expected to reside in urban informal settlements, or slums, by 2030. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals (SDGs) focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. We conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment (HIA) and adopting an urban health in all policies (HiAP) framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits.

Robotic Precursor Missions for Mars Habitats

NASA Technical Reports Server (NTRS)

Huntsberger, Terry; Pirjanian, Paolo; Schenker, Paul S.; Trebi-Ollennu, Ashitey; Das, Hari; Joshi, Sajay

2000-01-01

Infrastructure support for robotic colonies, manned Mars habitat, and/or robotic exploration of planetary surfaces will need to rely on the field deployment of multiple robust robots. This support includes such tasks as the deployment and servicing of power systems and ISRU generators, construction of beaconed roadways, and the site preparation and deployment of manned habitat modules. The current level of autonomy of planetary rovers such as Sojourner will need to be greatly enhanced for these types of operations. In addition, single robotic platforms will not be capable of complicated construction scenarios. Precursor robotic missions to Mars that involve teams of multiple cooperating robots to accomplish some of these tasks is a cost effective solution to the possible long timeline necessary for the deployment of a manned habitat. Ongoing work at JPL under the Mars Outpost Program in the area of robot colonies is investigating many of the technology developments necessary for such an ambitious undertaking. Some of the issues that are being addressed include behavior-based control systems for multiple cooperating robots (CAMPOUT), development of autonomous robotic systems for the rescue/repair of trapped or disabled robots, and the design and development of robotic platforms for construction tasks such as material transport and surface clearing.

Slum Upgrading and Health Equity

PubMed Central

Corburn, Jason; Sverdlik, Alice

2017-01-01

Informal settlement upgrading is widely recognized for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Almost one in seven people on the planet are expected to reside in urban informal settlements, or slums, by 2030. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals (SDGs) focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. We conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment (HIA) and adopting an urban health in all policies (HiAP) framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits. PMID:28338613

SOMOS: Evaluation of an HIV Prevention Intervention for Latino Gay Men

ERIC Educational Resources Information Center

Vega, Miriam Y.; Spieldenner, Andrew R.; DeLeon, Dennis; Nieto, Bolivar X.; Stroman, Carolyn A.

2011-01-01

Latino gay men face multiple barriers to human immunodeficiency virus (HIV) prevention, in particular a lack of intervention programs that integrate prevention messages with cultural norms and address issues of social marginalization from multiple communities (gay community and Latino community), homophobia and racism. In order to address these…

Patterns of health care utilization among vulnerable populations in Central Texas using data from a regional health information exchange.

PubMed

Schiefelbein, Emily L; Olson, Jerome A; Moxham, Jamie D

2014-02-01

Describe patterns of health care utilization among vulnerable subgroups of an underserved population and identify populations that could benefit from interventions to reduce health care costs and improve quality of care. Health Information Exchange data focused on underserved patients was used to estimate the risk of an emergency department (ED) or inpatient (IP) visit among vulnerable patients. Approximately 20.9% of the population was vulnerable, with behavioral health being the most predominant. Homeless, disabled, and severe behavioral health patients had an increased risk of ED utilization. Behavioral health, disabled, and near elderly patients had an increased risk of IP utilization. Inpatient risk was even greater for patients with multiple vulnerabilities. Improved primary care services are needed to address both the mental and physical needs of vulnerable populations, particularly people with severe behavioral health conditions. Improved access to services may help reduce the costly burden of providing hospital-based care.

Management of the marine environment: integrating ecosystem services and societal benefits with the DPSIR framework in a systems approach.

PubMed

Atkins, Jonathan P; Burdon, Daryl; Elliott, Mike; Gregory, Amanda J

2011-02-01

Ever increasing and diverse use of the marine environment is leading to human-induced changes in marine life, habitats and landscapes, making necessary the development of marine policy that considers all members of the user community and addresses current, multiple, interacting uses. Taking a systems approach incorporating an understanding of The Ecosystem Approach, we integrate the DPSIR framework with ecosystem services and societal benefits, and the focus this gives allows us to create a specific framework for supporting decision making in the marine environment. Based on a linking of these three concepts, we present a set of basic postulates for the management of the marine environment and emphasise that these postulates should hold for marine management to be achieved. We illustrate these concepts using two case studies: the management of marine aggregates extraction in UK waters and the management of marine biodiversity at Flamborough Head, UK. Copyright © 2010 Elsevier Ltd. All rights reserved.

Toward a national, sustained U.S. ecosystem assessment

USGS Publications Warehouse

Jackson, Stephen T.; Duke, Clifford S.; Hampton, Stephanie E.; Jacobs, Katharine L.; Joppa, Lucas N.; Kassam, Karim-Aly S. K.; Mooney, Harold A.; Ogden, Laura A.; Ruckelshaus, Mary; Shogren, Jason F.

2016-01-01

The massive investment of resources devoted to monitoring and assessment of economic and societal indicators in the United States is neither matched by nor linked to efforts to monitor and assess the ecosystem services and biodiversity that support economic and social well-being. Although national-scale assessments of biodiversity (1) and ecosystem indicators (2) have been undertaken, nearly a decade has elapsed since the last systematic assessment (2). A 2011 White House report called for a national biodiversity and ecosystem services assessment (3), but the initiative has stalled. Our aim here is to stimulate the process and outline a credible framework and pathway for an ongoing assessment of ecosystem functioning (see the photo). A national assessment should engage diverse stakeholders from multiple sectors of society and should focus on metrics and analyses of direct relevance to policy decisions, from local to national levels. Although many technical or science-focused components are in place, they need to be articulated, distilled, and organized to address policy issues.

House calls revisited: Leveraging technology to overcome obstacles to psychiatric care and improve treatment outcomes

PubMed Central

Olden, Megan; Cukor, Judith; Rizzo, Albert “Skip”; Rothbaum, Barbara; Difede, JoAnn

2014-01-01

Despite an increasing number of military service members in need of mental health treatment following deployment to Iraq and Afghanistan, numerous psychological and practical barriers limit access to care. Perceived stigma about admitting psychological difficulties as well as frequent long distances to treatment facilities reduce many veterans' willingness and ability to receive care. Telemedicine and virtual human technologies offer a unique potential to expand services to those in greatest need. Telemedicine-based treatment has been used to address multiple psychiatric disorders, including posttraumatic stress disorder, depression, and substance use, as well as to provide suicide risk assessment and intervention. Clinician education and training has also been enhanced and expanded through the use of distance technologies, with trainees practicing clinical skills with virtual patients and supervisors connecting with clinicians via videoconferencing. The use of these innovative and creative vehicles offer a significant and as yet unfulfilled promise to expand delivery of high quality psychological therapies, regardless of clinician and patient location. PMID:20955335

Listening to rural Hispanic immigrants in the Midwest: a community-based participatory assessment of major barriers to health care access and use.

PubMed

Cristancho, Sergio; Garces, D Marcela; Peters, Karen E; Mueller, Benjamin C

2008-05-01

Hispanic immigrants are increasingly residing in rural communities, including in the midwestern United States. Limitations in the ability of rural Hispanics to access and utilize health care contribute to patterns of poor health and health disparity. A conceptual model of "vulnerability" guides this community-based participatory assessment project designed to explore rural Hispanics' perceived barriers to accessing and utilizing health care. Findings from a series of 19 focus groups with 181 participants from three communities in the upper Midwest identified perceived barriers at the individual and health care system levels. The most commonly perceived barriers were the lack of and limitations in health insurance coverage, high costs of health care services, communication issues involving patients and providers, legal status/discrimination, and transportation concerns. Findings imply that these barriers could be addressed using multiple educational and health service delivery policy-related strategies that consider the vulnerable nature of this growing population.

Implementation of Parent Child Interaction Therapy Within Foster Care: An Attempt to Translate an Evidence-Based Program Within a Local Child Welfare Agency

PubMed Central

Topitzes, James; Mersky, Joshua P.; McNeil, Cheryl B.

2014-01-01

This paper describes an innovative adaptation of an evidence-based intervention – Parent Child Interaction Therapy or PCIT – to foster parent training services. The authors faced multiple problems that commonly plague translational child welfare research as they developed, implemented and tested their model. The paper discusses how the authors addressed these problems when: 1) specifying the child welfare context in which the intervention model was implemented and tested, choosing an intervention model that responded to child welfare service needs, and tailoring the model for a child welfare context; 2) securing external funding and initiating sustainability plans for model uptake; and 3) forging a university-community partnership to overcome logistical and ethical obstacles. Concluding with a summary of promising preliminary study results, a description of future plans to replicate and spread the model, and a distillation of project lessons, the paper suggests that child welfare translational research with PCIT is very promising. PMID:25729340

31 CFR Appendix A to Subpart B of... - Addresses for Service Under § 29.203

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Addresses for Service Under § 29.203 A Appendix A to Subpart B of Part 29 Money and Finance: Treasury Office of the Secretary of the... United States Postal Service is: Office of DC Pensions, Department of the Treasury, Metropolitan Square...

31 CFR Appendix A to Subpart B of... - Addresses for Service Under § 29.203

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Addresses for Service Under § 29.203 A Appendix A to Subpart B of Part 29 Money and Finance: Treasury Office of the Secretary of the... United States Postal Service is: Office of DC Pensions, Department of the Treasury, Metropolitan Square...

31 CFR Appendix A to Subpart B of... - Addresses for Service Under § 29.203

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance: Treasury 1 2013-07-01 2013-07-01 false Addresses for Service Under § 29.203 A Appendix A to Subpart B of Part 29 Money and Finance: Treasury Office of the Secretary of the... United States Postal Service is: Office of DC Pensions, Department of the Treasury, Metropolitan Square...

31 CFR Appendix A to Subpart B of... - Addresses for Service Under § 29.203

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Addresses for Service Under § 29.203 A Appendix A to Subpart B of Part 29 Money and Finance: Treasury Office of the Secretary of the... United States Postal Service is: Office of DC Pensions, Department of the Treasury, Metropolitan Square...

31 CFR Appendix A to Subpart B of... - Addresses for Service Under § 29.203

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Addresses for Service Under § 29.203 A Appendix A to Subpart B of Part 29 Money and Finance: Treasury Office of the Secretary of the... United States Postal Service is: Office of DC Pensions, Department of the Treasury, Metropolitan Square...

Anthrax Vaccine does not affect semen Parameters, Embryo Quality, or Pregnancy Outcome in Couples with a Vaccinated Male Military Service Member

DTIC Science & Technology

2005-02-01

concern that accination of predominantly reproductive-aged service- embers may result in deleterious effects on fertility or etal health (6). There are...requests: William H. Catherino, M.D., Ph.D., Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Building A...ORGANIZATION NAME(S) AND ADDRESS(ES) Uniformed Services University of the Health Sciences,Department of Obstetrics and Gynecology,4301 Jones Bridge Road

Toward a North American Standard for Mobile Data Services

NASA Technical Reports Server (NTRS)

Dean, Richard A.; Levesque, Allen H.

1991-01-01

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

Toward a North American standard for mobile data services

NASA Astrophysics Data System (ADS)

Dean, Richard A.; Levesque, Allen H.

1991-09-01

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

Challenges Addressing Unmet Need for Contraception: Voices of Family Planning Service Providers in Rural Tanzania.

PubMed

Baraka, Jitihada; Rusibamayila, Asinath; Kalolella, Admirabilis; Baynes, Colin

2015-12-01

Provider perspectives have been overlooked in efforts to address the challenges of unmet need for family planning (FP). This qualitative study was undertaken in Tanzania, using 22 key informant interviews and 4 focus group discussions. The research documents perceptions of healthcare managers and providers in a rural district on the barriers to meeting latent demand for contraception. Social-ecological theory is used to interpret the findings, illustrating how service capability is determined by the social, structural and organizational environment. Providers' efforts to address unmet need for FP services are constrained by unstable reproductive preferences, low educational attainment, and misconceptions about contraceptive side effects. Societal and organizational factors--such as gender dynamics, economic conditions, religious and cultural norms, and supply chain bottlenecks, respectively--also contribute to an adverse environment for meeting needs for care. Challenges that healthcare providers face interact and produce an effect which hinders efforts to address unmet need. Interventions to address this are not sufficient unless the supply of services is combined with systems strengthening and social engagement strategies in a way that reflects the multi-layered, social institutional problems.

A sample theory-based logic model to improve program development, implementation, and sustainability of Farm to School programs.

PubMed

Ratcliffe, Michelle M

2012-08-01

Farm to School programs hold promise to address childhood obesity. These programs may increase students’ access to healthier foods, increase students’ knowledge of and desire to eat these foods, and increase their consumption of them. Implementing Farm to School programs requires the involvement of multiple people, including nutrition services, educators, and food producers. Because these groups have not traditionally worked together and each has different goals, it is important to demonstrate how Farm to School programs that are designed to decrease childhood obesity may also address others’ objectives, such as academic achievement and economic development. A logic model is an effective tool to help articulate a shared vision for how Farm to School programs may work to accomplish multiple goals. Furthermore, there is evidence that programs based on theory are more likely to be effective at changing individuals’ behaviors. Logic models based on theory may help to explain how a program works, aid in efficient and sustained implementation, and support the development of a coherent evaluation plan. This article presents a sample theory-based logic model for Farm to School programs. The presented logic model is informed by the polytheoretical model for food and garden-based education in school settings (PMFGBE). The logic model has been applied to multiple settings, including Farm to School program development and evaluation in urban and rural school districts. This article also includes a brief discussion on the development of the PMFGBE, a detailed explanation of how Farm to School programs may enhance the curricular, physical, and social learning environments of schools, and suggestions for the applicability of the logic model for practitioners, researchers, and policy makers.

Considering an integrated nephrology care delivery model: six principles for quality.

PubMed

Hamm, L Lee; Hostetter, Thomas H; Shaffer, Rachel N

2013-04-01

In 2012, 27 organizations will initiate participation in the Medicare Shared Savings Program as Accountable Care Organizations. This level of participation reflects the response of Centers for Medicare and Medicaid Services to criticism that the program as outlined in the proposed rule was overly burdensome, prescriptive, and too risky. Centers for Medicare and Medicaid Service made significant changes in the final rule, making the Accountable Care Organization program more attractive to these participants. However, none of these changes addressed the serious concerns raised by subspecialty societies-including the American Society of Nephrology-regarding care of patients with multiple chronic comorbidities and complex and end stage conditions. Virtually all of these concerns remain unaddressed, and consequently, Accountable Care Organizations will require guidance and partnership from the nephrology community to ensure that these patients are identified and receive the individualized care that they require. Although the final rule fell short of addressing the needs of patients with kidney disease, the Centers for Medicare and Medicaid Innovation presents an opportunity to test the potentially beneficial concepts of the Accountable Care Organization program within this patient population. The American Society of Nephrology Accountable Care Organization Task Force developed a set of principles that must be reflected in a possible pilot program or demonstration project of an integrated nephrology care delivery model. These principles include preserving a leadership role for nephrologists, encompassing care for patients with later-stage CKD and kidney transplants as well as ESRD, enabling the participation of a diversity of dialysis provider sizes and types, facilitating research, and establishing monitoring systems to identify and address preferential patient selection or changes in outcomes.

Personalized cloud-based bioinformatics services for research and education: use cases and the elasticHPC package

PubMed Central

2012-01-01

Background Bioinformatics services have been traditionally provided in the form of a web-server that is hosted at institutional infrastructure and serves multiple users. This model, however, is not flexible enough to cope with the increasing number of users, increasing data size, and new requirements in terms of speed and availability of service. The advent of cloud computing suggests a new service model that provides an efficient solution to these problems, based on the concepts of "resources-on-demand" and "pay-as-you-go". However, cloud computing has not yet been introduced within bioinformatics servers due to the lack of usage scenarios and software layers that address the requirements of the bioinformatics domain. Results In this paper, we provide different use case scenarios for providing cloud computing based services, considering both the technical and financial aspects of the cloud computing service model. These scenarios are for individual users seeking computational power as well as bioinformatics service providers aiming at provision of personalized bioinformatics services to their users. We also present elasticHPC, a software package and a library that facilitates the use of high performance cloud computing resources in general and the implementation of the suggested bioinformatics scenarios in particular. Concrete examples that demonstrate the suggested use case scenarios with whole bioinformatics servers and major sequence analysis tools like BLAST are presented. Experimental results with large datasets are also included to show the advantages of the cloud model. Conclusions Our use case scenarios and the elasticHPC package are steps towards the provision of cloud based bioinformatics services, which would help in overcoming the data challenge of recent biological research. All resources related to elasticHPC and its web-interface are available at http://www.elasticHPC.org. PMID:23281941

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

PubMed Central

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

2016-01-01

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

Personalized cloud-based bioinformatics services for research and education: use cases and the elasticHPC package.

PubMed

El-Kalioby, Mohamed; Abouelhoda, Mohamed; Krüger, Jan; Giegerich, Robert; Sczyrba, Alexander; Wall, Dennis P; Tonellato, Peter

2012-01-01

Bioinformatics services have been traditionally provided in the form of a web-server that is hosted at institutional infrastructure and serves multiple users. This model, however, is not flexible enough to cope with the increasing number of users, increasing data size, and new requirements in terms of speed and availability of service. The advent of cloud computing suggests a new service model that provides an efficient solution to these problems, based on the concepts of "resources-on-demand" and "pay-as-you-go". However, cloud computing has not yet been introduced within bioinformatics servers due to the lack of usage scenarios and software layers that address the requirements of the bioinformatics domain. In this paper, we provide different use case scenarios for providing cloud computing based services, considering both the technical and financial aspects of the cloud computing service model. These scenarios are for individual users seeking computational power as well as bioinformatics service providers aiming at provision of personalized bioinformatics services to their users. We also present elasticHPC, a software package and a library that facilitates the use of high performance cloud computing resources in general and the implementation of the suggested bioinformatics scenarios in particular. Concrete examples that demonstrate the suggested use case scenarios with whole bioinformatics servers and major sequence analysis tools like BLAST are presented. Experimental results with large datasets are also included to show the advantages of the cloud model. Our use case scenarios and the elasticHPC package are steps towards the provision of cloud based bioinformatics services, which would help in overcoming the data challenge of recent biological research. All resources related to elasticHPC and its web-interface are available at http://www.elasticHPC.org.

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

PubMed

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

2016-01-01

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

Implementing solutions to improve and expand telehealth adoption: participatory action research in four community healthcare settings.

PubMed

Taylor, Johanna; Coates, Elizabeth; Wessels, Bridgette; Mountain, Gail; Hawley, Mark S

2015-12-01

Adoption of telehealth has been slower than anticipated, and little is known about the service improvements that help to embed telehealth into routine practice or the role of frontline staff in improving adoption. This paper reports on participatory action research carried out in four community health settings using telehealth for patients with Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. To inform the action research, in-depth case studies of each telehealth service were conducted (May 2012-June 2013). Each service was then supported by researchers through two cycles of action research to implement changes to increase adoption of telehealth, completed over a seven month period (July 2013-April 2014). The action research was studied via observation of multi-stakeholder workshops, analysis of implementation plans, and focus groups. Action research participants included 57 staff and one patient, with between eight and 20 participants per site. The case study findings were identified as a key source of information for planning change, with sites addressing common challenges identified through this work. For example, refining referral criteria; standardizing how and when patients are monitored; improving data sharing; and establishing evaluation processes. Sites also focused on raising awareness of telehealth to increase adoption in other clinical teams and to help secure future financial investment for telehealth, which was required because of short-term funding arrangements. Specific solutions varied due to local infrastructures, resources, and opinion, as well as previous service developments. Local telehealth champions played an important role in engaging multiple stakeholders in the study. Action research enabled services to make planned changes to telehealth and share learning across multiple stakeholders about how and when to use telehealth. However, adoption was impeded by continual changes affecting telehealth and wider service provision, which also hindered implementation efforts and affected motivation of staff to engage with the action research, particularly where local decision-makers were not engaged in the study. Wider technological barriers also limited the potential for change, as did uncertainties about goals for telehealth investment, thereby making it difficult to identify outcomes for demonstrating the added value over existing practice.

Using concept mapping in the knowledge-to-action process to compare stakeholder opinions on barriers to use of cancer screening among South Asians.

PubMed

Lobb, Rebecca; Pinto, Andrew D; Lofters, Aisha

2013-03-23

Using the knowledge-to-action (KTA) process, this study examined barriers to use of evidence-based interventions to improve early detection of cancer among South Asians from the perspective of multiple stakeholders. In 2011, we used concept mapping with South Asian residents, and representatives from health service and community service organizations in the region of Peel Ontario. As part of concept mapping procedures, brainstorming sessions were conducted with stakeholders (n = 53) to identify barriers to cancer screening among South Asians. Participants (n = 46) sorted barriers into groups, and rated barriers from lowest (1) to highest (6) in terms of importance for use of mammograms, Pap tests and fecal occult blood tests, and how feasible it would be to address them. Multi-dimensional scaling, cluster analysis, and descriptive statistics were used to analyze the data. A total of 45 unique barriers to use of mammograms, Pap tests, and fecal occult blood tests among South Asians were classified into seven clusters using concept mapping procedures: patient's beliefs, fears, lack of social support; health system; limited knowledge among residents; limited knowledge among physicians; health education programs; ethno-cultural discordance with the health system; and cost. Overall, the top three ranked clusters of barriers were 'limited knowledge among residents,' 'ethno-cultural discordance,' and 'health education programs' across surveys. Only residents ranked 'cost' second in importance for fecal occult blood testing, and stakeholders from health service organizations ranked 'limited knowledge among physicians' third for the feasibility survey. Stakeholders from health services organizations ranked 'limited knowledge among physicians' fourth for all other surveys, but this cluster consistently ranked lowest among residents. The limited reach of cancer control programs to racial and ethnic minority groups is a critical implementation issue that requires attention. Opinions of community service and health service organizations on why this deficit in implementation occurs are fundamental to understanding the solutions because these are the settings in which evidence-based interventions are implemented. Using concept mapping within a KTA process can facilitate the engagement of multiple stakeholders in the utilization of study results and in identifying next steps for action.

Comparing consumer-directed and agency models for providing supportive services at home.

PubMed

Benjamin, A E; Matthias, R; Franke, T M

2000-04-01

To examine the service experiences and outcomes of low-income Medicaid beneficiaries with disabilities under two different models for organizing home-based personal assistance services: agency-directed and consumer-directed. A survey of a random sample of 1,095 clients, age 18 and over, who receive services in California's In-Home Supportive Services (IHSS) program funded primarily by Medicaid. Other data were obtained from the California Management and Payrolling System (CMIPS). The sample was stratified by service model (agency-directed or consumer-directed), client age (over or under age 65), and severity. Data were collected on client demographics, condition/functional status, and supportive service experience. Outcome measures were developed in three areas: safety, unmet need, and service satisfaction. Factor analysis was used to reduce multiple outcome measures to nine dimensions. Multiple regression analysis was used to assess the effect of service model on each outcome dimension, taking into account the client-provider relationship, client demographics, and case mix. Recipients of IHSS services as of mid-1996 were interviewed by telephone. The survey was conducted in late 1996 and early 1997. On various outcomes, recipients in the consumer-directed model report more positive outcomes than those in the agency model, or they report no difference. Statistically significant differences emerge on recipient safety, unmet needs, and service satisfaction. A family member present as a paid provider is also associated with more positive reported outcomes within the consumer-directed model, but model differences persist even when this is taken into account. Although both models have strengths and weaknesses, from a recipient perspective the consumer-directed model is associated with more positive outcomes. Although health professionals have expressed concerns about the capacity of consumer direction to assure quality, particularly with respect to safety, meeting unmet needs, and technical quality, our findings suggest that the consumer-directed service model is a viable alternative to the agency model. Because public programs are under growing pressure to address the long-term care needs of low-income people of all ages with disabilities, the Medicaid personal assistance benefit needs to be reassessed in light of these findings. Consumer-directed models may offer a less elaborate and possibly less costly option for organizing supportive services at home. Study limitations may limit the generalizability of these findings. This was a natural experiment, in which only some counties offered both service models and counties assigned recipients to a service model. The use of a telephone survey excluded important recipient subsets, notably people with severe cognitive impairments. A more definitive study would include direct observations as well as survey approaches.

47 CFR 14.52 - Copies; service; separate filings against multiple defendants.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 1 2014-10-01 2014-10-01 false Copies; service; separate filings against multiple defendants. 14.52 Section 14.52 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL ACCESS TO ADVANCED COMMUNICATIONS SERVICES AND EQUIPMENT BY PEOPLE WITH DISABILITIES Recordkeeping, Consumer...

47 CFR 14.52 - Copies; service; separate filings against multiple defendants.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 1 2012-10-01 2012-10-01 false Copies; service; separate filings against multiple defendants. 14.52 Section 14.52 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL ACCESS TO ADVANCED COMMUNICATIONS SERVICES AND EQUIPMENT BY PEOPLE WITH DISABILITIES Recordkeeping, Consumer...

47 CFR 14.52 - Copies; service; separate filings against multiple defendants.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 1 2013-10-01 2013-10-01 false Copies; service; separate filings against multiple defendants. 14.52 Section 14.52 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL ACCESS TO ADVANCED COMMUNICATIONS SERVICES AND EQUIPMENT BY PEOPLE WITH DISABILITIES Recordkeeping, Consumer...

Characteristics of individuals screening positive for substance use in a welfare setting: implications for welfare and substance-use disorders treatment systems.

PubMed

Morgenstern, Jon; Hogue, Aaron; Dasaro, Christopher; Kuerbis, Alexis; Dauber, Sarah

2008-07-01

This study examined barriers to employability, motivation to abstain from substances and to work, and involvement in multiple service systems among male and female welfare applicants with alcohol- and drug-use problems. A representative sample (N= 1,431) of all persons applying for public assistance who screened positive for substance involvement over a 2-year period in a large urban county were recruited in welfare offices. Legal, education, general health, mental health, employment, housing, and child welfare barriers to employability were assessed, as were readiness to abstain from substance use and readiness to work. Only 1 in 20 participants reported no barrier other than substance use, whereas 70% reported at least two other barriers and 40% reported three or more. Moreover, 70% of participants experienced at least one additional barrier classified as "severe" and 30% experienced two or more. The number and type of barriers differed by gender. Latent class analysis revealed four main barriers-plus-readiness profiles among participants: (1) multiple barriers, (2) work experienced, (3) criminal justice, and (4) unstable housing. Findings suggest that comprehensive coordination among social service systems is needed to address the complex problems of low-income Americans with substance-use disorders. Classifying applicants based on barriers and readiness is a promising approach to developing innovative welfare programs to serve the diverse needs of men and women with substance-related problems.

Preventing and controlling foodborne disease in commercial and institutional food service settings: a systematic review of published intervention studies.

PubMed

Viator, Catherine; Blitstein, Jonathan; Brophy, Jenna E; Fraser, Angela

2015-02-01

This study reviews the current literature on behavioral and environmental food safety interventions conducted in commercial and institutional food service settings. A systematic search of the published literature yielded 268 candidate articles, from which a set of 23 articles reporting intervention outcomes was retained for evaluation. A categorization of measured outcomes is reported; studies addressed multiple outcomes ranging from knowledge, attitudes, and behavior of personal hygiene and food safety to management practices and disease rates and outbreaks. This study also investigates the quality of reported research methods used to evaluate the effectiveness of the interventions, using a nine-point quality index adapted by the authors. The observed scores suggest that there are opportunities to improve the design and reporting of research in the field of foodborne disease prevention as it applies to food safety interventions that target the food service industry. The aim is to aid researchers in this area to design higher quality studies and to produce clearer and more useful reports of their research. In turn, this can help to create a more complete evidence base that can be used to continually improve interventions in this domain.

The New Hampshire retail competition pilot program and the role of green marketing

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

Holt, E.A.; Fang, J.M.

1997-11-01

Most states in the US are involved in electric industry restructuring, from considering the pros and cons in regulatory dockets to implementing legislative mandates for full restructuring and retail access for all consumers. Several states and utilities have initiated pilot programs in which multiple suppliers or service providers may compete for business and some utility customers can choose among competing suppliers. The State of New Hampshire has been experimenting with a pilot program, mandated by the State Legislature in 1995 and implemented by the New Hampshire Public Utilities Commission (NHPUC), before it implements full retail access. Green marketing, an attemptmore » to characterize the supplier or service provider as environmentally friendly without referring to the energy resource used to generate electricity, was used by several suppliers or service providers to attract customers. This appeal to environmental consumerism was moderately successful, but it raised a number of consumer protection and public policy issues. This issue brief examines the marketing methods used in New Hampshire and explores what green marketing might mean for the development of renewable energy generation. It also addresses the issues raised and their implications.« less

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

PubMed Central

Cole, Donald C.; Muskat, Elisha; Raja, Shoba; Wiljer, David; Aylward, David

2016-01-01

In the debate in global mental health about the most effective models for developing and scaling interventions, there have been calls for the development of a more robust literature regarding the "non-specific", science of delivery aspects of interventions that are locally, contextually, and culturally relevant. This study describes a rigorous, exploratory, qualitative examination of the key, non-specific intervention strategies of a diverse group of five internationally-recognized organizations addressing mental illness in middle income countries (MICs). A triangulated approach to inquiry was used with semi-structured interviews conducted with service recipients, service providers and leaders, and key community partners (N = 159). The interview focus was upon processes of implementation and operation. A grounded theory-informed analysis revealed cross cutting themes of: a holistic conceptualization of mental health problems, an intensive application of principles of leverage and creating the social, cultural, and policy “space” within which interventions could be applied and resourced. These findings aligned with key aspects of systems dynamic theory suggesting that it might be a helpful framework in future studies of mental health service implementation in MICs. PMID:27011053

Intra-Hour Dispatch and Automatic Generator Control Demonstration with Solar Forecasting - Final Report

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

Coimbra, Carlos F. M.

2016-02-25

In this project we address multiple resource integration challenges associated with increasing levels of solar penetration that arise from the variability and uncertainty in solar irradiance. We will model the SMUD service region as its own balancing region, and develop an integrated, real-time operational tool that takes solar-load forecast uncertainties into consideration and commits optimal energy resources and reserves for intra-hour and intra-day decisions. The primary objectives of this effort are to reduce power system operation cost by committing appropriate amount of energy resources and reserves, as well as to provide operators a prediction of the generation fleet’s behavior inmore » real time for realistic PV penetration scenarios. The proposed methodology includes the following steps: clustering analysis on the expected solar variability per region for the SMUD system, Day-ahead (DA) and real-time (RT) load forecasts for the entire service areas, 1-year of intra-hour CPR forecasts for cluster centers, 1-year of smart re-forecasting CPR forecasts in real-time for determination of irreducible errors, and uncertainty quantification for integrated solar-load for both distributed and central stations (selected locations within service region) PV generation.« less

Making Earth Science Data Records for Use in Research Environments (MEaSUREs) Projects Data and Services at the GES DISC

NASA Technical Reports Server (NTRS)

Vollmer, Bruce E.; Ostrenga, D.; Savtchenko, A.; Johnson, J.; Wei, J.; Teng, W.; Gerasimov, I.

2011-01-01

NASA's Earth Science Program is dedicated to advancing Earth remote sensing and pioneering the scientific use of satellite measurements to improve human understanding of our home planet. Through the MEaSUREs Program, NASA is continuing its commitment to expand understanding of the Earth system using consistent data records. Emphasis is on linking together multiple data sources to form coherent time-series, and facilitating the use of extensive data in the development of comprehensive Earth system models. A primary focus of the MEaSUREs Program is the creation of Earth System Data Records (ESDRs). An ESDR is defined as a unified and coherent set of observations of a given parameter of the Earth system, which is optimized to meet specific requirements for addressing science questions. These records are critical for understanding Earth System processes; for the assessment of variability, long-term trends, and change in the Earth System; and for providing input and validation means to modeling efforts. Seven MEaSUREs projects will be archived and distributed through services at the Goddard Earth Sciences Data and Information Services Center (GES DISC).

42 CFR 102.45 - Multiple survivors.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Multiple survivors. 102.45 Section 102.45 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION... smallpox vaccine recipient or vaccinia contact may file Request Forms separately or together. Multiple...

42 CFR 102.45 - Multiple survivors.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Multiple survivors. 102.45 Section 102.45 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION... smallpox vaccine recipient or vaccinia contact may file Request Forms separately or together. Multiple...

42 CFR 102.45 - Multiple survivors.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Multiple survivors. 102.45 Section 102.45 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION... smallpox vaccine recipient or vaccinia contact may file Request Forms separately or together. Multiple...

42 CFR 102.45 - Multiple survivors.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Multiple survivors. 102.45 Section 102.45 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION... smallpox vaccine recipient or vaccinia contact may file Request Forms separately or together. Multiple...

42 CFR 102.45 - Multiple survivors.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Multiple survivors. 102.45 Section 102.45 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION... smallpox vaccine recipient or vaccinia contact may file Request Forms separately or together. Multiple...

Advanced multiple access concepts in mobile satellite systems

NASA Technical Reports Server (NTRS)

Ananasso, Fulvio

1990-01-01

Some multiple access strategies for Mobile Satellite Systems (MSS) are discussed. These strategies were investigated in the context of three separate studies conducted for the International Maritime Satellite Organization (INMARSAT) and the European Space Agency (ESA). Satellite-Switched Frequency Division Multiple Access (SS-FDMA), Code Division Multiple Access (CDMA), and Frequency-Addressable Beam architectures are addressed, discussing both system and technology aspects and outlining advantages and drawbacks of either solution with associated relevant hardware issues. An attempt is made to compare the considered option from the standpoint of user terminal/space segment complexity, synchronization requirements, spectral efficiency, and interference rejection.

Higher levels of multiple ecosystem services are found in forests with more tree species

PubMed Central

Gamfeldt, Lars; Snäll, Tord; Bagchi, Robert; Jonsson, Micael; Gustafsson, Lena; Kjellander, Petter; Ruiz-Jaen, María C.; Fröberg, Mats; Stendahl, Johan; Philipson, Christopher D.; Mikusiński, Grzegorz; Andersson, Erik; Westerlund, Bertil; Andrén, Henrik; Moberg, Fredrik; Moen, Jon; Bengtsson, Jan

2013-01-01

Forests are of major importance to human society, contributing several crucial ecosystem services. Biodiversity is suggested to positively influence multiple services but evidence from natural systems at scales relevant to management is scarce. Here, across a scale of 400,000 km2, we report that tree species richness in production forests shows positive to positively hump-shaped relationships with multiple ecosystem services. These include production of tree biomass, soil carbon storage, berry production and game production potential. For example, biomass production was approximately 50% greater with five than with one tree species. In addition, we show positive relationships between tree species richness and proxies for other biodiversity components. Importantly, no single tree species was able to promote all services, and some services were negatively correlated to each other. Management of production forests will therefore benefit from considering multiple tree species to sustain the full range of benefits that the society obtains from forests. PMID:23299890

Copayment and recommended strategies to mitigate its impacts on access to emergency medical services under universal health coverage: a case study from Thailand.

PubMed

Suriyawongpaisal, Paibul; Aekplakorn, Wichai; Srithamrongsawat, Samrit; Srithongchai, Chaisit; Prasitsiriphon, Orawan; Tansirisithikul, Rassamee

2016-10-21

Although bodies of evidence on copayment effects on access to care and quality of care in general have not been conclusive, allowing copayment in the case of emergency medical conditions might pose a high risk of delayed treatment leading to avoidable disability or death. Using mixed-methods approach to draw evidence from multiple sources (over 40,000 records of administrative dataset of Thai emergency medical services, in-depth interviews, telephone survey of users and documentary review), we are were able to shed light on the existence of copayment and its related factors in the Thai healthcare system despite the presence of universal health coverage since 2001. The copayment poses a barrier of access to emergency care delivered by private hospitals despite the policy proclaiming free access and payment. The copayment differentially affects beneficiaries of the major 3 public-health insurance schemes hence inducing inequity of access. We have identified 6 drivers of the copayment i.e., 1) perceived under payment, 2) unclear operational definitions of emergency conditions or 3) lack of criteria to justify inter-hospital transfer after the first 72 h of admission, 4) limited understanding by the service users of the policy-directed benefits, 5) weak regulatory mechanism as indicated by lack of information systems to trace private provider's practices, and 6) ineffective arrangements for inter-hospital transfer. With demand-side perspectives, we addressed the reasons for bypassing gatekeepers or assigned local hospitals. These are the perception of inferior quality of care and age-related tendency to use emergency department, which indicate a deficit in the current healthcare systems under universal health coverage. Finally, we have discussed strategies to address these potential drivers of copayment and needs for further studies.

Medical and pharmacy student concerns about participating on international service-learning trips.

PubMed

Chuang, Chih; Khatri, Siddique H; Gill, Manpal S; Trehan, Naveen; Masineni, Silpa; Chikkam, Vineela; Farah, Guillaume G; Khan, Amber; Levine, Diane L

2015-12-23

International Service Learning Trips (ISLT) provide health professional students the opportunity to provide healthcare, under the direction of trained faculty, to underserved populations in developing countries. Despite recent increases in international service learning trips, there is scant literature addressing concerns students have prior to attending such trips. This study focuses on identifying concerns before and after attending an ISLT and their impact on students. A survey comprised of closed and open-ended questions was developed to elucidate student concerns prior to attending an ISLT and experiences which might influence concerns. A five-point Likert-scale (extremely concerned = 1, minimally concerned = 5) was used to rate apprehension and satisfaction. Paired t-test was used to compare pre- and post-trip concerns; Chi-Square test was used to compare groups. Thirty-five students (27 medical, 8 pharmacy) attended ISLTs in December 2013. All completed pre and post-trip surveys. Significant decreases were seen in concerns related to cultural barriers (4.14 vs 4.46, P = .047), disease/epidemics (3.34 vs 4.60, P < .001), natural disasters (3.94 vs 4.94, P < .001), terrorism (4.34 vs 4.94, P < .001), travel (3.86 vs 4.51, P < .001) monetary issues (3.80 vs 4.60, P < .001), hospitality (3.94 vs 4.74, P = .001) and food (3.83 vs 4.60, P < .001). Language and group dynamics remained concerns post-trip. On open-ended questions, students described benefits of attending an ISLT. Students had multiple concerns prior to attending an ISLT. Most decreased upon return. Addressing concerns has the potential to decrease student apprehension. The results of this study highlight the benefits of providing ISLTs and supporting development of a curriculum incorporating trip-related concerns.

Evaluation of clinical pharmacy services in a hematology/oncology outpatient setting.

PubMed

Shah, Sachin; Dowell, Jonathan; Greene, Shane

2006-09-01

The Veterans Affairs North Texas Health Care System in Dallas, TX, provides a unique opportunity for clinical pharmacists to work as providers. Even though clinical pharmacists are actively involved in patient care, many of their efforts remain undocumented, resulting in an underestimation of the importance of their services and missed opportunities for improvements and new directions. To document and evaluate the services of a hematology/oncology clinical pharmacy in the outpatient setting. Pendragon Forms 3.2 software was used to design the documentation template. The template was designed to collect diagnoses, supportive care issues, drug-specific interventions, and prescriptions written. This template was uploaded to the personal digital assistant (PDA) for documentation. Patient-specific information was documented in a password-protected PDA. Data collected from November 1, 2002, to October 31, 2003, were retrospectively analyzed. Clinical pharmacists were involved in 423 patient visits for chemotherapy follow-up or disease management. Cancer diagnoses included colorectal (n = 99), multiple myeloma (59), non-small cell lung (56), chronic lymphocytic leukemia (44), myelodysplastic syndromes (22), and chronic myelogenous leukemia (19). During the 423 patient visits, 342 supportive care issues were addressed including anemia (34%), pain management (22%), constipation/diarrhea (15%), and nausea/vomiting (8%). Major drug-specific interventions included drug addition (41%), discontinuation (23%), and adjustment (21%). Four hundred forty-five prescriptions were filled, of which 181 were new and 150 were refilled. This is the first study, as of July 25, 2006, to document considerable contribution of an outpatient clinical pharmacist in direct cancer patient care. Although the disease management and supportive care issues addressed here may differ based on institution and patient population, the results of our study show that clinical pharmacists have ever-growing roles in the management of these patients.

Name-Based Address Mapping for Virtual Private Networks

NASA Astrophysics Data System (ADS)

Surányi, Péter; Shinjo, Yasushi; Kato, Kazuhiko

IPv4 private addresses are commonly used in local area networks (LANs). With the increasing popularity of virtual private networks (VPNs), it has become common that a user connects to multiple LANs at the same time. However, private address ranges for LANs frequently overlap. In such cases, existing systems do not allow the user to access the resources on all LANs at the same time. In this paper, we propose name-based address mapping for VPNs, a novel method that allows connecting to hosts through multiple VPNs at the same time, even when the address ranges of the VPNs overlap. In name-based address mapping, rather than using the IP addresses used on the LANs (the real addresses), we assign a unique virtual address to each remote host based on its domain name. The local host uses the virtual addresses to communicate with remote hosts. We have implemented name-based address mapping for layer 3 OpenVPN connections on Linux and measured its performance. The communication overhead of our system is less than 1.5% for throughput and less than 0.2ms for each name resolution.

Talking about Sexuality and Intimacy with Women Spousal Caregivers: Perspectives of Service Providers.

PubMed

Brotman, Shari; Drummond, Jennifer; Silverman, Marjorie; Sussman, Tamara; Orzeck, Pam; Barylak, Lucy; Wallach, Isabelle; Billette, Veronique

2016-11-20

This article reports the findings of an exploratory study examining service provider perceptions and experiences of addressing sexuality and intimacy with women spousal caregivers. The caregiver-provider encounter is examined, and challenges faced by service providers in addressing sexuality are considered. Themes identified include ambivalence and discomfort, personal and institutional barriers, meanings attributed to sexuality and intimacy, and lack of opportunities to discuss experiences. Strategies to overcome silence and invisibility on the part of service providers in the health and social services system are considered. © 2016 National Association of Social Workers.

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

PubMed

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

2015-10-05

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

47 CFR 8.9 - Other laws and considerations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRESERVING THE OPEN INTERNET § 8.9 Other laws and... Internet access service may have to address the needs of emergency communications or law enforcement... provider of broadband Internet access service to address copyright infringement or other unlawful activity. ...

47 CFR 8.9 - Other laws and considerations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRESERVING THE OPEN INTERNET § 8.9 Other laws and... Internet access service may have to address the needs of emergency communications or law enforcement... provider of broadband Internet access service to address copyright infringement or other unlawful activity. ...

47 CFR 8.9 - Other laws and considerations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRESERVING THE OPEN INTERNET § 8.9 Other laws and... Internet access service may have to address the needs of emergency communications or law enforcement... provider of broadband Internet access service to address copyright infringement or other unlawful activity. ...

Enhanced Terminal Information Services (ETIS) Utilizing the Discrete Address Beacon System (DABS) Data Link - Concept Description

DOT National Transportation Integrated Search

1979-07-01

This report describes a concept for providing enhanced terminal information services (ETIS) to aircraft utilizing the ground-air-ground data link capability of the Discrete Address Beacon System (DABS). ETIS is envisioned as an eventual replacement f...

7 CFR 225.19 - Regional office addresses.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 4 2013-01-01 2013-01-01 false Regional office addresses. 225.19 Section 225.19 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SUMMER FOOD SERVICE PROGRAM General Administrative Provisions § 225.19...

7 CFR 225.19 - Regional office addresses.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 4 2012-01-01 2012-01-01 false Regional office addresses. 225.19 Section 225.19 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SUMMER FOOD SERVICE PROGRAM General Administrative Provisions § 225.19...

7 CFR 225.19 - Regional office addresses.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 4 2014-01-01 2014-01-01 false Regional office addresses. 225.19 Section 225.19 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SUMMER FOOD SERVICE PROGRAM General Administrative Provisions § 225.19...

7 CFR 225.19 - Regional office addresses.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 4 2011-01-01 2011-01-01 false Regional office addresses. 225.19 Section 225.19 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SUMMER FOOD SERVICE PROGRAM General Administrative Provisions § 225.19...

47 CFR 8.9 - Other Laws and Considerations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRESERVING THE OPEN INTERNET § 8.9 Other Laws and... Internet access service may have to address the needs of emergency communications or law enforcement... provider of broadband Internet access service to address copyright infringement or other unlawful activity. ...

An integrated eco-hydrologic modeling framework for assessing the effects of interacting stressors on multiple ecosystem services

EPA Science Inventory

The U.S. Environmental Protection Agency recently established the Ecosystem Services Research Program to help formulate methods and models for conducting comprehensive risk assessments that quantify how multiple ecosystem services interact and respond in concert to environmental ...

78 FR 18285 - General Services Administration Acquisition Regulation; Submission for OMB Review; Modifications...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

...; Modifications 552.243-72 (Multiple Award Schedules) AGENCY: Office of Acquisition Policy, General Services... information collection requirement regarding the Modifications (Multiple Award Schedule) clause. DATES: Submit comments on or before: April 25, 2013. FOR FURTHER INFORMATION CONTACT: Ms. Dana Munson, General Services...

The determinants of policy for population health.

PubMed

Fox, Daniel M

2006-10-01

Many advocates of policy to implement the findings of research on the multiple determinants of health accord scant attention to the determinants of health policy in democratic countries. The principle determinants of the allocation of scarce resources to improving health include: the priorities of voters; the diffusion of responsibility for improving health; the absence of evidence about matters of consequence to policy makers; the arraying of some evidence in ways that frustrate policy making; resistance to addressing determinants other than clinical services and traditional public health practices among many professionals in these fields, as well as by industries that supply the health sector; and the special political influence of persons who suffer serious chronic disease and of members of their families.

Maritime Territorial and Exclusive Economic Zone (EEZ) Disputes Involving China: Issues for Congress

DTIC Science & Technology

2015-09-18

Affairs September 18, 2015 Congressional Research Service 7-5700 www.crs.gov R42784 Report Documentation Page Form ApprovedOMB No. 0704-0188 Public...NAME(S) AND ADDRESS(ES) Congressional Research Service,The Library of Congress,101 Independence Ave, SE,Washington,DC,20540 8. PERFORMING...Territorial and Exclusive Economic Zone (EEZ) Disputes Involving China Congressional Research Service Summary China’s actions for asserting and

The Community as Classroom: Multiple Perspectives on Student Learning.

ERIC Educational Resources Information Center

Kerrigan, Seanna; Gelmon, Sherrill; Spring, Amy

2003-01-01

Reports on the multiple perspectives of students, community members, and faculty to document the affect of student participation in service-learning courses. The study examined in this article used a large sample size and multiple qualitative and quantitative methods over several years. The results indicate that service learning affects students…

Strengthening partnerships between Black Churches and HIV service providers in the United States.

PubMed

Obong'o, Christopher O; Pichon, Latrice C; Powell, Terrinieka W; Williams, Andrea L

2016-09-01

Across the United States, Black Churches play a significant role among the Black community and are increasingly being used to deliver Human Immunodeficiency Virus (HIV) prevention services. This study sought to investigate HIV service providers' strategies for strengthening partnerships with churches to deliver HIV prevention services. Using a community-based participatory research approach, an HIV coalition and an academic institution formed a partnership to address the study aim. Individual interviews (n = 16) were conducted with providers from medical institutions and HIV social support agencies. A thematic analysis focusing on recommendations for addressing the challenges and benefits of partnership with churches for HIV services was conducted. Participants' interest in and intention to work with churches, as well as their comfort level discussing sexual health-related topics with religious congregations, was high. Four themes emerged to highlight the different perspectives of service providers' recommendations for addressing challenges and strengthening partnerships with churches to deliver HIV services including: (1) carefully selecting churches and HIV services to provide, (2) gaining "buy-in" and support of church leadership, (3) taking advantage of conflict with church doctrine, and (4) choosing appropriate delivery strategies. Study findings demonstrate that although challenges exist, heath service providers in this region of the United States may be interested in addressing HIV among faith communities. Study findings also provide concrete solutions to previously documented barriers to HIV prevention in Black Churches. Such information will benefit researchers and practitioners seeking to expand effective HIV prevention efforts with Black Churches in communities who bear a disproportionate burden of HIV infections.

Wireless Avionics Packet to Support Fault Tolerance for Flight Applications

NASA Technical Reports Server (NTRS)

Block, Gary L.; Whitaker, William D.; Dillon, James W.; Lux, James P.; Ahmad, Mohammad

2009-01-01

In this protocol and packet format, data traffic is monitored by all network interfaces to determine the health of transmitter and subsystems. When failures are detected, the network inter face applies its recover y policies to provide continued service despite the presence of faults. The protocol, packet format, and inter face are independent of the data link technology used. The current demonstration system supports both commercial off-the-shelf wireless connections and wired Ethernet connections. Other technologies such as 1553 or serial data links can be used for the network backbone. The Wireless Avionics packet is divided into three parts: a header, a data payload, and a checksum. The header has the following components: magic number, version, quality of service, time to live, sending transceiver, function code, payload length, source Application Data Interface (ADI) address, destination ADI address, sending node address, target node address, and a sequence number. The magic number is used to identify WAV packets, and allows the packet format to be updated in the future. The quality of service field allows routing decisions to be made based on this value and can be used to route critical management data over a dedicated channel. The time to live value is used to discard misrouted packets while the source transceiver is updated at each hop. This information is used to monitor the health of each transceiver in the network. To identify the packet type, the function code is used. Besides having a regular data packet, the system supports diagnostic packets for fault detection and isolation. The payload length specifies the number of data bytes in the payload, and this supports variable-length packets in the network. The source ADI is the address of the originating interface. This can be used by the destination application to identify the originating source of the packet where the address consists of a subnet, subsystem class within the subnet, a subsystem unit, and the local ADI number. The destination ADI is used to route the packet to its ultimate destination. At each hop, the sending interface uses the destination address to determine the next node for the data. The sending node is the node address of the interface that is broadcasting the packet. This field is used to determine the health of the subsystem that is sending the packet. In the case of a packet that traverses several intermediate nodes, it may be the node address of the intermediate node. The target node is the node address of the next hop for the packet. It may be an intermediate node, or the final destination for the packet. The sequence number is used to identify duplicate packets. Because each interface has multiple transceivers, the same packet will appear at both receivers. The sequence number allows the interface to correlate the reception and forward a single, unique packet for additional processing. The subnet field allows data traffic to be partitioned into segregated local networks to support large networks while keeping each subnet at a manageable size. This also keeps the routing table small enough so routing can be done by a simple table lookup in an FPGA device. The subsystem class identifies members of a set of redundant subsystems, and, in a hot standby configuration, all members of the subsystem class will receive the data packets. Only the active subsystem will generate data traffic. Specific units in a class of redundant units can be identified and, if the hot standby configuration is not used, packets will be directed to a specific subsystem unit.

The Role of Support Services in Promoting Social Inclusion for the Disadvantaged Urban-dwelling Elderly

PubMed Central

Nguyen, Vicky P.K.H.; Sarkari, Feroz; MacNeil, Kate; Cowan, Laura; Rankin, Joyce

2013-01-01

Background Disadvantaged older adults living in non-family situations in Toronto are more likely than older adults living in family situations to have less economic security, less social support, and less choice in housing. Older adults who live in poverty and are precariously housed are more likely to be chronically ill, to live with multiple illnesses, to have poor nutrition, high stress and loneliness, all of which are strongly associated with the determinant of health social exclusion. The aim of this study is to: 1) evaluate the level of social disadvantage and exclusion experienced by low-income older adults 65 years of age and older living alone or in non-family situations; 2) assess the level of dependency on government and community services (support services) to maintain a reasonable standard of living (minimize effects of social exclusion); and 3) identify consequences of social exclusion not addressed by current available services. Methods Fifteen male older adult members of the Good Neighbours’ Club in downtown Toronto were interviewed. Semi-structured questionnaires assessed barriers to, utility of, and perceived impact of support services available to disadvantaged older adults living in the central core of southeast Toronto. Results Support services for income, housing, food security, social support, and health care do mitigate the effects of social exclusion in the study participants. Data gathered from interviews identified factors that counter the efforts by support services to increase social inclusion in this population. Conclusions Support services reduce social isolation experienced by these older adults. Evidence of the detrimental impact of low financial literacy suggests a need to design and implement training programs to build the older adults’ capacity to manage their own finances effectively, and resist falling victim to financial fraud. PMID:24278093

The Role of Support Services in Promoting Social Inclusion for the Disadvantaged Urban-dwelling Elderly.

PubMed

Nguyen, Vicky P K H; Sarkari, Feroz; Macneil, Kate; Cowan, Laura; Rankin, Joyce

2013-01-01

Disadvantaged older adults living in non-family situations in Toronto are more likely than older adults living in family situations to have less economic security, less social support, and less choice in housing. Older adults who live in poverty and are precariously housed are more likely to be chronically ill, to live with multiple illnesses, to have poor nutrition, high stress and loneliness, all of which are strongly associated with the determinant of health social exclusion. The aim of this study is to: 1) evaluate the level of social disadvantage and exclusion experienced by low-income older adults 65 years of age and older living alone or in non-family situations; 2) assess the level of dependency on government and community services (support services) to maintain a reasonable standard of living (minimize effects of social exclusion); and 3) identify consequences of social exclusion not addressed by current available services. Fifteen male older adult members of the Good Neighbours' Club in downtown Toronto were interviewed. Semi-structured questionnaires assessed barriers to, utility of, and perceived impact of support services available to disadvantaged older adults living in the central core of southeast Toronto. Support services for income, housing, food security, social support, and health care do mitigate the effects of social exclusion in the study participants. Data gathered from interviews identified factors that counter the efforts by support services to increase social inclusion in this population. Support services reduce social isolation experienced by these older adults. Evidence of the detrimental impact of low financial literacy suggests a need to design and implement training programs to build the older adults' capacity to manage their own finances effectively, and resist falling victim to financial fraud.

Road to better health and integration: a Delphi study on health service models for Hong Kong migrants.

PubMed

Wong, William C W; Ho, Petula S Y; Liang, Jun; Holroyd, Eleanor A; Lam, Cindy L K; Pau, Agnes M Y

2014-12-19

In Hong Kong, migrants arriving from Mainland China often have multiple roles and responsibilities while adapting to new lives in their host destination. This paper explored the factors that contribute to the inequity in health services utilisation experienced by these migrants; and, identified the elements that could constitute an effective health delivery model to address the service gap. Site visits and a focus group discussion (n = 13) were held with both public and private health providers before a number of innovative health delivery models were formulated. They were then circulated among the panel in two further rounds of Delphi survey (n = 11) from March-April 2012 to systematically collect opinions and select the most endorsed health service models to serve this target population. Focus group members perceived that most migrants were unaware of, or even ignored, their own physical and mental health needs, and had low utilisation of healthcare services, because of their pre-occupation with daily chores and hardship as well as differing health values, practices and expectations. They further identified that the structural issues such as the healthcare setting or the operation of current service provisions had failed to meet migrants' health needs. Consequently, four new service models that incorporated professional advice and empowerment, which were identified as the two most important elements, were put forward. Thus, the model of having a nurse with social work training, supported by volunteer groups, was selected as the best option to familiarise and empower patients within the labyrinth of local healthcare services. Implementation of a social empowerment model by way of targeted support and specific health information is recommended. Further evaluation of this model is needed to understand its effectiveness for improving health literacy and health status in this disadvantaged group in the long term.

Note: Toward multiple addressable optical trapping

PubMed Central

Faustov, Alexei R.; Webb, Michael R.; Walt, David R.

2010-01-01

We describe a setup for addressable optical trapping in which a laser source is focused on a digital micromirror device and generates an optical trap in a microfluidic cell. In this paper, we report a proof-of-principle single beam∕single micromirror∕single three-dimensional trap arrangement that should serve as the basis for a multiple-trap instrument. PMID:20192526

DataHub: Knowledge-based data management for data discovery

NASA Astrophysics Data System (ADS)

Handley, Thomas H.; Li, Y. Philip

1993-08-01

Currently available database technology is largely designed for business data-processing applications, and seems inadequate for scientific applications. The research described in this paper, the DataHub, will address the issues associated with this shortfall in technology utilization and development. The DataHub development is addressing the key issues in scientific data management of scientific database models and resource sharing in a geographically distributed, multi-disciplinary, science research environment. Thus, the DataHub will be a server between the data suppliers and data consumers to facilitate data exchanges, to assist science data analysis, and to provide as systematic approach for science data management. More specifically, the DataHub's objectives are to provide support for (1) exploratory data analysis (i.e., data driven analysis); (2) data transformations; (3) data semantics capture and usage; analysis-related knowledge capture and usage; and (5) data discovery, ingestion, and extraction. Applying technologies that vary from deductive databases, semantic data models, data discovery, knowledge representation and inferencing, exploratory data analysis techniques and modern man-machine interfaces, DataHub will provide a prototype, integrated environement to support research scientists' needs in multiple disciplines (i.e. oceanography, geology, and atmospheric) while addressing the more general science data management issues. Additionally, the DataHub will provide data management services to exploratory data analysis applications such as LinkWinds and NCSA's XIMAGE.

Integrating human health and ecological concerns in risk assessments.

PubMed

Cirone, P A; Bruce Duncan, P

2000-11-03

The interconnections between ecosystems, human health and welfare have been increasingly recognized by the US government, academia, and the public. This paper continues this theme by addressing the use of risk assessment to integrate people into a single assessment. In a broad overview of the risk assessment process we stress the need to build a conceptual model of the whole system including multiple species (humans and other ecological entities), stressors, and cumulative effects. We also propose converging landscape ecology and evaluation of ecosystem services with risk assessment to address these cumulative responses. We first look at how this integration can occur within the problem formulation step in risk assessment where the system is defined, a conceptual model created, a subset of components and functions selected, and the analytical framework decided in a context that includes the management decisions. A variety of examples of problem formulations (salmon, wild insects, hyporheic ecosystems, ultraviolet (UV) radiation, nitrogen fertilization, toxic chemicals, and oil spills) are presented to illustrate how treating humans as components of the landscape can add value to risk assessments. We conclude that the risk assessment process should help address the urgent needs of society in proportion to importance, to provide a format to communicate knowledge and understanding, and to inform policy and management decisions.

Invited OSU class lecture: An integrated eco-hydrologic modeling framework for assessing the effects of interacting stressors on multiple ecosystem services

EPA Science Inventory

The U.S. Environmental Protection Agency recently established the Ecosystem Services Research Program to help formulate methods and models for conducting comprehensive risk assessments that quantify how multiple ecosystem services interact and respond in concert to environmental ...

An integrated eco-hydrologic modeling framework for assessing the effects of interacting stressors on multiple ecosystem services - 4/27/10

EPA Science Inventory

The U.S. Environmental Protection Agency recently established the Ecosystem Services Research Program to help formulate methods and models for conducting comprehensive risk assessments that quantify how multiple ecosystem services interact and respond in concert to environmental ...

Recognizing, Determining, and Addressing Entrepreneurial Innovations by Superintendents of Emerging or Established Educational Service Agencies

ERIC Educational Resources Information Center

Arfstrom, Kari M.

2009-01-01

This dissertation describes how entrepreneurial superintendents of educational service agencies (ESAs) recognize, determine and address common and distinct innovative characteristics within emerging or established regional educational environments. Because internal and external factors assist in recognizing innovative practices, this study…

Compositional diversity of rehabilitated tropical lands supports multiple ecosystem services and buffers uncertainties

PubMed Central

Knoke, Thomas; Paul, Carola; Hildebrandt, Patrick; Calvas, Baltazar; Castro, Luz Maria; Härtl, Fabian; Döllerer, Martin; Hamer, Ute; Windhorst, David; Wiersma, Yolanda F.; Curatola Fernández, Giulia F.; Obermeier, Wolfgang A.; Adams, Julia; Breuer, Lutz; Mosandl, Reinhard; Beck, Erwin; Weber, Michael; Stimm, Bernd; Haber, Wolfgang; Fürst, Christine; Bendix, Jörg

2016-01-01

High landscape diversity is assumed to increase the number and level of ecosystem services. However, the interactions between ecosystem service provision, disturbance and landscape composition are poorly understood. Here we present a novel approach to include uncertainty in the optimization of land allocation for improving the provision of multiple ecosystem services. We refer to the rehabilitation of abandoned agricultural lands in Ecuador including two types of both afforestation and pasture rehabilitation, together with a succession option. Our results show that high compositional landscape diversity supports multiple ecosystem services (multifunction effect). This implicitly provides a buffer against uncertainty. Our work shows that active integration of uncertainty is only important when optimizing single or highly correlated ecosystem services and that the multifunction effect on landscape diversity is stronger than the uncertainty effect. This is an important insight to support a land-use planning based on ecosystem services. PMID:27292766

Compositional diversity of rehabilitated tropical lands supports multiple ecosystem services and buffers uncertainties.

PubMed

Knoke, Thomas; Paul, Carola; Hildebrandt, Patrick; Calvas, Baltazar; Castro, Luz Maria; Härtl, Fabian; Döllerer, Martin; Hamer, Ute; Windhorst, David; Wiersma, Yolanda F; Curatola Fernández, Giulia F; Obermeier, Wolfgang A; Adams, Julia; Breuer, Lutz; Mosandl, Reinhard; Beck, Erwin; Weber, Michael; Stimm, Bernd; Haber, Wolfgang; Fürst, Christine; Bendix, Jörg

2016-06-13

High landscape diversity is assumed to increase the number and level of ecosystem services. However, the interactions between ecosystem service provision, disturbance and landscape composition are poorly understood. Here we present a novel approach to include uncertainty in the optimization of land allocation for improving the provision of multiple ecosystem services. We refer to the rehabilitation of abandoned agricultural lands in Ecuador including two types of both afforestation and pasture rehabilitation, together with a succession option. Our results show that high compositional landscape diversity supports multiple ecosystem services (multifunction effect). This implicitly provides a buffer against uncertainty. Our work shows that active integration of uncertainty is only important when optimizing single or highly correlated ecosystem services and that the multifunction effect on landscape diversity is stronger than the uncertainty effect. This is an important insight to support a land-use planning based on ecosystem services.

Assessing and managing multiple risks in a changing world-The Roskilde recommendations.

PubMed

Selck, Henriette; Adamsen, Peter B; Backhaus, Thomas; Banta, Gary T; Bruce, Peter K H; Burton, G Allen; Butts, Michael B; Boegh, Eva; Clague, John J; Dinh, Khuong V; Doorn, Neelke; Gunnarsson, Jonas S; Hauggaard-Nielsen, Henrik; Hazlerigg, Charles; Hunka, Agnieszka D; Jensen, John; Lin, Yan; Loureiro, Susana; Miraglia, Simona; Munns, Wayne R; Nadim, Farrokh; Palmqvist, Annemette; Rämö, Robert A; Seaby, Lauren P; Syberg, Kristian; Tangaa, Stine R; Thit, Amalie; Windfeld, Ronja; Zalewski, Maciej; Chapman, Peter M

2017-01-01

Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk-Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process; dealing with societal issues; risk-management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. The authors encourage both cross-disciplinary and interdisciplinary approaches to address their 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and nonchemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk-assessment process; 4) fully integrate risk assessors and communities of interest into the risk-management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological context for assessments in human-modified systems; 8) assess risks and benefits to humans and the ecosystem and consider unintended consequences of management actions; 9) avoid excessive conservatism or possible underprotection resulting from sole reliance on binary, numerical benchmarks; and 10) develop adaptive risk-management and regulatory goals based on ranges of uncertainty. Environ Toxicol Chem 2017;36:7-16. © 2016 SETAC. © 2016 SETAC.

Reconfigurable optical interconnections via dynamic computer-generated holograms

NASA Technical Reports Server (NTRS)

Liu, Hua-Kuang (Inventor); Zhou, Shaomin (Inventor)

1994-01-01

A system is proposed for optically providing one-to-many irregular interconnections, and strength-adjustable many-to-many irregular interconnections which may be provided with strengths (weights) w(sub ij) using multiple laser beams which address multiple holograms and means for combining the beams modified by the holograms to form multiple interconnections, such as a cross-bar switching network. The optical means for interconnection is based on entering a series of complex computer-generated holograms on an electrically addressed spatial light modulator for real-time reconfigurations, thus providing flexibility for interconnection networks for largescale practical use. By employing multiple sources and holograms, the number of interconnection patterns achieved is increased greatly.

Conservation of soil organic carbon, biodiversity and the provision of other ecosystem services along climatic gradients in West Africa

NASA Astrophysics Data System (ADS)

Marks, E.; Aflakpui, G. K. S.; Nkem, J.; Poch, R. M.; Khouma, M.; Kokou, K.; Sagoe, R.; Sebastiã, M.-T.

2008-11-01

Terrestrial carbon resources are major drivers of development in West Africa. The distribution of these resources co-varies with ecosystem type and rainfall along a strong Northeast-Southwest climatic gradient. Soil organic carbon, a strong indicator of soil quality, has been severely depleted in some areas by human activities, which leads to issues of soil erosion and desertification, but this trend can be altered via appropriate management. There is significant potential to enhance existing soil carbon stores in West Africa, with benefits at the global and local scales, for atmospheric CO2 mitigation and supporting, and provisioning ecosystem services, respectively. Three key factors impacting carbon stocks are addressed in this review: climate, biotic factors, and human activities. Climate risks must be considered in a framework of global change, especially in West Africa, where landscape managers have few resources available to adapt to climatic perturbations. Among biotic factors, biodiversity conservation paired with carbon conservation may provide a pathway to sustainable development, as evidence suggests that both may be inter-linked, and biodiversity conservation is also a global priority with local benefits for ecosystem resilience, biomass productivity, and provisioning services such as foodstuffs. Finally, human management has largely been responsible for reduced carbon stocks, but this trend can be reversed through the implementation of appropriate carbon conservation strategies in the agricultural sector, as shown by multiple studies. Owing to the strong regional climatic gradient, country-level initiatives will need to consider carbon sequestration approaches for multiple ecosystem types. Given the diversity of environments, global policies must be adapted and strategised at the national or sub-national levels to improve C storage above and belowground. Initiatives of this sort must act locally at farmer scale, and focus on ecosystem services rather than on carbon sequestration solely.

An Assessment of Institutional Capacity for Integrated Landscape Management in Eastern Cameroon.

PubMed

Brown, H Carolyn Peach

2018-07-01

Landscape approaches have become prominent in efforts to address issues of conservation and development through bringing together different actors and sectors, to reconcile diverse land uses, and promote synergies. Some have suggested that integrated landscape management approaches are consistent with the goals of REDD+ and offer a strategy to address multiple goals of climate change mitigation, biodiversity conservation, maintenance of ecosystem services, and socio-economic development. Institutional or governance arrangements have been shown to be a critical component in influencing outcomes in landscapes. Using diverse methodologies, this study investigated the capacity of institutions to support the planning, implementation, and resource mobilization needed to integrate climate change mitigation, conservation, and livelihood goals in a forest mosaic landscape in East Cameroon. Results showed that diverse institutions are present in the landscape, including institutions of relevant government agencies, local government, local non-government, the private sector, and hybrid institutions of conservation, development and research institutions. However, the overall institutional capacity for integrated landscape planning and management in the study area is limited, although some institutions exhibit increased capacity in some areas over others. Multiple strategies can be employed to build the necessary human, financial, and leadership capacity, and facilitate the institutional planning and coordination that is foundational to multi-stakeholder landscape governance. Given the complexity of integrating climate change mitigation, conservation and livelihood goals in a landscape, building such institutional capacity is a long term endeavour that requires sustained effort and ongoing financial, technical and human resource support.

Socioeconomic disadvantage as a social determinant of teen childbearing in the U.S.

PubMed

Penman-Aguilar, Ana; Carter, Marion; Snead, M Christine; Kourtis, Athena P

2013-01-01

We reviewed the literature focused on socioeconomic influences on teen childbearing and suggested directions for future research and practice related to this important indicator of teen sexual health. We conducted an electronic search of Medline, ERIC, PsychLit, and Sociological Abstracts databases for articles published from January 1995 to November 2011. Selected articles from peer-reviewed journals included original quantitative analyses addressing socioeconomic influences on first birth among teen women in the U.S. Articles were abstracted for key information, ranked for quality according to the U.S. Preventive Services Task Force guidelines, assessed for bias, and synthesized. We selected articles with a range of observational study designs. Risk for bias varied across studies. All 12 studies that considered socioeconomic factors as influences on teen childbearing (vs. moderators or mediators of other effects) reported at least one statistically significant association relating low socioeconomic status, underemployment, low income, low education levels, neighborhood disadvantage, neighborhood physical disorder, or neighborhood-level income inequality to teen birth. Few reports included any associations contradicting this pattern. This review suggests that unfavorable socioeconomic conditions experienced at the community and family levels contribute to the high teen birth rate in the U.S. Future research into social determinants of sexual health should include multiple levels of measurement whenever possible. Root causes of teen childbearing should be evaluated in various populations and contexts. Interventions that address socioeconomic influences at multiple levels could positively affect large numbers of teens and help eliminate disparities in teen childbearing.

A Bayesian-Based Approach to Marine Spatial Planning: Evaluating Spatial and Temporal Variance in the Provision of Ecosystem Services Before and After the Establishment Oregon's Marine Protected Areas

NASA Astrophysics Data System (ADS)

Black, B.; Harte, M.; Goldfinger, C.

2017-12-01

Participating in a ten-year monitoring project to assess the ecological, social, and socioeconomic impacts of Oregon's Marine Protected Areas (MPAs), we have worked in partnership with the Oregon Department of Fish and Wildlife (ODFW) to develop a Bayesian geospatial method to evaluate the spatial and temporal variance in the provision of ecosystem services produced by Oregon's MPAs. Probabilistic (Bayesian) approaches to Marine Spatial Planning (MSP) show considerable potential for addressing issues such as uncertainty, cumulative effects, and the need to integrate stakeholder-held information and preferences into decision making processes. To that end, we have created a Bayesian-based geospatial approach to MSP capable of modelling the evolution of the provision of ecosystem services before and after the establishment of Oregon's MPAs. Our approach permits both planners and stakeholders to view expected impacts of differing policies, behaviors, or choices made concerning Oregon's MPAs and surrounding areas in a geospatial (map) format while simultaneously considering multiple parties' beliefs on the policies or uses in question. We quantify the influence of the MPAs as the shift in the spatial distribution of ecosystem services, both inside and outside the protected areas, over time. Once the MPAs' influence on the provision of coastal ecosystem services has been evaluated, it is possible to view these impacts through geovisualization techniques. As a specific example of model use and output, a user could investigate the effects of altering the habitat preferences of a rockfish species over a prescribed period of time (5, 10, 20 years post-harvesting restrictions, etc.) on the relative intensity of spillover from nearby reserves (please see submitted figure). Particular strengths of our Bayesian-based approach include its ability to integrate highly disparate input types (qualitative or quantitative), to accommodate data gaps, address uncertainty, and to investigate temporal and spatial variation. This approach conveys the modeled outcome of proposed policy changes and is also a vehicle through which stakeholders and planners can work together to compare and deliberate on the impacts of policy and management changes, a capacity of considerable utility for planners and stakeholders engaged in MSP.

75 FR 57797 - Ocean Transportation Intermediary License Revocations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-22

... been revoked pursuant to section 19 of the Shipping Act of 1984 (46 U.S.C. Chapter 409) and the.... Knott dba DAK Logistics Services. Address: 1010 Bluejay Drive, Suisun City, CA 94585. Date Revoked...: R D Shipping Multy Services Inc. Address: 809 Adams Avenue, Elizabeth, NJ 07201. Date Revoked...

47 CFR 64.3100 - Restrictions on mobile service commercial messages.

Code of Federal Regulations, 2011 CFR

2011-10-01

... advertise or promote a product, service, or Internet website of the person or entity forwarding the message... subscriber; (2) Include a functioning return electronic mail address or other Internet-based mechanism that... communications made to the electronic mail address, other Internet-based mechanism or, if applicable, other...

Reciprocal and Scholarly Service Learning: Emergent Theoretical Understandings of the University-Community Interface in South Africa

ERIC Educational Resources Information Center

Smith-Tolken, Antoinette; Bitzer, Eli

2017-01-01

This study addresses underlying principles to interpret scholarly-based service-related teaching and learning. Such principles include addressing specific concerns of communities, transforming theoretical knowledge into lived experiences for students, making the knowledge generated within communities meaningful and forging constant growth and…

49 CFR 604.13 - Registration of private charter operators.

Code of Federal Regulations, 2011 CFR

2011-10-01

... provider: (1) Company name, address, phone number, e-mail address, and facsimile number; (2) Federal and, if available, state motor carrier identifying number; (3) The geographic service areas of public... intends to provide charter service; (4) The number of buses or vans the private charter operator owns; (5...

49 CFR 604.13 - Registration of private charter operators.

Code of Federal Regulations, 2013 CFR

2013-10-01

... provider: (1) Company name, address, phone number, e-mail address, and facsimile number; (2) Federal and, if available, state motor carrier identifying number; (3) The geographic service areas of public... intends to provide charter service; (4) The number of buses or vans the private charter operator owns; (5...

49 CFR 604.13 - Registration of private charter operators.

Code of Federal Regulations, 2014 CFR

2014-10-01

... provider: (1) Company name, address, phone number, e-mail address, and facsimile number; (2) Federal and, if available, state motor carrier identifying number; (3) The geographic service areas of public... intends to provide charter service; (4) The number of buses or vans the private charter operator owns; (5...

49 CFR 604.13 - Registration of private charter operators.

Code of Federal Regulations, 2012 CFR

2012-10-01

... provider: (1) Company name, address, phone number, e-mail address, and facsimile number; (2) Federal and, if available, state motor carrier identifying number; (3) The geographic service areas of public... intends to provide charter service; (4) The number of buses or vans the private charter operator owns; (5...

31 CFR Appendix B to Subpart A of... - Internal Revenue Service

Code of Federal Regulations, 2010 CFR

2010-07-01

... CFR 601.702. 2. Public reading room. The public reading rooms for the Internal Revenue Service are maintained at the following location: National Office Mailing Address Freedom of Information Reading Room, PO... Avenue, NW., Washington, DC Northeast Region Mailing Address Freedom of Information Reading Room, PO Box...

Genitourinary Injuries Sustained by Female U.S. Service Members During Operation Iraqi Freedom and Operation Enduring Freedom

DTIC Science & Technology

2017-10-07

2. REPORT TYPE 10/07/2017 Presentation 4. TITLE AND SUBTITLE GENITOURINARY INJURIES SUSTAINED BY FEMALE U.S. SERVICE MEMBERS DURING OPERATION ...IRAQI FREEDOM AND OPERATION ENDURING FREEDOM 6. AUTHOR(S) Author: Capt Amy Reed 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 59th Clinical...Professional 7 .0 GENITOURINARY INJURIES SUSTAINED BY FEMALE U.S. SERVICE MEMBERS DURING OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM

FASMA: a service to format and analyze sequences in multiple alignments.

PubMed

Costantini, Susan; Colonna, Giovanni; Facchiano, Angelo M

2007-12-01

Multiple sequence alignments are successfully applied in many studies for under- standing the structural and functional relations among single nucleic acids and protein sequences as well as whole families. Because of the rapid growth of sequence databases, multiple sequence alignments can often be very large and difficult to visualize and analyze. We offer a new service aimed to visualize and analyze the multiple alignments obtained with different external algorithms, with new features useful for the comparison of the aligned sequences as well as for the creation of a final image of the alignment. The service is named FASMA and is available at http://bioinformatica.isa.cnr.it/FASMA/.

Ecosystem services altered by human changes in the nitrogen cycle: A new perspective for assessment

NASA Astrophysics Data System (ADS)

Compton, J. E.; Harrison, J.; Dennis, R. L.; Greaver, T.; Hill, B.; Jordan, S. J.; Walker, H.; Campbell, H. V.

2011-12-01

Human alteration of the nitrogen (N) cycle has produced benefits for health and well-being, but excess N has altered many ecosystems and degraded air and water quality. US regulations mandate protection of the environment in terms that directly connect to ecosystem services. Here, we review the science quantifying effects of N on key ecosystem services, and synthesize existing information concerning the costs of N-related impacts or mitigation using the metric of cost per unit of N. Damage costs to the provision of clean air, reflected by impaired human respiratory health, are well characterized and fairly high (e.g. costs of ozone and particulate damages of 28 per kg NOx-N). We also consider the impacts of nitrogen and climate interactions. Damage to services associated with productivity, biodiversity, recreation and clean water are less certain and although generally lower, these costs are quite variable (< 2.2-56 per kg N). In the current Chesapeake Bay restoration effort, for example, the collection of available damage costs clearly exceeds the projected abatement costs to reduce N loads to the Bay ($8-15 per kg N). Although few damage costs specifically consider climate-nitrogen interactions, changes in precipitation and temperature are expected to have synergistic impacts on drinking water quality and eutrophication in particular. Explicit consideration and accounting of effects on multiple ecosystem services provides decision-makers an integrated view of N sources, damages and abatement costs to address the significant challenges associated with reducing N pollution.

Using ArcGIS software in the pre-hospital emergency medical system.

PubMed

Manole, M; Duma, Odetta; Custură, Maria Alexandra; Petrariu, F D; Manole, Alina

2014-01-01

To measure the accessibility to healtcare services in order to reveal their quality and to improve the overall coverage, continuity and other features. We used the software ESRI Arc GIS 9.3, the Network Analyst function and data provided by Ambulance Service of Iasi (A.S.I.) with emergencies statistics for the first four months of 2012, processed by Microsoft Office Excel 2010. As examples, we chose "St. Maria" Children's Emergency Hospital and "St. Spiridon" Emergency Hospital. ArcGIS Network Analyst finds the best route to get from one location to another or a route that includes multiple locations. Each route is characterized by three stops. The starting point is always the office of Ambulance Service of Iasi (A.S.I.), a second stop at the case address and the third to the hospital unit chosen according to the patient's diagnosis and age. Spatial distribution of emergency cases for the first four months of 2012 in these two examples is one unequable, with higher concentrations in districts located in two areas of the city. The presented examples highlight the poor coverage of healthcare services for the population of Iasi, Romania, especially the South-West area and its vulnerability in situations of emergency. Implementing such a broad project would lead to more complex analyses that would improve the situation of pre-hospital emergency medical services, with final goal to deserve the population, improve the quality of healthcare and develop the interdisciplinary relationships.

Barriers to rehabilitative care for young breast cancer survivors: a qualitative understanding.

PubMed

Miedema, Baukje; Easley, Julie

2012-06-01

The goal of this study was to assess the rehabilitation needs of young women breast cancer survivors under the age of 50 and to identify factors that may impact or prevent cancer rehabilitation utilization. Utilizing a grounded theory methodology, 35 young breast cancer survivors were interviewed twice in four Atlantic Canadian provinces. A considerable number of barriers exist to receiving rehabilitative care post-treatment for young breast cancer survivors. The systemic barriers include the lack of availability of services, travel issues, cost of services, and the lack of support to address the unique needs for this age group. However, the most complicated barriers to accessing rehabilitative care were personal barriers which related more to choice and circumstances, such as the lack of time due to family responsibilities and appointment fatigue. Many of these personal barriers were rooted in the complex set of gender roles of young women as patients, mothers, workers, and caregivers. The contexts of young women's lives can have a substantial impact on their decisions to seek and receive rehabilitative care after breast cancer treatment. The systemic barriers can be reduced by introducing more services or financial assistance; however, the personal barriers to rehabilitation services are difficult to ameliorate due to the complex set of roles within and outside the family for this group of young breast cancer survivors. Health care providers need to take into consideration the multiple contexts of women's lives when developing and promoting breast cancer rehabilitation services and programs.

A Survey of Parents with Children on the Autism Spectrum: Experience with Services and Treatments.

PubMed

Becerra, Tracy A; Massolo, Maria L; Yau, Vincent M; Owen-Smith, Ashli A; Lynch, Frances L; Crawford, Phillip M; Pearson, Kathryn A; Pomichowski, Magdalena E; Quinn, Virginia P; Yoshida, Cathleen K; Croen, Lisa A

2017-01-01

Autism spectrum disorders (ASD) are lifelong neurodevelopmental disorders, and little is known about how parents address the health and psychosocial consequences of ASD. Few studies have examined use of various treatments and services in a large, diverse sample of children with ASD and their families. This paper presents methods to create an autism research resource across multiple large health delivery systems and describes services and treatments used by children with ASD and their families. Four study sites conducted a Web survey of parents of children and adolescents with ASD who were members of Kaiser Permanente. We tabulated data distributions of survey responses and calculated χ 2 statistics for differences between responders and nonresponders. The children of the 1155 respondents were racially and ethnically diverse (55% white, 6% black, 5% Asian, 9% multiracial, 24% Hispanic) and representative of the total population invited to participate with respect to child sex (83% male), child age (57% < 10 years), and ASD diagnosis (64% autistic disorder). The most frequently used services and treatments were Individualized Education Programs (85%), family physician visits (78%), and occupational and speech therapy (55% and 60%, respectively). Home-based programs frequently included implementation of social skills training (44%) and behavior management (42%). Prescription medication use was high (48%). Caregivers reported disruption of personal and family routines because of problem behaviors. These survey data help to elucidate parents' experiences with health services for their children with ASD and serve as a potential resource for future research.

Pre-Service Teachers' Understanding of Fraction Multiplication, Representational Knowledge, and Computational Skills

ERIC Educational Resources Information Center

Son, Ji-Won; Lee, Ji-Eun

2016-01-01

Despite the importance of teacher fractional knowledge, there are several areas of teacher understanding that are not well understood. The purpose of this study was to characterise profiles of pre-service teachers' (PSTs) mathematical competence on the topic of fraction multiplication by examining PSTs' understanding of multiplication of fractions…

Teaching Multiple Literacies and Critical Literacy to Pre-Service Teachers through Children's-Literature-Based Engagements

ERIC Educational Resources Information Center

Lee, Cheu-jey

2016-01-01

This paper presents a pragmatic way of introducing pre-service teachers to multiple literacies and critical literacy through children's-literature-based engagements. The concepts of multiple literacies and critical literacy are reviewed, and their interrelationship is explained. Two instructional engagements, which connect theory to practice…

Contextual adaptation of the Personnel Evaluation Standards for assessing faculty evaluation systems in developing countries: the case of Iran

PubMed Central

Ahmady, Soleiman; Changiz, Tahereh; Brommels, Mats; Gaffney, F Andrew; Thor, Johan; Masiello, Italo

2009-01-01

Background Faculty evaluations can identify needs to be addressed in effective development programs. Generic evaluation models exist, but these require adaptation to a particular context of interest. We report on one approach to such adaptation in the context of medical education in Iran, which is integrated into the delivery and management of healthcare services nationwide. Methods Using a triangulation design, interviews with senior faculty leaders were conducted to identify relevant areas for faculty evaluation. We then adapted the published checklist of the Personnel Evaluation Standards to fit the Iranian medical universities' context by considering faculty members' diverse roles. Then the adapted instrument was administered to faculty at twelve medical schools in Iran. Results The interviews revealed poor linkages between existing forms of development and evaluation, imbalance between the faculty work components and evaluated areas, inappropriate feedback and use of information in decision making. The principles of Personnel Evaluation Standards addressed almost all of these concerns and were used to assess the existing faculty evaluation system and also adapted to evaluate the core faculty roles. The survey response rate was 74%. Responses showed that the four principles in all faculty members' roles were met occasionally to frequently. Evaluation of teaching and research had the highest mean scores, while clinical and healthcare services, institutional administration, and self-development had the lowest mean scores. There were statistically significant differences between small medium and large medical schools (p < 0.000). Conclusion The adapted Personnel Evaluation Standards appears to be valid and applicable for monitoring and continuous improvement of a faculty evaluation system in the context of medical universities in Iran. The approach developed here provides a more balanced assessment of multiple faculty roles, including educational, clinical and healthcare services. In order to address identified deficiencies, the evaluation system should recognize, document, and uniformly reward those activities that are vital to the academic mission. Inclusion of personal developmental concerns in the evaluation discussion is essential for evaluation systems. PMID:19400932

The changing paradigm for integrated simulation in support of Command and Control (C2)

NASA Astrophysics Data System (ADS)

Riecken, Mark; Hieb, Michael

2016-05-01

Modern software and network technologies are on the verge of enabling what has eluded the simulation and operational communities for more than two decades, truly integrating simulation functionality into operational Command and Control (C2) capabilities. This deep integration will benefit multiple stakeholder communities from experimentation and test to training by providing predictive and advanced analytics. There is a new opportunity to support operations with simulation once a deep integration is achieved. While it is true that doctrinal and acquisition issues remain to be addressed, nonetheless it is increasingly obvious that few technical barriers persist. How will this change the way in which common simulation and operational data is stored and accessed? As the Services move towards single networks, will there be technical and policy issues associated with sharing those operational networks with simulation data, even if the simulation data is operational in nature (e.g., associated with planning)? How will data models that have traditionally been simulation only be merged in with operational data models? How will the issues of trust be addressed?

Criminal justice coercion in the treatment of alcohol problems: an examination of two client subgroups.

PubMed

Polcin, D L

1999-01-01

An increasing number of individuals are being referred to alcohol treatment programs under coercion from the criminal justice system. While a substantial number of investigations have addressed coercive treatment for illicit drug-related offenses, fewer studies have focused on mandated treatment for alcohol-related problems. This article examines the treatment of two subgroups of clients coerced into alcohol treatment from criminal justice institutions. The article begins with an overview of the literature on clients coerced into treatment as a result of "driving under the influence" (DUI) charges. The characteristics of a subgroup that has received less attention are then described: lower socioeconomic clients who are coerced into alcohol treatment from the courts for non-DUI offenses, such as public inebriation, disorderly conduct, trespassing, assault, and theft. This subgroup of non-DUI coerced-treatment offenders depends primarily upon underfunded public services, although their treatment requires careful assessment and triage for multiple problem areas. The article addresses some potential political and economic roadblocks to comprehensive treatment and closes with questions and recommendations for further research.

Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless.

PubMed

Poremski, Daniel; Woodhall-Melnik, Julia; Lemieux, Ashley J; Stergiopoulos, Vicky

2016-02-01

Adults with mental illness who are homeless experience multiple barriers to employment, contributing to difficulties securing and maintaining housing. Housing First programs provide quick, low-barrier access to housing and support services for this population, but their success in improving employment outcomes has been limited. Supported employment interventions may augment Housing First programs and address barriers to employment for homeless adults with mental illness. The present paper presents data from qualitative interviews to shed light on the persisting barriers to employment among people formerly homeless. Once housed, barriers to employment persisted, including the following: (1) worries about disclosing sensitive information, (2) fluctuating motivation, (3) continued substance use, and (4) fears about re-experiencing homelessness-related trauma. Nevertheless, participants reported that their experiences of homelessness helped them develop interpersonal strength and resilience. Discussing barriers with an employment specialist helps participants develop strategies to overcome them, but employment specialists must be sensitive to specific homelessness-related experiences that may not be immediately evident. Supported housing was insufficient to help people return to employment. Supported employment may help people return to work by addressing persisting barriers.

Remote Data Retrieval for Bioinformatics Applications: An Agent Migration Approach

PubMed Central

Gao, Lei; Dai, Hua; Zhang, Tong-Liang; Chou, Kuo-Chen

2011-01-01

Some of the approaches have been developed to retrieve data automatically from one or multiple remote biological data sources. However, most of them require researchers to remain online and wait for returned results. The latter not only requires highly available network connection, but also may cause the network overload. Moreover, so far none of the existing approaches has been designed to address the following problems when retrieving the remote data in a mobile network environment: (1) the resources of mobile devices are limited; (2) network connection is relatively of low quality; and (3) mobile users are not always online. To address the aforementioned problems, we integrate an agent migration approach with a multi-agent system to overcome the high latency or limited bandwidth problem by moving their computations to the required resources or services. More importantly, the approach is fit for the mobile computing environments. Presented in this paper are also the system architecture, the migration strategy, as well as the security authentication of agent migration. As a demonstration, the remote data retrieval from GenBank was used to illustrate the feasibility of the proposed approach. PMID:21701677

Addressing Gender-Based Violence at Schools for Learners with Intellectual Disability in Gauteng, South Africa: A Multiple Case Study

ERIC Educational Resources Information Center

Phasha, T. N.; Nyokangi, D.

2012-01-01

This paper reports part of the findings of the study which investigated sexual violence at two schools catering specifically for learners with mild intellectual disability in Gauteng Province. It looks particularly on participants' suggestions for addressing sexual violence in such school. A multiple case study within the qualitative research…

Adaptation of a Counseling Intervention to Address Multiple Cancer Risk Factors among Overweight/Obese Latino Smokers

ERIC Educational Resources Information Center

Castro, Yessenia; Fernández, Maria E.; Strong, Larkin L.; Stewart, Diana W.; Krasny, Sarah; Hernandez Robles, Eden; Heredia, Natalia; Spears, Claire A.; Correa-Fernández, Virmarie; Eakin, Elizabeth; Resnicow, Ken; Basen-Engquist, Karen; Wetter, David W.

2015-01-01

More than 60% of cancer-related deaths in the United States are attributable to tobacco use, poor nutrition, and physical inactivity, and these risk factors tend to cluster together. Thus, strategies for cancer risk reduction would benefit from addressing multiple health risk behaviors. We adapted an evidence-based intervention grounded in social…

Multiple pathways to sustainability in the city: the case of San Juan, Puerto Rico

Treesearch

Tischa A. Munoz

2014-01-01

I examined the multiple visions of the future of the city that can emerge when city actors and organizations reconfigure themselves to address sustainability. In various cities worldwide, novel ideas, initiatives, and networks are emerging in governance to address social and ecological conditions in urban areas. However, cities can be contested spaces, bringing a...

Seeking mental health information and support online: experiences and perspectives of young people receiving treatment for first-episode psychosis.

PubMed

Lal, Shalini; Nguyen, Valentin; Theriault, Joanie

2018-06-01

Limited knowledge exists on youth mental health service users' experiences and perspectives of seeking mental health information, services and support online. Such information is important for developing online resources that are tailored to the needs of youth with different types of mental health concerns. The purpose of this study was to better understand the experiences and perspectives of young people receiving treatment for first-episode psychosis (FEP) on using web-based and mobile technologies for accessing mental health information, services and support. A qualitative approach using focus group methods was used. Seventeen participants between the ages of 21 and 35 were recruited from a specialized early intervention program for psychosis. A thematic analysis was conducted. The results are organized under three related themes: striving towards a better understanding of the illness and treatment; encountering multiple issues with accessing information online; and valuing online mental health information and support. The majority of participants described online activities related to information and support, rather than specific types of mental health services or interventions. Youth receiving treatment for FEP value accessing mental health information and support online; however, they encounter several challenges in this regard. The findings can inform the development of online resources and strategies that meet the needs of service users. This study also highlights the importance for mental healthcare professionals to address the topic of online mental health information and support seeking within the context of providing services to young people. © 2016 John Wiley & Sons Australia, Ltd.

A Multiple-Item Scale for Assessing E-Government Service Quality

NASA Astrophysics Data System (ADS)

Papadomichelaki, Xenia; Mentzas, Gregoris

A critical element in the evolution of e-governmental services is the development of sites that better serve the citizens’ needs. To deliver superior service quality, we must first understand how citizens perceive and evaluate online citizen service. This involves defining what e-government service quality is, identifying its underlying dimensions, and determining how it can be conceptualized and measured. In this article we conceptualise an e-government service quality model (e-GovQual) and then we develop, refine, validate, confirm and test a multiple-item scale for measuring e-government service quality for public administration sites where citizens seek either information or services.

Families as full research partners: what's in it for us?

PubMed

Vander Stoep, A; Williams, M; Jones, R; Green, L; Trupin, E

1999-08-01

This article describes a children's managed mental health care program that incorporates both a family participation service model and a family-initiated evaluation model. The authors begin by tracing the evolution of the family support and the participatory research movements leading to current developments in children's mental health services research. In the King County Blended Funding Project, three service systems pool funds that are spent flexibly by child and family teams. Family advocates have led efforts to design and implement the project evaluation. During this process, many tensions have arisen between meeting the demands of both scientific rigor and multiple community stakeholders. Examples are given of the issues raised by family advocates and research scientists as together they established a theory of change, identified meaningful outcomes, selected measurement tools, and implemented the evaluation protocol. Guidelines are given for how services research partnerships can be successfully built to better address community needs. This article was selected as a distinguished research paper based on a presentation by the authors at the 1998 11th annual research conference titled "A system of Care for Children's Mental Health: Expanding the Research Base." This conference is sponsored annually by the Research and Training Center for Children's Mental Health, Department of Child and Family Studies, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa.

Quality of life and economic burdens of malocclusion in U.S. patients enrolled in Medicaid.

PubMed

Bresnahan, Brian W; Kiyak, H Asuman; Masters, Samuel H; McGorray, Susan P; Lincoln, Adam; King, Gregory

2010-10-01

Patients enrolled in Medicaid have limited access to orthodontic services in the United States. No studies are available, to the authors' knowledge, regarding the clinical and psychosocial burdens of malocclusion on these patients from an economic perspective. The authors conducted a systematic review of the relevant economic literature. They identified issues from the perspectives of the various stakeholders (dentists, patients and parents, Medicaid programs) and developed a conceptual model for studying decision making focused on the strategy of providing early interceptive and preventive treatment rather than, or in addition to, comprehensive care in the patient's permanent dentition. Medicaid coverage and reimbursement amounts vary nationwide, and decision making associated with obtaining care can be complex. The perspectives of all relevant stakeholders deserve assessment. A conceptual framework of the cost-effectiveness of interceptive orthodontic treatment compared with comprehensive treatment illustrates the issues to be considered when evaluating these strategies. Policymakers and the dental community should identify creative solutions to addressing low-income families' limited access to orthodontic services and compare them from various perspectives with regard to their relative cost-effectiveness. Dentists should be aware of the multiple problems faced by low-income families in obtaining orthodontic services and the impact of stakeholder issues on access to care; they also should be proactive in helping low-income patients obtain needed orthodontic services.

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

PubMed

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

2017-11-01

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

Leadership, innovation climate, and attitudes toward evidence-based practice during a statewide implementation.

PubMed

Aarons, Gregory A; Sommerfeld, David H

2012-04-01

Leadership is important in practice change, yet there are few studies addressing this issue in mental health and social services. This study examined the differential roles of transformational (i.e., charismatic) leadership and leader-member exchange (i.e., the relationship between a supervisor and their direct service providers) on team innovation climate (i.e., openness to new innovations) and provider attitudes toward adopting evidence-based practice (EBP) during a statewide evidence-based practice implementation (EBPI) of an intervention to reduce child neglect. Participants were 140 case-managers in 30 teams providing home-based services to families in a statewide child-welfare system. Teams were assigned by region to EBPI or services as usual (SAU) conditions. Multiple group path analysis was used to examine associations of transformational leadership and leader-member exchange with innovation climate and attitudes toward adoption and use of EBP. Transformational leadership predicted higher innovation climate during implementation, whereas leader-member exchange predicted higher innovation climate during SAU. Innovation climate was, in turn, associated with more positive attitudes toward EBP for the EBPI group. Strategies designed to enhance supervisor transformational leadership have the potential to facilitate implementation efforts by promoting a strong climate for EBPI and positive provider attitudes toward adoption and use of EBP. Copyright © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Service oriented network architecture for control and management of home appliances

NASA Astrophysics Data System (ADS)

Hayakawa, Hiroshi; Koita, Takahiro; Sato, Kenya

2005-12-01

Recent advances in multimedia network systems and mechatronics have led to the development of a new generation of applications that associate the use of various multimedia objects with the behavior of multiple robotic actors. The connection of audio and video devices through high speed multimedia networks is expected to make the system more convenient to use. For example, many home appliances, such as a video camera, a display monitor, a video recorder, an audio system and so on, are being equipped with a communication interface in the near future. Recently some platforms (i.e. UPnP1, HAVi2 and so on) are proposed for constructing home networks; however, there are some issues to be solved to realize various services by connecting different equipment via the pervasive peer-to-peer network. UPnP offers network connectivity of PCs of intelligent home appliances, practically, which means to require a PC in the network to control other devices. Meanwhile, HAVi has been developed for intelligent AV equipments with sophisticated functions using high CPU power and large memory. Considering the targets of home alliances are embedded systems, this situation raises issues of software and hardware complexity, cost, power consumption and so on. In this study, we have proposed and developed the service oriented network architecture for control and management of home appliances, named SONICA (Service Oriented Network Interoperability for Component Adaptation), to address these issues described before.

EnviroAtlas - Ecosystem Service Market and Project Locations, U.S., 2015, Forest Trends' Ecosystem Marketplace

EPA Pesticide Factsheets

This EnviroAtlas dataset contains points depicting the location of market-based programs, referred to herein as markets, and projects addressing ecosystem services protection in the United States. The data were collected via surveys and desk research conducted by Forest Trends' Ecosystem Marketplace from 2008 to 2016 on biodiversity (i.e., imperiled species/habitats; wetlands and streams), carbon, and water markets. Additional biodiversity data were obtained from the Regulatory In-lieu Fee and Bank Information Tracking System (RIBITS) database in 2015. Points represent the centroids (i.e., center points) of market coverage areas, project footprints, or project primary impact areas in which ecosystem service markets or projects operate. National-level markets are an exception to this norm with points representing administrative headquarters locations. Attribute data include information regarding the methodology, design, and development of biodiversity, carbon, and water markets and projects. This dataset was produced by Forest Trends' Ecosystem Marketplace for EnviroAtlas in order to support public access to and use of information related to environmental markets. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) o

Haitian and international responders' and decision-makers' perspectives regarding disability and the response to the 2010 Haiti earthquake.

PubMed

Hunt, Matthew R; Chung, Ryoa; Durocher, Evelyne; Henrys, Jean Hugues

2015-01-01

Following disasters, persons with disabilities (PWD) are especially vulnerable to harm, yet they have commonly been excluded from disaster planning, and their needs have been poorly addressed during disaster relief. Following the 2010 Haiti earthquake, thousands of individuals experienced acute injuries. Many more individuals with preexisting disabilities experienced heightened vulnerability related to considerations including safety, access to services, and meeting basic needs. The objective of this research was to better understand the perceptions of responders and decision-makers regarding disability and efforts to address the needs of PWD following the 2010 earthquake. We conducted a qualitative study using interpretive description methodology and semistructured interviews with 14 Haitian and 10 international participants who were involved in the earthquake response. Participants identified PWD as being among the most vulnerable individuals following the earthquake. Though some forms of disability received considerable attention in aid efforts, the needs of other PWD did not. Several factors were identified as challenges for efforts to address the needs of PWD including lack of coordination and information sharing, the involvement of multiple aid sectors, perceptions that this should be the responsibility of specialized organizations, and the need to prioritize limited resources. Participants also reported shifts in local social views related to disability following the earthquake. Addressing the needs of PWD following a disaster is a crucial population health challenge and raises questions related to equity and responsibility for non-governmental organizations, governments, and local communities.